In this final interview of a series with various speakers at the 5th Conference on Digital Health 2019, in two days from now, a look at some important elements regarding the decisions to invest in new health technologies from a health economics perspective.
Prof. Dr. Dominique Vandijck, among others dept. chief executive officer at Kerteza, tackles the topic in a lecture, entitled ‘Smart investments in health technologies’ (check out the complete event schedule).
Can you tell us more about the topic of your lecture?
I talk about smart health technology investment decisions and healthcare innovations. I want to demonstrate that every well invested Euro that goes into healthcare will earn itself twice.
It’s important to note that in health economics we call everything a technology. So, it could also be a new drug, a new diagnostic or therapeutic intervention, a preventive measure, you name it. In other words: it doesn’t necessarily need to be an ICT-related technology.
And it’s in this broader picture of technology than the pure ICT one, such as for instance a new drug for cancer therapy, that we look at which technology we need to invest in or not. We always compare the costs versus the benefits since healthcare resources are scarce and we must make choices on which technologies resources are spent or not.
You could say that a technology for us is something that must produce health or wellbeing so we will spend our money in those things that result in the most health per invested Euro, that’s the rationale.
Comparing the cost versus the effect
Expressing the result of an investment in health spending in terms of health produced or wellbeing looks at the outcomes that in the end matter most. Could you give more details on how such outcomes are measured for people who are not familiar with it?
So, we always compare the cost versus the effects whereby we have parameters enabling us to estimate the effects of technologies on people’s health.
One of the most preferable ways, which we always use, is measuring the effect in terms of quality-adjusted life years. Other health effects which can be measured include improved outcomes, improved survival and so on.
What about criteria used in quality audits, certifications and other areas where you need health- and care-related parameters for your work?
There are several types of possible parameters. We normally divide them into structure measures, process measures, and outcome measures.
Structure measures can, for instance, be about questions whether there is a checklist, a procedure for hand hygiene, an APD process, you name it. An example of an outcome measure could be, for example, the one-year outcome after an acute myocardial infarction. In most cases it’s one of these three categories or a combination of the three.
A clinical audit is often represented as a cycle whereby data collection and analysis are an important part. Yet, patients can also be involved in other ways?
Mostly, yes. The patient-related data is the type of data that gets recorded in patient record and obviously anything regarding the patient is key.
While we can measure many different types of parameters, the most important ones are patient-related outcome measures or patient-related experience measures.
Everything we do in healthcare deals with or about patients – and making them better – so each parameter and measure – which you try to follow up – that involves the patient is always better.
Why electronic patient records matter for integrated healthcare
Electronic patient records; it’s a topic with quite some debates and challenges. You mentioned it as one of the health technology implementations you deal with most. Nearly everyone agrees: they’re important and, as Wouter De Ploey said, even a necessary foundation. One of many challenges is a lack of information sharing as research seemed to indicate again. What’s your take?
I think that health records are extremely important since we evolve towards an integrated healthcare approach and one of the main problems in healthcare and healthcare quality issues is the fact that there is too less communication and coordination between and among healthcare professionals, organizations etc.
Sharing information, preferably on the same platform, is one of the most critical factors towards a well-functioning, integrated system in my view.
However, at the same time I think that we are too focused on just measuring data and putting them all in records. We should use the data in a more pragmatic way: a way that helps healthcare professionals working more efficiently, that provides relevant information to patients etc.
And then there is the health technology investment decision side. People sometimes say they will use a new healthcare technology or innovation. Even if we can’t predict the future, as health economists it’s our role to make the best possible estimation about the current and future impact of such investments to help decide whether it will be a good investment or not, on the short, mid-term and long run.
So, when implementing an electronic patient record system it’s important to not just hope it will work but to set it up in a way that it works as it is meant to, also taking in mind what I just mentioned with integrated healthcare, the need to use data in a pragmatic way and the challenges regarding communication.
What do you see as main challenges for hospitals, the area you’re most active in?
One of the main challenges is to make those hospital networks work with much more cooperation, a centralization of medical activities and interprofessional as well as interdisciplinary collaboration.
Another big challenge is the use of data in that context. If we will not be able to share data through electronic patient record systems, the integrated care of networks will not be possible.
Care is a human given
A while ago you were at an event on the patient and the care provider relationship. It’s an essential relationship. What are the characteristics of a strong relationship between both in your view?
In my view trust is certainly among the main ones and very good access is also essential.
Access, also in the sense of not spending too much time behind a screen in patient-facing situations to mention a quite often heard criticism in these days of the previously mentioned electronic patient record systems?
Certainly. There also needs to be a pragmatic approach in registering and monitoring data and other things so that there remains enough time for patient contact. This is still what most patients want and expect.
Where do you see the main changes of technologies in care? Wouter De Ploey said that he didn’t see too much impact on running the hospital with new technologies like robots or even telemedicine. For him, the main role of technologies is in the medical, the clinical part.
I agree with Wouter. Care is still a human given and there are still many things in that human dimension which you can’t automate, or at least: it’s very difficult.
So, I also do believe that the clinical dimension is the most important one where technology can and has to play its role and where we will see most changes with new medical technologies that make treatments more effective, for instance.
Stay tuned for more news about the 5th Conference on Digital Health and check out the other events coming up in 2019 from the 5th Conference.