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Why hasn’t digital technology transformed health care delivery?

The health sector should focus on consumer needs to better harness the promise of digital technology, writes a Stanford Medicine professor and a colleague.

We’ve become accustomed to the excited buzz around digital technologies and their potential to transform the health care industry. But in a recent piece in The New England Journal of Medicine, co-author Kevin Schulman, MD, questions why the health sector hasn’t done a better job harnessing these innovations for broad improvement.

Schulman, a professor of medicine at Stanford, and Barak Richman, PhD, of Duke University School of Law, ask:

Why… have investments in digital technologies largely failed to lead to meaningful improvements along the axes of health care’s “quadruple aim” — enhancing patient experience, improving population health, reducing costs, and improving
the lives of health care professionals? And why have well-intended efforts to adopt digital technologies had so little systemic impact as compared with those in other industries?

Viewing the issue through a business lens, Schulman and Richman observe that policymakers seem to start with the status quo when looking to design a future for health care. The authors argue for a different approach that would focus on understanding what customers need, and then building solutions to meet those needs. For example, a shortage of primary care services could be addressed by encouraging telemedicine or featuring physician assistants, rather than pushing more physician trainees to choose primary care.

“Examining the services needed by the patient, rather than the available delivery-system resources, would lead to exploration of ways of delivering those services most efficiently and effectively,” Schulman and Richman write.

This “services approach” can be applied to a spectrum of patient needs, ranging from self-care to long-term care, they say. And health information technology can be an effective tool for making the approach work — as long as it’s seen as a support for the business strategy rather than the strategy itself. They write:

Each of the service layers would require ready access to high-quality clinical data to achieve its full potential. The services model would therefore be greatly facilitated by the development of an open, accessible, patient-centered data architecture (in contrast to the proprietary technology currently used by many hospitals and physicians).

Schulman and Richman say the health care sector also could learn from consumer tech companies that continuously test and improve their offerings. Though some may balk at such a dexterous approach, they say such a shift is needed. They write, “innovation as a reform agenda can only truly succeed when it forces change in business models and practices throughout the health care system.”

Photo by geralt

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