The patient at the heart of care

HEALTHCARE CHALLENGES AND TRENDS

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Quality healthcare is one of the most important factors in how individuals perceive their quality of life. In most countries, alongside the economy, it is the major political issue. In some countries, such as the UK with the National Health Service (NHS), the healthcare delivery organisation is a part of their national identity.We believe it is time for a new enlightenment in every aspect of the healthcare ecosystem, where every player, from governments to enterprises to individuals, is involved in improving healthcare. We want to bring you the best of our thinking, and the best of our partner’s thinking. That’s why we are writing a series of whitepapers. While we concentrate on the challenges of healthcare in the first paper, later into the series, we’ll look deeper at its correlation to the pharma industry, and the need for collaboration between the two and also at the innovative solutions we offer for better healthcare.

Globally, all health economies are facing similar challenges. In addition, the advent of new consumer technologies is introducing more challenges (or bringing older ones to the fore). These disruptive technologies promote greater patient power.

The most agile and forward thinking health economies have the opportunity to revolutionise the way care is delivered, and in doing so to transform their societies. This whitepaper, the first in a series from Logica, outlines the challenges we see our clients struggling with, and some of the trends we think will impact healthcare for the better.

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GLOBAL CHALLENGESThere are global challenges that will impact healthcare in the near future. These include:

Rising costs

Spending on healthcare almost invariably grows faster than GDP; the rate of growth of healthcare spend has exceeded that of GDP since records began. Moreover, spending and economic recession are closely linked. We can expect to see the rate of growth of healthcare spend in Europe outstrip GDP growth significantly during the current economically difficult times.

Macroeconomic factors like aging populations or insufficient public funding are challenging both receivers and providers of healthcare. Adoption and penetration rates of clinical information systems vary greatly. In fact, the number (and size) of buyers varies from country to country, and is not necessarily dependent on the size of the country but rather on the structure of the healthcare system. Additionally, purchasing behaviour is shifting towards more coordinated, joint purchasing.

Figure 1: Health expenditure as a share of GDP, 1960-2009, selected OECD countries, Source: OECD Health Data 2011.

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Changing demographics

Service is in demand

There is increasing demand on the healthcare delivery organisations. And this is happening in every country. Thanks to advances in our understanding of the causes of diseases, and consequent improvements in diagnostic techniques and treatments, people live longer. The average life expectancy in OECD countries has now reached 80 years and continues to lengthen. However, not only are people living longer, but increasingly people are living longer with chronic disease.

Figure 2: Life expectancy at birth, 2009 (or nearest year), and years gained since 1960. Source: OECD Health Data 2011; World Bank and national sources for non-OECD countries.

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Filling the resource gap

Even as demand increases, there is a global shortage of clinicians. Countries with the highest number of clinicians per population will need to address graduate intake in to medical schools, which is falling in real terms in many countries. The challenge isn’t limited to doctors either, as enrolment in nursing colleges has also fallen in some countries.

Figure 3: Medical graduates per 1,000 physicians, 2009 (or nearest year). Source: OECD Health Data 2011.

Arguably, a storm is brewing in France, where the number of doctors over 55 is amongst the highest in the OECD. Combined with an overall reduction in the number of graduates emerging from medical school, France may well see the number of doctors leaving the profession exceeding those entering. It is generally the case that a skills shortage increases costs (or reduces service quality) so a well run health system makes sure staff are properly equipped and doing the right tasks for their skills and training. This presents an ethical challenge, as European states seek to fill the gap by recruiting doctors and nurses from other countries, thus depriving those societies of their healthcare professionals.

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Easy access

The graph shows the distribution of hospital sizes. As demand and spending increase, health economies will increasingly need to balance ease of access to their services against the cost of operating smaller hospitals. For many countries, the rationalisation of the healthcare system means the closure of small regional hospitals, which becomes a politically-charged issue. This rationalisation also has to take into account the increasing specialisation of tertiary hospitals, which we address later.

Figure 4: Share of hospitals by number of beds. Source: Nordic Healthcare Group

Focus on quality

What patients expect is changing

The quality of care is increasingly important – as patients begin to exercise their right to choose how and with whom they engage for their healthcare. They demand transparency of data and processes. As a consequence, healthcare organisations will need to focus on how quality outcomes can be published in a meaningful way for patients. Patient safety is the major focus of patient advocacy groups and healthcare leaders. They will enforce deeper investigations of medication errors, hospital acquired infections, wrong site surgery or pressure sores, like never before.

Becoming customer-driven

Where the patient needs to be - at the heart of care

To address the needs of the expert patient, and to start the transition of healthcare to a demand driven model, some of the world’s leading hospitals are placing the patient firmly at the centre of everything they do. For example, the Cleveland Clinic in Ohio has a clear mission to improve the patient experience, and has a board-level Chief Experience Officer leading the Office of the Patient Experience. According to their website, the mission is to ‘ensure care is consistently patient-centred by partnering with caregivers to exceed the expectations of patients and their families’. Cleveland Clinic, along with a handful of other pioneering hospitals, has always been a bellwether in patient care, and it will be interesting to see how many European hospitals make similar arrangements.

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GLOBAL HEALTHCARE TRENDS

Move from being supply driven towards a demand driven consumer model

As a society, we are changing rapidly, and this is apparent in the relationship between care providers and the citizen. Patients are increasingly becoming stakeholders in their own care journeys; they demand transparency in access and information about their care and importantly, about the quality of service provided. Universal access is the basis of virtually all socialised healthcare economies. But citizens are now demanding access on their terms. They want to schedule appointments when and where it suits them, not the provider. They want the latest drugs or clinical trials; and of course, an end to surgical waiting lists. Or they want to be given the option to ‘go private’ without incurring a personal cost.

The internet is changing citizen behaviour. This means the way governments interact with their citizens has to change too. Municipalities are providing more services to the citizen using technology. We will see healthcare providers do the same - adopt technological solutions to streamline processes such as setting up virtual appointments with doctors or looking up lab results online.

Healthcare is the last of the major supply driven industries. It will not be so for long. It will be the citizen that demands the transition to an industry that answers their needs, fears and aspirations.

Informed patients and the rise of social media

Patients are becoming more and more involved in their healthcare, with a higher stake in the journey than before.

Patients are simply better informed than ever before. Information about medical conditions and treatments are now easily available on the Internet. This has to some extent, shifted the focus of the patient-provider relationship towards the patient. The advent of social media is also driving healthcare interactions in new ways. Patients are exploiting these resources to discuss treatments, procedures and even individual practitioners. Alongside, healthcare practitioners, agencies and charities too will need to use social media to communicate with their citizens; in times of crisis this will become a critical mechanism.

What this means is that healthcare agencies need to have a clear strategy to take full advantage of social media.

Patients exercising choice

Healthcare systems are under close scrutiny by society. With patients having a bigger say in what they choose and demand for, government policy is impacted and in turn, healthcare providers.

Healthcare needs to become demand-driven to satisfy the needs of citizens and governments. Patients increasingly want to decide how and when to engage with their healthcare environment. Governments, health authorities and the medical profession will be challenged to provide patients with the information and services that will allow citizens to make informed choices about their healthcare. This will mean publishing data on indicators of quality (such as outcome data, readmission rates, so on) and also introducing ways for patients to book appointments at hospitals at times that suit the patient, not the provider.

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Patient-centred medical home

Episodic, disease-oriented care in hospitals is not the most effective or efficient way to deliver care. The advent of the patient-centred medical home (PCMH) acknowledges this reality. It promotes care relationships across a spectrum of providers and in a variety of locations, of which the one that is most attractive to the patient is their home. This approach encourages patients to become stakeholders in their care. The care delivery system will be designed so that it fully exploits information technology, helps coordinate care across the community and monitor the patient’s conditions, and supports patient awareness.

It is the advances in IT to support real-time monitoring that will make PCMH the norm, the standard clinical practice. Hospitals will be able to discharge patients earlier, because they know that the patient’s condition can be continuously assessed, and interventions can take place to ensure acuity is addressed outside of the hospital environment.

Hospitals as networks

Building hospitals without walls; care for patients without borders

Increasingly, hospitals are part of their communities, and all communities are facing the demographic and disease challenge, as described earlier. Hospitals may have to implement complex, multi-organisational processes to address these challenges in an efficient and effective manner. A shift in paradigm is called for that will mean large, tertiary hospitals building networks of smaller hospitals and primary care clinics. Care can then be divested to these networks, made available closer to the patient’s home and therefore more convenient. This model will require coordination of all providers in the network and flow of information to continually manage the care of a patient through time.

Personalised medicine

The practice of medicine has always been based on evidence uncovered through observation. And today, clinicians are at an advantage. There’s a host of diagnostic techniques available that allows them to make faster and more accurate diagnoses. Radiology allows clinicians to investigate structures deep within the body, whilst histopathology allows clinicians to investigate tissue samples using microscopes to identify tumours, viruses and so on.

Translational research and the advent of personalised medicine

Increasingly however, core science is providing new insights for the clinical community, particularly in the field of genetics. Translational research is about how fundamental scientific research benefits patient outcomes, either through the development of new diagnostic techniques, new drugs, or the modification of clinical practice, the latter often referred to as the Bench to Bedside cycle. To stress the importance of this field, the National Institutes of Health in the United States has established the National Centre for Advancing Translational Sciences (NCATS). According to their website, the action was made possible by Congress’ approval of a fiscal year 2012 spending bill and the president’s signing of the bill, which includes the establishment of NCATS with a budget of US$575 million. Similar initiatives are underway throughout Europe and Asia Pacific.

Genetic sequencing offers immense potential for improvements in healthcare. Understanding the molecular composition of each citizen allows clinicians to profile patients for active but undiagnosed diseases. Clinicians will also be in a good position to assess a citizen’s disposition to disease in the future, and to devise care plans to ensure the patient’s wellbeing is addressed in the most direct manner. This concept of personalised medicine will allow society to move away from treating disease in a ‘one size fits all’ manner. And move to targeted and accurate strategies that will reduce unpleasant side effects and improve health outcomes.

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LOGICA CAN HELP Governments and healthcare organisations need partners who can help them understand how our healthcare landscape is changing, and how to make the most of the emerging trends and technologies. Logica knows European healthcare like no one else. We bring our experience and expertise, and those of our partners, to help our clients.

Here are some of our innovative IT solutions for healthcare in Europe:

• e-CareLogic: approach to information aggregation and portals, supporting clinical processes and patient management across multiple locations by releasing and re-using existing information both for patient care and for organisational management.

• eHealthbox: supports patient care through a combination of electronic patient records, telemonitoring and a joint care process between the patient and the clinician.

• Defence Medical Information Capability Programme (DMICP): a global health technology project linking 450 fixed and mobile clinic locations with a real-time centralised electronic patient record for 300,000 military and government employees and their families.

• Logica I Can Help: a smartphone application where health professionals register skills and availability to a register that can be accessed by emergency services seeking specialist or geographic availability.

• Logica’s Machine2Machine (M2M) platform is the realisation of ‘The Internet of Things’, where any ‘thing’ being a machine, device, even a plant or a person who will communicate to another ‘thing’ regarding its current status over any available connection. The available connection can be wired, wireless, mobile or any combination. A SIM card or mobile data connection is, therefore, not a prerequisite for transporting status information. Logica runs two of the three world’s biggest M2M platforms, and we believe this could be transformational for healthcare.

Logica is a business and technology service company, employing 41,000 people. It provides business consulting, systems integration and outsourcing to clients around the world, including many of Europe’s largest businesses. Logica creates value for clients by successfully integrating people, business and technology. It is committed to long term collaboration, applying insight to create innovative answers to clients’ business needs.

Logica is listed on both the London Stock Exchange and Euronext (Amsterdam) (LSE: LOG; Euronext: LOG).

More information is available at www.logica.com.

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Logica

Ed PercyEuropean Healthcare

E: ed.percy@logica.com

www.logica.com/healthcare