spotlight
Information Technology in
Healthcare
Creating a stronger healthcare
system
While improving computer systems would not eliminate all medical errors, researchers
believe they will reduce them dramatically. Now is the time to share progress, challenges
and best practices to enable interoperability and link the ecosystem in the delivery of better
quality care.
Madhav R Ragam
Director - Healthcare and Life Sciences
IBM Asia Pacific
R
ising costs, aging populations and
antiquated healthcare systems
have put pressure on governments,
businesses and society to make significant
changes in the delivery of care.
These challenges, combined with the
emergence of a new environment driven by
globalization, consumerism, demographic
shifts, increased burden of disease, expen-
sive new technologies and treatments are
expected to force fundamental change on
healthcare within the coming decade.
One of the great ironies of modern
medicine is that while many of us enjoy the
benefits of scientific discovery and sophisti-
cated equipment, many patients across the
globe do not receive adequate standards of
quality care due to a variety of issues un-
derpinned by the application of insufficient
resources and fundamental technology inef-
ficiencies.
In countries where information tech-
nology is commonly used for services such
as banking, telecommunications and en-
tertainment, many medical organisations
today still rely on paper records for the de-
livery of their service.
Furthermore, most existing medical
electronic systems don’t interact, which
means that important information is often
60 Asian Hospital & Healthcare Management
isolated and disconnected. While physi-
cians keep their own records, they do not
have access to information about the care
their patients receive outside their offices.
Hospitals rarely have access to these patient
records and emergency room doctors know
little about patients’ pre-existing conditions.
This often results in redundant tests and as-
sessments, increasing the cost of care and
missed diagnoses or treatment resulting in
injury.
Such disconnects across the world’s
healthcare systems are causing an increase
in poor health outcomes and in some cases
even death.
A recent Institute of Medicine (IOM)
report found that preventable medical er-
rors kill up to 98,000 people each year in
the United States alone. While improving
computer systems would not eliminate all
medical errors, many researchers believe
they will reduce them dramatically.
In addition to saving lives, we at IBM
believe between five and 20% of all health-
care costs could be saved by eliminating
unnecessary tests. This view is supported
by The Economist, which recently reported
that redundancy and inefficiency account
for between 25% and 40% of the US$3.3
trillion the world spends on healthcare ev-
ery year and that this could be eliminated
with proper IT implementation.
Change must be made. Healthcare
systems that fail to address the chal-
lenges of the emerging environment
will “hit the wall” and require imme-
diate and major forced restructuring.
ISSUE-12 2007
The choices left to stakeholders of
today’s healthcare systems are when and
how. If they wait too long or do not act
decisively enough, their systems will be
unable to continue on the current path.
This is a frightening, but very real prospect.
Which direction will the industry take?
The answer is complicated. The health-
care ecosystem is extremely complex, based
on intricate relationships, often with differ-
ing motivations. Most agree the chief goal
is to improve healthcare systems to provide
better quality service to more people, more
efficiently and at lower cost. How to achieve
that goal, however, varies widely by stake-
holder. These complex factors create an
urgent need to break down industry silos,
establish partnerships and increase collabo-
ration to drive progress.
That’s why IBM has taken a leadership
role in the global healthcare transformation.
It is working with major ecosystem stake-
holders—ranging from healthcare providers
and standards bodies to governments and
other employers—to influence the adoption
of a consumer-driven model.
This emerging, patient-centric model
focuses on improved outcomes through
disease management, prevention and well-
being programs. It gives consumers greater
control over their healthcare, including in
the selection of primary care providers and
access to information needed to make better
healthcare decisions.
Clearly, technology plays a key role in
 i n f o r m at i o n t e c h n o l o g y

patient-centric healthcare by enabling the
fast, efficient and secure flow of digital infor-
mation between patients and their doctors.
Moreover, it provides the tools to improve
clinical decision making, collaboration, ef-
ficiency and administrative processes.
Fortunately, much of the technology
needed to enable patient-centric networks
is available today. But the transformation to
a patient-centric model will require more
than technology—it requires innovation
and a shift to more open, collaborative and
integrated systems. There remains a great
deal of work to be done around standards,
governance and workflows, which is critical
to the easy flow of information within the
tourism across Asia with India, Thailand
and Singapore paving the way
- Many of the leading pharmaceutical
companies are moving clinical trials from
the U.S. and Europe to India
- The Philippines is renowned as a leading
exporter of highly skilled nurses around
the globe
- The U.S. has turned to Indian and Aus-
tralian companies for the outsourcing of
radiology readingsand
- Australia has enhanced the U.S.’s Diagno-
sis Related Groups (DRG) system, which
was subsequently adapted by Singapore,
France and Germany.
According to the World Health Organi-
inefficiently or inappropriately.
The graphs below—from the WHO
2005 statistics for Health Systems—high-
light the healthcare facts and figures of
relevance to key Asia Pacific countries and
compares them to some of the world’s most
developed countries.
In these graphs, India, China and Ma-
laysia clearly stand out as having a significant
low number of beds, physicians and nurses
for every 10,000 people in their respective
countries. As a result, we expect to see expo-
nential growth of the healthcare industry in
Physicians per 10000

healthcare ecosystem. sation (WHO), the Health Systems Statis- Singapore

tics vary significantly across the world’s de- Republic of Korea

An Asia Pacific portrait veloped and emerging countries. In the case New Zealand

Malaysia
Asia Pacific Healthcare market is cur- of Asia Pacific, WHO claims inequitable
Japan
rently the smallest in size out of the 3 ge- health systems are preventing many Asia China

ographies—the US and Europe being the Pacific nations from meeting international Australia

other two. However, it is exerting a tremen- goals set on health and poverty. Further- India
Europe
dous influence on the Global Healthcare more, the healthcare systems of many Asia North America
scene, for example Pacific countries are failing to deliver servic- 0 5 10 15 20 25 30

- There is an expanding interest in medical es of adequate quality, often using resources Source: WHO

w w w . a s i a n h h m . c o m 61
 i n f o r m at i o n t e c h n o l o g y

Nurses per 10000

resulting in fragmented patient data and ment with new business models to address
poor coordination across the continuum of the lack of incentives or the perverse incen-
Singapore care; inadequate information on quality and tives built in the existing reimbursement
Republic of Korea
outcomes; worrisome patient safety issues; system, both for their own benefits and the
New Zealand
Malaysia and misaligned financial incentives that greater good of the community.
Japan focus resources on episodes of care instead To further illustrate these points, the
China
of preventive medicine and long-term care chart below indicates the typical stakehold-
Australia
India outcomes. ers in a Healthcare Ecosystem, the initiatives
Europe These ecosystem issues have resulted in that are of interest to them and the types of
North America
a strong interest across several countries to solutions that IBM can offer.
0 20 40 60 80 100
leverage technology (healthcare interoper- At the early stages of an initiative it is
Source: WHO
ability) in order to create regional electronic key to carefully approach planning, constit-
patient information exchanges. The basic
these three countries while the more devel- concept is that these exchanges will provide
oped countries will focus on reining in the physicians with the patient information Hospitals beds per 10000
healthcare costs and improving quality. they need at the time treatment decisions
are made—e.g.: what prescriptions is this Singapore

Republic of Korea
Linking the healthcare ecosystem patient on?, what tests has he/she received? New Zealand
In all of the world’s markets, the etc.—which in turn permits a substantial Malaysia

Healthcare industry functions as an ecosys- increase in the quality of care, patient safety Japan

tem, with its various constituents, rules and and efficiency gains. China

Australia
interactions. More than just data sharing utilities, India
Currently, that ecosystem is plagued these regional electronic patient informa- Europe

by a number of pervasive issues including: tion exchanges are also envisioned as places North America

poor communications among constituents where community constituents can experi- 0 20 40 60 80 100 120 140 160

Source: WHO

62 Asian Hospital & Healthcare Management ISSUE-12 2007

 i n f o r m at i o n t e c h n o l o g y

Total expendeture on health (% of GDP) across

Singapore
Republic of Korea
New Zealand
Malaysia
Japan
China
Australia
India
Europe
North America
0 2 4 6
Source: WHO
uent participation/buy in, governance, legal
entity creation, and overall strategy in order
to find the most effective and efficient path
to success. Multiple technical options exist
to set up a community and regionally based
information exchange and IBM of course
has strong competency in this area.
Establishing a sustainable multi-stake-
holder business model is a bit more com-
plex given the well known value imbalance
between providers and payers.
However, a range of potential redistri-
bution mechanisms and incentive programs
do exist and IBM is prepared with a meth-
odology and financial model to assist with
these critical planning and organisational
milestones.
IBM’s financial model assists in creat-
ing a safe way for competitive constituents
within the Healthcare Ecosystem to con-
duct meaningful and critical conversations
key stakeholders.
But, the rewards of
successful transformation
are high. Successful trans-
formation will require all
stakeholders to actively
participate, collaborate and
change.
Much of the comput-
ing infrastructure for mod-
ern systems already exists.
What is now required is
leadership, accountability
8 10 12 14 and collaboration among
governments, businesses
and the community to em-
brace healthcare ecosystem
integration. If governments are prepared to
initiate change, they will need partners to
implement it. Companies like IBM already
have the track record of implementing suc-
cessful e-health integration projects.
IBM sees the industry progressing in
steps—from today’s world of siloed process-
es and technologies, toward Patient-Cen-
tric Networks where information is shared
seamlessly across the healthcare ecosystem.
IBM can provide end-to-end industry and
Interest within the entire ecosystem to reduce cost and Improve overall value
Health Care Ecosystem's Primary Stakeholders
1. Empower 2. Manage Payers
Employees
1.1 Self Benefits
Management
e-Benfefits
technology expertise to link business pro-
cesses to IT. We can help with the business
planning, funding, solution development
and delivery of a full end-to-end national
healthcare information networks (NHIN)
initiative. We can assist with the promotion
and adoption of open standards to help with
the integration efforts of NHIN projects.
We have the capability to build and run the
infrastructure for an NHIN system.
More importantly leaders in the health-
care industry internationally are recognising
the value of NHINs, as evidenced at The
Asia Pacific National Healthcare Informa-
tion Network Forum 2006. The Forum,
hosted by IBM Asia Pacific on 27–28
February 2006 in Beijing, China, brought
together international thought leaders and
practitioners in healthcare to discuss current
industry challenges; the best approaches
to NHINs; how to develop global NHIN
standards; and share ideas about best prac-
tices for healthcare interoperability.
The change is definitely occurring. Now
is the time to share progress, challenges and
best practice to enable healthcare interoper-
ability and link the ecosystem in the deliv-
ery of better quality care.
3. Incentivize 4. Encourage 5. Promote
Providers Community based Legislative
Collaboration Change

regarding cost and benefits. The key and 1.2 Influence Healthy 2.1 Decrease 3.1 Improve
Lifestyle Administrative Pharmacy
most elusive success factor in deploying a Wellness Programs Costs e-Rx
e-Claims & Audit Pharmacy
community or regional network is the will 1.3 Promote Consumer Management
and ability for multiple constituents to Flexibility
Consumer Driven
2.2 Dsease 4.1 Promote
Management Community Health
work together on a sustained basis. Health Plans (CDHP)
& Health Savings
Disease Clinical
Management Outreach Programs
Accounts Programs

Leadership, accountability and 1.4 Self Health

Management
collaboration for a win-win e-Disease Management
3.2 Improve
transformation 1.5 Promote Consumer Quality of
Choice Care
The transformational challenge facing Provider Selection Pay for 4.2 Promote
Incentives 2.3 Increase Buying Performance Interoperability
many healthcare systems globally is daunt- Power RHIO & National
Purchasing Health Information
1.6 Health Record
ing. It often needs to be achieved with lim- Portability Coalitions
3.3 Promote
IT Adoption
Network (NHN) 5.1 Promote
New
Personal Health
ited incremental funding in an increasingly Records
Pay for Use
e-MR
Legislation
Lobbying
competitive global economy and healthcare
environment. The task will require the es- Most of these initiatives exist in multiple flavors. For example, chronic disease management typically covers
tablishment of a clear, consistent account- 6-15 different conditions. Similarly, RHIOs vary widely based on the mix of stakeholders, or given communities’
priorities and approach. At this stage, the analysis remains at a high level and does not attempt to inventory
ability framework supported by aligned
each variation of a given initiative.
incentives and reconciled value perspectives
Source: IBM

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