More Than a Passing Fad: Digital Transformation in Healthcare Organizations

Published in South Florida Hospital and Healthcare Association Newsline –

Over the years, those of us who have worked in healthcare for a while have seen, heard, and used our share of buzzwords and industry lingo. Terms like “population health”, “value-based care”, and “social determinants of health” have worked their way into the healthcare vernacular and have actually resulted in moving the industry away from an episodic, disease-specific treatment model toward a more holistic, more comprehensive system of improved access, better clinical outcomes, enhanced continuity of care, and greater efficiency. The most recent buzzword that I have begun noting in the healthcare literature has to do with the “digital transformation” of the healthcare delivery system.

Even before the COVID-19 pandemic, there were signs that the industry was considering how to innovate and better engage with patients, providers, and community members with existing and potential digital tools. The novel coronavirus pandemic limited in-person interactions between providers and patients, and we all witnessed the explosion in telehealth visits, but we also saw a resultant increase in interest in digital technologies to support remote visit scheduling, contactless payments, and use of artificial intelligence and digital analytics to track COVID’s progression from community to community.

All of this leads me to my central question: What exactly is this “digital transformation” of healthcare? And, secondly, what specific technologies are being considered and adopted by healthcare providers?

There are a several ways to classify and analyze digital transformation. Many of the digital technologies are complementary to one another, and, even as I write this, these technologies are ever-changing and new ones are evolving. Nonetheless, one needs to start somewhere. So the taxonomy I have chosen will examine opportunities in the following categories.

Artificial Intelligence
Big Data
On-Demand Care Everywhere
Internet of Things
Blockchain
Contactless Healthcare

Following is a brief explanation of each of these digital technologies as well as some examples of how healthcare organizations might apply these technologies to their daily operations.

Artificial Intelligence: Perhaps the most hotly debated and widely used term in healthcare’s digital transformation is Artificial Intelligence, or AI. At its core, AI refers to the ability for computer systems to perform tasks that normally require human intelligence, such as visual perception, speech recognition, and data- dependent decision making. There are several sub-categories of AI, including, but not limited to, machine learning, natural language processing, computer visioning, 3-D printing, and robotics.¹ The machine learning function enables a computer to collect and analyze huge amounts of data and use its phenomenal data aggregation capabilities to recommend optimal treatment approaches to patient care. Machine learning can also incorporate personal health and genetic data to recommend a “precision medicine” approach to care, that is, prescribing the most appropriate medications and recommending the right lifestyle and behavioral choices for a unique individual as opposed to treating the “average” patient.

One of the more promising applications of AI in healthcare is in using “computer visioning” to diagnose and treat disease. The healthcare literature is replete with examples of how deep learning combined with computer vision has surpassed the human capability to accurately diagnose skin lesions and predict precancerous or cancerous tissue in breast images. Computer vision is also being used to assist surgeons intraoperatively to improve visualization, to guide surgical movements, and even to program robotic arms to make fine, precise motor movements that are impossible to make with the human hand. 3-D printing is a technology that uses digital images and computer-assisted drawing to create anatomically precise implants for joint replacements, dental restoration, and prosthetic devices.

Big Data: A close cousin to Artificial Intelligence is the use of Big Data in making healthcare system-level decisions. Big Data refers to the ability for computers to accept and process large volumes of structured and unstructured data (like numeric data, photos, audio, video, monitoring devices, etc.) from a wide variety of sources and to quickly analyze those data to produce meaningful and actionable reports, information, and recommendations. Big Data has been used successfully to combine patient-level data with demographic and epidemiological data to develop predictive analytics for healthcare leaders.² For example, by monitoring and predicting the likelihood of public health emergencies, Big Data can inform public health leaders of the next likely region of disease or illness outbreak, can prospectively advise supply chain managers on the need for proper supplies and equipment to manage the disease, and can allow on-site operations managers to adjust staffing to meet patient demand. As systems take on more population-level risk, Big Data can also empower population health managers with information and algorithms on how to risk-stratify and prioritize interventions with patients. In order to manage capitated or risk-based financial arrangements, health system administrators can use Big Data to analyze their system’s patient retention rates and in- or out-migration of patients to or from their hospital system.

On-Demand Care Everywhere: Besides using Big data to predict COVID outbreaks, another aspect of the industry’s digital transformation was thrust into the limelight by the COVID-19 pandemic. On-Demand Care Everywhere, facilitated by telehealth, refers to the ability of a health system to meet the patient at his or her location and on his or her terms, as opposed to forcing the patient to physically come to the provider or facility.³ On-Demand Care Everywhere is expected by today’s healthcare customer and has been facilitated by the broad consumer adoption of mobile technology, the development of digital video, and the gradual expansion of broadband into underserved and rural areas. The introduction of 5G technology will further reinforce the interest in and demand for on-demand healthcare. Long-term reimbursement for telehealth remains a question, and demand for telehealth services, although significantly higher than pre-pandemic levels, has seen a marked decrease since March and April of this year. Nonetheless, On-Demand Care Everywhere is likely to see continued investment as forward-thinking system leaders realize its cost-saving potential and begin to consider it as a competitive advantage.

Internet of Things: Internet of Things, or IoT, technology, which refers to the ability of physically disconnected objects and devices—things like smartphones, wearable devices, or even smart pills with embedded sensors—to “talk” to one another via the internet, has also experienced explosive growth in the healthcare industry. For consumers, items like Fitbits and Apple watches have moved beyond being trendy fashion accessories to being critical remote health monitoring devices. IoT technology allows patients to digitally transfer their individual-level patient data to their healthcare providers. In the home and outpatient environment, IoT technology empowers patients to take ownership of their personal health data, and, by extension, for their own health and wellbeing. In the inpatient setting, IoT can assist with wayfinding in large and complex care settings and can support digital “command centers” similar to air traffic control centers to monitor high-risk patients and to alert providers to warning signs which foreshadow the possibility of a significant patient event.⁴ IoT data can be used by health plans to monitor patients’ exercise habits, medication adherence, and compliance with recommended treatment regimens.

Blockchain: One of the more controversial applications in the digital transformation of healthcare is the use of Blockchain technology. Blockchain is essentially a decentralized, distributed ledger of transactions (each transaction known as a “block”) linked together by cryptography which provides for increased security and transparency. The blockchain may be built as a public chain, which anyone can join, or a private chain, where access is controlled by the creator of the chain. Because Blockchain is a peer-to-peer network and there is no central repository of data, and because each transaction is immutable and must be consistent with other Blockchain transactions and validated by the majority of users in the network, conflicting information is automatically detected, data integrity is greatly enhanced, and the system is not susceptible to hacking. Most people associate Blockchain with the notoriety of Bitcoin and the cryptocurrency bubble. But Blockchain has more applications in the healthcare industry than just payment. Blockchain technology could be used to build secure credentialing databases for providers, to track supplies and drugs across the entire supply chain of manufacturers, distributors, wholesalers, retailers and end users, and it’s already being used to build “smart contracts” which patients, providers, and payors can access to insure accurate billing, adjudication of claims, payment, and coordination of benefits. One potential clinical application for Blockchain is in using its secure data sharing capability to match clinical trials recruiters with patient interest and suitability in order to find the most appropriate patients for clinical trials. Although there are not yet any widely accepted models of using Blockchain to transfer or share Protected Health Information (PHI), there are public and private organizations like the Food and Drug Administration, the Health Care Services Corporation, and MedicalChain which are exploring how to do so safely and securely.⁵

Contactless Healthcare: The last area within the digital transformation realm that will be addressed here is Contactless Healthcare, which has numerous applications in the healthcare system, particularly in the Patient Access and Revenue Cycle arenas. Contactless Healthcare refers to the ability for the patient to enter the healthcare system without being physically present to register or pay for services. The healthcare industry is admittedly a laggard in this area and should take a few pointers from the banking industry or Amazon, the undisputed giant of contactless purchasing. Particularly in the COVID environment, consumers want to be able to access their provider or their facility in a “contactless” fashion, through mobile technology or on-line scheduling, thereby eliminating long lines to register and complete the all-too-voluminous demographic, medical history, medication usage, and payor information “paperwork” which is necessary to begin treatment. Many forward-thinking providers have already instituted patient portals and kiosks to simplify their registration processes. With contactless technology, providers can offer pre-purchase incentives, text-to-pay options, and streamlined admissions and discharges from care. During treatment, providers can implement immediate, integrated, point-of-service referrals to specialists or post-acute resources, thus enhancing continuity of care and patient experience.⁶

With the multitude of digital transformation alternatives available to providers and systems, administrators may wonder where to start or how to build upon existing technologies. Fortunately, there are some basic, time-honored management principles they can use to navigate the digital jungle. Here are a few recommended steps to start or enhance the digital transformation journey.

First and foremost, envision and embrace the future. The undeniable fact that the healthcare system is already changing. More importantly, recognize that digital transformation is not only inevitable, it is also necessary for survival and desirable to streamline and improve the patient experience. In order to embrace the future, health system leaders will need to conduct a realistic assessment of the organization’s current digital business maturity and readiness for change.
Second, set up a digital transformation governance team if one is not already in place. The governance team will establish a structure to understand and evaluate the myriad of technologies that are available and/or emerging. Members of the team may include system or hospital executives, finance and IT personnel, technical experts, process engineers, and biomedical specialists. Consider age and ethnic diversity and include millennial digital natives on the team. Involve functional leaders as necessary to understand and vet potential departmental options. Be sure to involve caregivers in the conversation; front line caregivers have a vital perspective on what currently works, what doesn’t work, and what could be possible. They are also invaluable in flowcharting current and future state processes.
Establish system priorities. The governance team should create evaluation criteria and set up a prioritization matrix, considering factors such as patient safety and experience, cost, complexity, integration with existing systems and processes, potential provider acceptance or resistance, speed to market, and anticipated benefit to patients and providers. Administrators and financial management personnel can explore and report on the resource implications of a potential digital investment, and they can recommend those projects with the greatest clinical, operational, social, and financial return.
Once priorities are established, chart a path for the digital journey. Develop project teams and report on project requirements, milestones, and communication points. Within each chosen project, clarify the required steps to implement change. Include a plan on how to gain organizational buy-in for the chosen technologies. Assure that affected staff members will be afforded an orientation and adequate training to fully understand, support, and implement the technology. Develop multi-modal communication to inform all stakeholders—patients, providers, staff members, partners, vendors, community members, etc.—of the impending change, including the timeline and intended benefits of the technology.
Finally, execute the plan, allowing sufficient time for testing, validating and implementing the technology. Consider strategic partnerships and vendor relationships that align with the organization’s digital vision. If parallel processes are necessary during the testing phase, prepare the affected department for some redundancy of effort. Build in time and resources for technical setbacks or resistance to change. Frequently, a soft or partial roll-out is preferable to a full, all-at-once go-live. And, obviously, each organization should develop Key Performance Indicators to evaluate the success of its digital strategies.
Lastly, celebrate successful digital product launches and project completions. Digital transformation is hard work, and staff should be complimented and rewarded for the extra effort of being digital pioneers.

Clearly, this article has only scratched the surface in considering the possibilities of digital transformation in the healthcare industry. There are plenty of current challenges and issues we still need to address, like EHR interoperability, cybersecurity, inherently inefficient industry processes, and concerns about resource availability and ROI of digital investments. The opportunities are enormous, and the imperative for inquisitive, innovative, and thoughtful leadership is paramount. In considering the words “digital transformation,” this article has perhaps focused on the digital component of that term, but it will take truly transformational leadership to succeed.

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