There are rare occasions when an event, or a pause, provide an opportunity to look back and reflect on change and progression that may not be apparent when working day to day, or week to week.
I recently returned from the Oracle Cerner Health Conference (OCHC) in Kansas City – the first visit for many clients, partners, and employees since October 2019, before the pandemic began. OCHC has been the focal point of our event calendar since the late 1980s, and it is the perfect convergence of client learning, innovation, and the sharing of product updates and news.
The event brought together over 7,000 attendees over the three days, from 11 countries globally, and for a few days Kansas City once again was an international hub of healthcare technology innovation. When compared to previous years, there was a subtle shift in language from a very US-first message, to one that was more inclusive of global healthcare practice and learning. The customer presence from outside the US was higher (as a percentage) than in previous years, stories from around the world took centre stage, and the sessions delivered by customers from Australia, Canada, Europe, Middle East, and UK were particularly well attended.
While that shift alone would be cause for pride and celebration, there was one defining area that stood out about OCHC, and in a way that was a microcosm of a general shift in healthcare narrative: health equity. Over the last three years, the pandemic shone a light on the inequalities in healthcare provision globally. Between countries and regions, a disparity in access to vaccination and hospital facilities for the acutely ill has been apparent and visible.
Even in richer nations, with socialised healthcare models that offer free care at the point of need, it quickly became apparent that COVID-19 disproportionately impacted those on lower incomes, the frail, certain ethnic groups, and those unable to speak the local predominant language. COVID-19 discriminated – not for clinical/medical reasons, but for reasons of lived environment, exposure, and access Was COVID-19 simply a lighthouse for broader issues with health inequity? In the UK, the correlation of wealth and health have been known for a long time.
There is nothing new here – it’s been an issue since the very origins of healthcare – but returning to OCHC it became apparent that the pandemic has had a profound effect on the way that it’s discussed, and the platform provided. Since we last gathered in 2019, the issue of equity has shifted from being an underlying theme to holding a central position on the main stage. Now, it is considered a fundamental consideration in healthcare practice and system design.
So why the interest, and why now? There are many reasons. Among them, the availability of data, the inescapable evidence presented by the pandemic, and the need to do something to address the acute pressures on health services around the world.
Many health systems are in crisis. The well-documented aging of populations with increasingly complex and costly care needs, combined with a shrinking workforce and governmental debt accumulated through pandemic support have resulted in a need to take drastic measures. It is simply not excusable in many cultures to just respond to those that can pay the most or shout the loudest. By doing so, those without the money or the voice are forgotten, with the result that they are diagnosed later, wait longer and eventually cost the system more.
Health equity is not just a matter of social justice – it’s good economics too. It’s not ‘fixed’ by big overarching policy, but is addressed issue by issue, practice by practice. It was equally remarkable and heart-warming to hear Lewisham, a relatively deprived borough in southeast London, mentioned repeatedly in front of a global audience as an exemplar, a leading light in the use of data to address inequity. At OCHC, both Dr Liz Aitken and Dr Aaminah Verity put Lewisham on the map – describing how data aggregated and analysed from across health and social care allowed them to screen for the most vulnerable, target interventions, and deliver timely and effective care – keeping people out of hospital and alleviating pressure further up the system. The result? Cost reduction and improved quality of life for the individuals impacted.
Pausing to look back, the last three years have been transformational. Addressing the issue of inequity is daunting. True social justice, equity in provision, and equality in outcome is a utopian goal. After an hour of discussion in the customer workshop that preceded OCHC on the Sunday, one client voiced the concerns of many: “We are creating a monster!” she said. It’s true that the ready access to data could lead to the emergence of issues so large and widespread that they cannot all be addressed. However, the data also makes visible numerous issues that raise the pressure for action. It’s not possible to solve all the underlying problems of unequal health and welfare, but through careful assessment, it is absolutely possible to link redistributed healthcare and social provision with improved outcomes – not necessarily incurring more cost, but as a clear benefit to society.