The Electronic Healthcare Curve Where the US stands in connected health technology

According to a recent extensive Accenture healthcare study, the US is ahead of the connected health curve in at least one important respect: More patients can access their health records online than in most of the other countries surveyed.
Specialists and hospital physicians in the US led an Accenture survey in many dimensions of healthcare IT adoption and health information exchange (HIE), particularly for clinical results and electronic patient notes. The US health system has more than double the percentage of doctors providing patients with electronic access to their own medical information compared to their international counterparts (8 percent global average versus 17 percent US average).1 In terms of technologies that directly engage patients, the US is relatively advanced compared with the other countries surveyed. With the exception of Singapore, all other countries surveyed (Australia, Canada, England, France, Germany, Singapore and Spain) are far behind in this area. Approximately one quarter of US physicians report that their patients can see health-related information from their medical records during consultations, use e-channels for communications and electronically request prescription refills. Fewer physicians report that their patients can electronically book, change or cancel appointments (mentioned by 17 percent), receive electronic reminders when it is time for preventive or follow-up care (mentioned by 19 percent) and electronically access health information/education to help them manage their own conditions (mentioned by 21 percent). (See Figure 1.) However, progress toward remote monitoring of patients with chronic conditions is relatively limited in the US (and indeed across all countries), with only a small minority of physicians, 8 percent, stating that their patients can use telemonitoring devices to monitor and record their own health indicators and remotely inform physicians of their conditions.

A closer look at connected health in the US

While there are pockets of good practice across US health systemsand within specific statesexperts suggest that connected health capabilities are generally more advanced when it comes to managing or treating specific diseases or conditionssuch as cancer, diabetes, congestive heart disease, hypertension and asthmawhat one executive surveyed called the low-hanging fruit. Experts point out that the needand the business casefor connected health is particularly strong when it comes to managing chronic conditions, which requires a more interactive provider/patient relationship as well as care coordination with other caregivers. Some HIEs are focusing their initial efforts on chronic care because this is where there are the greatest opportunities to reduce costs, improve the quality of care and demonstrate

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The technologies available to patients

US
Patients can electronically access their medical information

Figure 1. The technologies available to patients

The survey across eight countries asked respondents to identify which of the following patient-related technologies are available to their patients. Survey average 8.2% Australia 2.4% Canada 2.8% England 6.7% France 5.2% Germany 3.2% Singapore 42.6% Spain 6.6%

16.6%

Patients can electronically book/change/cancel appointments

16.8%

20.7%

2.6%

4.0%

33.3%

7.6%

22.8%

52.5%

44.9%

Patients receive electronic reminders when it is time for preventative or follow up care

18.8%

18.9%

19.8%

6.4%

17.1%

8.0%

16.9%

51.5%

32.3%

Patients can see health-related information during the consultation

26.6%

29.2%

41.5%

18.4%

35.9%

28.3%

24.8%

44.6%

22.6%

Patients can electronically request prescription refills

25.8%

20.6%

4.6%

7.2%

33.3%

12.0%

27.8%

29.4%

29.9%

Patients can communicate with me electronically, for example, through secure email or video conferencing Patients can use tele-monitoring devices to monitor and record their own health indicators and remotely inform me of their conditions Patients can electronically access health information/education to help them manage their own conditions

25.4%

27.4%

20.6%

19.2%

16.7%

29.5%

47.4%

45.1%

25.7%

7.5%

7.5%

3.6%

4.4%

8.2%

6.4%

6.7%

26.5%

8.0%

21.0%

19.3%

17.0%

14.2%

25.9%

14.5%

4.4%

39.2%

30.1%

value (since the data necessary to measure and demonstrate value is being collected and reported at the disease-specific level). Moreover, the focus of innovation is around these chronic diseases. Connected health refers to healthcare delivery that leverages the systematic application of healthcare IT to facilitate the accessing and sharing of information, as well as subsequent analysis of health data across healthcare systems. Connected health encourages communication and collaboration among all of the various stakeholders involved in a patients health. It uses knowledge and technology in new ways for more effective, efficient and affordable healthcare.

As the US population continues to age and people are living for longer, healthcare IT-supported care coordination across organizationsand with patients themselves is particularly critical to manage the rising demand for (and cost of) care. New care delivery models such as patient centered medical homes and accountable care organizations are thought to hold great potential for improving chronic disease management, while the development of mobile solutions will enable patients to manage their own care.

Insight driven healthcare

Given the fragmented picture of healthcare IT adoption and information exchange across the US healthcare system, it is perhaps unsurprising that value optimization is as yet in the early stages. The experts interviewed for the Accenture study, however, are very optimistic about the potential value once the levels of meaningful use of healthcare IT matures. The ultimate business case was that all of our investment in healthcare IT and HIE is ultimately rooted in the ability to accelerate the transformational innovation and learning cycles, so that we can more efficiently and effectively discover new knowledge implement new knowledge, test the outcome and refine it. John Mattison, Chief Medical Information Officer, Kaiser Permanente

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In the survey of physicians, Accenture asked how patient data is currently shared. In both primary and secondary/specialist care settings, approximately three-quarters of physicians state that their patients clinical data is shared across their own organization and used to help improve their clinical care protocols. As is

the case in most countries around the world, electronic patient data is less regularly shared across other organizations to improve protocols and patient care: Only 37 percent of primary care clinicians and 43 percent of secondary care clinicians state that data is used for this purpose (see Figure 2). The picture is similar

when it comes to sharing patients clinical data for population health reporting and disease management. Comparing US progress in this area to the other countries surveyed, US physicians are slightly less likely to share data within and across organizations.

Figure 2. How electronic clinical patient data is used

US
Primary Care Patients clinical data are shared across my organization and used to help improve our clinical care protocols and clinical outcomes Secondary Care

How electronic clinical electronic data is used Note: number of physicians who usepatientclinical patient data for different purposes to some extent or to a great extent.
Global Average
Primary Care Secondary Care

73%

76%

78%

77%

Patients clinical data are shared with other organizations, including public health authorities, to improve protocols and patient care

37%

43%

44%

45%

Patients clinical data are shared with other organizations, including public health authorities, for population health reporting, disease management

39%

44%

46%

47%

As is the case in most other countries around the world, the use of data analytics for organizational and public health reporting is still in its early stages in the US, but it is likely to be an important focus of connected health development in the future. Experts welcome this development as they believe that analytics has a huge potential for improving quality of care at the local level, shaping improvements in public health and developing more cost effective solutions across the system. The meaningful use criteria will, experts believe, drive future progress and accelerate the use of analytics.

The relatively limited use of patients clinical data for analytical purposes is largely due to a lack of comprehensive and comparable patient data sets. To enable sophisticated analytics, healthcare professionals need to collect and store individual patient data in a form that is easily accessible and enables interrogation. This in turn, requires physicians and other health professionals to enter data in a structured, ideally coded, way. To shed light on the extent the USand the other seven countries surveyedis able to apply analytics to drive improvements, Accenture

asked physicians to indicate how they currently enter data in their medical record systems (see Figure 3). In the US, just one in five of the physicians surveyed enter patient data in a coded way. By international comparison, this level of coded data use is among the lowest levels across the eight countries surveyed. However, nearly three in five US physicians report that they enter data in a structured way. As such, there is a relatively solid information base for some level of analytics.

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Figure 3. How patient data is currently entered into the system

The Accenture survey asked respondents to indicate which statement most closely describes how they currently enter the following data in their electronic system.

How patient data is currently entered in the system

US

Coded Structured

Spain

Unstructured

Singapore

Germany

France

England

Canada

Australia

Average Survey Total

20%

40%

60%

80%

Connected health challenges

While there is progress toward connected health in the US, significant challenges remain. Health leaders identified five key barriers that are holding back progress. Of these five barriers, the two mentioned most often are the need to encourage behavioral change across the system to address physician resistance, including cultural and workflow changes, and the need to provide incentives for sharing information in what is essentially a competitive system. Other challenges experts cited include cost, lack of interoperability of systems and concerns over privacy and security. While the health system leaders and experts Accenture interviewed do not perceive technology to be a critical challenge to the widespread adoption of connected health, they do acknowledge a number of issues that need to

be addressed including, for example, the unique identification of patients. There is a recognized need to change payment models for healthcare providers one that focuses on quality as opposed to quantity. At the end of the day in a lot of ways, technology becomes the easy part. Its policies, its standards and change in the ways things are being done that become the bigger challenges. Daniel Porreca, Executive Director HEALTHeLINK, United States A willingness to differentially reward improved quality of care and efficiency is central not only to future sustainability but also to share the benefits from the investments. In many

countries, including the US, current physician payment schemes (for example, those based on fee for service) do not provide the appropriate incentives. Accentures physician survey shows that only approximately one in five physicians, on average across all countries in the survey, receives incentives for proactively managing patients with chronic conditions (though the numbers range from just 11 percent in the US to 44 percent in Singapore). (See Figure 4.) Less than 20 percent receives incentives for using healthcare IT to achieve clinical quality of care targets or enhanced preventive care, and only 10 percent or less for coordinating care with other organizations or for conducting non-face-to-face consultations. However, the majority of US physicians surveyed said that

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they would be more likely to use healthcare IT if they were motivated to do sofor example: Coordinating care with other health providers (70 percent of respondents said they were very or fairly likely to use healthcare IT to do this if incentivized to do so).

Providing preventive care (72 percent). Proactively managing patients with chronic conditions (71 percent). Offering non-face-to-face interactions with patients, for example via email or telephone (65 percent).

Figure 4. Financial incentives for healthcare IT Financial incentives for usingusing healthcare IT
Proactively managing patients with chronic conditions (e.g. diabetes, asthma) Achieving specific clinical quality of care targets

Providing enhanced preventive care Coordinating care with other health provider organizations Non face to face interactions with patients (e.g. via email or telephone) % N=3,727 5% 10% 15% 20% 25%

Connected Health: The Drive to Integrated Healthcare Delivery, Accenture Institute for Health & Public Service Value, 2012.

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About the Survey Methodology

In 2011, Accenture explored the distinguishing characteristics of connected health systems in eight countries: Australia, Canada, England, France, Germany, Singapore, Spain and the United States. It looked at how these countries, with their very different health systems, are progressing in setting up connected health networks and systems and how they are using the components of connected health to support the move to integrated healthcare. The research entailed a literature review and more than 160 interviews with healthcare experts and health system leaders in the eight countries, including government officials, clinicians and clinical organization leaders, healthcare IT executives, and academics and analysts. Accenture also conducted an online survey of 3,727 physicians across the eight countries. Approximately 500 physicians per country (200 for Singapore) participated in the survey, which assessed doctors attitudes and perceptions on the benefits of health information and communications technology. The analysis provided comparisons by country, sector, age and use. For more information, please contact: Rick Ratliff Global Managing Director Accenture Connected Health Services +1 703 947 2525 richard.ratliff@accenture.com

Accenture: Insight Driven Health

Insight Driven Health is the foundation of more effective, efficient and affordable healthcare. Thats why the worlds leading healthcare providers and health plans choose Accenture for a wide range of insight driven health services that help them use knowledge in new waysfrom the back office to the doctors office. Our committed professionals combine realworld experience, business and clinical insights and innovative technologies to deliver the power of Insight Driven Health. For more information, visit: www. accenture.com/insightdrivenhealth.

About Accenture
Accenture is a global management consulting, technology services and outsourcing company, with more than 246,000 people serving clients in more than 120 countries. Combining unparalleled experience, comprehensive capabilities across all industries and business functions, and extensive research on the worlds most successful companies, Accenture collaborates with clients to help them become high-performance businesses and governments. The company generated net revenues of US$25.5 billion for the fiscal year ended Aug. 31, 2011. Its home page is www.accenture.com.

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