Hospital Management Asia speaks to Mr Krishna Ayagari, who is Vice President Embedded Solutions & Partnerships at Wolters Kluwer Health.
- This COVID-19 pandemic is turning out to be the biggest challenge for healthcare in recent times, what do you think will be the implications of this on the healthcare providers?
I agree, this pandemic has been extremely challenging on numerous fronts and the rapid surge in COVID cases is severely testing the capacity of healthcare systems, healthcare professionals and the entire logistics supply chain. Among the numerous challenges, I see that the lack of accurate and timely information around the availability of resources is a clear issue in most countries. Hundreds, if not thousands of lives could have been saved if information such as availability of beds, oxygen or medications, was available real-time on a city or town’s medical administration systems.
Also, the use of available patient information and genomics to identify the more vulnerable patients, or those with chronic-comorbidity conditions, would have definitely helped healthcare professionals or rapid response teams to better prioritise resources and save lives.
These obviously will drive more investments in basic healthcare infrastructure as well as healthcare IT technology, so digital transformation can be expected to take place at a faster pace. We can also expect more regulatory and compliance requirements; and also higher patient expectations with a plethora of apps, online tools, and personalised services through technology. Lastly, we should see more data-driven decisions. Growth and dependence on data is clearly increasing and there will be a greater and more urgent focus on harnessing “data”, in particular rapid access to right data and presenting it to relevant experts in a timely manner.
- You mention digital transformation, technology, and an increasing dependence on data, which areas in the healthcare IT technology space do you think will be given priority?
Great question! Obviously, healthcare providers will need to look at their digital strategies to deploy new digital tools, patient-facing technologies, platforms to enhance care experience and provide clinicians with enriched analytics. Within Asia-Pacific markets we have countries that have already embarked on these and also countries at the starting stages of their transformation, so each country will need to develop their specific strategy and roadmap. Also, providers will need to think of new ways of designing the basic infrastructure to bring in more flexibility. For example, to create more isolation wards or beds to monitor vital parameters with oxygen etc.
I see a few common themes across the markets:
Telemedicine or Telehealth: While Telehealth has been around for some time, COVID-19 has made it more meaningful and acceptable both by the doctor and patient community as a safe, convenient, and efficient mode of care.
Electronic Medical Records (EMR): Adoption of EMR is expected to increase, with more scalable and sophisticated packages now available. These enable paperless transactions as well as remote mobile access. Cloud-based EMR solutions for general practitioners (GPs) and specialists will help improve productivity. Another area is Clinical Decision Support Systems (CDSS) which, when integrated with EMRs, can streamline workflows, and detect and alert clinicians to potential problems such as medication errors (ME).
Supply Chain Management (SCM): Even before the onset of this pandemic, top executives identified SCM as a priority in managing costs and improving care quality. COVID-19 worsened supply chain problems as it brought high level of uncertainties. And so investment in supply chain solutions now becomes more of a mandatory requirement rather than a cost-saving measure. By combining Machine Learning and augmenting existing Business Intelligence solutions, SCM will help healthcare providers be better equipped in predicting, forecasting demand in uncertain situations much more precisely.
Analytics, Artificial Intelligence (AI) & Machine Learning (ML): We all expect future healthcare to be data-driven, and AI and ML coupled with analytics will provide deeper insights to drive and improve clinical and operational efficiencies, and improve patient experience.
Healthcare Internet of Things: Smart devices and sensors can help monitor patient conditions in ICUs and other areas, and alert ICU doctors immediately when emergencies occur. Further combining these with solutions that can integrate data and intelligence through AI or ML, will reduce burden on critical healthcare staff and improve patient care significantly.
Robotics: We have heard about robotics assisted surgery, but during the pandemic we have seen robots deployed for a wide range of tasks. One clear advantage is reduced exposure to pathogens. So, we can expect to see robots play a wider role.
Lastly, using new technologies and applications will bring in tremendous benefits but at the same time expose the provider and patients to more security-related vulnerabilities, so cybersecurity will be another area of extreme importance.
And I will add that there will be a greater emphasis on increasing availability of healthcare professionals – GPs, specialists, pharmacists, nurses etc and developing a leadership pipeline.
- And how do you see the future and the various technologies helping from a patient’s point of view?
Good point, a patient-centric approach is being widely adopted. Patients are not only more receptive to digital technology such as telehealth but are also embracing wearable devices, health-based apps, and other tools which help in home-based diagnostics. However, there is a clear digital divide in our patient population. We do have patients who are well equipped with latest digital technologies, more aware and eager to take a lead in taking better care of their own health. Most of the population in Asia still lacks access to basic health infrastructure or cannot afford it. As institutions adopt new technologies, I would emphasise that it is important to take note of this digital divide, these inequalities and ensure that the less privileged are not deprived of much needed health care. In other words, with these new technologies we should not end up creating a WALL.
- Can you elaborate how investments in technologies contribute to population health management and a patient’s experience?
There are a number of areas and let me elaborate on a few of them.
There is enormous amount of data within every healthcare provider and this is increasing so rapidly that it is impossible to harness or draw any intelligence from this data, without using AI or other tools. CDSS is one tool which, when used with EMRs, can provide meaningful and timely information such as reminders for delivery of medication, change in dosage, or even alerts for ME.
A second example is around use of genomic data. Population demographics and genetics analytics can help provide a better understanding of population health such as chronic diseases, and if a section of population is more prone to diseases like asthma, diabetes etc.
I also want to bring up an example around predictive clinical analytics or precision medicine. These use ML algorithms to tap into investments made by a provider in EMR systems. Using ML models on patient data available in EMR, these models can identify patients in the high-risk category – for example a risk of re-admissions, or life-threatening condition or an avoidable ME.
- It is interesting you talk about medication errors, so how do these impact patient safety and healthcare providers?
As we know, MEs occur during the lifecycle of prescribing to administrating drugs. They can cause harm to patients in several ways – mortality, injury to patient which can be short or long term, with serious cases leading to admissions into ICU etc.
They also negatively impact both top and bottom line performance of a healthcare provider. Studies show that ME lead to longer hospital stays or higher re-admission rates. And the reputation of a provider may also be put at stake.
- What are the key factors impacting medication errors?
I would say there are several factors that lead to ME and these differ across markets. In general, this topic is not given adequate focus in developing markets and this is one of the biggest and a leading contributor to high MEs. The other factors are lack of a “pharmacovigilance” team which is responsible for tracking and reporting ME. The adverse drug reported in developing markets is way below those reported in developed markets. Other factors include a shortage of pharmacists as well as lack of appropriate technology such as EMR and suitable process in place to report ME.
- What steps are needed to control these medication errors?
Just as other initiatives like digital transformation, quality assurance or patient safety, the first step is for healthcare regulatory bodies, agencies, and executives to make the reporting and control of ME a priority. A top-down approach with executive focus is needed. Regulatory changes where required must be introduced to make this a mandatory requirement. And of course, this needs to be followed by ensuring proper resources, technology and a process to monitor and regulate are in place, to eventually reduce ME. Awareness campaigns and incentive programmes are needed to motivate concerned teams to bring about the change.
- I am sure there are solutions that are available today which healthcare providers can implement to reduce medication errors?
We at Wolters Kluwer offer a leading solution called Medi-Span Clinical which addresses the challenges of reducing MEs, thereby reducing costs, and improving patient safety. Medi-Span Clinical is an evidence-based solution designed for high-volume and high-speed screening and alerting in a “point of care” setting. This allows healthcare professionals to detect any MEs as soon as they occur. We have many leading reputed public and private hospitals across the region as our customers of Medi-Span Clinical.
- What stops hospitals then from implementing these solutions and improving patient safety?
I can attribute this to lack of budgets, infrastructure such as EMRs, use of electronic prescriptions and also a lack of focus as pointed out before for being key reasons that stopped providers from focusing on ME in the past. Patient safety is now a top priority and providers are investing in infrastructure and Medi-Span Clinical. Providers are also now looking at accreditations as a way to communicate the importance of patient safety and Medi-Span Clinical helps in achieving accreditations by bodies such as HIMSS, JCI and local accreditation bodies.
- Does your solution help in population management or patient preference that you mentioned previously?
Yes, Medi-Span Clinical takes into consideration individual patient profile, medical condition etc and will provide information that is increasingly customised to a patient’s condition.