Driving savings and efficiency in healthcare
Written by Lindsey Sutherland – Director of IT, Newton Europe
The information needed to yield necessary cost savings within the healthcare sector already exists, stored in one or more systems within healthcare organisations.
Yet the power of this information (when it is used in the right way) is often unknown or underestimated and all it requires is joined up thinking and visibility in order to significantly boost operational efficiency and lower spend.
With £20 billion of savings to be made over the next four years, the NHS is under increasing pressure to deliver more for less, but the successful use of IT could be the key to overcoming this challenge.
Currently a range of IT systems are available to the healthcare industry. Newton Europe has delivered more than 60 successful improvement projects to the NHS in the last three years alone and the development of purpose-built new systems has played a key role in the projects’ success, particularly across operating theatres and clinics.
Typical annual financial benefits can range from £750,000 to £2 million per NHS Trust in the UK, generated through a number of routes including increased case volume, decreased volume outsourced, cost reductions and a decreased length of stay.
Highly-customised information systems are emerging to play an increasingly important part in the project because they bring to light – in visual terms – information including theatres not in use, consultants' timetables, lost time causes and length of stay opportunities.
This allows areas for improvement to be identified and addressed as well as subsequent improvements to be measured in an accessible and uncomplicated manner – in a manner of which no other systems are currently capable.
Every Trust has a different mix of standard systems, which is why off-the-shelf packages that must be configurable to cope with every possible permutation are less effective.
A comprehensive suite of IT tools was recently created for a London Trust – which at start of the project was maintaining theatre records using a paper-based system.
The new system allowed for touchscreen entry of operating progress in theatres that feed straight into a tracker to show live progress and performance – a real cornerstone of the Trust-wide programme to deliver tangible improvements.
A speciality within a Northampton NHS Trust was experiencing difficulty meeting the 18-week patient pathway given the existing capacity of its operating theatres. An increase in utilisation of eight percent was therefore required to meet government targets and to reach sufficient capacity to perform additional operations, making cost savings of £243,000 additional profit for the Trust.
Working collectively with the management team, secretaries and booking clerks, we focused on ensuring that operating theatre lists were appropriately booked and that cancellations were reduced.
The systems have consistently delivered between 10 and 50 percent improvement in the key performance measures, on average representing around a six-month return on investment.
A key component in more recent cost efficiency projects has been the Newton PasPlus healthcare process system, developed as a solution to maximise the productivity of vital A&E, theatre and outpatient facilities.
The advanced reporting tools give high level reporting covering all the individual operational areas covered by Newton systems.
Building on visibility, reporting and developing training to ensure cost benefits can be sustained as best possible and, importantly to improve the standard of patient care as a result of better information available, more predictable waiting times, less cancellations and shorter waiting lists.
We are already seeing evidence that cost pressures are leading to salami-slicing of services and staff, which invariably has a negative impact on an NHS organisation, reducing income or leaving remaining staff to do more.
However, from working with NHS Trusts across the UK, it is clear that blindly applying cuts will simply not be enough to cope with the increased demand without an increase in funding.
The NHS should now be intelligently targeting areas to improve quality and efficiency while squeezing out cost to drive the required efficiencies now being realised across the private sector.
Well designed, developed and implemented IT systems will deliver real, measurable and sustainable savings to key areas of all NHS Trusts as well as helping to deliver a better, more responsive NHS designed to meet 21st century demand.
Newton Europe is an operational efficiency specialist, delivering business intelligence and operational efficiency programmes to the healthcare sector.
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The future of pharma: personalised healthcare
Ever since the very first healthcare systems were created, the earliest documented being in ancient Egypt, medical professionals have had a reactionary approach to finding cures for ailments. That is to say that a solution is sought after someone has become sick, using whatever methods were thought to work at the time. Thousands of years later, with advances in genomics and molecular modelling, emphasis is starting to shift towards preventative, personalised healthcare rather than "sick care".
This move is led by data analytics as well as genetic sequencing to inform decision-making, which can ultimately lead to more individualised care. "Identifying the right data will support personalised health outcomes", explains Chris Easton, who is Takeda’s Senior Director and Global Commercial Lead, specialising in personalised health and innovation and applying this to rare blood disorders. "It's about how we can empower patients, interpret data and then apply it."
"The historic pharma model, in a very simplified form, is: a patient has symptoms, gets diagnosed, and gets given drugs for symptoms", Easton says. "Now, with holistic patient care in mind, it's much more about the additional components to care that would make a difference. Yes, drug therapy is one of them, but likewise, it's okay to talk about mental health, as the impact of chronic diseases means often there is a mental health challenge. So what can we do to build a mental health and physical health support package, both of which have data associated with them, that we can use together?"
By way of example, Easton cites the approach taken by elite athletes and astronauts. "Their model is to keep as healthy as possible. If someone on a space mission gets a cold, they're off the mission - it's not affordable to send someone to space that might have a health issue. If you look at footballers and runners, their coaches maintain them at the highest level, and they're using technology and wearables to help monitor their health so that they can make adjustments to stay at peak level for as long as possible."
The aim is to provide a complete, holistic package of care, which Easton acknowledges will pose some challenges to the pharmaceutical sector. "Our model is not necessarily that of a total care package. It's drug therapy or device and technology support therapy. So some things will need to evolve, and that's part of what my role is about."
One way of effecting this change is by collaborating with other organisations, not necessarily limited to healthcare and life sciences. "I'm a big advocate of partnerships and joint ventures. For the pharma sector, these are traditionally through universities and research houses, but I think we need to be willing to look outside the box and look for scalable and transferable technology that is used in everyday life."
"An example is the smartphone you probably have sitting on your desk or the smartwatch you're wearing. These are gathering data all the time. There are probably hundreds of data points that we could use, just from our everyday technology", Easton adds.
While apps like Apple Health, Google Health, and devices like Fitbit collect data, they could be linked to WhatsApp, WeChat or Telegraph to connect to members of a user's care team if a health issue arises. "It's using technology that is already embedded in our lives, that would enable us to share information and photographs. For example, if your knee is swelling and you want to ask a doctor for their opinion, you can send an image, then share the log from your treatment, and it becomes a way of integrating and sharing information."
Shifting towards preventative medicine is one of Takeda's strategic goals for the next few years. An example of how this could work is how people affected by Von Willebrand disease could be supported. This lifelong bleeding disorder prevents blood from clotting and particularly affects girls and women, causing menstrual bleeding to be excessively long and heavy, which has a big impact on their quality of life.
"It's a hereditary disorder, so many women in a family can be affected, but it's hard to diagnose", Easton explains. However, using existing technology that tracks the menstrual cycle via a smartphone perhaps an alert can be issued to let the user know when it's time to start taking replacement therapy for Von Willebrand.
"This means that by the time a period begins, Von Willebrand levels are normalised, and menstrual flow goes down to normal levels. That's actually a massive outcome for someone who has been living with two-week-long periods that bleed through clothing every month. Suddenly for just four or five days, they can use regular tampons and pads. That's a huge improvement to life."
The field of rare blood disorders typically hasn't seen the same amount of attention focused on it - at least in terms of tech innovation - as other chronic illnesses like diabetes. "Rare blood disorders are difficult to show returns on because you've got small patient numbers and often high costs. But if we think about the total patient journey, we could use technology to triage vast numbers of patients and data into more specific diagnosis boxes, so that what is then presented to physicians are smaller groups, of the more likely issues."
Data analysis could, for instance, show that the combination of headaches, nausea and lethargy equates to a specific type of bleeding disorder. "You can start to put these things in categories", Easton says. "And then you're able to do differential diagnosis. But ultimately, what you're trying to do is get a faster, more accurate diagnosis, leading to a specific therapy."
This would be more efficient than administering plasma-based treatments, for example. "A lot of bleeding disorders are caused by a deficiency of something", Easton explains. "There is a lot of combination therapy in blood disorders when you give people plasma-based products because plasma is like the golden chalice of medicine. It has a bit of everything you need. In some cases, when you don't know what the disorder is, this can help patients, but it's not the most precise way of doing it."
"That's one of the ways having very clear diagnostic support linked to advanced direct therapy can help, only treating what you need to. From a payer's perspective, it's very targeted, and there's no wasting money and resources on patients being hospitalised for things that are not necessary."
"If you go back 15-20 years, market access to the pharmaceutical industry was the emerging trend", Easton adds. "We saw all these diagrams of physician decision-making coming down and payer decision-making going up. Now we have another divergence of change, which is the application of technology to support personalised care. This is one of the transformative pieces of pharma right now, and there are a lot of good companies, big and small, being very intelligent about how they're approaching it and investing in those spaces. There's definitely a community building."