Sitting on the tram this morning, flicking through my e-mails and preparing for the busy day ahead, I began to muse on the incredible impact that information technology has had on my life. Doing this sort of communication was inconceivable even when I had my first management role. My own personal secretary was highly skilled in typing and error free stenography was a premium skill. Each of my colleagues had his or her own secretary as well and the morning routine was well laid out with opening correspondence and crafting responses which were checked and signed and duly sent to the post office. What a different world we live in now.
Transforming healthcare remains an opportunity largely untapped. New treatments have transformed the lives of hundreds of millions but the scope for redesigning the care pathway remains almost untouched. Essentially, most health systems operate in the same way that they did at the turn of the last century with patients waiting in hospitals or doctor’s offices to be seen and appointments being scheduled out into the far distance. The integration of modern medical devices with information and communications technology offers the possibility of completely reshaping the way that the increasingly large population of chronically diseased patients are managed. An article in this week’s New York Times admirably sets out some of the opportunities and issues.
Progress is slow in moving to new models and the ‘cost’ argument is more or less consistently at the core of the discussion. ‘New technologies are expensive and we cannot afford them even if we would like them’ is the standard response. This hides a more serious deficit of analysis which has two main components from my perspective. Firstly, in any change process the incentives of economic parties need to be addressed. Reimbursement systems which pay hospitals and individual doctors on the basis of consultations will create strong disincentives for the model to move to a situation where the income of both is diminished. Both hospitals and doctors will come out fighting with an array of more or less rational arguments to retain the status quo.
The second big area, which interacts directly with the first, is the inadequacy of most health technology assessment (HTA) processes to cope with anything much beyond drugs. HTA has not been adequately developed to assess the real value proposition for new ways of treating people in hospitals let alone get anywhere near generating methodologies that can be used in the management of patient’s in the community. The first element of this that will need addressing is the role of the patient, who interacts very directly with the technology in the community, in the HTA process.
Much opportunity exists but much work and political will is need if the status quo is to be shifted towards new ways of delivering care which are both better for the patient and more sustainable for those funding the system.
– John Wilkinson, Chief Executive Eucomed