In December of 2019 I shared ideas for building a successful eHealth strategy1 based on my experiences working with health systems in the Nordics and the United States. Little did I know that a catalyst for record-fast adoption of eHealth was developing half a world away. This is a follow up to the 2019 article, reflecting on some of the lessons learned, as well as how to plan for what comes next.
eHealth strategy – lessons from a global health crisis and planning for what’s next
True digital transformation in healthcare occurs when one leverages the opportunities provided by information technology to re-design care delivery and supporting processes”
Egil Nilsen
Head of Solutions Center of Excellence and Consulting Principal, Western Europe
Pandemic accelerates the global adoption and usage of eHealth solutions
While eHealth comprises more than e-consultations (text, video, and telephone), this is the eHealth solution that comes first to mind for many. This is indeed the solution where we observed the most rapid adoption during the pandemic, much thanks to legislators and authorities around the world introducing new guidelines or legislation allowing for new or improved reimbursement for e-consultations. This, combined with desires to limit in-person interactions across society, caused the number of remote consultations to skyrocket. In Norway, as in most other countries, remote consultations historically accounted for a very small percentage of general practitioner consultations – fewer than 5% of all consultations the week of March 2, 2021. However, only two weeks later, e-consultations accounted for the majority despite the total number of consultations changing only slightly.2 The proportion of e-consultations have since dropped, but one is hard pressed to think we will ever go back to the way it was, the convenience factor, especially for patients, is just too great.
While e-consultations may have been the most visible solution, others, some still emerging, may prove to be more transformational, enhancing access to care, improving quality, helping to bend the cost curve in healthcare – and, yes, prove valuable amid a pandemic. The World Health Organization’s “Rapid hospital checklist” for the COVID-19 pandemic3 includes 12 components. While none call out eHealth specifically, at least three are meaningfully addressed by eHealth solutions, namely “Surge capacity”, “Rapid Identification and Diagnosis”, and “Infection prevention and control”. One example is tele-ICU. A tele-ICU allows a trained intensive care physician to remotely monitor patients from a different floor, building, or even from halfway across the globe. The physician has access to the same patient monitor data a physician in the patient’s room has, plus real-time video. In many countries, physicians with an intensive care specialization are in short supply. As a result, non-specialty trained physicians are left to cover shifts in intensive care units, especially in smaller hospitals, potentially affecting the quality of care. A tele-ICU allows experienced, specialty trained physicians to support lesser trained colleagues 24/7, providing hospitals and their patients with access to intensive care expertise even in the absence of on-site intensive care physicians. Beyond this it may allow for much needed surge capacity. A hospital’s limitations in surge events are often not related to a lack of space, hospital beds, or even equipment, but rather availability of trained staff. A tele-ICU solution may allow for additional beds to be designated ICU beds on wards or in hospitals where intensive care physician staff is a limiting factor. Beyond this, tele-ICUs may allow for more rapid identification of patient deterioration and in turn fewer adverse events given the involvement of more experienced experts in the assessment. The latter potentially supported by embedded early warning score data may further help pre-empt patient deterioration and avert more serious adverse events. Lastly, the benefits related to infection prevention and control are obvious. Tele-ICU reduces traffic in and out of patient rooms whether employed between hospitals or within. Philips Senior Director and Head of Medical Affairs for Monitoring, Analytics and Therapeutic Care, Adam Seiver, MD, PhD, who also serves as eICU Physician Specialist for Sutter Health in Sacramento, California, reported that the solution even proved valuable in ensuring proper donning and doffing of personal protective equipment – the tele-ICU physician serving a “buddy” function during this process.
While e-consultations may have been the most visible solution, others, some still emerging, may prove to be more transformational, enhancing access to care, improving quality, helping to bend the cost curve in healthcare – and, yes, prove valuable amid a pandemic. The World Health Organization’s “Rapid hospital checklist” for the COVID-19 pandemic3 includes 12 components. While none call out eHealth specifically, at least three are meaningfully addressed by eHealth solutions, namely “Surge capacity”, “Rapid Identification and Diagnosis”, and “Infection prevention and control”. One example is tele-ICU. A tele-ICU allows a trained intensive care physician to remotely monitor patients from a different floor, building, or even from halfway across the globe. The physician has access to the same patient monitor data a physician in the patient’s room has, plus real-time video. In many countries, physicians with an intensive care specialization are in short supply. As a result, non-specialty trained physicians are left to cover shifts in intensive care units, especially in smaller hospitals, potentially affecting the quality of care. A tele-ICU allows experienced, specialty trained physicians to support lesser trained colleagues 24/7, providing hospitals and their patients with access to intensive care expertise even in the absence of on-site intensive care physicians. Beyond this it may allow for much needed surge capacity. A hospital’s limitations in surge events are often not related to a lack of space, hospital beds, or even equipment, but rather availability of trained staff. A tele-ICU solution may allow for additional beds to be designated ICU beds on wards or in hospitals where intensive care physician staff is a limiting factor. Beyond this, tele-ICUs may allow for more rapid identification of patient deterioration and in turn fewer adverse events given the involvement of more experienced experts in the assessment. The latter potentially supported by embedded early warning score data may further help pre-empt patient deterioration and avert more serious adverse events. Lastly, the benefits related to infection prevention and control are obvious. Tele-ICU reduces traffic in and out of patient rooms whether employed between hospitals or within. Philips Senior Director and Head of Medical Affairs for Monitoring, Analytics and Therapeutic Care, Adam Seiver, MD, PhD, who also serves as eICU Physician Specialist for Sutter Health in Sacramento, California, reported that the solution even proved valuable in ensuring proper donning and doffing of personal protective equipment – the tele-ICU physician serving a “buddy” function during this process.
Tele-ICU is one example of an eHealth solution allowing provider-to-provider consultation. Another, remote overread services for radiology images, has been available for decades and we increasingly observe remote readings of digitalized pathology slides becoming standard practice. Both extend the reach of specialized services and provide a platform on which to scale clinical decision support, including AI powered solutions.
eHealth solutions for clinical services
eHealth solutions are not solely the domain of physicians. Remote acquisition of radiological images, a radiographer in one location supporting a radiographer in another location, is a newer such solution. Similar, to provider-to-provider consultations, here, typically remote smaller hospitals can pull on experience and expertise only larger facilities can afford or attract. A more experienced or specialized radiographer can guide their colleague or even take control as if he was in the control room next to the patient in the scanner despite being 100s of kilometers away. This in turn allows patients to access services that traditionally required travel, which is especially undesirable during a pandemic, but even during normal times due to time spent in transit – including the environmental burden transport may entail.
What comes next and how do we get there? For any transformation, including ones involving eHealth solutions, a clear vision – the reason why the transformation is needed – should be the starting point. Transformation for the sake of transformation is unlikely to pass go and is even less likely to stick, in the rare chance it gets through the starting gates. Assuming the reason for the change is clear to stakeholders, sponsors and those responsible for designing and carrying out the transformation, this same group, with additional participation by end-users, should align on exactly what one is aiming to achieve. Skipping this step and jumping directly to how to do something is a common pitfall. Having a good understanding of what to solve can dramatically influence how to solve said challenge. In my article referenced earlier, I listed an example where one simply took a manual process and digitalized parts of it. True digital transformation in healthcare occurs when one leverages the opportunities provided by information technology to re-design care delivery and supporting processes.
What comes next and how do we get there? For any transformation, including ones involving eHealth solutions, a clear vision – the reason why the transformation is needed – should be the starting point. Transformation for the sake of transformation is unlikely to pass go and is even less likely to stick, in the rare chance it gets through the starting gates. Assuming the reason for the change is clear to stakeholders, sponsors and those responsible for designing and carrying out the transformation, this same group, with additional participation by end-users, should align on exactly what one is aiming to achieve. Skipping this step and jumping directly to how to do something is a common pitfall. Having a good understanding of what to solve can dramatically influence how to solve said challenge. In my article referenced earlier, I listed an example where one simply took a manual process and digitalized parts of it. True digital transformation in healthcare occurs when one leverages the opportunities provided by information technology to re-design care delivery and supporting processes.
At Philips we use a co-create approach, where during the course of one or more HealthSuite Labs, we discover and frame a challenge before we ideate and build solutions. Then, with a complete understanding of the challenge, we can jointly approach how one solves the challenge (ideate and build). Working with Helsinki University Hospital (HUS) and their vision to build a virtual hospital accompanied by standardized virtual clinical pathways, we employed our co-create framework to pressure-test assumptions and identify potential solutions. The result was a use-case with solution architecture that more completely addressed HUS’ needs than if we had started directly with how to address a specific integration challenge.
Ten years ago, entrepreneur and investor Marc Andreessen famously coined the term “software is eating the world”4. He discussed software and online services’ role in disrupting industries, arguing the relative importance (value) of software vs. traditional hardware or brick-and-mortar businesses. We are nowhere near the healthcare equivalent of Amazon, who put the brick-and-mortar bookstore out of business, but we do see the increasing importance of software as it continues to elevate the role of IT in healthcare. Long gone are the days when IT was solely the domain of hospital CIOs, and this has put a spotlight on the need for an overall integration strategy. Even the largest Electronic Medical Record (EMR) vendors don’t allow all integrations necessary for a complete solution, where hospitals and health systems are able to fully realize the potential afforded when combining third-party applications and devices with EMR information. The canned reports on one’s health watch may look cool and even lead to some useful insights, but only when they are combined with validated health records, do you have a solution that allows hospitals and health systems to alter the way they provide care. The integrated solution, combining data from inpatient and outpatient settings, allows for the establishment of virtual clinical pathways. This in turn allows patients to take ownership of parts of their care and reduces strain on physicians who now can dedicate more time to complex cases and patients – patients for whom a virtual pathway is not suitable. An integration strategy needs to allow for flexibility, which again is most effectively accomplished by starting with what is desired. An example would be integration between an EMR, devices, and third-party applications. Once this has been established is it time to build a solution (how) that is as future proof as possible.
The reason for a transformation should be clear to most by now (the why), so the focus needs to be on what one is solving for, and then how”
Egil Nilsen
Head of Solutions Center of Excellence and Consulting Principal, Nordics region
We have seen how healthcare providers with solutions built on flexible and scalable platforms, including ways to integrate various sources of health data, have been able to provide new offerings during the pandemic and be relatively more successful than traditional brick-and-mortar hospitals. While the pandemic will end, it is farfetched to believe the growth of virtual care will end anytime soon. The macro picture all but guarantees it. We see an increase in the proportion of elderly persons living with multiple comorbidities and not enough trained healthcare workers to care for them, paired with the emerging benefits of deploying the Cloud and AI throughout healthcare processes.
Collaborating to drive healthcare transformation
In summary, the pandemic has fast-tracked some digital transformations in healthcare benefiting healthier patients being able to interact with their physician from anywhere. Outside of primary care, early adopter hospitals and health systems are reaping the benefits of hospital-to-hospital collaboration allowed by eHealth solutions. The reason for a transformation should be clear to most by now (the why), so the focus needs to be on what one is solving for, and then how. 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 specific 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 specialized resources between hospitals and health systems 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 better healthcare, to more patients in a sustainable way.
We would welcome the opportunity to be your partner on your journey to deliver better healthcare, to more patients in a sustainable way.
1 Nilsen, Egil ”Key elements for a successful eHealth strategy”, Philips White Paper, December 2019
2 Johnsen T, Norberg B, Kristiansen E, Zanaboni P, Austad B, Krogh F, Getz L Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners J Med Internet Res 2021;23(2):e26433 URL: https://www.jmir.org/2021/2/e26433 DOI: 10.2196/26433 3 www.who.int/publications/i/item/WHO-2019-nCoV-hospital-readiness-checklist-2020.1 accessed November 27, 2021
4 Andreessen, Marc,” Why Software is Eating the World”, The Wall Street Journal, August 20, 2011
About the author
Egil V. Nilsen
Head of Solutions Center of Excellence and Healthcare Transformation Services
Consulting Principal,
Western Europe
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.
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