The future of healthcare lies outside of the hospital. Getting there requires better standards, and deeply integrated clinical decision support at all levels.

Hospital care: Tear down these walls!

By Philipp Grätzel von Grätz
06:39 AM

There is a broad consensus among experts that in order to cope with the challenges posed by ageing societies, healthcare will have to de-institutionalise to a certain degree. “There is an enormous number of things that can be done outside of hospitals and other intensive care settings”, said Cris Ross, CIO of the Mayo Clinic in Rochester, USA. “We really have to think about how technology can replace some of the things that we currently do.”

Leaving behind the institutional walls won’t be easy, though. Outside of the hospital, there is a multitude of IT systems, platforms, and actors that will have to be connected with each other once more sophisticated treatments will take place in patients’ homes. Technical standards that work outside of hospitals are thus urgently needed, but they weren’t available until recently. This is changing, though, said HL7 CEO Charles Jaffe: “We believe that HL7 is developing some of the platforms and tools that will enable this transition.”

An important one is the HL7 FHIR standard. According to Cris Ross, FHIR was fundamental for any hospital aspiring to get into digital contact with the outside world: “FHIR is going to allow us to take different data systems and let them communicate with each other semantically. This is really mind-blowing.” Nevertheless, there was more work to do, said Ross. At the moment, FHIR was primarily conceptualised as a read-only interface: “If we really want to communicate with patients, we need FHIR to become bidirectional. This is what FHIR versions 5 and 6 will be about.”

Beyond technical standards, another key challenge for an interconnected healthcare world beyond hospital walls is the shortage of labour. Attractive as it might be to treat as many patients as long as possible outside of medical institutions, it will also require skilled healthcare workers at all levels – healthcare workers that are not necessarily available in ageing societies. “A key issue will certainly be to redefine traditional roles,” said Charles Alessi, chief clinical officer at HIMSS. "We continue to spend too much time on unnecessary things and fail to focus on important ones, like talking to patients."

For Anne Cooper, chair of the HIMSS UK Advisory Council, redefining traditional roles can mean using technology that enables people in the healthcare workforce to act up to their highest level of competence. Technology and clinical decision support tools, she said, could help skilled nursing practitioners to provide high quality care to many more patients than possible without technology and were increasingly becoming standard in many places.

Decision support systems will only be accepted by members of the healthcare workforce, though, if they don’t eat up additional time. “We need to get more skilled in implementing clinical decision support systems so that they fit into the routine workflows”, said Alessi. This, again, is at least partly a matter of standards. With CDS Hooks, HL7 is offering a tool that allows a much more seamless integration of clinical decision support systems into routine workflows across different IT systems.

Jaffe recommended to take a look at John Hopkins University which has recently established its Capacity Command Centre that brings together data from more than a dozen different IT systems and allows for a continuous monitoring with proven cost reduction and improved quality of care. In the future, scenarios like this will likely extend beyond individual hospitals and incorporate ambulatory medical institutions of all kind.

Full coverage: HIMSS & Health 2.0 Europe 2019

Healthcare decision makers, patients, clinicians, nurses, life science professionals, innovators and many more are set to convene at the HIMSS & Health 2.0 European Conference 2019 in Helsinki on 11-13 June.