Can we Achieve Healthcare System Sustainability with Fixed Budgets and Insatiable Demands?

Get used to doing more for less!

One does not have to be a rocket scientist to see that healthcare system sustainability is going to be a huge challenge for nations in the years to come. Already, demand outstrips supply in many developed countries. Approximately 50 million people do not have health insurance coverage in the US and 5 million Canadians cannot find a family doctor. These are not uncommon examples internationally of healthcare systems under pressure. Not only are these situations reflective of concomitant personal tragedy, but they also reflect the fact that unless countries get healthcare costs under control, this problem has the potential to sink the economies of great nations.

We hear terms such as 'healthcare reform', shared services strategies, automation of paper processes, but what does it mean to patients and to those providers in the trenches who are tasked with delivering the care? To name a few of the driving forces, we have:

• Aging populations
• Increasing prevalence of chronic diseases
• New and more expensive medications
• Advanced diagnostics and therapies
• Increased demand for clinical services

We exist in a world of increased expectations and fixed buckets of funding. In this situation, there are few alternatives. In addition to doing more for less, we have to improve efficiency and decrease waste. Some of these strategies need to focus on reducing duplication, reducing costly errors and reducing inappropriate investigations. In addition, becoming more targeted with how care is provided - something that is impossible in the dominantly paper world in which we function.

No matter how you slice and dice the problem - the automation of healthcare is one of the solutions. So get ready for more talk and action relating to EMRs, EHRs, PHRs, Patient portals and Mobile Health.

We do not have many viable alternatives!

To add your thoughts or comments, click on the 'Comments' link below

Comments

[Dr. Merrilee Fullerton]

mHealth initiatives using smartphones have huge potential...too bad that in Canada our politicians are married to very expensive EMR systems that will cost billions and billions many years into the future. I'm not saying that EMRs aren't important..just that not all patients need to have one.

[Morgan Price]

Alan

Here is an interesting article in the NY Times on the subject

Incentives to Doctors Would Curb Readmissions to Hospitals - NYTimes.com

One of the challenges has been that in nearly all industries, advances appear to lead to reduced costs. Toyota and other car companies add robots to be more efficient and competitive. Banking adds ATMs. Wall-Mart streamlines their supply management and that increases their profits.

In healthcare, however, these advancements, often lead to increased costs to the system. New tests mean I CAN order them. So the cost went from $0 to $X. Chronic disease management is a huge and ongoing cost, the better we get at it.

I think we need to find ways to also streamline processes and increase capacity -- and we need to have evidence to support those activities. Simple automation isn't enough, we know that. The right kind of automation and the ability to reflect on practice capacity and performance are going to be important in the long run.

[Heather]

Will EMR replace Medical Transcription?

[Alan Brookstone]

Heather, in some instances, yes I believe that EMR will replace medical transcription. However, in many instances there will still be demand for transcription services but in a different format. For example, a physician may dictate a report which is in digital format, this could then be sent from the EMR to a transcription service, the transcription completed, correctly tagged and sent back to the EMR for inclusion in the paper chart. All this could happen seamlessly via the Internet using a secure form of communication.

While there are some specialists who would wish to manage the document creation themselves, many find this distracting and time consuming and will still require professional transcription services.