Integration is Key to Wringing Efficiencies out of Health Care


Canada’s health care system is central to our identity. It’s a matter of national pride. It also eats up almost half of the public purse. And that number will only increase as the bubble of baby boomers enter retirement, bringing on the ills of age while contributing less to the tax coffers.

These pressures on the system demand that we be able to wring ever more efficiencies out of it. One key to that is integration of institutions, processes and documentation. Technology, especially collaborative technology such as videoconferencing, has a vital role to play in that integration.

Picture a hub-and-spoke model, along the lines of the FedEx’s distribution. Rather than product being pushed from the hub to points on the spoke, though, the product is pulled by the end points.

The “product,” in this case, is expertise. While government incentives encourage general practitioners to serve rural and remote communities, specialists still tend to congregate in urban centres. That’s where the volume and medical infrastructure necessary to ply their trade is. Videoconferencing technology allows the patients of those rural doctors to have face-to-face consultations with big-city specialists without traveling for hours. Specialized medical videoconferencing rigs can also transmit patient instrumentation—blood pressure, heart rate, temperature, etc.

Change that equation by substituting “remote” for “rural” and “hours” becomes “days.” In some Far North communities, specialty care is a plane ride away. The cost in both time and money is such that patients might simply refuse a necessary consultation. Here again, videoconferencing is a more viable option.

cisco_healthPresence_largeHere are just two of many examples of the application of videoconferencing to remote health care. Toronto’s Hospital for Sick Children has a full-time staff of mental health professionals serving at-risk youth in northern communities in Nunavut. In Washington, D.C., pediatric cardiologist Craig Sable has made consultations at 100 sites in 20 states from Children’s National Medical Center. His practice is so sophisticated, he can create models of patients’ hearts with a 3-D printer.

There are integration scenarios that aren’t quite so sexy, but are still important to the streamlining of health care delivery. In fact, simple integration within a local health unit saves even more money because the elements are used so much more often. Scheduling hospital rounds, getting consistent patient records regardless of the clinical setting, instant return of test results, viewing patient imaging anywhere there’s a computer … all of these save time and money while improving patient outcomes. And it can be the result of fairly routine integration. Much of it could be handled with something as simple as a Web portal.

The technology infrastructure that underpins all these scenarios must be:

* Standards-based. Disparate tools and systems have to work together. For example, videoconferencing equipment may be from different manufacturers, so session initiation protocol (SIP) is crucial.

* Absolutely reliable. Being knocked offline during a consultation or procedure can’t be tolerated. Nor can not having access to patient records. Redundancy should be part of the architecture, making a hosted solution an attractive option.

* Secure. The privacy of a patient’s health information is not negotiable. Security must be built in throughout the system, whether the data is in transit or at rest. As we’ve learned from previous incidents, encryption and data leak prevention technologies should be used to prevent exposure of patient data. Virtual desktop infrastructure allows clinicians and other staff to work with patient data from virtually any connection, without the data ever leaving the virtual server.

Improving health care’s IT infrastructure is crucial to helping the systems survive its coming challenges. Fortunately, the technological tools are available to enhance patient outcomes while streamlining processes. We’ll talk more about the future—and present—of health care technology in the next post.


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