The Business Years talks to Michael Pomerance, Managing Director, Cerner, Middle East and Africa on integrating IT into healthcare, the UAE's fragmented market, and new methods of diagnosis.
What opportunity is there to integrate IT products into surgical prosthesis and diagnostic systems to increase patient provision?
The electronic healthcare record (EHR) is moving away from being simply a data collection tool and toward supplementing the duties of an automated physician. The best EHRs of today, such as Cerner's, is similar to an on-call physician. Previously, if a patient was becoming sick, a doctor would have to look at a chart and look for trends in the vital signs to determine if there is a problem. Today with the vast power of computers and the excellent data that is collected throughout the care process, computers who are looking for trends can spot them instantly. For instance, if there is information about the patient in terms of the strengthening or weakening of a particular body system, the computer can alter the physician or care team instantly versus waiting until a person reads the chart or visits with the patient. Additionally, there are much more capabilities to send data from everywhere into the medical record. From home, from schools, from clinics, etc. This free flow of medical data from physician offices, clinics, and hospitals to one another and back into EHRs is called data liquidity. Now, rather than doctors spending time questioning the patient and trying to read thousands of pieces of paper, the computer assists the doctor and their time is better spent analyzing various healthcare solutions proposed and discussing options with the patient.
How do you balance the traditional aspects of healthcare with modern trends that embrace technology and innovation, and reduce patient-doctor contact time?
Our philosophy is to give the caregivers as much direct interaction with the patients as possible and in this way minimize the impact of technology. Having the capability to absorb data in its liquid form is important because it will minimize repetition of data entry. In the healthcare industry, efficiency means the more patients a doctor can effectively consult, the better. That means that as an EHR provider we must make our system very fast, smart, easy to navigate, very intuitive, and simple for the physician to use. In the future we are going to see a shift to consumer-based healthcare where, like taxis and ride sharing companies, we must innovate and adapt to provide patients with more choice, flexibility, and ease without sacrificing quality. For instance, if a patient is ill and prefers to not leave the house, telemedicine will have to enable a virtual visit with a physician and deliver prescription drugs to the patient's house via Uber or drone. Another worldwide trend in medicine is the shift toward wellness and being able to impact a patient's wellbeing simply by educating them. Future consumer-based healthcare providers are going to be more focused on coaching and helping people achieve their goals rather than prescribing and diagnosing. Whereas large providers tend to make business decisions based on profit margin and typically evolve slower, in the near future there will be smaller and more nimble care providers providing efficiency and innovation at a lower cost. This new ability and the popularity of preventative care will eventually be the primary focus rather than the focus on the more expensive, traditional procedures.
How are you working with a fairly fragmented market, with 100 hospitals and 2,000 clinics across the UAE?
Unlike the majority of healthcare markets where there are silos of information between the hospital and clinic systems, here in the region 100% of all Cerner clients leverage one system for all of their venues of care, including clinics, school health, home visits, etc. allowing a seamless exchange of data. In our global experience and industry research, this is the most effective approach to digitalize healthcare. Otherwise when there is gaps in information, the patient does not usually receive the best outcomes. For example, if a patient comes into the hospital Emergency department with a headache we can immediately inform the doctor that the patient might be behind on their diabetes medication or has a chronic condition that they have not been treated for in the last six months. The second strategy Cerner is deploying in conjunction with the first is an effort to proactively manage people's health. This translates to compiling information from all over the world to be analyzed and evaluated so that we can predict who will need care before they need it. At Cerner, we call this system HealtheIntent®. HealtheIntent is a proactive health system that enables governments and organizations to gather data from thousands of individual sources and then use statistical analysis to determine and predict the risks of individual patients, allowing providers to match the right care programs to the right individuals, and helps to improve outcomes and lower costs for health and care. For instance, HealtheIntent can help identify if the patient is at high risk of readmission within 30 days. If they are, HealtheIntent provides suggestive actions to take while the patient is still in the hospital so that the patient does not have to be readmitted again and again.
Are there any dangers in deciding treatment and care based on IT solutions?
Actually quite the opposite. The average time it takes for new medical practice, that has been peer reviewed and published until it is at least 50 percent of the clinicians utilizing it in mainstream healthcare is 17 years It would be unthinkable to buy a cellphone or a car that is 17 years old, whereas the process for human diagnostics is using information that is almost two decades old. Another theory states that in order for physicians to keep themselves updated they must read 20.9 hours of medical journals every day. While both of these facts are staggering, modern HER technology has given birth to computers that can suggest things to physicians as well as monitor 100% of the data 100% of the time. This additional oversight can monitor, diagnose and suggest treatment for the majority of common ailments, which account for over 30% of the total healthcare episodes of care. Furthermore, the study of genomics is advancing into the practice of personalized medicine. It is cheap and common enough to be readily available and sophisticated enough to indicate which medications and treatment will work or work better. The more genomics is integrated into EHRs the more developed and effective our systems will be. Cerner has great capabilities in this area. The last hurdle in integrating these systems is how well it matches consumer demand. While big data and predictive modeling are important for providing the most technological advanced and sophisticated healthcare, customers want to turn on their smartphone and enter information about themselves, connect it to their EHR and have easy access to a personalized plan. This is what we foresee in terms of a consumer-based healthcare model. The biggest problem with current registries is that they utilize old information and are not updated fully and consistently. HealtheIntent utilizes a massive amount of integrated information that is added to every day from different inputs. For example, for the Ministry of Health we leveragedall of the data from the last 9 years and created a single, interactive registry system that is concurrent with data today and that keeps current as people edit or add new information.
How does your company and your client's respective growths reflect the trends of growth in the healthcare sector in the UAE and the GCC?
Although healthcare in the GCC is provided by the state, most governments are looking to privatize or corporatize. The problem is that we are spending a lot of time building systems and hospitals that are great in 2016 but may not viable in the future. Currently, insurance, customers, and hospitals are paying large amounts of money for new healthcare facilities where procedures are very expensive.. The whole provider based system of today is geared toward making more money. However, this is not sustainable in shifting economies, shifting consumer demands, and emerging market trends. A new way of thinking focuses on reimbursing wellness and preventative healthcare will slowly creep into today market. By reimbursing wellness you are introducing an incentive into people's lives that will have a direct impact how healthcare is implemented. This practice is starting to emerge in many markets including the United States. While healthcare in the UAE and the GCC is “care" based today, it is evolving beyond this. In 2016, many of our clients came to us and asked us to provide higher-level services at a lower cost, signaling the beginning of the transition toward a value based market and this is where the consumer based system of tomorrow. Our future in the UAE and GCC will not be simply an EHR tool business, but as a healthcare partner helping with analytics, revenue cycle, preventative care and other specialized healthcare needs. The shift toward highly centralized, highly digitalized, consumer based healthcare has begun.