Tackling healthcare cost challenges with digital solutions

This article was originally published in ISSUE #15 of CONNECT magazine on 1 July 2024.

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It’s no secret that issues with overspend are currently dominating the agenda for the New Zealand health system. Drastic action is being taken to contain costs and ensure that the health system continues to support the public, including redundancies and cancelation of projects and tenders. Unfortunately, investment in critical digital platforms – which exist to support workflow efficiencies and patient-centric care – have been slowed or put on hold, with the potential to negatively impact care outcomes and perpetuate less than effective ways of working.

The impact of this underinvestment in digital enablement is known all too well to those within the system who are forced to develop their own solutions. Health NZ has more than 7000 systems deployed, many of which have been developed by well-meaning smart innovators, frustrated by the inability to gain traction to adopt modern systems to resolve everyday problems. These home-grown solutions are often brilliant and solve the problem they were built for, however supporting (and importantly, updating) them becomes a challenge, expanding their capabilities is resource intensive and extracting data in an interoperable form can be impossible. 

An exciting recent development from Health NZ its move to take a platform approach to technology adoption, tackling data interoperability and data management as a collective system – expanding utility and visibility of its most valuable information. We have seen phrases such as ‘digitally enabled models of care’, and ‘digital modernisation’ of various services and capabilities. This approach would see cost avoidance and IT simplification through the retirement of home-grown solutions and the adoption of industry standard platforms that are transforming healthcare globally –signalling the advent of smarter, connected healthcare.

What does it take to achieve this modernisation? What are the critical systems that form the core of a digitally enabled clinical workflow? How do we avoid overpaying for solutions that are both beyond the needs and the means of Health NZ?

After initial measures that have been put in place to stem the cost overruns, the biggest “bang for the buck” could come from adopting a core set of tightly integrated platforms that form the heart of solutions needed by our clinicians and operations teams. It is well known that effective adoption of digital solutions frees up time for healthcare staff, and this is a strategy that needs to be aggressively pursued in by Health NZ to transform care delivery and release the human resources required to meet the needs of the population.

At a minimum, this would include the following platforms:

1. Patient administration system (PAS) – largely in place, but can be modernised

2. Digitised clinical documentation, observations, and medication management

3. Consolidated patient record and patient flow system

4. Communications including clinical decision support, secure messaging and tasking

5. Enterprise resource scheduling, orders, and booking

6. Patient and whānau (family) engagement

7. Analytics platform for forecasting and predictive capability

Why these platforms, and why not others?

The first item on the list is the PAS, which is the core system used for patient management, scheduling, billing and regulatory compliance. This is the area on the list where New Zealand is doing OK, however there are potential opportunities to modernise and improve.

Moving to digitisation of clinical documentation and observations. This is an area where many hospitals globally are seeing strong benefits from investment, in particular releasing clinician time from traditional approaches to care. eNoting for example, has matured dramatically in recent years and doctors have reported gaining more than an hour back each shift.  New Zealand was one of the early adopters of capturing vital signs digitally and realised significant benefits for management of patient deterioration, however, this initiative has also stalled even though proven.

Healthcare systems investing in real-time fully integrated patient flow systems have seen the benefits of a true consolidated patient record, with a ripple effect amounting to thousands of available bed days being released, worth millions of dollars to the health system, and more importantly, invaluable benefits for patients seeking treatment in those beds.

The integration of clinical decision support (CDS) systems into clinical workflows has shown to improve clinician performance. One study reported practitioner performance increased in 64% of the cases where a CDS system was used compared to traditional care approaches without these systems.

The effectiveness of a CDS system hinges on its usability and seamless integration into existing workflows. Poor user experiences, particularly issues like alert fatigue, have historically been a barrier to the interest and adoption of these systems. For example, a study from BMC Nursing found that nurses in intensive care units (ICUs) are exposed to an overwhelming number of alarms, 85–99% of which are not actionable. As a result, care teams became desensitised to the alerts which lead to decreased engagement and trust in these systems. 

This is where integrated messaging, tasking and alerting becomes critical, providing a reliable and trusted source of truth, and the all-important task list that many of our clinicians live by. Many of our clinicians today still write out their task list each day, rather than having an effective, reliable and trusted workflow management system acting as their digital safety net.

An independent study at Alfred Health 

How do we know where to start? 

Recently, an independent review by Monash University and funded through the Digital Health Cooperative Research Centre (CRC) in Australia evaluated the impact of Alcidion’s Miya Precision across 38 wards at Alfred Health – a leading tertiary hospital facility in Melbourne. 

The study conducted over 18 months assessed the implementation of several modules, including Miya Flow, Miya Access and Miya Command, all powered by the Miya Precision CDS platform. The results highlighted a wide range of benefits, which provide an insight into the potential upside for Health NZ.

Digital bed allocation decreased call duration by 67%

The study identified a 67% reduction in bed allocation time, reducing the average call duration from 5 minutes to 1.65 minutes. This equates to close to a million minutes of time for nurses and bed managers released from sitting on phone calls each year. If a similar magnitude of benefit was achieved by Health NZ it could deliver a benefit of more than 20 million minutes per annum, freeing up roughly 185 nurses and bed managers to provide care activities.

17.7% reduction in outliers at the point of admission

By providing real-time visibility of demand and bed capacity in target wards the study found that Miya Precision enabled Alfred Health to reduce the percentage of outliers from 11.8% to 9.7% of admissions, a 17.7% reduction. Outlier patients, those who are cared for outside the optimal ward, have been found to experience twice the length of stay compared to non-outliers.

If Health NZ was able to achieve a similar outcome, outliers would be reduced by more than 55,000 patients annually, potentially releasing more than 250,000 bed days back into the system.

12.1% reduction in average length of stay (LoS)

During the course of the study, a consistent decline in patient length of stay was observed, decreasing by 12.1% over an 18-month period. Contributing to this was an uplift in recorded estimated discharge dates (EDD) from 61% to 100% of patients. Having an EDD has been shown to directly improve discharge planning. 

Assuming Health NZ was able to achieve only 50% of this benefit, a 6% reduction in the length of overnight stays would free up more than 500,000 bed days and the associated care resources. To put that in perspective, a 1000 bed hospital provides only 365,000 bed days per year.

Benefits of this magnitude can only be fully realised when these systems are embedded in the daily routines of our clinical and operational teams. When these systems are interconnected and able to communicate fluidly, they provide a responsive digital safety net to enhance clinical decision-making without disrupting the natural flow of patient care.

Explore this topic further with insights from Alcidion’s Chief Marketing Officer, Nick White, at Digital Health Week NZ 2024. Or reach out to us using the button below.

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