Process

By Michael Gill and John Grant, Directors, IBSG, Cisco

Healthcare is facing a global crisis, but what that crisis looks like depends on where you stand. In the developing world, governments are increasing their spending on healthcare, trying to build up the infrastructure - facilities and personnel - needed to deliver services to more than an elite fraction of their country's population.

In the developed world, the cost of running healthcare systems is spiraling out of control. Governments are trying to cut spending, often in ways that limit access to services. And healthcare quality is a problem everywhere, limited by an immature infrastructure in the developing world and by the lack of adequate evidence-based protocols and processes in the developed world.

Connectivity Concerns

But for both worlds, the solution for this crisis depends on the same thing: connectivity. Only the development of an IP infrastructure that supports the rapid exchange of data among these areas can overcome the healthcare crisis:

• People
• Institutions
• Regions
• Applications

This is true both in the private sector, with its emphasis on productivity and profit, and in the public sector, where the focus is on access and equitable treatment. A brief look at the differing healthcare problems of the developing and developed worlds and some of the solutions being developed to address them can illustrate the common thread: improved connectivity for faster, more efficient communication and collaboration.

Healthcare in India

A good example of the trajectory of healthcare in the developing world is India. Only a fraction of the population can afford or even has access to healthcare approaching first-world standards, generally only in urban areas through private institutions.

Rural areas are almost entirely dependent on public healthcare of the most basic kind, if it is even available. Labor costs are low, even for skilled professionals, so technology is not seen as a solution for rising healthcare costs as it is in the developed world. Instead, India's medical technology efforts are focused in four areas: modernization, export medicine, safety, and rural community health development.

It's a kind of "bootstrapping" strategy. Modernization and the development of centers of medical excellence that can attract foreign patients and capital will help build out the healthcare infrastructure and create a larger pool of trained professionals. The emphasis on safety appeals to the elite portion of the population that can afford private care, ensuring customer loyalty and a stable base of practice to build upon. The government hopes to leverage this kernel of growing expertise to extend medical care into rural areas and improve public health countrywide.

Contrasted with Australia

By contrast, in Australia, the pressures on the healthcare system are those of virtually any developed country:

• Cost
• Access
• Quality of care

The demographics of an aging population and growing emphasis on chronic disease management are just two factors pushing up the overall cost of running the system. Paradoxically, the more developed state of medicine has left healthcare trammeled with inadequate safety and evidence-based medical protocols, resulting in many unnecessary deaths and injuries, which further drives up costs. Technology efforts are largely focused on addressing the very high cost of labor in medicine. And cost-cutting efforts are working against efforts to extend healthcare access to the poor and to rural areas.

Map of Medicine

Yet, despite these differences, in both countries the solution depends on IP communications. A good example of how critical connectivity is to solving healthcare problems in both worlds is the Map of Medicine product. This is a web-based visual representation of patient care "pathways" representing the best practices for dealing with various diseases and conditions available. Originally developed in cooperation with the National Health Service in the United Kingdom, Map of Medicine helps drive a collaborative, evidence-based means of delivering health services.

A pilot program in Kijabe, Kenya, has demonstrated its particular value in extending the reach of healthcare in the developing world by allowing less well-trained healthcare workers to treat conditions otherwise beyond their ability, and by serving as an on-the-job educational resource that's equivalent to full-time access to the most up-to-date textbooks. This collaborative model is critical to the success of efforts like those in India to bootstrap the healthcare system by enhancing knowledge transfer from urban to rural regions. A further value to the developing world is the product's ability to be regionalized: tuned to deal with the diseases or conditions endemic to a given area.

The collaborative model of Map of Medicine is important in the developed world, as well. There, it and similar case management efforts can help move treatment away from the expensive, acute-care end of the system (hospitals), to the less expensive, primary-care arena, where most healthcare happens anyway: family physicians, local clinics, elder-care facilities, physical therapy centers, and the like. In Australia, for instance, approximately 60 percent of emergency room visits are unnecessary - how much money could be saved by equipping primary-care facilities with the knowledge needed to treat conditions that really don't require a hospital visit? The same is true for managing chronic disease and elder health: improved collaboration through efficient communications is the only way to train the healthcare workforce rapidly enough to address these increasingly costly issues.

Modify Processes

Of course, processes and practices have to be modified, as well. A good example of this can be found in how Australia is addressing mental health care. There, 90 percent of mental health professionals are found in urban regions, but 50 percent of mental health issues occur in rural communities. Psychiatrists are virtually unanimous is agreeing that after the initial consultation, videoconferencing between patient, psychiatrist, and primary care physician can be a very effective form of counseling.

However, doing this requires three changes. First, a payment system that recognizes video-based consultation, as has now become law in Australia. Second, evolving video consultation practices that fit into a profitable primary care business, where the average consultation time is less than 10 minutes. And third, video technology that is simple to operate: doctors don't want to, and shouldn't have to, become video technicians to serve their patients.

In the end, though, it all rests on architecting an efficient connectivity infrastructure on both the macro (regional or national) and micro (institutional) level. Without that, medical professionals will remain dependent on phone, fax, and paper, and that's no way to run a healthcare system in the 21st century.