January 2009

A New World of Health : Dr Mark Parrish, Physician Executive, Health Solutions Group Asia Pacific, Microsoft Pty Ltd

In the current economic scenario no stone is being left unturned by organisations to increase efficiency and outputs with what little they have. Dr Mark Parrish of Microsoft’s Health Solutions Group gives an interesting example of how Microsoft is taking on the challenge of transforming the healthcare industry.

Technology has the power to transform industries. We see examples of this across a wide variety of businesses and organisations but less so in health.  For example, two highly visible industries which affect many of us directly as consumers – the insurance and travel industries – have seen massive changes in business practices and productivity as a result of the effective application of Information Technology.

If we look at the insurance industry as an example of successful application of IT, we have seen a revolution in the way claims are processed. Mobile claims facilities can be triggered remotely and customers do not have to wait for inspectors to visit. The insurance industry can also better understand and more efficiently determine risk today, since the technology model assists in better forecasting and analysis. The result is more accurate underwriting of risks.

Similarly, the travel industry has changed fundamentally. It seems almost impossible to remember a time when technology wasn’t an integral part of our travel experience. Today we make our bookings online, our tickets are emailed, we check in online and only need to interact with someone once we arrive at the airport and they need to stamp our passport. Travel companies use technology to run their businesses, and there are a number of similarities to the healthcare industry. An airline has seats (beds) to fill with passengers (patients) 24 hours a day while rostering the right numbers and types of staff (pilots, aircrew, ground staff/doctors, nurses, administrators) to provide a safe and effective service while running support services of linen, laundry, food, cleaning, servicing; and buying and maintaining expensive pieces of equipment that need regular maintenance (aircraft/imaging modalities, healthcare facilities).

You can only take this analogy so far, but it is remarkable how much healthcare does not use technology in such a coordinated manner -  even though it embraced technology as a tool to help cure disease and to advance the science of medicine over many years. It has seemingly ignored the advances in information technologies and the value they can add in the delivery of care.  At the same time, we know that healthcare is in crisis as a result of rising costs, inherent inefficiencies, and inconsistent delivery of care.  So why is it so difficult to integrate information technology into our healthcare systems?

There are some very real, long-standing barriers at the root of this issue. One reason is that healthcare is unlike the insurance and travel industries and has different drivers and market forces. But this is only part of the story. The challenges in health services exist because of a vast, complicated and often unrelated ecosystem that is more like the world’s largest cottage industry, with a variety of levels of regulation, a mixed environment of public and private services, and a variety of business models (and sometimes no business models) that make the design, implementation and operation of integrated “patient centric” healthcare systems both difficult and expensive.

But even this is only part of the story; complexities in relationships compound these issues. Effective healthcare is interdependent upon relationships between physicians and patients; between physicians, administrators and government; and between physicians, contributors and life sciences organisations. These relationships are frequently challenging to reconcile and can be compounded by political drivers.

There are also global forces and challenges at work here. The World Health Authority has outlined the biggest challenges to universal healthcare. They include:

  • Financial constraints – healthcare costs have increased to over 10% of GNP in most developed nations, but there is a much lower number here in Asia.
  • Intellectual constraints – The belief in science holding the solutions to all healthcare problems is often no longer accepted
  • Medical constraints – Seventeen per cent of prescriptions and medical diagnostics are wrong
  • Operational constraints – In many countries, large segments of the population still have no access to quality healthcare. In the US, this figure stands at 45 million people and in Asia there is a massive discrepancy between rural and urban populations.
  • Administrative constraints – Healthcare is often over – regulated by local authorities, with the industry often held between the limits of an administrative arena, rather than the open, competitive areas experienced by other industries.
  • Workforce constraints – WHO estimates that there is a shortage of 4.3 million health workers around the world. Fifty-seven countries in the world do not have a health worker density sufficient to deliver basic services. Nine of these countries happen to be in Asia.
  • Rise of chronic disease – Whilst there has been a dramatic improvement in Asia’s healthcare over time, new issues such as the growth of obesity, diabetes and cardiovascular disease create additional challenges. We have more medical issues along with fewer trained professionals, treating an ever-increasing number of patients.

Add to this the fact that healthcare provisioning is increasingly driven by globalisation, consumerism and demographic shifts and one begins to realise that more pressure is placed on our health systems everyday in the midst of a difficult economic climate.  Healthcare systems that don’t address this new environment will fail and this will put increasing pressure on their countries’ economies.

There is hope however, in the form of Information Technology, which holds the promise of addressing many of these complex issues through creating new efficiencies and lowering barriers through effective communication and improved processes – just as we have seen in other industries. Whilst the traditional healthcare structure does not lend itself easily to integration, the good news is that there are some examples of success. In fact, we have already seen that the committed application of effective IT resources can enhance patient experiences, increase safety, manage workflow and boost capacity while reducing overall operating costs.

Bumrungrad: A case study for success

A great example of information technology being adopted into a health system and revolutionising the health experience can be seen with the evolution of Thailand’s Bumrungrad Hospital. In 1980, Bumrungrad Hospital opened its doors and became recognised as a premium private healthcare provider in Southeast Asia. The hospital serves over 1.2 million patients each year, including an average of 3,000 outpatients per day. Popular as an international medical destination, Bumrungrad also provides care for over 130 nationalities. As CEO Curtis Schroeder explains, Bumrungrad is “the world’s first truly international hospital.”

While Bumrungrad enjoys a great reputation for quality care and professional service, its administrators were not always so positive. After several successful years, the hospital expanded its services by 554 beds. Before they launched the new facility, the management realised that they would not have the clinical or financial capabilities to meet the demands of patients and the hospital staff.  Their predictions were correct and once the new wing opened, hospital administration could only manage at 45% capacity.

Hospital management took an innovative view of the role of technology in increasing the productivity of the hospital. Schroeder explained, “We needed to create an environment that would allow our doctors to practice medicine in the best way and create the best relationships with their patients. We wanted clinical information at the fingertips of our doctors to enable them to make better decisions.”  They knew they needed to implement these changes quickly.

The hospital in Thailand was in a unique position. Senior leadership was committed to adopting technology, and the medical staff had already been accessing 17+ years of scanned records. Technology was not new to them and it was viewed as an opportunity. This allowed Schroeder and his team to search for a system that would satisfy the requirements of doctors, nurses, and radiologists. Administrative staff also needed integration of basic functions such as billing and inventory management.

Keeping costs in mind, the team did not want to make significant changes to the layout or resources of the hospital, and did not want to increase administrative staff. The only thing that they wanted to change was the IT system.

In 2000, Bumrungrad chose the Hospital 2000 solution. This enterprise software solution, now offered as Microsoft Amalga, was able to integrate every department in the hospital. For the first time, a hospital was integrated across the board. Not only were clinical systems, emergency departments, labs and radiology connected, but the back office functions such as billing, purchasing and inventory were also online and sharing information.

The results continue to speak for Bumrungrad, which today has expanded its patient volume to 3400 patients a day. Medical records are available instantaneously, and lab-processing time has been reduced from over 14 minutes per sample to only three minutes today. They have also seen a massive savings in radiology – film costs have been reduced from USD 294,000 to USD 26,000 through efficiencies gained from saving images to hard disk. The average wait in outpatients, even without an appointment, is 17 minutes – a figure unheard of in most other health organisations; and the financial records, which used to take 4 weeks to reconcile, now take only four days.

As Schroeder explains, “there is no conceivable way that a hospital could cope with 3,400 patients in one day, 80 percent without appointments, with a total treatment time of 45 minutes and an accurate demand bill at the time of service without a system like that provided by Microsoft’s Amalga.”

But the savings in time and resources are only a small benefit when compared to the impact IT is having on improvement in care delivery.  Success, as Schroeder explains, has been achieved because Bumrungrad has been able to bring quality healthcare to patients in a timely, effective and pleasant manner. While patients can choose to use public hospitals at a much lower price, the real differentiator is in the time and efficiency of services Bumrungrad can deliver. By ensuring a seamless information system, Bumrungrad has transformed the patient experience, improved efficiency, and positioned themselves as leaders in hospital care.

A New World of Health

At Microsoft, we believe that health is a key ingredient to the stability and success of all nations. Healthcare is a critically important human endeavour, and Information Technology needs to play a fundamental role in helping to deliver better solutions, reduced costs, and better patient outcomes when properly utilised.

It may not be happening as rapidly as many desire, but slowly the healthcare community will embrace information technology as a core tool in resolving the complex challenges facing the industry.  With committed leadership like that at Bumrungrad, healthcare systems can look to reform themselves to create positive experiences for healthcare workers as well as patients. It will be important in the current economic climate to realise what ongoing investments in effective healthcare systems can bring � reduced costs and complexities, increased workflow and capacity, and enhancements to patient safety and the quality of care. These are principles upon which all of us in the healthcare field can agree, as we prepare for a new world of health.

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