A Medical Director’s perspective of Business Model Innovation in hospitals

Hospital innovation should be a thoroughly thought process; not cut and paste the success from other sectors.

“I remembered tuberculosis was extremely common during my days as a medical student and junior doctor in India,” says Dr. Kaushik Banerjea, Executive Director of Medical Services at Portland District Health in Australia.

Patients would be given Rifampin for their treatment. Noncompliance was high. So, doctors tended to ask if the patients had experienced any problem with their urination. If patients said yes and expressed their urine had changed colour, that would be an indication they had taken their medications because Rifampin produced orange urine. Nonetheless, the trick wouldn’t last. As patients gradually learnt what physicians were after, they would claim their urine was orange.

Fast forward to present day, as a senior consultant, Dr. Banerjea gave his diabetic patients devices and booklets to monitor and record their blood sugar levels at home. “But again, I would not know if those blood sugar records were genuine. All I could do was to verify with the patients and trust that they were giving me the right information,” Dr. Banerjea continues.

Dr. Banerjea believes these are the areas where innovation can help. “We now have implantable, blue-tooth enabled monitors that capture patients’ blood sugar continuously. These monitors will send all collected data to the patients and/or doctors’ laptops and/or smartphones”. Doctors will have access to more robust and reliable information. Patients are also spared from finger pricking three to four times a day.

“In 2017, the FDA approved the first digital pill with an ingestible sensor that released data to keep track if patients had complied with their medication regimen,” Dr. Banerjea adds. “This is a milestone especially for patients who are known to be very noncompliant with their medications”.

While Dr. Banerjea might have been a supporter, he cautioned innovations needed to be deployed moderately and carefully in healthcare. He agreed it should not be taken for granted that outcomes are dependent on the technology the system has paid for. The EMR is a classic example.

Dr. Kaushik Banerjea, Executive Director of Medical Services at Portland District Health

“EMR has many advantages. We no longer have to read the illegible handwriting of doctors. We also don’t have to wait for our turn to read clinical notes since EMR offers simultaneous availability at multiple different locations,” Dr. Banerjea explains. “But the EMR was never designed specifically with clinicians in mind. It was meant for administrators to bill. So, it wasn’t surprising when clinicians, particularly the senior ones like myself, began to take longer time to write what we would like to write”.

The time meant for interacting with patients is now taken over by entering information on the EMR. This causes dissatisfaction in patients. Healthcare systems employ senior consultants as they have the know-how and experiences to better diagnose and establish treatment plans, not EMR data-entry.

“I think innovation is making a problem less of a problem, rather than creating new problems from existing problems”. Dr. Banerjea cites another obvious example; telehealth. During a consultation, the concept of interaction fidelity comes into play. When patients are in the clinics, physicians not only listen to their complaints. They also observe the patients if they display any unusual like limping, looking pale, or sweaty palms. Some of these symptoms may be a tell-tale sign of hidden medical concerns.

Telehealth is not able to recreate the kind of high fidelity interactions physicians expect. Video conferencing tools on the market, like Zoom and Skype, were not born with the level of confidentiality and security demanded by the healthcare sector. Yet, at the very least, physicians can still see the patients. In the case when only phone-call is allowed, it is very challenging for physicians to make a holistic judgment.

Dr. Banerjea says he is not against the use of EMR or telehealth. He feels innovation in healthcare should be a thoroughly thought process. There is a need to find out what is going wrong in the system and organically come up with ways to address it. We should not have the attitude of, “this technology or innovation works for this sector, let’s cut and paste it into healthcare”.

Besides, innovation ought to make healthcare more personalized. Dr. Banerjea brings out the success of Uber. Younger generation prefer the service to traditional taxi is because it is on-demand. “I can call an Uber, it is there at my door on the time that I wanted and takes me to wherever I want to go. It provides convenience”.

Healthcare used to be like this too. Before the idea of hospitals or centralized service providers were conceptualized, family doctors travelled to patients’ homes to deliver care. Technology and innovation are just enablers to re-introduce those personalized moments.

“A recent example I came to know is some hospitals are now offering 3D printed knee replacement. They are leveraging 3D printing technology to make artificial knees that are exactly suited to the needs and wants of specific patients,” Dr. Banerjea says. “The healthcare of tomorrow should be fuelled with objectives. If my objective is to provide efficient care, I should think about the resources; the technology and innovations I have got. What are the best ways to recalibrate them to come closest to fulfilling that objective”.