Will Mobile Apps Bring Wound Care Technology to the “Cutting Edge”?
CSC_HealthcareJourney
1. The Shift to Digital Health
and the Era of Healthcare 3.0
Office of the CTO
Second Edition, 2016-2017
2. SUMMARY
Health systems in most countries clearly recognize
the potential of digital health, yet e-health programs
have delivered only modest returns in quality,
efficiency or better patient outcomes. Ambitious
e-health initiatives focus on providing actionable
information to clinicians, but often struggle with the
legacy systems that impede data integration. The
solution is a digital services platform that holds
healthcare data and optimizes data access, enabled
with APIs and common IT services for identity,
access and consent management. This digital health
platform could serve as the basis for an ecosystem
of digital-health services innovation by certified
third parties and could be steered by the respective
health systems. It could revolutionize health-service
use and delivery, help health systems bend the
cost curve, and usher in an era of contextualized
information that could be called “Healthcare 3.0.”
2 | The Shift to Digital Health and the Era of Healthcare 3.0
3. The services and structure that constitute
the next phase of healthcare are beginning
to take shape, and it looks considerably
different from the past. Regulatory reform,
advances in technology and changing
demographics are just a few of the factors
driving healthcare toward a better future.
At the same time, the advent of wearables,
smartphones, cloud computing and global
connectivity has created a population of
patients/consumers accustomed to mobile
technology pervasive in other sectors of
the economy, such as banking and retail.
Increasingly, consumers wonder why
health systems cannot provide similar
service innovations. In that respect, digital
health companies would appear to be well
positioned, but so far they have been
impeded by a lack of access to health data
and uncertainty about how to distribute
the economic benefits generated by
e-health applications.
Healthcare IT is shifting toward integrating
and exploiting the diverse health IT ecosys-
tem, focusing on patient-centric information
integration and communication, rather than
on building new centralized and proprietary
systems. This shift will require open data
approaches to allow the friction-free flow of
data, and cognitive analytics to use that data
to inform decisions at the patient, organization
and population levels.
Patients are finding their voices in the
conversation about healthcare, and the
result is a significant shift in the patient-
demand curve. Three dominant trends
illustrate the influence of patients:
• Patient-centric care. “Partner with me
to engage in and manage my health. My
care team truly cares about my holistic
health. I am not alone.”
• Consumer engagement. “Enable me to
engage in and take charge of my health.
I feel engaged in my health and am
empowered to make informed decisions.”
• Science of prevention. “Empower me
to direct my life plan. I understand my
health and wellness profile and what I
need to do to live long and well.”
Meanwhile, market behaviors are changing.
A record pace of organizational activity
— including amalgamations and new busi-
ness and reimbursement models — and
changing clinical work patterns are fueling
the need for value-based care, coordinated
care and efficient innovation. Rapid
advances and lower costs for technology
are fueling innovation that was not previ-
ously feasible, creating a distributed and
loosely connected ecosystem of services.
The shift to digital health creates new rules of
data engagement and healthcare innovation,
where interfaces are wearable, and where
physical is merging with digital. It leads to
new business models, new delivery models,
and new levels of transparency and openness.
This environment creates a sophisticated
clinical pathway, powered by data insights,
that enables healthcare organizations to
deliver the right therapy, tailored to the
right patient in the right place and at the
right time — all dynamically orchestrated.
New patient-centric care models make
care more collaborative and focused on
outcomes. New investments will need to
focus on the power of combined informa-
tion sources to derive greater context. This
context is needed to more effectively and
securely leverage patient data, recognize
patterns faster, and manage the health of
populations more effectively.
Simply put, digital health is about using
technology to enable the delivery of a
3 | The Shift to Digital Health and the Era of Healthcare 3.0
Surveyed healthcare organizations cite the
primary goals for becoming more digital
as increased efficiency (50%), keeping
up with existing competitors (39%), and
cutting costs (30%).
Source: Global Digital Enterprise Survey 2016-2017, conducted by the Economist Intelligence Unit and sponsored by CSC.
4. better patient experience, with improved
results, at a lower cost. It is not a panacea; it
will need to be accompanied by initiatives
that go above and beyond IT, including
business and clinical transformation.
Digital Health Today
By its very definition, digital health is built
on a foundation of next-generation
technologies. But it isn’t something in the
far-off future. Several broad technology
trends support the drive toward digital
health, all of which are occurring today:
• Digital health is becoming mainstream.
Doctors and healthcare workers cur-
rently use digital applications to be more
efficient, provide better care and take on
4 | The Shift to Digital Health and the Era of Healthcare 3.0
Putting Data to Better Use
The shift to digital infrastructure presents opportunities for
healthcare providers and patients to collect and share new kinds
of data, with the potential for more personalized healthcare.
Personalized healthcare is more than merely using predictive
analytics to generate tables and graphs. It requires advanced
analytics capable of adding context to large varieties of data and
distilling it down to something actionable.
Take, for example, the task of reducing the amount of time a
patient spends recovering from a procedure. Reducing patient
recovery time lowers expenses for the hospital and improves the
level of care for the patient. But thousands of factors could affect
a patient’s recovery time.
CSC used industrial-scale machine learning to tackle this issue, to
find out which factors really matter for each patient and how to
take action. We started by using digital platforms to access new
sources of healthcare data. To produce a model to predict length
of hospital stay, we used a data extract of routinely collected
administrative data supplied by the healthcare purchasers for a
specific geographic locality. We used machine-learning algorithms
to extract new insights. We looked for features that were most
important in predicting length of stay for patients undergoing hip
or knee replacements. We found key leading indicators (such as
the patient’s age, the patient’s core healthcare providers, and the
secondary diagnosis) for predicting length of stay. We built a
regression model using the leading indicators, which allowed us to
predict a patient’s stay. Those predictions became the basis of
operational dashboards that alert hospitals to future costs and
help identify patients who may experience problems in recovery.
We’re at the beginning of a new phase of big data — a phase that
has less to do with massive data capture and storage and much
more to do with producing impactful, scalable insights. In health-
care, there is no shortage of data, but the shift to digital platforms
and industrial machine learning puts that data to better use.
— Jerry Overton, Data Scientist, CSC Distinguished Engineer
Healthcare Insights aaS Sample: Hip and Knee Replacement Procedure LOS Predictions
Industrial Machine Learning leads to insights that help improve patient care. We can predict future hospital costs and identify patients likely to experience
problems during recovery.
5. increasingly complex tasks. Clinicians are
using multiple channels to access patient
data. Many physicians use smartphones
to research medications. In some coun-
tries, physicians, ambulatory centers,
hospitals and health systems have
deployed enhanced electronic health
record (EHR) systems.
• Digital health is bridging the gap
between the old economy and the new.
The old economy measured success by
patient volume; the new economy mea-
sures success by outcomes. APIs and
modern application development create
bridges between legacy systems, off-the-
shelf solutions and new applications. And
much of this innovation is cloud-based.
• The healthcare platform revolution has
arrived. It’s now possible to define eco-
systems of healthcare technologies and
design healthcare IT platforms to capture
data from disparate sources (e.g., wear-
ables, phones, glucometers). All of these
new data sources and systems provide
patients and caregivers with a holistic
and real-time view of patients’ health.
• The era of the intelligent enterprise
brings it all together. The data explosion
— accompanied by advances in process-
ing power, industrial-scale machine
learning, health analytics and cognitive
technology — is fueling software intelli-
gence. Medical devices and wearables
can now “think” with contextual and
situational awareness, and respond
accordingly. Huge amounts of data and
smarter systems lead to better health-
care and the development of capabilities
such as population health management.
These trends are driving several shifts in
focus in the care-delivery approach:
• Population Health: From the needs of an
individual patient to a holistic view of the
needs of the population
• Care Coordination: From the support of an
individual provider at the point of care to
all providers across the spectrum of care
5 | The Shift to Digital Health and the Era of Healthcare 3.0
Early adopters will begin to consider 3rd
Platform EHR replacements in 2016 and
will begin replacement implementations
in 2017.
Source: IDC FutureScape: Worldwide Healthcare 2016 Predictions, November 2015
6. • Continuity of Care: From the activities in
a particular care setting or location to all
activities in the entire spectrum of care
• Preventive Care and Patient Engagement:
From a discrete episode of illness and
care to all the activities that promote
wellness, prevent illness and recurrence
• Care Anywhere: From multiple, uncoor-
dinated, “siloed” records per patient to
one patient, one record, one system
— anywhere, anytime
• Predictive Medicine, Personalized
Medicine and Personalized Service:
From reactive care to personalized,
patient-centric care that closes the loop
of care through better patient engage-
ment and use of dynamic models to
refine risk scores and care plans
Considering the speed and scope of change
that comes with increased adoption of
digital health, it’s hardly surprising that
many organizations are struggling to adapt.
Some trends, such as the evolution of
patient-centric care, have challenged norms
that existed throughout the life of organized
care systems. Once seen as the sole author-
ities in matters of treatment and care,
doctors and hospitals now share responsi-
bility with patients. Business models that
were built on the volume of patients and the
number of treatments are now shifting to
payments based on health outcomes.
As patients become active participants in
determining the kind of treatment they
want, organizations will need to coordinate
across the care continuum, recognizing that
patients touch many different components
of the wider health system. Providers and
payers alike are putting a lot of effort into
integrating new technologies and absorbing
the growing volume of data generated by
smart devices and wearables. The need for
flexible and interoperable computing
resources is growing, and the current IT
status quo is not suited to that need.
Elements of Transformation
By design, digital health technologies are
disruptive. Health systems need to thor-
oughly evaluate how they will adopt and
apply them.
At an operational level, health systems
must change their structure and workflows
to derive maximum benefits. They must set
clear goals, get active participation from
leadership, assess their technology require-
ments and create an effective rollout strategy.
A winning strategy requires aligning key
stakeholders — patients, physicians, care
providers, payers, et al. — to a common set
of outcome objectives and redesigning the
interaction models between them. In many
cases, this could be a significant
change-management activity.
6 | The Shift to Digital Health and the Era of Healthcare 3.0
Isolated and disconnected data reposi-
tories have been, and remain, among
the biggest barriers to efficiency gains
and improved services in the industry.
Virtual care will become routine by 2018,
and by 2020, 80% of consumer service interactions
will make use of IoT and big data to improve quality, value, and timeliness.
Source: IDC FutureScape: Worldwide Healthcare 2016 Predictions, November 2015
7. The move to an advanced, standards-based
health IT system (HIT) is essential to digital
health, but it needs to be tailored to sup-
port the characteristics of digitally enabled
population health management, including:
• An organized system of care
• The use of multidisciplinary care teams
• Coordination across care settings
• Enhanced access to primary care
• Centralized resource planning
• Continuous care
• Patient self-management and education
• A focus on health behavior and life-
style changes
• The use of HIT for data access and
reporting for communication among
providers and payers and between
providers, payers and patients
The selection and implementation of
HIT is among the most important compo-
nents of planning for population health
management. EHR adoption is only the
first step toward creating the needed
infrastructure. A wide range of other
digital applications is required to automate
digital health and to engage patients in
their own care. Moreover, systems must be
constantly re-evaluated because of rapid
changes in technology, as well as new
government regulations.
Developing an Ecosystem of Services
Commissioners, and potentially even indi-
vidual patients, now need to be able to
“assemble” healthcare services from multi-
ple organizations to deliver optimum care.
One of the potential steps, particularly in
addressing care-transition challenges, is the
creation of a digital health-enabled patient
7 | The Shift to Digital Health and the Era of Healthcare 3.0
The Cybersecurity Challenge
A recent U.S. Department of Health and Human Services study reveals that healthcare
providers are at risk of losing $305 billion in cumulative lifetime patient revenue over
the next five years due to the mishandling, loss and theft of patient data.
To avert these losses and the liability they create, providers must prioritize cybersecu-
rity improvements for clinical and financial systems. Often healthcare IT security is
based on binary security controls – i.e., “you can have all of my information or none of
it.” The introduction of the Internet, consumer devices and many more outside elements
complicates this approach, and the growing consumerization of IT in healthcare means
this trend will continue. Providers that have confidence in the identities of their users
will be able to more successfully manage the risk associated with the disclosure and
sharing of sensitive patient data. Concurrently, they will boost trust among their
patients while also improving the individualized patient experience, as individuals can
decide what information to release to whom, when a certain situation arises.
Active defense requires a risk-based approach to cybersecurity management, using
threat intelligence and analytics to proactively detect potential events, as well as
enabling a swift response to incidents. The reality is that security is an ongoing activity,
not a single project. As such, healthcare companies that are able to automate their
monitoring and response capabilities will be able to create the “fire doors” that stop
data leakage during a breach, track the remediation, and re-scan the system to ensure
the vulnerability has been corrected. Health systems must make security the foundation
of every application they launch and every infrastructure they procure.
Healthcare providers that successfully make this leap will limit the damage cyberattack-
ers can cause. Active defense measures can safeguard future patient revenue that
would otherwise be lost to competitors and also safeguard consumers who have
entrusted providers with their medical and financial information.
Patients with low
engagement levels
incur costs from
8-21% more than
patients who are
actively engaged
in their own health
decisions, according
to a 2013 study
published in Health
Affairs.
Source: IDC, Best Practices: Changing Payer and Provider
Relationships — Processes and IT Tools in a Reformed,
Collaborative Environment, Deanne Kasim, July 2015
8. care coordination center (CCC). The CCC
can determine the best entry point for a
patient to receive the most appropriate and
cost-effective care. Central to the success of
this center are the digital health technolo-
gies that support it. A care-coordination
system must present a patient’s data to
clinicians across the local health and social
care system in a contextual manner.
The key to improving population health
management is building a deep understand-
ing of patterns of health, disease and
well-being. The power of data comes from
analytics, and many providers need to
liberate the large amounts of data already
residing in enterprise systems, such as
EHRs. Such patient data is of enormous
value to individual patients and physicians,
but the potential value to the healthcare
system is much greater.
Organizations need to identify and under-
stand innovative uses of data that will help
them reduce costs and identify new revenue
streams. With aggregation, standardization
and analysis, data can offer the insights
healthcare providers need to close gaps,
improve care and make distinctions in
patient populations that can help stratify
services, deliver care more efficiently and
provide more appropriate, higher-quality
care in a wider range of settings.
Newer technologies also hold great promise
for population health management. Home
telehealth devices, for example, have
become more sophisticated and less expen-
sive, and telemonitoring data can be trans-
mitted to care managers more easily than in
the past. Interactive Web-based applica-
tions and tailored educational programs can
also be effective. These programs must,
however, be coupled with other interven-
tions to motivate patients to improve their
health. The coordination center could also
be leveraged to do telehealth monitoring,
some telemedicine consultations, as well as
telecoaching. While there is little data yet
on how mobile health applications affect
patient outcomes, healthcare organizations
should watch this space carefully, because
the number of mobile health applications
and devices is exploding.
8 | The Shift to Digital Health and the Era of Healthcare 3.0
One out of three individuals
will have their healthcare records
compromised by cyberattacks in 2016.
Source: IDC FutureScape: Worldwide Healthcare 2016 Predictions, November 2015
9. The Big Challenge: Data Mobility
Digital health technologies and new value-
based care models such as accountable care
organizations (ACOs), clinical network collab-
oration and care management, hold great
promise for optimizing care delivery. However,
their ability to recoup the anticipated value is
heavily discounted. In many cases, they are
targeting only silos in the healthcare value
chain. This means that the paucity of full-scope
data access and availability in healthcare will
continue to be a drag on realizing the promise
of digital health.
Addressing this data void — bridging the
healthcare data chasm with key information
flow pivots — will enable organizations to
create next-generation digital health services
that will coalesce the current fragmented
landscape. Four key levers are essential:
• A data ingestion/accessibility pipeline
that supports real-time, potentially
transactional, batch and streaming
interfaces
• The capability to semantically and
structurally transform incoming data
(and/or persist where necessary and
preserve provenance) so that down-
stream operations can operate on a
more stable base
• Federated query capabilities that
range from non-time-sensitive queries
against read-consistent information,
to highly transactional, real-time
continuous requests
• The ability for upstream business
processes and applications to exploit
the integrated data
These pivots create a connected network of
information that enables a healthcare enter-
prise to act with massive information bias
and drive toward gaining more and more
information that is current. This feedback
loop applies that data throughout the orga-
nization to enable better, faster and more
meaningful decisions. This is Healthcare 3.0.
Healthcare 3.0: The Target State
Healthcare 3.0 delivers the next wave of
productivity gains in healthcare delivery.
It is not coming just from the delivery of
information but also from the cross-linked
aggregation of a more complete informa-
tion corpus that understands the context
of a transaction and therefore provides the
critical information that is necessary to fulfill
the obligation.
At the heart of this productivity gain is
just-in-time information delivery. This is why
many health systems are moving to hybrid
clouds and have chosen platforms that
naturally have better information-access
properties. Despite the disruption to their
environments, firms are implementing these
platforms because they can cut latency to
end clients, minimizing the time it takes to
get interaction and collaboration moving.
They also offer an elastic capability to scale
up and down with demand. And they bring
rich information together cheaply and
deliver it cheaply to an end user. These
clouds are providing business advantages
not only in their operating cost, but also
in their operating model, very close to the
9 | The Shift to Digital Health and the Era of Healthcare 3.0
Payers Patients Providers Retailers CCG/ACOs Life Sciences Med Devices
Provider
Engagement
Patient Contact
Center
Patient
Engagement
Directory of
Services
Disease
Management
AWS Azure Biz
Cloud
Soft
Layer
Care
Transition
Care
Coordination
Care
Logistics
Systems of Engagement
Systems of Insight
Systems of Record
API Gateway/Open Data
Cognitive
Ploatform
Virtual Lifetime Patient Record
Cognitive
Platform
Cognitive
Insight
3rd Party
Services
IOT/PHR
Cognitive
Insight
3rd Party
Services
AWS Azure Biz
Cloud
Soft
Layer
AWS Azure Biz
Cloud
Soft
Layer
CSC Agility Platform
(Enterprise 1)
CSC Agility Platform
(Enterprise 3)
CSC Agility Platform
(Enterprise 2)
Popluation Health Enablement
11. By applying relevant technology and auto-
mation to every aspect of healthcare man-
agement, provider and payer organizations
will be able to deliver high-quality care to
patients in an efficient and sustainable
manner. As a result, the transition from
volume to value will be smoother and have a
much better chance of yielding the results
all healthcare providers desire for their
patients and their practices.
11 | The Shift to Digital Health and the Era of Healthcare 3.0
Healthcare Industry Disruption
A Leading Edge Forum (LEF) Perspective
In recent decades, the healthcare business has become increasingly industrialized
and bureaucratic — vast medical facilities, highly specialized training and practices,
complex information and management processes — all creaking under rising work-
loads and relentless financial pressures.
Modern medical technology can chip away at these problems. Hospitals expect
they will need fewer beds as more treatments are consumerized and performed in
homes, clinics, pharmacies and assisted-living facilities. New technologies will make
many tests — blood tests, blood pressure, ECG, insulin, eye, fertility — inexpensive
and increasingly self-administered. Pharmacies such as CVS, Walgreens and Boots
will become ever-bigger parts of the overall healthcare ecosystem.
Automated data collection — based on mobile phones and IoT devices — will be
faster, more detailed and more accurate than self-reporting; 3D printing will be
used to make everything from prosthetics to eyeglasses; advanced analytics will
sift through enormous data volumes to develop new knowledge, and algorithms
will nudge us all toward the “right” behavior.
All of these innovations will help deinstitutionalize care, lower costs and increase
the transparency of prices and efficacy. Additionally, many of today’s healthcare
startups will sell directly to consumers, often bypassing national or private insur-
ance. Over time, these new relationships could become increasingly disruptive,
especially as service volumes rise, costs fall and innovation migrates to the cloud.
For the foreseeable future, however, healthcare will remain a hybrid sector — part
government responsibility, part institutional marketplace and part empowered
customer experience. This will make the industry less susceptible to full-scale dis-
ruption, but disruption around the edges will become increasingly common.
Healthcare providers with agile digital infrastructures will be best positioned to
embrace these changes.
The Leading Edge Forum (LEF) is the independent research arm of CSC.
Only 5.5% of hospitals reported maintenance costs for EHR have
been higher than expected, while 26.5% of hospitals reported that
the total cost of ownership for the EHR is lower than expected.
Source: IDC, Business Strategy: Trends and Opportunities in the U.S. Healthcare Provider Market — A Discussion of the 2015–2016 Healthcare Provider Technology Spend Survey Results, Judy
Hanover, January 2016
12. 12 | The Shift to Digital Health and the Era of Healthcare 3.0
How CSC Can Help
CSC believes that our Agile Health framework, coordinated care solutions and innova-
tive technology platform can bring together major healthcare system stakeholders and
create an environment for success.
While taking into account possible constraints in existing organizations and systems, our
Agile Health framework brings together all stages of the HIT evolution:
CSC’s eHealth Optimization solutions enable organizations to maximize their financial
investments in EHR systems and create greater clinical value through new integration,
and open information and API gateways that support interoperability.
CSC’s Population Health Enablement solutions expand the care model and the integra-
tion of services to deliver better health and well-being population outcomes by enabling
enhanced clinical function and collaboration, and data insights to optimize care and
improved patient outcomes.
CSC’s Agile IT approach promotes an “as-a-service” enterprise that automates IT opera-
tions and ensures consistency of deployed solutions in a continuous delivery model that
enables organizations to meet the aggressive cycle time frames.
All of these components are delivered in a heterogeneous healthcare landscape that
lets organizations derive value from a flexible IT environment that enables and
responds to transformational change. It offers the richness of open clinical collabora-
tion with a built-in situation awareness security framework, which ensures privacy and
confidentiality.
CSC’s Agile Health as a Service Framework
13. 13 | The Shift to Digital Health and the Era of Healthcare 3.0
Authors
Femi Ladega is chief technology officer for CSC’s Healthcare and Life Sciences global
industry group. With experience of delivering major transformation engagements to private,
public and international organizations in Europe, America, Middle East, Australia and the
United Kingdom, Femi provides leadership for driving the solution strategy and technology
direction for the industry group.
oladega@csc.com
Gurdip Singh is vice president and general manager, responsible for the development and
delivery of software products and business services for CSC’s Healthcare and Life Sciences
global industry group. His primary skills include program leadership, operational business
management and business transformation.
gsingh69@csc.com
* CSC’s ResearchNetwork contributed to this paper.
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