As information technology and the healthcare industry move forward during a time of uncertainty, what are the core types of technologies that need to be put in place?
On the one hand, as the authors of a new report note, “Dozens of infrastructure technologies have matured over the past five years that can significantly improve data access, interoperability, personalized interactions and ubiquitous computing.” These technologies range “from the smallest sensors to the omnipresent smart phones,” they point out. Yet the question remains: how should CIOs and other IT leaders in hospitals and health systems think strategically about the building blocks of the IT-infrastructure future?
Michael Garzone, Fran Turisco, and Jared Rhoads, consultants with the Falls Church, Va.-based CSC, recently published a white paper titled, “Technology Cornerstones of Tomorrow's Healthcare System,” in which they ask that very question. The Dallas-based Garzone, and the Waltham, Mass.-based Turisco and Rhoads, find that there are four “technology cornerstones” on which tomorrow's healthcare system will base its applications and services. They are:
In other words, enabling end-user mobility (particularly that of clinicians); providing transparency of use and availability for end-users making use of all types of information; and ensuring consistent, 24/7/365 reliability, will be essential to the success of healthcare and of patient care organizations going into the future.
What is particularly important is to understand what can happen when all four cornerstones are not in place, say the report's authors. “We've witnessed information transparency and seen enough projects to find out that there are some underlying technologies that have to be put in place,” says Garzone, who is partner in Health Care Technology Services at CSC. “It's irresponsible, for example, to deploy an iPhone app for viewing results on a mobile level without considering the end-users, the infrastructure, the security requirements, and so forth,” he says, “and if you don't put those in place, you put your project at risk.” Put simply, it's all about strategizing around the needs of end-users, he affirms.
What's more, says Turisco, principal researcher in the Waltham, Mass.-based Emerging Practices group at CSC, “We've found that all four foundations must be there. What's the use of having an iPhone app, if I can't provide the data the doctor wants, or the application he needs, or if the service is lost by going out of range? So it's always a balancing act you're performing going into these implementations,” she notes. Interestingly, the findings provide an update to a report CSC published in 2003. “We created these cornerstones then, and when we revisited them in 2009, we realized that the cornerstones remained the same, but the technology had advanced.”
Standards and expectations
A number of issues have emerged in the past several years, according to the authors. For example, says Garzone, “One of the things that I see continuing to evolve when we talk about transparency and access to data is the influence of standards, and the influence of our ability to provide data in a transparent manner. There's been a lot of progress in our industry to codify data into useable, meaningful data,” he says. “That's been an advance.” In addition, he says, “When we talk about access, wireless technologies have boomed, the bandwidth and range have improved; so access has been greatly improved, because of our ability to extend high bandwidth and data-intensive images and video through smaller devices and across a longer distance.”
At the same time, Garzone says, end-users' expectations are rapidly outstripping the capabilities of their perceived needs. “Are doctors asking for iPhone apps? Yes,” he adds. “You have clinician consumers who are familiar with the functionality the technology provides, and who don't see the same level of capability at work in patient care. That's especially true for doctors. So yes, we're seeing a lot of movement forward. Are those mobile applications widely deployed yet? Not yet.”
Rhoads, a senior research analyst in Emerging Practices, says one of the key points in the paper deals with extending boundaries - a topic that applies to patients as well. If patients are going to go through the trouble of doing self-care at home, he notes, they expect to see some type of value-added service coming out of their submitting data. “And that's a concern as well. So if a patient wants to be able to e-mail their provider or caregiver, chat with a patient with a similar condition, share a photo of the rash on their arm, and if they have the expectation that their hospital or physician can facilitate such communications, but they can't, there certainly will be a mismatch of capabilities,” and consumers will experience disappointment, he says.
Meanwhile, what must CIOs do now in order to lay the groundwork for advances in the next few years? “Security is a big concern for me,” says Garzone. “I don't think a month goes by where I don't read that a doctor has a laptop that's been stolen, and there's a data breach. And there's no excuse for that; that needs to be a priority. The other thing would be continuous computing, but in laypeople's terms, it's uptime. If we're putting these technologies in place, and requiring physicians to enter orders electronically, we really need to prevent any downtime. And whether it's wireless, or infrastructure, or power, across the grid, it has to be a hardened environment so that it's up.”
For Turisco, the network is a priority. “You want to be able to go to whatever device you're using, and be able to connect,” she says. “It sort of all fits together. Right now, though, what hospitals and physician practices are concentrating on right now is just getting the systems in place that will lead to meeting the meaningful use requirements.”
The report, “Technology Cornerstones Supporting Tomorrow's Healthcare,” by Michael Garzone, Fran Turisco, and Jared Rhoads, can be accessed at http://www.healthcare-informatics.com/CSC_report.
CIOs must ensure the creation of a technology foundation underlying the implementation of new applications, in order to guarantee continuous computing and other essential characteristics of IT service for end-users, going forward.
Focusing on the needs of end-users will be essential to creating that foundation.
End-user expectations are already outstripping technological capabilities, putting pressure on CIOs to carefully balance the offering of highly desired applications with the creation of a strong tech foundation to undergird those apps.
Healthcare Informatics 2010 March;27(3):44-45