16 minute read
Preparing for Patient Surges Amid a Pandemic
While patient and provider experiences vary by country, COVID-19 has illuminated the global nature of healthcare and tested the resilience of organisations. At the beginning of the pandemic, hospitals braced for an incoming wave of COVID19 patients and took proactive steps to preserve hospital capacity and resources. Many countries directed public hospitals to cancel non-urgent surgeries and to ramp up their intensive care unit (ICU) bed capacity to accommodate any potential surge in pandemic patients.
At the individual level, many patients chose to delay their care and stay home to reduce their risk of contracting COVID-19. On this side of
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In March 2020, the World Health Organisation (WHO) declared COVID-19 a global pandemic. Since that time, health systems and patients have been challenged to rapidly adapt in the face of capacity surges, unprecedented resource consumption and an array of new safety procedures. As vaccines continue to roll out, a surge of patients needing non-emergent care is likely to put new strains on our healthcare resources. Solutions and new workflows will be needed to cope with the increased volume of patients seeking care.
John Lee-Bartlett, Country Director, Allscripts Canada
the world, research showed that fewer Canadians sought medical care for significant concerns like cardiac events and trauma, as well as for common concerns like abdominal pain colds and the flu1. In the Asian region, Malaysia saw an overall surgery cancellation rate of about 71 per cent, which was projected to take 11 months to clear the backlog of surgeries2 .
This may be one of the largest indirect consequences of COVID-19: more than 28 million cancelled or postponed operations, which means a significant number of patients are waiting for care3 . For conditions such as cancer, surgery is central to diagnosis and treatment, and a delay in either can significantly worsen outcomes4 .
The true impact of the pandemic on our healthcare system — and the global population’s healthcare in general — is so far-reaching we likely do not yet know its full scale. It may likely take years before we can determine the full impact of these care delays, and potentially the same amount of time for the system to recover financially and operationally.
According to a global study3 using data from 359 hospitals across 71 countries, the total number of cancelled elective surgeries in 190 countries across duration of 12 weeks of peak disruption were estimated to be at 2.3 million operations per week. These numbers represent a massive backlog of delayed surgeries and procedures, which are
1 Canadian Institute for Health Information (CIHI). Overview: COVID-19’s impact on health care systems. Available at: https://www.cihi.ca/en/covid-19- resources/ impact-of-covid-19-on-canadas-health-care-systems/overview-covid-19s-impact-on Accessed on: May 25, 2021. 2 British Journey of Surgery, COVIDSurg Collaborative: Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans 3 World Economic Forum: 28 million elective surgeries may be cancelled worldwide: how non-COVID-19 medical care is suffering 4 Eskander et al. Access to Cancer Surgery in a Universal Health Care System During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(3):e211104. Available at: https://jamanetwork.com/journals/jamanetworkopen/fulla rticle/2777399?resultClick=1#zld210019r1. Accessed on: May 25, 2021. likely to worsen with additional week of continuing restrictions and lockdowns. It will also place unprecedented stress on healthcare systems across the globe in the coming months and years, which for some countries, were already routinely filled beyond capacity even before the pandemic with patients experiencing long wait times for specialist referrals, surgeries or diagnostic procedures.
The same study also predicted that it would take at least 45 weeks to clear the surgical backlog and get back on track. However, these projections assume hospitals will be able to operate at 20 per cent above pre-pandemic volumes over the coming years, which remains an existential challenge for already overcrowded healthcare systems.
Rethinking what it means to be digital
While increasing funding is critical to help our hospitals prepare for patient surges, healthcare leaders and decision-makers will also have to find innovative ways to increase volume and capacity above pre-pandemic levels to clear the backlog. Organisations are all at different stages of workflow modernisation, and, from a culture perspective, acceptance of technology is as important, if not more so, than the adoption of new solutions.
We need to explore solutions that enable patients to access the surgeries or procedures they are waiting for, without compromising quality of care. To achieve this, we need to get to the root of the problem – inpatient capacity planning — which includes hospital admissions, discharges, and transfers, as well as staffing and operating-room utilisation. For example, a significant step would be to move from electronic versions of analog processes to digitalfirst processes, where healthcare providers can then realise the full potential of digital workflows that are bolstered by artificial intelligence, machine learning and other technologies poised to transform healthcare delivery, operations and more.
Managing surges in patient volume
The backlog of appointments resulting from suspending non-urgent procedures and screenings during COVID-19 waves has become a major side effect of the pandemic. However, the healthcare sector can boost patient access using some creative approaches. There are five opportunities healthcare leaders and decision-makers can consider:
1) Optimise patient access and bed management
Adopting bed management technology can enable fast, accurate patient placement. With visibility into transfer and discharge activities, hospitals can rely on the data to match patients to beds under the right service lines more quickly, expediting patient throughput.
2) Eliminate environmental services inefficiencies to prioritise patient safety
Eliminating manual processes and ensuring environmental services tasks are completed safely and efficiently will minimise hospital-acquired infections which require lengthened hospital stays.
3) Effectively manage the porter pool To optimise the porter service and limit delays, many organisations centralise the transport workload. Streamlining transport processes with a mobile application maximises staff productivity by optimising task allocation with batching and barcodes.
4) Harness the power of predictive analytics for proactive decisionmaking
From an operational perspective, organisations can leverage predictive analytics to make actionable staffinglevel decisions based on history and predicted demand and ensure that they have the capacity to effectively manage volumes during any given shift. When staffing decisions are aligned with demand, a foundation for improved patient access is created. Powerful predictive analytics can optimise capacity planning and discharge forecasting.
5) Deploy a single command and control team
This provides an integrated patient flow solution that incorporates bed management, portering, environmental services, transfer management, surgical flow and predictive analytics, ensuring communication, efficiency and patient throughput are maximised.
Bringing care to the patient
While optimising in-person care experiences is a worthy endeavour, there is no denying that remote care is on the rise. During the pandemic, telehealth enabled patients with everything from behavioural health to post-surgical care needs to engage with clinicians flexibly and comfortably. The possibilities for telecare will only expand as connected device technologies advance, where the smart thermometers and sleep trackers of today suggest that more comprehensive and efficient care is within reach. Patients can get visibility into their progress and useful information to help improve their health along the way. Managing the volume of data collected in our personal environments will thus be key to actualising this vision.
John Lee-Bartlett is VP International Solutions Management & Managing Director Canada and Americas (non US). Originally from the UK, John has a 20-year growing passion for healthcare transformation. Having worked for many years in the NHS and then for various healthcare IT companies, he provides a clear and passionate approach to improving the ways healthcare IT can enable clinical transformation. For the last several years, John has worked in Canada providing leadership across the Allscripts business for existing clients and growing the business to provide innovative solutions to organizations and patients.
About Allscripts
Allscripts (NASDAQ: MDRX) is a leader in healthcare information technology solutions that advance clinical, financial and operational results. Our innovative solutions connect people, places and data across an Open, Connected Community of HealthTM. Connectivity empowers caregivers and consumers to make better decisions, delivering better care for healthier populations. To learn more, visit www.allscripts.com, Twitter, YouTube and It Takes A Community: The Allscripts Blog.
As of 6 May 2022, the Allscripts Healthcare Solutions’ Hospitals and Large Physician Practices business segment has since been acquired by N. Harris Computer Corporation (“Harris”), a wholly-owned subsidiary of Constellation Software Inc. (TSX:CSU). The segment is now operating as Altera Digital Health, a business unit of Harris Healthcare. To learn more, visit www. alterahealth.com.
John Lee-Bartlett is VP International Solutions Management & Managing Director Canada and Americas (non US). Originally from the UK, John has a 20-year growing passion for healthcare transformation. Having worked for many years in the NHS and then for various healthcare IT companies, he provides a clear and passionate approach to improving the ways healthcare IT can enable clinical transformation. For the last several years, John has worked in Canada providing leadership across the Allscripts business for existing clients and growing the business to provide innovative solutions to organizations and patients. AUTHOR BIO
LUCIANO BRUSTIA
DIGITAL ENGAGEMENT PUTS PATIENTS AT THE CENTRE OF CARE
Asian hospitals have learned the value of data from the pandemic. Delivering world-class care and the best patient experience is now the minimum standard. The race is on to go fully digital with leading providers moving to digitally engage their patients inside and outside the hospital for the best virtual experience.
COVID has given digital health technology a huge boost. It has spurred investments in telehealth, patient engagement via mobiles, and electronic medical record systems.
With fewer hospital visits, healthcare providers are looking to technology to fill the gap. Strategies include empowering patients to take more responsibility for their care and finding ways to provide care virtually, not just in the hospital or clinic.
We spoke with Luciano Brustia, Regional Managing Director, Asia Pacific at InterSystems1, about the latest developments in digital patient engagement, the challenges that hospitals
1 https://www.intersystems.com/ face, and how the company is working with leading hospitals in the region.
The digital patient engagement trend shouldn’t surprise anyone in the healthcare industry, says Brustia. “Digital engagement is already part of life in almost every other industry. Consumers expect to interact with their trusted suppliers digitally, particularly through their smartphones, and healthcare is now catching up.”
But healthcare is not like every other industry. The “customer” data that providers collect about patients is far
more complex and difficult to interpret. This gives rise to many challenges. For example, while hospitals want to move quickly to engage patients digitally, the services they roll out must also do no harm.
“There is a great advantage in encouraging patients to take responsibility for their care,” says Brustia. “The Value of Engagement Research shows that engaged and activated patients have higher satisfaction levels and use fewer resources. Combined with telehealth, clinicians can see more patients, and providers can maintain closer relationships with their customers.”
Personal Community2 patient engagement solutions from InterSystems, for example, provide a range of capabilities. These include reviewing care records, uploading data from personal medical devices, scheduling appointments, completing forms for care providers, receiving alerts and notifications, and accessing thirdparty SMART on FHIR apps.
Many Asian hospitals have already pressed ahead with digital engagement strategies focused on patient communications. These have already proven valuable in maintaining relationships with patients that were making fewer hospital visits because of the pandemic.
Patients expect clinical data access
Brustia says these initiatives have been a significant first step. Hospital management teams have moved quickly to develop new business strategies and invest in technology to implement them. But they run the longer term risk of not meeting patient expectations.
“With digital engagement, healthcare providers need to think about their brand. Are they an organisation that promotes medical treatments, or do they provide the best care for each
2 https://www.intersystems.com/interoperability-platform/ personal-community patient? If you want to be known for patient-centred care, clinical data has to be part of the equation.”
“We need technology to be a bridge between healthcare providers, patients and clinicians,” says Brustia. “But we also need to do that in a clinically safe and simple way that benefits the patient and the clinicians, and meets the business objectives of healthcare providers.”
Providers that have invested in digital clinical systems have a massive advantage over those that rely on paper-based systems. The need to capture clinical data and make it available for sharing with patients and clinicians makes an electronic medical record (EMR) system a must-have. stakeholder group, says Brustia. “You need to meet patients’ expectations, but you also need buy-in from clinicians and a commitment from hospital executives to an ongoing digital engagement program.”
Thinking strategically, healthcare organisations should look at digital engagement as the lens through which patients view and benefit from the digital transformation of hospitals.
Luciano Brustia
InterSystems
While provider organisations want to move quickly, digital patient engagement should be approached like any other new clinical process, says Brustia. “Hospitals should start with some simple use-cases. You need to try them, test them and prove that they work before releasing them into the world.”
While every hospital will have a different strategy, the most popular use-cases include booking appointments online, reviewing lab results, and checking medication lists. More advanced strategies include medication refills. A mobile app may alert patients when medications need replacing and set up a telehealth consultation with a doctor.
Before implementing these strategies, you need to involve each
Delivering hospitals’ future vision
“While patient engagement is the goal, it is just one part of digital transformation. We are only at the beginning of a long transformation journey for healthcare. While we can provide the technology to deliver the hospital’s vision for the future, you cannot achieve everything at once.”
Brustia says that while InterSystems offers a wide range of technologies for the digital transformation of healthcare, the real value lies in how they are used. That is one reason why InterSystems prefers to work in partnership with healthcare providers. “We want our customers to move as quickly as they can.” But healthcare is not an industry where you can ‘move fast and break things’, as Facebook founder Mark Zuckerberg said.
“Digital patient engagement involves more than technology,” says Brustia. “You need to consider many issues to develop the best solution. These include clinical safety, social safety, security and privacy. How are you going to verify the identity of the patient? How will you protect against the potential for medical information to be stolen or misused and avoid potential liability for the hospital and the clinicians?”
He says that InterSystems has invested in large clinical safety and information security departments to keep abreast of these issues and advise its customers. “We pour millions of dollars into the things that make up a complete solution. We tell our customers that you should trust us to work together in a true partnership to succeed.”
Start small, achieve wins and build one step at a time
InterSystems believes that healthcare providers should win their patients’ trust one step at a time when it comes to digital engagement. The company is currently working with several Asian hospitals on digital engagement. In almost every case, the strategy is to start small, achieve some wins, and build the program from there.
For example, Bumrungrad International Hospital3 in Thailand recently implemented InterSystems TrakCare 4 Personal Community. Another leading hospital group, Rumah Sakit Pondok Indah5 (RSPI) in Indonesia, is also working with InterSystems to make digital patient engagement a reality.
“We are working to help RSPI achieve HIMSS EMRAM Stage 7 validation, and patient engagement is central to their strategy,” says Brustia. “In particular, they are looking to leverage InterSystems TrakCare’s ability to integrate EMR data with mobile apps.”
Starting small may mean enabling patients to book appointments and access lab results from the TrakCare EMR. But the long-term goal would be to give patients the information they need to manage their health. That might include reminders for vaccinations or regular appointments to manage a chronic health condition.
Both Bumrungrad International Hospital and RSPI are building patient engagement on top of mature EMR systems. But organisations implementing new EMR systems are also building patient engagement into their digital transformation plans.
“One of our customers is implementing InterSystems TrakCare at a new hospital,” says Brustia. “As well as digitising their patient records and providing clinical support from
3 https://www.bumrungrad.com/en/ 4 https://www.intersystems.com/au/products/trakcare/ 5 https://www.rspondokindah.co.id/en day one, one of their objectives is to build interoperability for digital patient engagement.”
Patient engagement driving need for interoperability
TrakCare can integrate with mobile apps, Brustia points out, and the new hospital wants to leverage its EMR data for patient engagement. “This organisation already has some home-grown mobile apps for patients, and they are looking to increase the richness of the engagement with clinical data.”
Asian hospitals have long seen EMR systems as desirable in supporting world-class levels of healthcare. Now, digital patient engagement is driving the need for other advanced technologies, including interoperability and data analytics.
This is something that has already happened in other industries, says Brustia. “If you look at the financial or the travel industries, you see the ability to combine multiple sources of information into a single customer service using Internet technologies. When you search for the best airline flight on a booking site, you see information from multiple databases that have been combined in a meaningful way.”
The healthcare industry is also making rapid advances in interoperability, driven by new standards for exchanging healthcare information like FHIR (Fast Healthcare Interoperability Resources). Another new standard, SMART on FHIR6, builds on FHIR and other
6 https://www.intersystems.com/fhir/ Internet standards to provide secure data interchange with EMR systems like InterSystems TrakCare.
When it comes to digital patient engagement, FHIR offers a standard way to integrate mobile apps, for example, with a hospital’s information systems. Organisations can also take advantage of a healthcare data platform, like InterSystems IRIS for Health™,7 to develop FHIR apps, provide advanced interoperability, and orchestrate digital services.
“Learn to walk before you can run”
Likewise, data analytics, artificial intelligence and machine learning will also be essential capabilities as digital patient engagement evolves. Healthcare providers could potentially analyse engagement patterns, for example, and correlate them against healthcare outcomes to make informed recommendations to individual patients.
Building the technology capabilities to support future enhancements is essential. Right now, however, Asian hospitals need to develop a digital patient engagement strategy and go after the low-hanging fruit, says Brustia in conclusion.
“How many healthcare providers have a strategy to care for their customers’ whole families, for example. How do we help them become responsible for not only health but also wellness? How can we look after our patients remotely, so they don’t need to visit the hospital? Many of these strategies are achievable, but you must learn to walk before you can run.”
AUTHOR BIO
7 https://www.intersystems.com/intersystems-iris-for-health
LUCIANO BRUSTIA is Regional Managing Director, Asia Pacific at InterSystems, a provider of innovative data solutions, including cloud-first data platforms which solve interoperability, speed and scalability problems, as well as the world’s most proven electronic medical record which supports advanced data management in hospitals.
