Guest Speakers:  Michael Hyatt | Dr. Rueben Devlin | Andrew Day

Across the board disruption, led by the rapid advance of technology, is changing everything about the delivery of healthcare, from how we think about healthcare, and how we plan tools and strategies for the future and implement these, to what hospitals, primary care, and long term care facilities are going to look like and how they will function in the coming decades.

On October 29^th, HH Angus invited leaders from Ontario’s healthcare sector, as well as the financial, real estate, architecture, engineering and construction industries who focus on healthcare, to join us for our Ideation: Healthcare Reimagined. The conference explored how delivery of care will evolve and benefit from the digital transformation disrupting nearly every industry today.

We’re sharing a few of the many fascinating insights from this event to help frame the degree of disruption ahead and the change that will be necessary to successfully deliver better healthcare.  We’d like to thank our speakers for their insights into the impact of technology disruption, the evolution of change in the healthcare industry, and for allowing us to share highlights from their presentations.

Technology Disruption

Michael Hyatt is one of Canada’s top entrepreneurs, and a Founding Partner and Fellow at the Rotman School of Management’s Creative Destruction Lab. He examined the larger view of how disruption is both prevalent and good, and how we must embrace it to create positive change.

Michael shone a spotlight on the sheer unlikeliness of most disruptive changes, which explains the tendency of human beings to not see these big changes coming. Disruption isn’t new; it has been changing the nature of work since the Industrial Revolution, leading to better and more productive work than ever. The explosion of computing power is increasing predictive capacity, with far-reaching consequences and untold benefits. Knowledge is compounding exponentially and the growth in machine learning will bring myriad new opportunities and make obsolete low value, repetitive work. Which is good, Michael said, because studies show that autonomy and a sense of purpose mean more to employees than money when it comes to job satisfaction. Sponsoring creativity, invention and random thinking days in your organization will bring unexpected positive results. Despite the public spotlight on technology, innovation is still about people, and leaders need to focus on keeping staff engaged if they want their organizations to innovate. 

The Future of Healthcare in Ontario

Dr. Rueben Devlin is an orthopedic surgeon and an experienced health care executive with demonstrated success working in hospitals and the health care industry. The former CEO of Humber River Regional Hospital, North America’s first fully digital hospital, Dr. Devlin is currently Special Advisor and Chair of the Premier’s Council on Improving Healthcare and Ending Hallway Medicine in Ontario, and is well positioned to influence the future of health care delivery in Ontario.

Dr. Devlin highlighted the need to take action with a long-term view in mind, in order to significantly improve health outcomes—to plan for services and the facilities that will be needed ten to fifteen years from now, not just next year.  The Council’s second report identified a roadmap for the future of healthcare delivery, outlined under four headings:  integration, innovation, efficiency/alignments, and capacity. Enabling all of these are digital supports, the tools that replace processes and tools now at the end of their useful life, such as outdated fax technology. Digital supports enable improvements in service delivery and make interactions with the health care system more effective for patients and providers.

Integration

Patient-centric health care systems allow medical staff to connect easily with patients and to share information safely and securely among the health care team to the benefit of each patient. He noted that we need to improve patients’ ability to navigate the health care system, ensuring primary care is the foundation of an integrated health care system. We need to connect multiple health care providers to ensure better integration and a simpler, smoother patient/caregiver experience.

Innovation

Improved options for health care delivery include increasing the availability and use of virtual care options, both synchronously and asynchronously. The latter allows patient/practitioner to interface at times that are convenient for both. Patients and providers should be able to use technology to access health services in the most efficient way possible. For example, Ontario has the opportunity to modernize home care, and provide better alternatives in the community for patients who require a flexible mix of health care and other supports.

Efficiency and Alignment

Improvements happen by doing things differently. Data should be strategically designed, open and transparent, and actively used throughout the healthcare system to drive greater accountability and to improve healthcare outcomes. Two examples are:

1. Ensure Ontarians receive coordinated support by strengthening partnerships between health and social services, which are known to impact the social determinants of health.

    

2. As the healthcare system transforms, design financial incentives to promote improved health care outcomes for communities and increase value for taxpayers.

Capacity

This includes bricks and mortar, human resources and collaborative inter-professional leadership. We need strong leadership throughout the system—we can’t just simply be caretakers of the current system, because if you are caretakers of the system, you continue to get what you’ve already got.

What could be achieved if we made bold changes?

• Imagine a health care system where patients can conveniently and securely access their own personal health care information and make healthy choices by accessing preventive services in the community after talking with their primary care provider.

   

• Imagine a system where providers are working in a team environment and have access to a full continuum of care for their patients, in addition to digital tools and professional development support and resources.

Moving Forward

Dr. Devlin describes one of his main tasks as the identification of barriers in order to make the system work more effectively.

“What are we going to look for? More virtual options for patients and providers. Data used as a management tool—how do we exchange it, how do we share it across the province, and how do we start using it for predictive analytics so it works for us?  We need to think about coordinated treatment plans, designed and delivered by integrated and inter-professional teams as well as upstream interventions, how to modernize our funding system and use Predictive intelligence and predictive analytics. When data is used strategically, information becomes relevant for decision making and we will be better positioned to connect patients to the right care at the right time.”

The Health System of the Future 

Andrew Day is a Principal with GE Healthcare Partners where he leads their global analytic consulting team and the design of GE’s real-time data analytics for hospital command centres. He has extensive experience in the US, Canada, UK, Asia and Australia, working with clients to focus on the future of healthcare facility design to improve operational efficiencies and deliver better health outcomes.

Andy explored the trend he is seeing towards localized community care.  Overwhelmed tertiary and large urban healthcare facilities can’t grow beds or services quickly enough to meet demand—budgets simply do not allow for this. Instead, they are partnering and trying to leverage other care settings (community care and outpatient strategies) as a matter of necessity, not as a matter of convenience. The focus is on how the acute care facilities and the community can work together to solve for the system-wide solution.

Digital Twinning

For new hospital development, digital twinning and simulation models provide the ability to test how systems and spaces will work together prior to construction. It’s vital to redesign the care delivery system itself—it’s not enough to simply digitize the status quo; the actual process of delivering care in the new setting has to change.  By changing the workflow, changing the dynamics and leveraging automation, delivery of care can be done better.

Command Centres

Command centres across a range of industries have common elements. The first is individual operators, individual experts from different functions, co-located, with their own transactional and operational systems in front of them. They also have a wall of analytics providing shared visibility to what’s going on across the system which alerts them to situations they need to act on. Key is that these alerts need to be in near real time and they need to be very specific. The best ones are about a specific patient that needs a specific action right now – or better yet, to forecast that it will be needed before it happens.

In designing a command centre, Andy recommends starting with the problem that needs to be solved, design the action, design the trigger for that action, and then make sure the right people are in the room and empowered with the right culture and the right tools to deliver care more effectively and at a higher utilization rate.

The analytics, or tiles, available in the command centre are also available on tablets as staff move around the hospital, and available on any terminal for staff to log in.

What’s Next for Command Centres?

Andy is looking ahead to broader adoption of command centres to ensure better integration between healthcare units.  Optimizing and connecting care across healthcare systems beyond single campuses. Leveraging AI/Machine Learning (ML) to forecast discharge date, likelihood of re-admission, etc. Guided ML being applied to limited but reliable variables is what is needed for using ML in real time. ML, neural networks, and simulation in the loop are useful forecasting tools and the basic building blocks of true AI, and they are already starting to quietly be applied in healthcare.

Key Take-aways From the Event

The pace of change is phenomenal. Humans initially tend to be afraid of change but time and again history has proven that change has improved our lives dramatically. We’re only seeing the opening act of what technologies like artificial intelligence will do. In healthcare, artificial intelligence will impact the role of health professionals and how they do their jobs, as well as the design of and access to healthcare facilities.

Currently, the hospital is seen as the epicenter for receiving healthcare. However, as demographics and technology changes, we will see a decentralization of healthcare. Healthcare will likely be distributed close to where it is needed – from clinics to homecare to even your phone. Hospitals will continue to be important, but their role will evolve to one more of facilitating and optimizing the system, as opposed to just focusing on the acute care piece of it.

Technology will be critical to the transformation of healthcare. The ability for patients to have access to their electronic health records and to easily transport this to the healthcare provider of their choice will significantly reduce friction in the system and lead to better care. As healthcare becomes decentralized, command centres will play a key role in integrating the various players.

The importance of change management cannot be overlooked. The transformation of healthcare will involve dramatic changes. Governments, healthcare professionals, patients and other stakeholders" need to be informed to the opportunities and buy into a collective vision for the future.

What Will Be the Role of Engineers?

Reflecting on the above highlights, Harry Angus (HH Angus’ CEO) foresees the use of current and foreseeable technology changing the face and means of healthcare delivery in profound ways and, if properly constructed, enabling far better knowledge and control for all patients.

Nice in theory but, practically, how can current leaders of healthcare effect the changes necessary at this point? Although the following is by no means comprehensive, here are some thoughts.

The formation of Ontario Health teams will mean that all health providers within a defined geographic district will need to agree how health care should be managed going forward, which institution or provider is to provide what service, how they will cooperate in creating comprehensive electronic health records and intra-communications systems, and who will assume the role of primary responsibility across a continuum of care.

To fund the changes necessary to address the above points, it will be necessary to create efficiencies out of a district’s cumulative budget, a goal made more difficult in light of the aging demographics of many areas and the fact that the many healthcare providers in the geographic region currently have their own priorities, management structures, and methodologies. It will be a huge change management task and a testament for the leaders who successfully take it on.

There are many areas for consideration; following are our thoughts in areas where we as engineers might be of assistance.

1. Assessment of facilities located within a geographic region and evaluation of which are up to the task going forward; e.g., would it help to have sole practitioners be co-located, to move non-intensive activities to a different level of facility, or close down some facilities due to age/condition, operating costs, or inability to support on going medical procedures?

    

2. As the combined vision of healthcare delivery is developed with the team, recommending strategies for how team members will share information, across which systems and infrastructure.

    

3. Engage with healthcare facilities at the outset of strategic visioning to determine how hospital operations will be reimagined/modified to take advantage of current best practices.

    

4. Understand how team members will take advantage of alternative technologies and delivery systems, such as virtual care and augmented reality; e.g., how a paramedic might quickly access enhanced medical expertise necessary to a patient.

    

5. Consider and make recommendations on how remote monitoring may be utilized in proactive and beneficial ways.

The next ten years will witness rapid change in healthcare delivery, due in part to the advancement of technology. The scope and speed of change will be disconcerting to many, but welcome news to every patient who will have the opportunity to access their own comprehensive medical records, much as other industries have already converted their systems.

By proposing a model of healthcare delivery based on geography and a co-ordinated full continuum of care for every individual in that region, the province has served notice that the status quo will disappear. What the new model will look like, and how it will function, will likely vary between regions due to local needs. Technology will be the enabler to move the necessary changes forward.