How Government Healthcare Can Prevent Global Illness

A few years ago, when I was working as a new physician in the San Francisco Bay Area, I joined a Meetup group focused on design and tech in the healthcare space. The group included representatives from all kinds of startups and healthcare entities with big, paradigm-shifting ideas. But after a few meetings, I noticed something: I was always the only healthcare professional in attendance. Where were my colleagues and clinical partners?

The tech world is used to big, flashy ideas that can win the attention of venture capital firms and theoretically change the world with a single click. But healthcare is not flashy work. It’s messy, slow, and difficult. There is not a lot of room for the merely theoretical when you’re dealing with peoples’ lives. “Reforms in how we deliver healthcare are often nuanced, labor-intensive, and complex,” said my colleague Daffodil Baez, assistant director of clinical operations at University of Texas Southwestern Medical Center. In addition, healthcare is a highly litigated field full of potential pitfalls for practitioners.

For all the innovation that happens on the medical side – new treatments and high-tech screening technologies, for example – the health systems underneath them have remained antiquated. This has led to worse outcomes for patients and frustration for care providers.

“Health is rigid compared to other sectors of the economy,” said Francesca Colombo, head of the Organisation for Economic Co-operation and Development’s health division. “If you look at the pace – not of medical innovation, but of innovation in health systems – you see some that are straight out of the 19th century.”

We have seen a perfect example of this phenomenon during the coronavirus pandemic: Well-funded medical researchers have swiftly developed effective treatments and powerful vaccines. However, the underlying systems adapting to this rapidly changing landscape continue to strain under both the weight of logistical challenges related to the pandemic and the pressure it has put on patients and care staff.

We have also seen successful tech and financial entities stymied by the challenge of healthcare. Look no further than Haven, the joint venture between Amazon, JPMorgan Chase, and Berkshire Hathaway, which sought to improve healthcare for their employees. The fact that a well-intentioned and well-resourced venture was forced to rethink its effort before getting off the ground speaks volumes about the complexity of healthcare. The pandemic, however, has also opened up a window of opportunity. 

The urgency of the moment has forced us to address long-standing problems in health systems technology. It has also reminded us of a simple truth: Any one of us could be a patient at any time. In other words, everybody is in healthcare. We have a collective responsibility to bridge the gap between the tech innovators I met in San Francisco and the patients I now serve in Texas and California. Doing so will have a direct impact on access to quality care. 

The problems afflicting the health industry are especially prevalent in government systems, which are slowed by political gridlock, budget constraints, and inertia. But these systems also offer evidence that rapid change is possible – and provide lessons for how crises can become catalysts for structural change. 

Some of these transformations are directly related to processes implemented to treat, test, and vaccinate COVID-19 patients. Others are related to second-order consequences of the pandemic, such as the accelerated shift to telehealth. Even making small changes in the way massive bureaucracies operate can be challenging, but these agencies were able to do it because their leaders had a vision that predated the pandemic.

Case study: How Ireland’s government healthcare quickly prepared for COVID-19

When Ireland recorded its first COVID-19 case in March 2020, the country’s national healthcare system, known as the Health Service Executive (HSE), had undertaken significant planning work to prepare for the spread of the novel coronavirus within the country. It also recognized that it would need a different approach for a national vaccination program, should a vaccine be found (at that time no vaccine was approved). The agency had various regional vaccine systems in place, as well as programs to manage smaller concentrated outbreaks, but nothing at a national scale.

“In this case, HSE needed a national program that could enable its teams to move quickly as they work to keep people safe,” said HSE interim chief information officer (CIO) Fran Thompson.

It was able to implement such a program quickly because the agency didn’t need to start from scratch. There were already plans underway to modernize the agency and centralize data and communication so that it could more effectively offer community care and keep people informed.

“Our reform plans jumped off of PowerPoints and Excel sheets and were put into action immediately, turning what easily could have been a traditional, reactive response into a transformative, strategic approach,” said Paul Reid, CEO for HSE.

How exactly did this happen? The HSE team partnered with IBM and Salesforce to build and launch CoVax (COVID-19 Vaccination Information System), a nationwide vaccine platform that handles everything from patient intake to ongoing communication and employee training. The build-out took only nine working days from conception to launch. It has been growing rapidly ever since, becoming the connective tissue holding together Ireland’s doctors, nurses, trained vaccinators, thousands of call-center workers, and millions of citizens.  

That connective tissue will remain in place long after the pandemic has receded. HSE adapted to solve an immediate problem; it will move forward as a more agile, efficient healthcare system. 

“The work we have done here has solved today’s COVID-19 vaccination challenges and will pave the way for years to come,” said Thompson. “This strategy gives us a model, a framework, for linking doctor systems to hospitals, portals, and patients. This strategy gives us a framework for delivering a modern patient experience, regardless of ordinary days or extraordinary times.”

Digital transformation of the U.S. government healthcare system

The pandemic forced healthcare systems to make changes that go beyond just COVID-19. It has had a domino effect, impacting hospital beds and doctors’ offices. It’s kept patients home who would have otherwise sought timely preventative screenings, management of chronic diseases, or treatment for various illnesses. Care providers and organizations continue to encounter challenges in reaching their patients during this time – especially in government agencies that may lack agility or the necessary infrastructure to perform effective outreach.  

Adapting new technology in a country with a single centralized healthcare system is one thing. But what about in the United States, where government healthcare is only one part of a massive and complicated system?

“The U.S. public healthcare system is extraordinarily fragmented,” said Priya Chandran, senior partner and global lead for public sector healthcare at Boston Consulting Group (BCG). “In many countries, the public health system is the core of the healthcare system, whereas in the U.S., we have a large private healthcare system. So the whole idea of public health itself has been massively underinvested in for a very long time.”

Underinvestment is not the only obstacle to change, either. Local health agencies in the U.S. are multilayered bureaucracies with a range of stakeholders that includes administrators, policy makers, and academic partners. Getting all of these forces aligned to impact change is extremely difficult. 

Take Los Angeles County, where the population is twice that of the entire nation of Ireland. L.A. County’s Department of Health Services (DHS) is the second largest municipal healthcare system in the United States. It operates dozens of facilities, employs more than 23,000 full-time workers, and has an annual budget over $6 billion. 

“County technology, like anything else in government, moves quite slowly,” said Francis Tang, the CIO at Rancho Los Amigos, a nationally renowned rehabilitation hospital operated by DHS. “But the pandemic absolutely accelerated a lot of things we wanted to do all along.” 

DHS quickly contracted with Zoom for Healthcare. That was a necessity when the lockdown began. But it was also the first step in a complete paradigm shift. The county is building the infrastructure to maintain its telehealth options beyond the pandemic. Providing additional access points is pivotal for patients at facilities like Tang’s.

“For Rancho patients who are going through rehabilitation, transportation is often a major issue,” said Tang. Telehealth options can be a huge help for those patients even far into the future. 

But offering telehealth options isn’t like flipping a switch or simply uploading a software program to county computers. These transformations require training and physical investments; they require rethinking care spaces to serve as digital studios and augmenting the technology in them. Hospitals and clinics had to install new monitors and cameras. Those cameras will still be in place when we discover a new normal.

The exciting thing is that for public health systems across the country, that new normal will involve more virtual health and leveraging insights from multiple data points. Smart businesses have learned the value of hybrid workspaces. They are more efficient, more convenient, and more flexible. The same goes for medical care: Why expose healthy people to sick people for consultations that can just as easily be done virtually? Why limit our imagination of what healthcare could be to the physical space of a doctor’s office or a hospital wing?

“One of the positives in the pandemic from a government perspective is that it actually forced people to learn digital tools more,” said Tang. 

It becomes a matter of not just changing technology, but changing behavior. 

What’s the future of government healthcare systems?

The pandemic has placed our public health agencies under a microscope and empowered leaders to make bold and, in some cases, long-overdue changes. For that reason, we have a chance to emerge from the COVID-19 outbreak with stronger government healthcare systems than we had when we entered. This trend must continue. Astute companies are constantly examining their own processes, adjusting workflows, and incorporating new technologies. Despite the obstacles, this mindset must also apply to the systems that keep our society healthy.

“There is a risk that COVID-19 might end up being equated only to pandemic preparedness – having added those surveillance systems in places or the ability to quickly respond by creating new vaccines or new treatments,” said Colombo. “But there is also a realization that the entire health system needs to be strengthened. Broader holistic changes need to happen.”

What can the next phases of this transformation look like? It begins in the same place it does for businesses: With a powerful data stack. 

Imagine the ability to monitor patients digitally – to check blood pressure and glucose levels without the cost and inconvenience of in-person visits. Right now, many health systems are built to take care of sick people, but they are not optimized to keep people healthy. With regular access to health data, government providers could improve their primary care and help prevent those illnesses. 

This is already happening in Denmark, where all citizens have a one-stop web portal to access prescriptions, care providers, telehealth appointments, lab results, and more. The result is a healthcare system that is more holistic, more cooperative, and more effective because it embraces tools such as digital home monitoring.

What if government systems can create virtual health workforces dedicated specifically to remote care? These specialized doctors, nurses, and community health workers would be able to master the tools of virtual health. 

“We know that telemedicine exploded during the pandemic,” said Chandran of BCG. “It will come back down a little bit. But it is something that is very patient-centric. It is something that allows people in remote areas and rural areas more access. It can improve the quality of care, especially if it is better tied to primary care and not just for standalone services.”

What can the next phases of this transformation look like? I believe it’s proactive, collaborative, and connected – not just in the way we deliver care but also in the way that we seek to develop potential partnerships and solutions.

Imagine widespread adoption of “hospital-at-home programs” that offer acute care where people live. These programs can go a long way toward preserving inpatient resources. The pandemic exposed the fact that we have a limited number of hospital beds, and revealed that if we put our minds to it, we can keep people healthy without hospitalizing them. As our population ages, the ability to keep folks at home and out of long-term stays in facilities could be not only more humane, but also transformative. 

Imagine design thinkers, hospital administrators, and clinicians creating the future state of healthcare together. Imagine the ability to monitor patients remotely outside of a traditional office or hospital setting. This is already the reality for some but not enough among us. Imagine putting actionable data insights in the hands of clinical decision makers – then being able to use that data stack to predict, mitigate, or even prevent illness or poor outcomes. 

Right now, many health systems are built around episodic sick care and are not optimized to keep the population healthy. With the right resources, the right mindset, and the right data, we are capable of doing more. Government providers can improve the collective health of the populations they serve.  

A single thought can coalesce into a big idea and, ultimately, a paradigm shift. But transformation takes work – and it takes leaders who are willing to turn big ideas into big actions. The pandemic has forced us to look more closely at the way we take care of people than our society ever has. It has forced us to realize that for all the big ideas I used to see at those health and design meetings, the real challenge – and the real opportunity – is systemic. It’s slow and hard, but it can happen. And the momentum must not stop.