Addressing System Change Challenges
Martin Lindner | Dec 06, 2017
Healthcare is in transition – with value-based, more efficient and patient-centered care as major premises for the future. At an exclusive conference recently in Germany, global experts and executives discussed ways to reach these goals.
The need to think big and unconventionally
Transformative changes in the healthcare field are calling for new approaches and strategies from sector participants worldwide. At the same time, model solutions are emerging for value-based, more efficient and more patient-centered care. Scaling these solutions to meet the needs of entire healthcare systems is one of the great challenges for the future. That was one of the core findings of the Siemens Healthineers Executive Summit, a high-level gathering recently held in Frankfurt, Germany. Experts in a variety of fields examined the future of healthcare in a dialog with many top executives from international healthcare providers.
“Healthcare needs to get better at solving system-change challenges,” said Bernd Montag, CEO of Siemens Healthineers, explaining the strategic goal of the first-time event that drew 50 executives and experts from around 20 countries and will be continued in the coming year. This form of exchange, both exclusive and informal, “offers a unique platform to share forward-thinking ideas, connect with peers and learn from best practices,” Montag noted.
Siemens Healthineers, as the organizer, saw its role as being, above all, to listen and learn, said Montag. With its broad portfolio of products and services extending well beyond its traditional lines in radiology and lab technology, the company is particularly able, as a partner to healthcare providers, to supply cross-system infrastructures useful in the transformations taking place in the healthcare sector. In doing so, Siemens Healthineers aims for a more precise practice of medicine with optimized care delivery and an improved experience for patients, supported by and based on a consistent digitalization strategy.
Creating a value-based healthcare delivery system
The participants in Frankfurt agreed that moving toward a more value-based and efficient practice of medicine was the order of the day and a logical development within the healthcare industry. “Value” in this case is understood as the ratio of benefits to costs of medical procedures, with the main emphasis on the outcomes that matter to patients themselves and that affect their quality of life.
A powerful example was offered by Professor Hartwig Huland, Medical Director of the Martini-Klinik in Hamburg, Germany, which has the world’s largest database of treatment outcomes for prostate cancer.
Through systematic analysis of Patient Reported Outcome Measures (PROM), this specialized hospital steadily improved its surgical procedures over the years and was able to reduce significantly, compared with other providers in Germany and internationally, the incontinence and erectile problems that often occur after surgery, as well as limit the variability in treatment outcomes and enhance overall treatment quality– all while holding cost levels steady or even lowering them. “Outcome measurement with transparent results requires an investment, but it pays off,” Huland said.
The International Consortium for Health Outcomes Measurement (ICHOM), a multi-stakeholder non-profit organization, has developed standardized and globally applicable indicator sets for numerous diseases to enable the most comprehensive quality comparisons possible between treatment procedures and healthcare providers, thus promoting value-based care. The National Health Service (NHS) in Wales, for example, is presently introducing the current ICHOM quality standards in all its clinics.
It is clear that value-based healthcare requires a fundamental transformation of care delivery. Interdisciplinary, strictly patient-oriented cooperation among all medical, nursing and administrative staff, for instance in a hospital, plays a critical role. “Yesterday, we had clinical specialties; today, we have patient pathways,” explained Anna Göjeryd Ulander, Head of the Healthcare Transformation Office at Karolinska University Hospital in Sweden. This innovative institution has begun to eliminate the traditional boundaries between individual departments and clinics, and to track value and patient flow costs (the treatment costs for each patient along the entire treatment chain) – a restructuring process that engenders and requires behavioral change on the part of employees as well as new organizational structures. Overall, value-based care in the future will involve checking and rechecking the measurable value for patients of workflows and processes, with advanced, interoperable IT structures likely to play a major role.
Precision medicine and the transformation of care
Closely tied to the idea of outcome-oriented healthcare is the concept of precision medicine. The basic principle lies in personalized prevention, diagnostics and treatment, aimed at identifying the individually right measures to be taken at the right time in each specific case, and at avoiding whatever is unnecessary or even harmful.
As the experts discussed in Frankfurt, a rapid rise in the availability of genetic data is putting personalized advising and targeted pharmaceutical treatment within reach in many cases, or is already making them a reality. “For example, there are emerging approaches to monitor chemotherapy resistance in cancer patients through analyzing DNA from blood samples, and to tailor clinical decisions accordingly,” said Professor Lawrence Chu, Executive Director of Stanford Medicine X, describing an initiative that aims to explore how emerging technologies will shape future healthcare.
Another example of precision medicine is the transformation of radiology into a quantitative discipline supported by artificial intelligence (“radiomics”), which enables a whole new level of individualized diagnostics and treatment planning using extensive data analyses. “We are seeing a mathematical revolution in radiology,” confirmed radiologist Professor Stefan Oswald Schönberg of University Hospital Mannheim in Germany. For instance, many tumor foci exhibit a high degree of genetic heterogeneity, which can critically affect treatment outcomes. Integrated interpretation of genetic and imaging data using, say, machine-learning procedures, interoperable IT platforms and databases could furnish a much more precise disease picture and enable treatment to be tailored to the individual patient, Schönberg said.
Individualization is possible even in prevention, added Amy Compton-Phillips, Chief Clinical Officer at Providence St. Joseph Health, a large not-for-profit health and social services system in the United States. By linking health information available digitally in personal “health data clouds,” genetic factors and individual living conditions could be considered more and more in relation to one another, for example. In this way, patients themselves could take more control of their own health, such as by “self-tracking” their lifestyles – in line with the transformation toward predictive, preventive, personalized and participatory medicine (P4 medicine).
Improving patient experience
In all the discussions, there was an emphasis on the need not only to manage individual disease courses better, but also to get the patients and their family members more involved in the care process as people and as experts on their own health. “Patients first means people first,” noted Susannah L. Rose of the Office of Patient Experience at Cleveland Clinic in the U.S. Subjective experiences and personal interactions contribute significantly to the “value” in value-based care, she said.
In the end, a focus on patient experiences is “a competitive advantage in an environment where patients navigate the system,” added Sven Gierlinger, who formerly held a series of leadership positions with the Ritz-Carlton Hotel Company and is now Chief Experience Officer at Northwell Health, a large integrated healthcare organization in New York. Because patients nowadays play the role of customers, Gierlinger advocated – along with safety and excellence in medical procedures – a new creed of service excellence in the sector: “Healthcare is a place where the genuine care and comfort of our patients is our highest mission.” This kind of cultural transformation toward an attitude that “every moment matters” requires the full commitment of all employees and participants in the healthcare sector, he said.
About the Author
Martin Lindner is an award-winning science writer based in Berlin, Germany. After completing his medical studies and a doctoral thesis in the history of medicine, he went into journalism. His articles have appeared in many major German and Swiss newspapers and magazines.
The statements by Siemens’ customers described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.