The Rising Healthcare Revolution: The Future Is Already Here
Roughly every fifty years, healthcare experiences significant disruptive changes leading to a healthcare revolution in clinical care. In the 1870s, the germ theory of disease, antiseptic techniques, and advances in anesthesia, made life-saving surgeries possible and drove significant and lasting advances in public health. In the early twentieth century, a few dozen visionary clinicians laid the foundation for modern clinical care by designing the initial physical layout and operational structure of the modern hospital, creating the basic four-year medical school curriculum, establishing postgraduate educational requirements, installing strict licensure requirements for physicians, and launching the first modern nursing practices. With the discovery of penicillin in 1928, the use of medication as treatment for disease was dramatically accelerated. In the 1940s, the adoption of the randomized controlled trial as the gold standard for evidence ushered in the era of evidence-based medicine, thereby defining healthcare as we know it today.
The next revolution is now upon us. After decades as a technological laggard, the healthcare industry has entered the digital age. The enabling technology for this transformation fell into place over the past two decades with the emergence of massive, ubiquitous, and increasingly cheap processing power, and more recently, the widespread adoption of electronic health records. These trends — coupled with advances in analytic software, mobile technologies, sensors, and genomic sequencing — have made it possible to capture and analyze vast amounts of information about individual patients, populations, and the environments in which they live.
What’s Coming: Data-driven Healthcare
Collectively, these advances have laid the foundation for a core component of the next revolution — data-driven healthcare. Data-driven healthcare can be defined as the effective use of vast amounts of data collected in the process of managing the health and wellbeing of millions of patients in a continuous effort to improve the quality, efficacy, and cost of care. Data-driven healthcare also creates the possibility of delivering care that is highly personalized to each individual patient, while shifting more control and responsibility from doctors to the largest untapped healthcare workforce in the country—patients and their families.
The randomized controlled trial (RCT) will remain a key foundational element of evidence-based care. However, the availability of vast amounts of clinical and operational data collected in the process of delivering care creates enormous opportunities to learn and to improve the quality, safety, efficiency, and cost of care. In fact, there is a synergy between the RCT approach and large population quality improvement studies. Each RCT is a slow, expensive process that can take years to complete, and there are often questions about how generalizable the findings of an RCT are because of the very small sample populations typically studied. On the other hand, analyzing large amounts of data collected in the process of delivering care to patients with a specific disease (e.g., diabetes, asthma, congestive heart failure) can help determine the generalizability of an RCT’s findings while also improving outcomes. Furthermore, the effective analysis of large amounts of data obtained in all clinical care environments — ultimately including the patient’s home — creates the opportunity for healthcare providers to better understand and manage the environmental and behavioral factors that are major determinants of health.
In essence, data-driven healthcare creates the possibility of turning every care environment into a data-driven learning environment—an environment in which clinicians operate in a highly supportive and rational care improvement system that allows them to optimally manage care processes while collecting data to support continuous learning and improvement over time.
The Future Is Not Evenly Distributed
The increasing focus on the quality and cost of care, evolving state and federal regulations, and the growing emphasis on reimbursing for value rather than transactions will most certainly aggressively push the data-driven healthcare trend forward. One could ask, how long will it be before we actually see the results of this latest healthcare revolution? Five years? Ten years? Longer?
Actually, the future is already here. Innovative healthcare organizations are already demonstrating the results of data-driven healthcare. Using data, Geisinger has lowered the complication rate for coronary artery bypass graft (CABG) by 11 percent, improved inpatient mortality by 67 percent while increasing the contribution margin for CABG by 17.6 percent, and total inpatient profit per case by $1,946. Texas Children’s Hospital focused on appendectomy outcomes resulting in a 36 percent reduction in length of stay, a 19 percent reduction in average variable costs, a 19 percent decrease from diagnosis to surgery, and a 53 percent increase in the percentage of patients receiving recommended antibiotics. MultiCare reduced mortality rates for septicemia by 22 percent saving millions in the process. The list of such examples is long and steadily growing.
In reality, the future is already here. It is just not yet evenly distributed.