Leapfrog: The (hopefully) rapid adoption of HIS in Asia

Governments in emerging markets would be wise to learn from the evolution (or lack thereof…) of the health care delivery systems in the developed countries and understand why systems that consume so much in terms of resources can deliver such highly variable patient care outcomes. This exercise will help emerging market countries position themselves for more cost effective progressive solutions (see IBM). Developed countries without doubt, have the best physicians in the world, though many if not most are immigrants from developing countries! ; they also have access to the finest facilities and technologies; are home to complex “market driven” or government payment systems; and have cultivated the largest and most innovative companies in the healthcare R&D space from pharmaceuticals to medtech.

Innovation and medicine have gone hand in hand together since the beginning of time. The development of blockbuster drugs, sophisticated imaging systems, high tech devices, genome projects, stem cell research have been all driven by a fundamental desire to improve the quality of human life…and at the same time make a nice little profit. Despite the history of innovation, the healthcare delivery sector however suffers from inherent structural arrangements that compels it to be reluctant to embrace information technologies and as a result has silently perpetrated extremely expensive and inefficient delivery systems. The question is how to preserve and encourage the market driven innovations in R&D while affecting sector specific structural factors that persistently resist implementing cost saving technologies and efficiencies and to do it in a manner that maximizes the healthcare benefit while minimizing the economic burden for the patient and society. In other words, how do we enable creative disruptive innovations to penetrate this bastion of inertia.

I believe the biggest impediment to innovation has been the suppliers of healthcare services themselves. Doctors and other healthcare professionals, including ancillary services providers and hospitals, have been notoriously slow adopters of new technologies. Doctors in most parts of the world continue to work primarily with pen and paper and have a tendency to delivery advice in a paternalistic stance from on high. Being a physician myself, I can understand this tendency as a direct result of the years of hellish training providing such intense domain expertise that challenges to habit or practice are not well received.

Simply having particular types of systems and incentives will distort practicing habits. The typical delivery framework of healthcare services is extremely fragmented with independent physicians or other providers in private practice essentially running small businesses. The incentive for these small businesses to adopt expensive IT systems on an individual practice basis does not make financial sense nor does it translate into any other real obvious benefit for the provider. Managed care in the U.S. did provide incentives for physicians to consolidate into vertically or horizontally integrated larger groups and this trend will need to continue in order for providers to reach sufficient scale to adopt the technologies on their own. On a macro level governments and other payors must coordinate and create either open IT systems (HIS) or uniform standards for technologies to be implemented and then provide financial incentives for healthcare providers to compel them to adopt such systems. Payors are in the strongest position to force the adoption of technologies onto providers and should do so immediately. Governments and insurance companies should have a higher reimbursement levels for providers who submit electronically and for those who maintain electronic medical records (EMR). Participation in reimbursement should be contingent on the ability for the various components of the supply chain to anonymously datamine information from medical records. Pharmaceutical and medtech companies should be able to datamine for adverse reactions to medications and other relevant outcomes. Payors should be able to datamine for cost effectiveness comparisons of various treatment alternatives; are some treatments providing the same benefit for less cost or does the additional cost justify the improvement in outcome. Providers such as physicians should be able to datamine for information on best outcomes from various treatment protocols.

And why do we need all this?

Because ultimately the Healthcare Information Systems (HIS), the Electronic Medical Record and the digitalization of all health information will be the disrupting innovation which will allow countries to develop sustainable innovating healthcare systems at effective cost. The ability to create searchable medical databases will truly allow all components of the health care supply chain to evaluate the efficacy and the cost effectiveness of new and existing therapies. Currently despite increasing use of treatment protocols, the particular treatment a patient receives depends on region, doctor prescribing preferences, payor reimbursement preferences and other arbitrary criteria not even related to the overall healthcare cost benefit equation. For the simple common cold, the same patient may receive several different antibiotics from different providers at different costs with no view as to the optimal cost effective most efficacious treatment. Ultimately the access to large amounts of information on adverse reactions, comparative outcomes, and other factors should drive these decisions not whether you went to Dr. X or Dr. Y and his or hers prescribing habits.

Given soaring healthcare costs insurers and healthcare systems will begin to restrict payments or new technologies unless it can be shown conclusively that the new treatments will produce better outcomes and offer value for money. This information will only be forthcoming by the digitalization of the medical experience and I believe this must be a government sanctioned and forced if necessary structural element of change. HIS systems can advise doctors on best practices and help hospitals and others identify the causes of variability. According to the Economist, a study published in the Archives of Internal Medicine in January 2009 compared a group of hospitals in Texas that has adopted advanced HIS systems with a group that has not. It found the first group suffered 15% fewer deaths and 16% fewer complications, as well as enjoying lower costs.

Interestingly, the developing world has began the leapfrog phenomenon. India’s Apollo hospital chain has been using an advanced HIS system for years and as countries and private players invest heavily in healthcare infrastructure (see GE), IT investments will be a significant priority as HIS and EMR make medicine more systematic and evidence based. And a doctor will no longer limited by the lessons of personal experience.

Tej Deol, M.D.