Elisabetta Zanon, Director of the NHS European Office, describes how digital hospitals can deliver better care whilst improving productivity and efficiency
Hospitals across Europe share the same challenge of improving standards of care and moving to a better patient-centred approach, while at the same time improving their productivity and efficiency to respond to the continuous increase in demand at a time of funding squeeze.
Responding to this challenge requires looking at innovative approaches to delivering care, including adopting new ICT solutions. The added value of digital technology is that it allows data to be shared between patients, clinicians and providers in the quickest and most effective way, not only to cure the patient but also to put in place the most adequate preventative and early intervention measures to keep citizens healthy and reduce the risk of hospital admissions.
Pioneering digital hospitals
A pioneer in this area is Ribera Salud, a healthcare provider in Spain, which had been contracted by the regional authority to provide free, universal access to a range of primary, acute and specialist health services to the local population, against a capitated budget. This approach is also known as the Alzira model, from the name of the Spanish town where it was first launched more than 15 years ago.
The success of Ribera Salud relies on a highly integrated clinical, business and ICT model, stretching between and across primary and secondary care, with the alignment of incentives for the different providers to ensure that work is carried out in the most appropriate, and therefore efficient, care setting.
An electronic health record, combined with citizens information from the local authority, and supported by a unified ICT system, is the building block of this model. A vast amount of personal data and a set of indicators and algorithms are used to allocate the local population into 12 different risk groups. This health pyramid approach allows effective prevention measures to be put in place for those citizens at higher risk, but local health services can also be adapted to take into account the health profile of the local population.
Importantly, the digital system enables spending to be tracked and provides information on exactly how much each patient costs. The financial information is broken down for each procedure, allowing a detailed picture of spending for each individual in each area. Furthermore, a set of financial and clinical data on individual clinicians is also available, allowing performance comparison and variations to be identified (including readmissions and mortality rate) which may need to be addressed.
More patient-centred and efficient
When comparing the Alzira model with other healthcare providers in the region, some of the results are impressive. For example, emergency admission rates are 10% (compared to 14% for other hospitals); re-admission within 3 days per 1,000 discharges is 4 (compared to 6 in other hospitals); outpatient major surgery is over 73% (compared to 50% in other hospitals); patient satisfaction (on a scale of zero to ten) is over 9 (compared to 7 for other providers).
These results clearly illustrate the power of data and technology to develop better patient-centred care while improving staff productivity and efficiency. Of course, this is just one example. Other parts of Europe have also successfully embraced the use of digital technology to deliver better healthcare in a more efficient way.
Denmark, in particular, is a world leader in digital healthcare, with Danish hospitals having a tradition of working closely with industry to co-develop innovative solutions to meet their specific needs. This approach has recently been extended to a core methodology in so-called intelligent hospital construction, with more than €10bn being spent on 16 new hospital construction projects in Denmark. One of the larger projects is the New Odense University Hospital, which is scheduled to be ready in 2022 and which will become the largest hospital in the country.
Digitalisation will play a crucial role in this new hospital. ICT will help convert patient data into information, which will flow freely and automatically, supporting the hospital processes in the best possible way at any time and providing staff with the knowledge needed to perform their tasks in the most efficient way. The technology will allow information and knowledge to be integrated and used by all operators in the network, both inside and outside the hospital. This means, for example, that during an operation a surgeon can pull vital information to which the researcher at the university will have full access.
Digital hospitals in the UK
Both the Alzira and the Odense experiences are very inspiring and offer useful insight for NHS leaders in their journey towards the development of local sustainability and transformation plans. The recent Wachter Review has indeed been unequivocal about the fundamental role of ICT for the future of the health service, arguing that successfully digitalising the NHS will be essential to achieve the triple aim of better health, better healthcare and lower cost.
Following this Review, 12 of the most digitally advanced hospitals in the NHS have been selected to trailblaze new ways of using digital technology to drive radical improvements. These exemplars will get funding to invest in digital infrastructure to deliver benefits for patients, doctors, nurses and other NHS staff. They will share learning and resources with other NHS organisations through networks, which it is hoped will lead to a wide uptake of technology across the service.
While this is a very positive development, the lesson from the Alzira and Odense experiences is that transformation takes time and requires perseverance and that it is important to set realistic timelines. Furthermore, they also teach us that the digital revolution is not only about technical change, but also about cultural and whole system change, which requires a new paradigm to structure the way in which healthcare is organised and delivered.