Why is digital transformation so slow in healthcare?

Digital transformation has long been pursued across industries - delivering efficiency and personalised customer experiences. However, when it comes to healthcare, adoption of the most basic digital technologies has been painfully slow by comparison.  

Despite the potential for AI to transform healthcare, the fax machine is still alive and well within healthcare in 2023. Healthcare is a good illustration of the adage the future is here, it's just not evenly distributed.

In this article, we'll share some of the counterintuitive approaches we've used to accelerate digital transformation initiatives within healthcare. Why the traditional IT paradigms don't always work for healthcare, and why health consumers (patients) are still receiving letters in the mail? We will also share some real-world yet counterintuitive approaches that can unlock the potential of digital innovations in the sector.

Why is digital adoption in healthcare taking so long?

Unlike retail or banking, healthcare consumers rarely buy a product or service that delivers the health outcome they are after in a single transaction.  

The stakes are also usually much higher. 

As a patient, I can't return to the healthcare service if I don't get the outcome I was after. Healthcare outcomes are complex, take time to achieve, often require consumers to carry out a series of actions or behaviours and rely on expert advice from a range of clinicians.  

Every patient is different, with different complexities and a different set of desired health outcomes. Their health increasingly depends on what they do away from their clinician, the clinic or the hospital. For clinicians, the intervention or advice they provide depends in large part on the patient's previous medical history and any underlying conditions.  

Digital innovation in healthcare has so much potential to improve patients' health outcomes. However,  to date, digital adoption has been limited to automating some of the transactional elements of healthcare, like booking appointments or ordering a script.  

We've spent the last decade working with frontline healthcare professionals to deliver digital innovations that simultaneously; improve patient care, reduce the burden on clinicians/staff, and drive efficiencies for their organisation.  

Below are the four counterintuitive approaches that we've developed at Personify Care to accelerate digital transformation initiatives and start to unlock the potential of digital innovations in healthcare.  

1. Start by digitising existing (sometimes flawed) models of care.

Conventional wisdom suggests that digitising a flawed model of care just entrenches that model or workflow even further - making it harder to improve later.  

The traditional approach would be to: 

1. Map the current model of care and workflow
2. Define and agree on a future desired state for that model of care
3. Engage a change management initiative to gain support from staff and clinicians
4. Once the new model is bedded down - apply some technology

Seems logical - right? In healthcare, not so much.

It's well and good in theory, but we tend to find if you're lucky, you might get to step 2 in the process.  

Why?  

The health system is at breaking point. Staff and clinicians are working at their limit in "survival mode". More patients with more complex needs continue to come through the "front door". The capacity of frontline staff to deal with a change in their way of operating is limited at best. However logical or sound the desired state might be.  

In healthcare, getting consensus from clinicians on a consistent clinical operating model is also a critical factor, one that can often be challenging to attain. Each and every clinical group works just a little differently depending on their local context and the needs of their patient population.  

There is also a distinct lack of trust that digital innovation will deliver on its promises. The past experience of "IT solutions" often creates more administrative work, they get in the way of patient care, and once implemented, are very slow, expensive or impossible to change.  

That's because most of the solutions they are using were built in a waterfall development era where every solution was custom-built based on a fixed set of requirements.

Patient safety is also paramount. So anything that has the potential of getting in the way of delivering care to at least the same quality we're delivering now needs to be considered carefully.

The result is, despite all the best intentions of innovation teams in mapping the future desired state. We end up sticking with the status quo.  

The counterintuitive answer to these realities in healthcare is to start by digitising the existing workflow or model of care despite any of its current imperfections. In healthcare, this works because: 

1. You can quickly give clinical staff some capacity/time back to spend more of their time on patient care and start to consider improvements to the model of care. 
2. By starting with the existing model of care, we already have consensus from clinicians about their local operating model, and there's no concern about any compromise to quality and safety. 
3. As a result, teams gain visibility to data analytics about their existing models of care. They have the time and the information to drive discussions about ongoing quality improvement initiatives and clinical best practices.
4. Using modern solutions also means that any quality improvements to the model of care and clinical workflows can be implemented immediately in the digital solutions via configuration changes and without the need for lengthy delays or expensive software development change requests.  

As with any change initiative, executive support is needed to recognise and incentivise teams that drive ongoing improvements within their unit or department. Benchmarking data analytics across teams and linking them to organisational priorities can also serve as a driver for improvement and standardisation across an organisation or health system.  

2. First, focus innovations on low-complexity patients.

In healthcare, the conventional wisdom is to apply innovations to the highest complexity patients since they need the most complex care, the most time and attention from clinicians and are associated with higher costs. 

Whilst this may be a sound approach for some clinical interventions, when it comes to consumer-facing digital innovations in healthcare, the opposite approach tends to be true. That is, starting with the least complex patients first.  

In developed economies, demand for healthcare is growing at an unsustainable rate, driven by ageing populations and rising chronic conditions. In order to continue to deliver healthcare to patients that need care without compromising quality & safety - we need to find ways of allowing frontline healthcare professionals to spend more of their time on high-value care to the patients with the most complex needs.  

In healthcare, we have a workforce shortage problem. Current staff are under stress with high attrition and burnout rates. And yet, we're still expecting the vast majority of clinical staff to exchange clinically-specific information with their patients through paper forms and phone calls - information that is critical to providing the appropriate care for that patient.  

We can't keep spending more money to do the same thing.  

We have to apply digital innovations to get the most out of the available workforce without compromising safety and quality: 

• Automating administrative steps in the workflow
• Using modern technology to digitise clinical models of care
• Provide clinical teams with digital tools to exchange information with their patients

By automating the exchange of information based on evidence-based models of care, we've shown in some clinical settings there's potential to automate 70-80% of the administrative burden on staff by replacing analogue information exchange (via paper forms and phone calls) within digital check-ins for low acuity/patients that require routine care.  

In doing so, we can actually improve access and quality of care to high-complexity patients by enabling clinicians' time to be spent on high-value care to the patients that need it most.  

Counterintuitively, by focusing digital innovations on high-volume, low-complexity patients first, we actually improve access and quality of care delivered to high-complexity patients across the system whilst also reducing the administrative burden on the workforce.  

3. More data from patients can reduce the clinical workload.

As patients spend less time with their clinicians in clinics and hospitals, there's an opportunity for digital innovations to allow patients to share more data and information with their clinical teams remotely.  

However, there is an underlying concern within health services that increased clinical data from patients means increased workload. In healthcare, providers have a duty of care to act on information they are provided with by patients under their care.  

In the context of workforce shortages, providers receiving and monitoring new data feeds from patient remote monitoring devices has not seen widespread adoption due to a lack of established models of care or funding models.

However, by applying digital innovations to the exchange of information that exists between clinicians and patients within the context of existing models of care, we have shown that by engaging with patients often and early in their healthcare journey can actually reduce the workload on clinical and nursing staff by:  

• Eliminating manual exchange of clinically-specific information previously delivered through paper forms and phone calls
• Identifying patients that require support or intervention without a manual screening of clinical progress 
• Automating the process of manually updating patient records with the information provided by patients

By focusing digital innovation on the optimisation of existing models of care and workflows, engaging patients early and often counterintuitively reduces costs and improves access for patients. 

What we've shown in a number of examples is that in doing so, patients' health literacy and the patient experience are significantly improved. Patients are much more engaged in their health outcomes, and digital solutions provide the opportunity to deliver personalised information at the right time to the right patient - so patients are much more likely to consume, recall and act on that information - which is key to achieving optimal health outcomes.  

4. Translating evidence-based care into common practice

In his 2017 TED Talk titled "How do we heal medicine", surgeon, author and health researcher Atul Gawande presents the findings of the benefits of applying pre-surgical checklists in the context of team-based care, which is referred to as "pit crews for patients". His research found that "The best care often turns out to be the least expensive. It has fewer complications, the people get more efficient at what they do, and what that means is, there is hope."

Healthcare is largely delivered by healthcare professionals based on the information they have available. The quality of care a healthcare team can deliver is only as good as the quality of information they have about their patients.  

Meanwhile, there is a rapidly growing body of evidence about new models of care that have been proven through robust studies to deliver high-quality outcomes for patients at lower costs to the health system. 

However, the adoption of these models of care has traditionally been slow due to workforce challenges and the need for additional workforce to deliver them at scale.

There is a significant opportunity for digital innovations to solve both of these challenges in the delivery of high-quality, evidence-based models of care. With patients spending less time in the clinic or the hospitals, clinicians and health executives often find themselves with limited data available, "flying blind". And yet, the majority of healthcare spending tends to be focused on spending more money on doing more of the same things within hospital walls.  

What we've found is that by enabling the patient to be included in the "pit crew" and providing patients with their very own "checklist", we can reduce the cost and increase the frequency of capturing high-quality data that is fundamental to delivering high-quality clinical care.

By providing digital solutions that enable clinical teams to rapidly convert evidence-based models of care into digital patient experiences, we can reduce the friction for health services adopting evidence-based models of care.

In doing so, we are supporting health services to deliver high-quality, evidence-based models of care that reduces clinical variation and enhances patient outcomes.  

How to unlock the potential of digital innovation in healthcare

For digital innovations to deliver on their promise, we can't simply copy and paste the strategies that may have delivered results in other industries.  

As patient outcomes increasingly "happen" away from the hospital or the clinic, we need to invest in infrastructure that supports the entire patient journey.  

And whilst investing in more hospital beds, physical infrastructure and GP capacity is essential in the future - we also need to invest in the digital infrastructure that supports the patient across their entire journey.  
Yes, there are significant challenges in scaling up digital innovations within healthcare settings. However, there has never been a more pressing time for digital innovation to measurably deliver on its potential.

Importantly, digital innovations in healthcare needs to simultaneously: 

• Improve access and quality of care for patients
• Reduce present pressures on the workforce
• Deliver measurable efficiencies for healthcare organisations

To deliver this, here's a proven approach to accelerate digital transformation in healthcare: 

• Start small, define the problem you're solving, solve it and build trust before scaling. 
• Start with current models of care and workflows. 
• Engage patients early and often in their care and measure how much capacity this gives back to clinical teams across the organisation. 
• Provide clinical teams with data about their existing models of care and where the bottlenecks are.   This drives quality improvement and efficiency within teams.
• Benchmark results across clinical teams and recognise clinical teams driving change towards evidence-based care.  

At Personify Care, we are committed to helping health services navigate the complex landscape of digital transformation - that's why we created digital patient pathways. 

Personify Care started supporting teams to optimise care delivery in surgery, where the cost was highest. The platform has now expanded across 20+ specialities supporting over 10 million patient interactions in the past 12 months throughout the patient journey. Looking to the future, Personify Care is working with research and clinical teams to translate evidence-based pathways into active care models. 

By providing data-driven, patient-centred digital solutions, we support health services adopting new models of care, and we empower healthcare providers to deliver exceptional care while ensuring a seamless and efficient healthcare experience for patients.