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Key elements for a successful eHealth strategy

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Service innovation and new business models that are accompanied by systematic governance and performance measurement according to the Quadruple Aim, are pre-requisites for successful eHealth programs"

Egil Nilsen

Principal, Nordics

My first introduction to eHealth and its potential to transform healthcare delivery happened nearly twenty years ago as part of a student project. I helped redesign a process that would allow several healthcare clinics in Florida to transfer radiology images to a California university hospital for a second opinion. The Florida clinics transferred the images electronically and transferred the reports via fax. Using a fax in this context sounds very outdated, but collaboration between healthcare providers across a distance was a new and exciting concept at the time. The project resulted in a smooth running process that closely resembled the one the university hospital used for in-house reads, exactly what the radiologists had asked for. This was typical of many early eHealth initiatives involving collaboration between healthcare providers or communication between healthcare providers and patients; existing workflows were simply “digitized”. In this article, I share my insights on why eHealth is important, the barriers we frequently encounter in our eHealth projects with customers and suggestions on how you can address them based on my experience over the past 17 years.

Like most projects of its kind at the time, this approach simply added new technology on top of existing ways of working. That is why many early attempts at introducing eHealth solutions failed to be cost effective¹ and/or improve outcomes. Even worse, trying to incorporate the technology on top of their regular daily routines caused great frustration among physicians, nurses and administrators. In other words, these initiatives were a complete failure when measured against the goals of the Quadruple Aim.

Early on, incorporating technology in processes became a goal in itself, not a means towards an end. We have since learned that innovating service delivery and business models – and involving payers – is the key to successful eHealth programs. We should measure new eHealth technologies by their potential to deliver on the Quadruple Aim, before designing work processes, quality assurance systems and governance to apply them in a health system. And we should start from the bottom up. I’ll explain this in more detail later.

Why is eHealth important?

This area began with telehealth – using phone lines to connect and transfer images between care professionals in order to improve the efficiency and quality of the care process. Today this area has evolved into eHealth. It encompasses all the information and communication technologies that can be used to improve the overall delivery of healthcare services – from software applications and the cloud to data analytics and artificial intelligence.

There are several major trends that are shaping the future of the health technology we develop. I can speak to these trends from my personal experience working as a Philips healthcare consultant in the Nordic countries. Today we have far more elderly patients with chronic conditions and far fewer younger people to take care of them. Our hospitals have to serve more patients who are sicker which raises our healthcare costs. Hospitals also have fewer financial and operational resources to draw upon. At the same time, patients are more engaged in their own health and well-being. They are comfortable using smartphones, tablets and other digital technologies. So we need to find new ways of delivering care. New digital solutions and technologies that are becoming available can help here.

Barriers to incorporating eHealth in healthcare systems

There is a strong drive to incorporate eHealth to improve the delivery of care, but hospitals still have many challenges to overcome. In our eHealth projects, we frequently encounter the same barriers:

Adding new technology on top of the current way of working
Imagine you have set up a tele-consult service to improve efficiency for physicians and patients. Instead of in-person consultations, physicians do a 20-minute Skype call with patients. This saves travel time for patients, but the physician still has to spend 20 minutes on a call, so it hasn’t made their work any more efficient.
Reimbursement issues
We often see that there is no financial incentive for healthcare systems to change and use technology in a meaningful way, which can block eHealth initiatives. In the Nordics, for example, the specialist care is owned by one entity (the hospital), but once the patient leaves the hospital they enter the municipality that has another budget. So the system as a whole would benefit from the investment in eHealth, but the municipalities do not want to pay for that. They save money when the patient is in the hospital.
Patient privacy
Many solutions are cloud based and local legislation often requires that patient information be stored within the borders of the respective country, or even within the walls of a hospital, meaning your eHealth solution may not be able to leverage economies of scale.
Complete medical record
Another big challenge is having a complete view of the patient’s medical record since this can be spread over different care settings that are not organized to exchange information with each other. At Philips we offer interoperability solutions that aim to streamline clinical workflows by enabling smooth data exchange within hospital enterprises and across multiple hospital networks.

Rethink service delivery from the bottom up, by focusing on the patient who receives care.”

Egil Nilsen

Principal, Nordics

Key elements for developing an eHealth strategy

In my experience the following elements need to be considered when developing an eHealth strategy in order for it to be successful.

Rethink service delivery from the bottom up
Start by focusing on the specific patient who receives the healthcare services. For instance, you want to manage patients with a chronic condition more efficiently. Perhaps the standard interval for patient follow-up is every 3 months, so you put in place a system that relays the data from patients’ self-management programs to physicians. Patients who can effectively self-manage their condition are flagged for visits twice a year and patients who cannot effectively self-manage their condition are flagged for more frequent follow up (in person, or virtually). This makes much more efficient use of limited resources and importantly patients feel happier.
Evaluate and establish governance policy for eHealth projects
Sweden is already ranked as one of the top countries for eHealth and the Swedish government has the ambition of being the world leader in eHealth by 2025. Philips Healthcare Transformation Services has helped one of Sweden’s largest regions, Skåne, by first identifying which eHealth initiatives are being worked on in the region, and second by recommending which care flows, such as pregnancy care or cardiac care, would best benefit the region. Our consultants went on to help the region develop and implement a governance framework for their new eHealth initiatives. So-called “stage-gates” were created to evaluate whether a pilot really added value across the chain or to certain elements. This helps the local leadership continue high-potential pilots and stop pilots that does not bring added value.
Innovate business models
We see other examples of service innovation and new business models that take advantage of new communication technologies. For example, Emory University Hospital in the U.S. uses Philips eICU (“electronic intensive care unit”) solutions to connect with physicians at Royal Perth Hospital in Australia. Through the program specially trained intensive care physicians (intensivists) in Australia can be on call for consultations with their U.S. counterparts when it is day in Australia and night in the U.S. and vice versa.

Governance model and associated “stage- gates” for eHealth initiatives. A stage-gated approach ensures that eHealth initiatives delivering against Key Performance Indicators (KPIs) efficiently progress from ideation to full-scale implementation, while those not delivering are halted (de-funded or re-designed). Click on image to enlarge.

Collaborating to drive healthcare transformation

In summary, service innovation and new business models that are accompanied by systematic governance and performance measurement according to the Quadruple Aim, are pre-requisites for successful eHealth programs. At Philips, we can help you with your healthcare transformation, including development and implementation of eHealth programs. We use a collaborative approach based on insightful data and deep clinical expertise to help customer teams develop eHealth solutions that meet your goals. The eHealth solutions that Philips develops, together with its customers and their partners are wide-ranging. They can be designed to improve access to medical images across a hospital or help health systems effectively manage patient populations across a region. We would welcome the opportunity to be your partner on your journey to deliver on the Quadruple Aim.

¹Wade VA, Karnon J, Elshaug AG, Hiller JE. A systematic review economic analyses of telehealth services using real time video communication. BMC Health Service Res 2010;10: 233. [PMC free article] [PubMed] [Google Scholar]

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About the author

Egil V. Nilsen

Principal Consultant, Nordics region

Egil has extensive strategic and operational healthcare consulting expertise in program development, care flow optimization and technology implementation. As a former hospital executive, he brings practical knowledge to his consulting engagements with both public and private customers. He is a published author on topics such as adverse drug effect monitoring and improving operations in the operating room, as well as a frequent speaker on topics ranging from eHealth to service design in healthcare. Egil holds an M.Sc. in Industrial Engineering and a B.Sc. in Mechanical Engineering.