Is Digital Transformation in Healthcare Living Up to Expectations?

Exploring Emerging Technologies, the Patient Experience, and Post-Pandemic Expectations with John Hendricks

According to research studies, by 2040, “healthcare as we know it today will no longer exist.” In its place, we will see hyper consumer-focused, prevention and wellness-oriented care, radically changed by the seamless exchange of information across open, secure platforms and the use of artificial intelligence – driven, in large part, by digital transformation. Despite the positive picture for the future, has digital transformation lived up to its hype in healthcare? Is healthcare transforming at a pace that will achieve this vision? We discuss our best guess on the outcome (or the prognosis, if you will,) for digital transformation in healthcare IT with John Hendricks, Chief Technology Officer of Huntzinger Management Group who, in prior roles, has served as the CTO in major healthcare organizations around the United States. In this conversation, John and I discuss how digital transformation is understood by healthcare leaders, specific promises of emerging digital technologies, and some of the major challenges that remain. We also discuss the impact of COVID-19 on healthcare adoption of digital technologies and ways of working.

David Crouch: I often tell people that, to me, digital transformation is like beauty – it’s in the eyes of the beholder. What does digital transformation mean to you in the healthcare space?

John Hendricks: Digital transformation in healthcare is a moving target. In some ways, organizations have been doing digital transformation for forever. Five years ago, healthcare professionals would have said that Electronic Medical Records (EMR) implementation constitutes digital transformation. These days we might call it clinical transformation but not really digital transformation. Now, EMR is considered “old hat.”

I think that digital transformation goes beyond automation. It has to do with changing the way the organization works and interacts with patients, providers, and partners. But, at the same time, as every hospital starts to embrace a new technology and new way of working, it’s no longer really transformative. Transformation – or the potential for transformation – occurs in the conceptual phase and maybe throughout implementation and shortly thereafter.

But, fundamentally, the technology itself is only strategic up to a point. And once the new business model is baked-in and adopted by all or most hospitals, the model itself does not provide any new strategic value.

David Crouch: You mentioned that EMR implementation does not in and of itself constitute digital transformation. What are some examples of digital technologies being used in healthcare?

John Hendricks: Digital technologies span across a wide variety of functions within healthcare. EMR systems are one example that we already talked about. Some others include:

• Robotic Healthcare Automation
• Personal Health Technology (monitoring devices/trackers)
• Data Analytics and Artificial Intelligence
• Telemedicine
• Back-Office Technologies, especially within the HR and Finance functions (e.g., onboarding), although those are really examples of extreme automation.

David Crouch: I’m a bit perplexed regarding how much healthcare has really adopted digital technologies and ways of working. There’s a lot of hype about digital healthcare, but I’ve seen recent statistics that say only about seven percent of healthcare and pharmaceutical companies report that they’ve gone digital – compared with twice that amount in other industries.

From your perspective, what is the “state of digital transformation” in healthcare?

John Hendricks: We still have a long way to go in healthcare. There is a lot of potential in digital technologies and digital business models, but the potential has not been realized for any stakeholder – patients, providers, hospitals, and clinics. There was not really a conception of “end-to-end” service delivery using digital technologies. For any given stakeholder, a solid business case or use case has not been made.

David Crouch: What are some of the challenges you see with digital transformation in healthcare?

John Hendricks: To be sure, EMR is something that hospitals and healthcare organizations have invested in greatly. And there is no turning back.

From the hospital perspective, they did this largely to go after “meaningful use” dollars. In other words, the U.S. government, through the American Recovery and Reinvestment Act of 2009 (ARRA) through the Centers for Medicare and Medicaid Services, defined minimum standards for electronic health records. This addressed how patient data could be exchanged between healthcare providers, between providers and insurers, and between providers and patients.

Through the EHR Incentive Program (a.k.a. Meaningful Use), ARRA provided financial incentives to healthcare organizations to adopt “meaningful” and interoperable Health Information Technology (HIT) and electronic health records.

Healthcare organizations, to be in compliance with ARRA and to capture “meaningful use” dollars, rushed to implement EHR systems. However, did anybody consider end-to-end delivery and use cases for various stakeholders?

David Crouch: To be honest, I don’t feel that I have personally been impacted, as a patient, by digital transformation. There are a few instances where reviewing online patient notes for my children has helped me to understand their medication regime, but I often still need to print out records or ask one doctor to send their records to another doctor we are consulting who is not part of the same health provider network. I would have expected more and better in 2020. Has digital transformation improved the patient experience?

John Hendricks: In general, I don’t think that EMR has helped the patient experience. I wonder if we offered the patient something they don’t want. Less than 1% of patients actually download electronic health information.

The question is, why aren’t patients downloading their patient information? Part of this is behavioral. After all, who wants to think about their doctor all day? From the patient perspective, isn’t the whole point of EHR that health information follows the patient from provider to provider so that the patient never needs to download information?

The broader challenge is that the end-to-end delivery is just not there. Not every provider is using EMR systems. And even the ones that do often ask patients to print out and bring their records or have their doctors send the records. This is even the case when two providers are using the same EMR system, for example, two providers who are both using EPIC; but are from different hospitals.

Maybe eventually there will be a huge benefit in this portability of health information; always assuming the privacy and cybersecurity issues are addressed. But the benefit has not been fully realized.

David Crouch: If the patient experience has not been greatly improved, how about the healthcare provider experience. Has digital transformation improved that?

John Hendricks: The provider experience breaks down into the clinic and the hospital. Both settings are very different.

The clinic is the realm of primary care. For doctors and clinicians providing primary care, EMR slows them down. Doctors say that they are working more than they used to. The problem from their perspective is that their head is in the computer, but their eyes are not on the patient.

EMR is more useful in the hospital setting. In the hospital, EMR contributes greatly to patient safety, and it really does help protect patients by having a “living record.” Ironically, though, the patient is probably not aware of the safety benefit. It is not obvious or tangible, but it is nevertheless very real.

David Crouch: What about personal health technologies? I remember they used to be all the rage even as recently as a few years ago. But I hear less and less about them outside of the recreational context.

John Hendricks: For the “weekend warrior,” personal health technology is still fun and popular. I am an avid runner and like to use devices to track my stats when I go for a run and share the data with my friends.

But in the realm of healthcare, there has been a decline in interest in health-tracking products (although you wouldn’t know it based on the trade shows). In 2014, there was a theoretical shift in the U.S. to “value-based” care. In other words, healthcare providers would earn financial incentives to keep patients healthy and out of the hospital or clinic. The idea was to treat both the individual patient and the population-at-large.

But since 2016 or so, organizations have largely forgotten about this due to the large shift in political priorities away from “value-based” care.

So much excitement is generated from a product perspective and then will never go anywhere. For a while there was a lot of buzz around data collected from mobile devices that could be shared with healthcare providers. But do doctors and clinicians really care about this data? Not really. The doctor needs to know the patient’s blood pressure now; not two weeks ago. The patient might want to track what they ate today and yesterday. But the doctor is more interested in the longer-term nutritional and health habits of the patient, only some of which mobile devices can track. Then there is always the problem of having too much data. How much is enough to collect about each individual patient?

Having said this, clinics are still experimenting with personal heath technologies with the sickest of the sick – people who are difficult to reach directly, difficult to get them to come into a clinic, and who might benefit from a device buzzing and telling them when to take a pill or to watch the foods they are eating.

David Crouch: What about leveraging technologies like data analytics and artificial intelligence? It seems EMR and mobile devices have the benefit of collecting vast amounts of data that could be mined and used to improve health outcomes, identify health risks and triggers, and even improve business outcomes for providers?

John Hendricks: Sadly, healthcare is not really using data analytics in the way originally intended. Part of the problem is that providers are so busy taking care of patients that they don’t have time to slice and dice the data.

Researchers are better equipped to design experiments and run studies, but they don’t usually have the same skills as data scientists. Data scientists know how to work with data, but they don’t have the clinical background to know what to look for.

IT potentially supports all of this, but only from an applications point of view, and the applications are offered by third-party suppliers.

Then there is the issue of integrating data from multiple sources and technologies.

With respect to AI, two years ago, people thought that AI would take over the world. But it really has gotten nowhere in healthcare. Once again, here is an area where there are many possibilities, but they have not been exploited.

David Crouch: What trends are you seeing in terms of how healthcare organizations are organizing around digital transformation?

John Hendricks: A lot of hospitals are hiring Chief Digital Officers (CDO) and Chief Innovation Officers, who are separate from the more traditional role of Chief Information Officer (CIO). Generally, if an organization has hired a CDO, they are probably not happy with their CIO. But if you ask the hospital what they are trying to get from a CDO or to define the role in a meaningful way, you probably will not get very good answers. Some hospitals are looking for a technologist and some are looking for a marketer.

On the one hand, CDO sounds like a fad and there is always the potential that these jobs are precarious. On the other hand, if I were the CIO at a lot of hospitals, I would be polishing-up my resume.

David Crouch: Has the outbreak of COVID-19 and the global pandemic compelled healthcare to more quickly adopt digital transformation? On a personal level, I’m not sure how much benefit I’ve gotten out of telehealth check-ins with my doctors.

John Hendricks: Not really. COVID-19 has had an obvious impact on the daily lives and routines of physicians and other clinicians. But from a digital transformation perspective or digital technology perspective, the pandemic has not fundamentally accelerated the rate of digital transformation for healthcare providers.

Work still goes on, but healthcare providers haven’t really changed the way they work. The obvious exception to this is that there is a big uptick in patients having telemedicine appointments with their doctors over videoconference. But for anything serious, patients still need to see the clinician in-person. In many cases, non-clinical staff are working from home.

Where does this leave us?

Prior to interviewing John Hendricks, I anticipated learning that digital transformation has gained traction and digital technologies have become more entrenched in healthcare. After all, I have a background in healthcare IT myself and for years have served as a judge of a business plan competition at The Johns Hopkins University School of Engineering that has a major focus on healthcare technologies.

As it turns out, the promise of digital transformation in healthcare is still large, but progress has been slow. Although healthcare organizations have spent treasure chests of capital on implementing EMR and EHR systems, other digital technologies have been deployed in a scattershot way, and technology integration has been inconsistent. In part, technology has not been effectively leveraged due to a focus on the technology itself and poorly defined objectives around patient benefits (both in health and convenience) and business goals. The American Recovery and Reinvestment Act attempted to tie patient and population health outcomes to financial incentives for healthcare organizations and providers, but when the incentives diminished due to changing political whims, so too did many of the intended benefits. To be crystal clear, this is not to say that doctors are unconcerned about the wellbeing of their patients. They absolutely care! But policy that financially incentivizes health outcomes has a systemic impact that goes well beyond individual caregivers, and that impact is not fully understood.

Where does this leave us? To be sure, there is not just one solution. From a service management perspective, digital transformations tend to be more effective when the organization’s vision, mission, and objectives are defined prior to technology implementation. At the same time, business executives need to be aware of emerging technologies – both the benefits and risks – prior to investing in them. This is where IT can come into play as a trusted advisor (indeed, in a truly digitalized organization, there is no separation between “the business” and IT).

Once objectives are defined and it is understood how digital technologies can drive these objectives, overcoming organizational and process silos need to be addressed. A focus on how digital technology transforms the patient and clinical experience and improves operational efficiency is in order. In other words, there must be a focus on end-to-end service delivery and value creation.