The future for digital in healthcare The future for digital in healthcare

Lydia Lee discusses the future benefits and challenges for digital healthcare

KPMG's Healthcare Review speaks to Lydia Lee about digital healthcare, the challenges of implementation and cyber security, and her perspectives on the industry's future. Recognized as a Canadian healthcare IT leader, Lydia brings over 20 years of industry and public sector experience, previously working as Senior Vice President and CIO at the University Health Network (UHN) in Toronto. Lydia now leads KPMG Canada's CIO Advisory Services and Digital Health practice, in addition to roles in the KPMG global healthcare network. She was awarded the distinction of IT Association of Canada (ITAC) Public Sector CIO of the Year (2015). Interview with Andy Cowper.

Lydia Lee (LL): The role of a Chief Information Officer (CIO) is evolving, while the role of IT as we know it in any healthcare organization is really changing. This is an oversimplification, but cloud computing is shifting the whole nature of how IT services will be provided in future. Traditionally, the Chief Information Officer was responsible for buying software and servers, managing them in a data center, maintaining controls and setting access and deciding when it's lights on/off.

We're moving into an era where nearly everything can be accessed from the cloud: you'll be subscribing to applications, platforms, storage, and computing capacity from the cloud. The skill sets for IT people going forwards will not just be about traditional application support, or even engineering. IT professionals will need to be a broker of IT services, whether provided internally or externally. The attributes of tomorrow's healthcare IT leader will prioritize collaboration, customer experience, and vendor relationship management to enable clinicians and staff to improve the quality and safety of care to improve the patient experience.

(LL): One of the common characteristics of successful digital healthcare implementations is that they should support clinical workflow for users rather than hindering it.

Sometimes, a new system might make some functions take a bit longer than manual processes for an individual, but offer a compensatory benefit to reduce overall incidence of harm across the organization. Computerized physician order entry (CPOE) sometimes falls into this category. It might take longer for an individual order to be placed electronically, though using decision support and other system checks can also improve order accuracy, thus improving patient safety. At the macro level, it's worth it: at the individual level, there's a trade-off that smart organizations have to manage and balance. If the benefits versus trade-offs equation is communicated clearly to clinicians, they are usually willing to adjust to the change.

Most clinical information systems have been built to automate the existing processes and record electronically what we did originally on paper records, and to capture billing detail. However, the functionality is generally not intuitive and requires heavy training and a steep learning curve for adoption into clinical practice.

Greater use of digital will reshape the recruitment, training and retention landscape for healthcare staff, clinical and non-clinical. Generally, millennials are consumers of digital in their personal life first and foremost; they expect the same level of digital enablement at work too. System design absolutely matters in this case. The technology should enhance the user experience to reduce the likelihood of error. A huge element of successful implementation is about good design and considering user experience from the beginning of a project.

(LL): Generally, organizations don't invest in IT for IT's sake, though this is not the case for cyber. Healthcare organizations are expected to have proper controls in place to protect information security. However, since the cybersecurity landscape changes so quickly with new threats constantly emerging, it is a challenge to know how much protection is enough. CIOs don't have endless budgets to throw at cybersecurity, so they need to take a risk-based approach to investing in the right areas to protect their organization's data. How much should they reasonably invest to ensure sufficient protection for organization's information and systems, and so that they don't look irresponsible? How much resource should be at the ready for breach management and remediation? Threat protection technology and services? Organizational training and awareness? That invest-versus-return choice is a constant balancing act between prevention and remediation.

(LL): The role that patients will play when it comes to proactive health management through digital health could be significant. When patients have access regularly to their own health information (as opposed to only getting them from their doctor), the hope is that patients will be empowered to take care of themselves as they'll understand wellbeing, and be more engaged in self-care decisions.

For example, if someone with hypertension could link their diet, weight gain and increases in blood pressure by seeing their data, they will better understand the cause and effect of their behaviors to their health. This is what we mean when we talk about patient empowerment.

We also know that when patients, who are tethered to their healthcare data and are supported by health coaches and caregivers, they become more engaged and tend to sustain the use of health apps, more so then when they are not followed by a health coach. The support and training is what ensures more stickiness and sustainability of self-empowered care. This has fascinating implications for patients with chronic diseases to improve their health outcomes.

In a changing healthcare landscape, who coaches people becomes an interesting question. Should it be clinicians? Non-clinical people? Family members? Or is it a new role if we're trying to support more virtual care in the community and less in the acute sector? Those questions are really changing our thinking about how patients interact with `the health system' especially in the context of broader population health management.

Are the biggest opportunities for digital in healthcare around genomic medicine, or around improving the management of long-term conditions? Or around the opportunities from big data and predictive analytics?

(LL): Digital technologies provide healthcare organizations the tools to support greater standardization of work, which can improve efficiency. At the same time, “big data” also holds the promise of personalized medicine, which is about individualized care. This creates a potential system design paradox - which one is more important? Can digital support both at the same time? Simply put, a clinician I worked with previously asked me `Why put effort into care pathways for patient cohorts if we're moving to personalized medicine?' While some CIOs think they might have to choose between these solitudes, I would argue that this tension creates an interesting opportunity for technology designers, developers and those who support implementation to work together in harnessing digital for collective aims.