Healthcare Without Walls

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Carla Smith, Executive Vice President of The Healthcare Information and Management Systems Society (HIMSS) discusses the need to adopt innovation and retrain the workforce to provide healthcare without walls.

If we are short-sighted and base our future workforce projections upon outdated models, we will experience a significant shortage in the types of workers we need, and an over-supply of workers where we will not.

 

A little over a year ago, the Network for Excellence in Health Innovation (NEHI) launched a major initiative to envision health care in the year 2025. Thanks to the leadership of CEO Susan Dentzer, and the outstanding efforts of NEHI’s five Work Streams, NEHI recently published “Health Care Without Walls: A Roadmap for Reinventing the U.S. Healthcare System”.

 

We need “Health Care Without Walls” because health systems around the world are in the midst of profound change. From 2010 to 2014 in the United Kingdom, the number of patients has grown by 14% while the number of district nurses has fallen by 45%.  And, according to 2018 AAMC research that is predicated upon doctors practising in the future the same ways they’ve practised in the past, by 2030 the US will experience a shortage of between 15,000 and 50,000 primary care physicians.  

 

If we are short-sighted and base our future workforce projections upon outdated models, we will experience a significant shortage in the types of workers we need, and an over-supply of workers where we will not.  As NEHI’s Work Streams discovered, no projections of the needs for future health workers had accounted for the technological and payment revolutions we are currently experiencing. However, if we change the model for the better, we can create the chance of having the right quantities of the right kinds of doctors – and all clinical professionals – in 2030.

We’re witnessing a technological revolution in healthcare. Artificial intelligence and machine learning are impacting a number of clinical disciplines…

So, let’s be smart.  No one wants to drive smart, committed, highly-trained health workers out.  We must find ways to retrain – and retain – the skilled workforce we have. We need to rework governance policies and provide meaningful tools that health workers can use that allows them to practice at their highest competencies.  Our educational systems must be modernized so that we are equipping the health worker of the future with the skills needed for deeply-satisfying, well-compensated, and meaningful careers.  And, we must fully embrace the philosophy of the patient at the centre. After all, “nothing about me, without me”.

 

We’re witnessing a technological revolution in healthcare. Artificial intelligence and machine learning are impacting a number of clinical disciplines including retinopathy, pathology, radiology, oncology, and dermatology.  Radiology, for instance, is currently being significantly disrupted as the number of practising radiologists has plateaued, and technology has been deeply embedded in the practice of radiology for many years.

 

The UK is spending £1.5B on artificial intelligence projects data mining National Health Service records, while Daniel Petre Director of the Innovation Science project for the Australian government says that use of machine learning with general practitioners and students can greatly increase the early diagnosis of certain melanomas.

 

And, payment structures are steadily evolving.  Starting in January of 2019, CMS (the largest payer of care in the United States), will start paying for numerous telehealth services between clinicians and patients in the home. For example, CMS is finalizing policies so physicians can bill for virtual care check-ins, remote evaluations of patient-generated videos and images, virtual monitoring of chronic conditions, and internet-based inter-professional consultations. And, CMS will allow practitioners to provide substance abuse and co-occurring mental health treatment virtually to patients in their home.

 

All these examples have profound workforce implications.  I had the honour of co-leading one of the five Work Streams for NEHI – Work Force Development.  My co-leaders and fellow volunteer experts created a narrative of what the health workforce of 2025 needs to encompass in order to achieve “healthcare without walls”. Our workforce narrative was combined with findings from technology, human factors, payment & reimbursement, and regulatory issues Work Streams into a cohesive vision for the future.

 

Take some time to acquaint yourself with “Healthcare Without Walls”. It’s an incredibly exciting time, with many opportunities to become part of the solution.  Together, we can positively transform health systems so that our “new normal” is the right care at the right time in the right place at the right price.

Follow Carla on Twitter @CarlaMSmith

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