Dr. David C. Rhew, global chief medical officer and vice president of healthcare at Microsoft and an adjunct professor at Stanford University School of Medicine, is steeped in the healthcare industry. When he speaks, people pay heed.
Healthcare IT News interviewed him ahead of the big HIMSS20 conference and exhibition, asking him to put his finger to the wind and discuss the most pressing trends affecting healthcare that HIMSS20 attendees need to keep top of mind. He did not disappoint, identifying three major trends and challenges facing the industry right now.
Addressing the rising cost of care
According to the World Health Organization, a “swift upward trajectory” of global health costs is resulting in an increase in domestic healthcare spending and out-of-pocket expenses.
“At the policy level, this means less funding for other important programs, such as education, jobs, social programs, infrastructure and more,” Rhew stated. “In the U.S., healthcare represents almost 18% of the GDP, the federal government supports 50% of healthcare costs, and costs continue to rise. This is unsustainable.”
Quality and cost of healthcare are impacted directly by clinical decision-making. Clinicians rely on their healthcare training and the knowledge they gather every day by seeing patients, reading journals, and talking to colleagues when making clinical decisions (for example, which tests to perform, whether or not to hospitalize or treat as an outpatient, which treatments to offer, how long to treat).
“Technology can help support clinicians and researchers by analyzing massive amounts of information, machine reading, and applying learning heuristics that support the decision-making process.”
Dr. David C. Rhew, Microsoft
“However, in many cases, this approach yields just a fraction of the amount of information required to make an informed clinical decision,” Rhew remarked. “Today, a medical article is published every 30 seconds, there are 50 million medical publications in public databases, and medical knowledge doubles every 73 days. At the same time, decisions often are influenced by cognitive bias and emotion.”
With so much data and so many complexities in the healthcare ecosystem, embracing new technologies like artificial intelligence and machine learning is critical, he advised.
“Technology can help support clinicians and researchers by analyzing massive amounts of information, machine reading, and applying learning heuristics that support the decision-making process,” he explained. “This can help clinicians and researchers make more informed decisions faster, thereby improving patient care and outcomes, and ultimately reducing costs for everyone.”
An example of this in action, Rhew said, is the work of The Jackson Laboratory, which is embracing AI to accelerate development of precision medicine.
Diminishing access to high-quality, affordable care With the rising costs of care, one might reasonably assume the quality of care would improve. Paradoxically, however, this is not the case, Rhew said. Several studies have demonstrated that there is no or, in some cases, an inverse relationship between healthcare spending and the quality of care delivered at the national, state, hospital and physician levels.
“And directly tied to quality and cost is access to high-quality, affordable healthcare,” he said. “Where a person lives is highly predictive of the quality of care received, and this is a direct reflection of the socioeconomic factors that impact and surround an individual. Moreover, at the individual level, healthcare is rapidly becoming unaffordable for most people.”
For example, the average U.S. employer health insurance premium for a family in 2019 exceeds $20,000.
“With a growing shift toward value-based care, providers and systems are incentivized to enable access to care anywhere and anytime,” Rhew noted. “Virtual healthcare visits are one way this can be accomplished. Preventing a specific place-based visit and focusing on active surveillance with streamlined care coordination is the broader goal.”
An example Rhew pointed to is work Walgreens Boots Alliance has embarked on with Microsoft to develop new healthcare delivery models and technology and retail innovations to advance and improve the future of healthcare. The work, he said, aims to make healthcare delivery more personal, affordable and accessible.
New tools to combat clinician burnout
The focus on reducing costs and increasing productivity impacts how care is delivered at the encounter level. While electronic health record systems have been successful in achieving the digitization of health records, much of the burden of documentation has fallen on the shoulders of providers, and this has directly contributed to clinician burnout.
“Providers also are having to deal with the administrative burden of providing justification for coverage, prior authorizations and reimbursement,” Rhew said. “These and other factors are contributing to an epidemic level of caregiver burnout. In a 2019 study by the National Academy of Medicine, 54% of physicians and 35% of U.S. nurses are experiencing professional burnout. Clinician burnout is a serious issue that could lead, if unaddressed, to an even greater shortage of healthcare providers. This would further exacerbate access to care for patients.”
Advanced technologies can help: For example, ambient clinical intelligence systems can help capture clinical conversations between clinicians and patients, integrate this with information from patients’ EHRs, and then automatically generate medical summaries. The result, Rhew concluded, is more quality time for clinicians to spend with patients and less paperwork.
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Healthcare IT News is a HIMSS Media publication.
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