Building a Digital Health Ecosystem

COVID-19 expedited the digital transformation of healthcare, and patients and providers alike saw benefits. To sustain this transformation, however, health systems need a robust digital health ecosystem. This ensures that healthcare workflows and processes are offered within the required quality, access and security framework, and patients are provided with personalised solutions tailored to their needs.

The Building Blocks of a Digital Health Ecosystem

"Building a digital health ecosystem starts with governance and workforce. A workforce able to deliver digitally enabled care and a strong governance and policy framework that helps ensure data is captured, is kept private, is stored securely, but is also accessible to patients, their caregivers and the provider teams they're working with," said Anne Snowdon, RN, PhD, FAAN, director of clinical research at HIMSS.

Snowdon shared that the next building block is interoperability, which is the "democratisation of data." This refers to the ability of data to flow from one team to the next, across the entire journey of care. Patients and their families can then have confidence that every provider team they are working with has the most current and up-to-date health data to work with to inform decisions.

She mentioned that data is not enough, however, and the ability to track and trace outcomes is also vital. "How well is the patient population doing? That's the job of analytics, to mobilise that data, help us understand which patients and families are doing extremely well with care programmes that they have," she added. "And for the ones that are not, so have to make sure that we improve those care programmes so that every global citizen has access to the best care available."

Snowdon explained that when all of those things come together, that's when we describe a health system having the digital capacity to engage patients and families meaningfully, connected in a manner that is most helpful and of interest to them, and in a way that helps them stay healthy and well.

"And that's where the future is for the digital health system—population health and wellness—rather than what today's health systems tend to focus more heavily on, which is disease management," she concluded.

Watch Reid Oakes, executive vice president and Snowdon discuss with HIMSS TV the changes and the opportunities that COVID-19 has created for digital health.

Placing Users at the Centre

For Bruce Winzar, executive director for innovation and digital services and regional chief information officer of Australia-based Bendigo Health, a digital health ecosystem puts users' needs first. 

"What's key is that we always match our technology with what our end-users really want. And that means that our patients need to be first and foremost around the safety and the quality of our systems," he said. "And of course, our end-users could also be clinicians and third parties, such as other providers."

Patient engagement is more than just a clinical portal, he added, saying that it is about how you provide a front door to your organisation, and what that front door looks like.

"How do you empower and provide the appropriate information to each of your patients or to your consumers? And the consumers could be third parties; they could be providers like the local specialist or GP. Or they could be patients who are really just looking to see what services you've got," he said.

He went on to explain that it was about empowerment, and the provision of information that's beyond just clinical information. Customers and patients may want to know about what's going to happen pre- and post-care, and what the experience is going to be like when they go into a renal department or cancer centre. This would potentially help reduce levels of anxiety due to lack of knowledge.

Derrick Chan Kum Keong, chief executive officer of Sunway Medical Centre Velocity (SMCV) in Malaysia shared that his hospital works on three core principles, one of them being to make sure that they are patient centric. The other principles are to provide clinical excellence and to make sure that management is efficient.

"We have what we call automatic pre-registrations. Before coming to the hospital, patients can register themselves onto our patient queue via their mobile phones. A QR code will be given to them when they arrive at the hospital," he said. "All they need to do is to scan the QR code and the queue number follows them wherever they go, whether it's outpatient clinics or radiology labs."

This enables obvious, efficient tracking of where the patient is through a dashboard. Hospital administrators are then able to see where the chokepoints are, and why patients are waiting so long. The data assists them in making sure the flow within the hospital works.

During the early months of the pandemic, SMCV introduced an initiative for a drive-through COVID-19 test. Patients did not need to enter the hospital for their test and could have the swab test done in their cars. This ensured minimal contact with anyone in the hospital.

"They registered for the test back home. A confirmation was to them, and they made payment the day before. The next morning, they just had to come to the hospital in their cars and present themselves for the swab," he said. "Results were issued to patients via SMS, and this data was connected to our government, our public services, such that with COVID-19 positive patients, we could arrange for appropriate interventions."

SMCV was also one of the first hospitals in Malaysia to start eInsurance claims. In the past, physical forms had to be submitted for insurance claims so that the patient can obtain a letter of guarantee. It used to take up to four hours for the letter to be ready. Now, when the patient comes in, the eClaim form is sent to insurance agencies and the letter arrives within an hour.

"We are also exploring having all necessary patient information on an app. So that patients will always have their medical records—for example their radiology images. If they travel, they're able to pull out their previous medical records to be seen by physicians overseas," he said.

Getting Buy-In at All Levels

Leadership support is crucial for the digital health journey, according to Winzar. "My board is very supportive of digital health. We have our chief medical information officer, allied health officer and chief nurse officer that are all leading right from the front and are matching our operational or strategic plans to bring a successful digital health implementation," he explained.

Bendigo Health also has a digitally savvy workforce. When they first started their digital health journey, health informatics was at the forefront.

"We had everyone from nurses to our legal counsel to our clinicians to our accounts department take courses. The idea was that they get a better understanding of why we have data, the importance of protecting data, the difficulties we have when we integrate medical devices, speed, capacity, efficiencies, etc.," he said. "And that was a great, great effort. We were investing really early into our workforce, and we've continued to invest into that, and we provide a whole range of third-party type for the delivery of our workforce."

Change management is also important for delivering a digital health ecosystem, Winzar added. When they were building new systems, a specific change management budget line item in the project helped. This ensured that there were sufficient resources allocated to ensure that all key players who needed to use the new systems undergo the required retraining.

Some doctors who were nearing retirement, did not want to go undergo the retraining. In these cases, tough decisions had to be made and they were asked to retire if they were not prepared to do the hard work and retrain.

"You need to have strong leadership. You need to be able to identify that if you want to go forward, everyone's got to come," said Winzar.

Ensuring Interoperability

Before he joined SMCV, Chan managed a diagnostics company that did radiology, diagnostic and MRI scans. The business had many integrations with payers or organisations where images had to be sent to.

"To be able to connect other systems together really give us a lot of flexibility because we are empowering patients to be able to bring their records and results to wherever they want, such that it doesn't hamper them in terms of critical medical treatment," he added.

Empowering patients to be able to make their own decisions is something that he has always been trying to encourage. At SMCV, the goal is to always ensure that information systems are integrated. A lot of effort was put in to make sure that if there are medical facilities that need to draw a patient's information from the hospitals' system, it will be via that patient's approval.

"The patients themselves must be the one that send medical records or images to the clinicians. So that they are the ones in control of their own data."