Low-code in healthcare: 5+1 real life examples

By Health, News

If there is one benefit of the Covid-19 crisis, it is the growth of digital remote care. Resuming regular care in a 1.5-meter setting is simply not possible without digital applications. However, new solutions are needed quickly. These are preferably also affordable, easily adaptable and scalable without any problems. This is at odds with how we have known IT development in healthcare up to now and therefore a different approach is needed. Low-code platforms can provide a solution. They are known for being fast, cheap and flexible. This article uses five plus one examples to illustrate how low-code can make healthcare more digital. 

The advantages of remote care such as less travel, less waiting and less risk of infections have often been highlighted in recent years. Nevertheless, development has always lagged far behind expectations. This has now changed due to the Covid-19 pandemic. The use of digital applications in communication, monitoring and treatment increased rapidly, as did the demand for new applications. More and more patients and healthcare providers are opting for “at home when possible and at the healthcare provider if necessary“. 

Now more than everhealthcare does not benefit from too complex and costly IT processes, which will result in a cumbersome solution after a long time. On the contrary, applications with high ease of use are needed within weeks so patients and caregivers can use them quickly and care delivery can continue and improve. If care provision changes, rapid and controlled adaptation of care is a must. Also, to prevent us from reverting to old behaviour. 

It is striking that, in contrast to other sectors, little is developed with low-code in healthcare. While low-code is intuitive, iterative and flexible and lends itself to (patient) portals, apps or even complex back offices. Developers do not need to master a programming language, but only need to know a program where they set configurations in a graphical user environment. Low-code is therefore fast and adaptive: developers can test the (new) needs of healthcare providers and / or patients directly during development. Another advantage is that it easily integrates with existing IT systems and standards (such as HL7), so new functionalities are added to the existing systems without disrupting the current operation. Leading research firm Gartner expects that by 2024, 65% of all applications will be co-developed or managed with low-code. Well-known players are OutSystemsMendix and Betty Blocks, which already have various applications in healthcare, especially internationally. 

National Coordination Center for Patient Distribution (The Netherlands)
Shortly after the seriousness of the Covid-19 crisis in the Netherlands became clear, the National Coordination Center for Patient Distribution (LCPS) was established. The aim of LCPS is spreading the patient care workload as effectively as possible throughout the Netherlands. To perform this assignment properly, insight is required into the most up-to-date information about available beds and transport capacity. In less than two weeks, an application, the coordination platform, was developed and made operational with low-code to provide this insight into all hospitals in the Netherlands and some in Germany. The coordination platform is used to process the transport movements of patients on request by matching supply and demand. Part of this is finding the best hospital and suitable transport for each patient based on 90+ different input variables. In addition, the platform provides reports that are in the news nationwide.  

Kermit (United States)
The American Kermit developed a low-code analysis platform for medical implants such as pacemakers and insulin pumps within nine months. The application manages contracts and invoices and monitors supplier compliance. The entire process is transparent: from unpacking the material during the treatment to sending the invoice and payment to the supplier. The data-driven platform maps trends to optimize processes, provides buyers with information about fraud and prices, and provides specialists with information for treatment choice. The Kermit platform is now running in 23 hospitals, saving on average 30% of their costs for medical implants. 

Saga Healthcare (United Kingdom)
Years ago, the English Saga entered the homecare market in its own country. The big difference with other healthcare providers was that Saga focused on an agile technology platform. The IT team of 

Saga was able to deliver SACHA, a homecare planning system, within six months. The built application automates a huge amount of manual tasks so that caregivers can use this time for personal care of clients. Building with low-code was mainly of added value for Saga because the expertise was immediately embedded within its own IT department. As a result, it kept control in its own hands without having to commit to third parties. 

Medtronic (United States)
Medtronic has been one of the market leaders in medical devices such as heart implants for years. These implants are constantly collecting data from patients all over the world. It is very complex for healthcare providers to extract timely and actionable insights for the care and well-being of patients from the enormous amounts of data. Therefore, Medtronic built FocusOn in six months based on low-code, which filters 80% of the data for healthcare professionals. In addition to the fact that healthcare professionals can now deliver faster and better remote triages, the application of the low-code platform has also resulted in 50% IT budget savings. The platform makes it quite simple for new clinics to join this new technology: within 15 minutes, new customers and end users are ready to use. Since its launch in 2018, more than 335,000 triages have been performed through FocusOn, saving clinical staff time for 27 year.  

Kuwait Maternity Hospital (Kuwait)
Kuwait Maternity Hospital is one of the largest hospitals in Kuwait. The biggest problem for the hospital was the lack of insight into patient and capacity information due to the paper administration. Within twelve weeks, an external party put a Hospital Management System (HMS) live on low-code. This system offers the user a uniform patient view and provides real-time information for care managers: from the number of occupied beds and appointments to the number of operations and emergencies per day. Within a few weeks of implementation, the total registration time per patient decreased from 45 to 15 minutes. The number of errors in the patient file has also been reduced by 60 percent and communication between hospital departments has improved significantly. Due to its success, five other hospitals are now also using the system. 

National Health Service (United Kingdom)
The National Health Service (NHS) is known as the United Kingdom’s public health system. Especially for doctors with mental health problems, there is a Practitioner Health Program (PHP) within the NHS with free confidential care. The idea behind this is that doctors can return to work faster and more vital after treatment. The NHS started the program for doctors in the London area, but wanted to expand across the country in 2016. To also be able to offer the same confidential service nationwide, PHP has built a mobile app and a fully automated GP care system in seven weeks in low-code. With the app, healthcare providers can find therapists in their area and make an appointment anonymously. The app has now been used by more than 2000 doctors. 

Conclusion
The development of remote and connected care is complicated enough for healthcare providers. Who provides which care and when, who bears what responsibility for the quality of care and who pays for which care? Technology should therefore not be the problem. The development of low-code applications may be easier and faster, but not happens automatically. That is why we end this article with 5 tips to be part of the low-code revolution: 

1) Start small and finish big: start with the (agile) development of a working prototype in a pilot and discover the value of low-code development (proof of value);
2) By the patient, not for the patient: design continuously from the patient’s point of view and experiment with the flexibility of low-code development;
3) From doittogether to doityourself: get advice on the right platform, acquire the right low-code competencies and experience and then build them yourself;
4) Complexity is failed simplicity: work under architecture and don’t allow IT to add unnecessary complexity;
5) You go faster alone, you go further together: never develop alone, but learn from each other by working together. 

Contact
Walter Kien
E: walter.kien@igh.com

This article has also been published on: ICT&health

 

Healthcare vendors want less market and more cooperation

By Health, News

Purchasing and selling between healthcare providers and insurers is increasingly a strategic activity. New mutual agreements do not merely consist of budgeting and enabling expense claims. On the contrary, both parties contribute their strategic intentions. As a result, healthcare contracting becomes the starting point for joint projects. IG&H conducted a research among hospital healthcare vendors and found that healthcare contracting is increasingly at the heart of the healthcare system. To cope with core healthcare issues, however, more cooperation is required.

Download the Zorgverkoopmonitor 2019 (healthcare vendor monitor 2019) here (in Dutch).

In the Zorgverkoopmonitor 2019, IG&H takes stock with healthcare vendors and looks at the future. Nearly 25 healthcare vendors and finance managers at hospitals and clinics participated in the research. Together, they represent a total revenue of approximately €8 billion.

It turns out healthcare vendors want to set aside twice as much time to discuss policy themes and quality with insurers. Currently, price and volume still dominate more than 60% of all meetings. If it is up to healthcare vendors, 50% rather than 25% of meetings will be about substantive themes, such as the right care in the right place, meaningful care, and a vision of the region.

Approximately half of the respondents have concluded long-range agreements with the largest insurer – and a quarter of them with nearly all insurers – laying a solid foundation for a different type of meeting. ‘Unfortunately,’ not all of these are cooperations between providers and insurers. Part of the long-range agreements are simply concluded because banks require financial security. However, these long-range agreements provide peace of mind and room for a different type of meeting.

There’s a reason why healthcare vendors appreciate insurers bringing their own vision of healthcare to the table. You may disagree on this vision, but it is the main reason why 45% of healthcare vendors consider Zilveren Kruis the most professional of healthcare purchasers, and 25% believe it to be VGZ. According to healthcare vendors, they have set up a proper foundation for healthcare purchasing, and it is now time to give healthcare purchasers more authority and room for customization.

Ultimately, 30% of healthcare vendors consider the affordability of healthcare as the main challenge – especially the gradual transition (25%) to a different healthcare landscape (25%).

Healthcare vendors mainly want realistic financing, and they are willing to contribute to a financial transition. They, too, realize that healthcare should remain affordable for everyone. At the same time, they also need to deal with fixed accommodation and staff expenses, which means they can’t rush into cutting costs.

The art of concluding contracts in a new era

Even though they seem to have conflicting interests at times, healthcare providers and insurers face the same task. Of course, it can be completed through harsh negotiations, but lowering revenues and costs together requires a substantive cooperation.

The latter starts with mutual trust, which is created by truly empathizing with the other party.

The next step is for both parties to define a shared ambition that serves each party’s interests. Develop a vision of the region or certain types of healthcare, look beyond your own organization, and determine what it is you want to achieve together. Set up a joint project group, allow each other access to data, and perform the analysis together. Joining forces will automatically eliminate old behavioral habits. Discussions will no longer be about each letter in the contract but about what is good for the patient, the policy holder, and society. This will ultimately benefit insurers and healthcare providers, too.

By Walter Kien, Senior Manager Healthcare

Tech companies take giant steps in healthcare

By Healthcare, News, Technology

Tech giants, such as Google and Apple, have had their sights set on the health market for years. They have a good reason: the health sector ticks every box that technology companies are interested in. They are suffering from problems such as affordability and scarcity, it is a relatively non-transparent market and there is a lot of money in it.

In the past, competitive forces proved they were able to shape and dominate other sectors. Apple, Google, Amazon and Microsoft have completely changed the way we communicate, shop and work. These tech companies have the same similar ambitions in healthcare, although each concern has its own approach based on its own strengths. Apple focuses on consumer electronics, Google on data and Microsoft on online services and analytics. Which steps did they take recently during last year?

Apple

Apple has offered the ‘health, care and research kit’ for years in order to be able to build healthcare apps quickly, and to gather and share information. In 2018, Apple launched Health Records on iOS, allowing customers to see and change their medical dossier, as well as share them with healthcare providers. This can also consist of data from electronic patient records belonging to hospitals or other healthcare providers.

By mid-2018, more than 500 hospitals were connected to Health Records. Apple also further developed their personal metrics programs, such as cardiac monitoring (ECG) via the newest Apple Watch. They are also forging partnerships to work towards digital eye tests and revalidation programs for those recuperating from knee and hip operations.

Alphabet

Google’s parent company Alphabet was possibly the most active in the healthcare branch in 2018. Most noteworthy was the launch of the new Google Fit platform and their new partnership with Fitbit. Their goal is to make data more easily accessible for doctors. They are now in direct competition with Apple in the e-health market.

Alphabet also showed strong support for the American company Oscar Health. The online health insurance company gained almost 400 million dollars in investment capital last year. Oscar Health customers can save for discounts on their health insurance premium by exercising. On top of this, Alphabet also has two subsidiary companies which are focused on healthcare. Verily develops possibilities for medical machine learning, whilst Calico is focused on genome research.

Amazon

Amazon shook up the healthcare market last year in their quest for growth. Firstly, they announced that they are going to set up their own health care providers for staff. This will be done in partnership with business bank J.P. Morgan Chase and Warren Buffett’s megacorporation Berkshire Hathaway.

Amazon’s CEO Jeff Bezos wants to start his own healthcare company that will offer smarter, cheaper, and better care. After this announcement, Amazon bought online pharmacy Pillpack for 1 billion dollars. Through smart use of data, Pillpack improves service for patients. The client receives precisely measured doses, is reminded when it’s time to take medication, and no longer has to take care of declaring costs to insurance companies, as Pillpack takes care of that as well.

On top of all this, Amazon has started developing products to gather and process medical data via the cloud service Amazon Web Service, with digital assistant Alexa fulfilling the role of digital doctor.

Microsoft

Microsoft is mainly focusing on researchers, doctors, and biotech. The company is developing various AI and cloud computing projects through the NExT program. In 2018, Microsoft launched diagnostic support of images and tooling for doctors and scientists in the field of genomics.

Both projects are AI-driven and are saved in the cloud. Microsoft emphasises the latter. The company offers cyber security by saving healthcare data safely in the cloud following strict compliance and confidentiality regulations.

Alibaba/Tencent

Large Asian tech companies are also active in the healthcare sector. Alibaba is predominantly known as a cheap web shop, but in Asia they are leading the application of Artificial Intelligence in healthcare. CEO Jack Ma rapidly developed a platform for the interpretation of diagnostics like CAT scans. The tech giant also has a virtual assistant that supports doctors when selecting treatments.

It’s even less well-known that Tencent- Asia’s number one tech company- is also extremely interested in healthcare. Customers can get medical advice and make appointments via the app WeChat. The company has an online and offline ecosystem at their disposal in order to provide healthcare through partnership with Trusted Doctors. Moreover, Tencent has developed diagnostic programs in order to help doctors diagnose cancer early. They’ve also started initiatives to utilise their AI platform in order to help diagnose other diseases, including Parkinson’s disease.

The future

Tech companies are on a roll and are going to have an increasingly large impact on the healthcare sector. The degree to which this occurs depends on a number of developments:

  • Tech companies are wrestling with a lack of information standards in health care, which hinders the exchange of data. In 2019, Google, Amazon, Microsoft, and IBM are working on further developing a new standard, FHIR, in order to enable unhindered connection.
  • Medical professionals are critical of tech companies’ developments, and they are the ones who decide in the end if these developments are implemented. There are, for example, doubts about the reliability of these developments, such as the ECG of the Apple Watch. Moreover, the sector is suffering from ‘not invented here’ syndrome.
  • Tech companies are not always as careful with data as they should be. Facebook is the most recent example of this. Many consumers don’t let this stop them. However, it remains to be seen how long they will accept this when dealing with sensitive information such as illnesses and treatment.
  • Everything is different in healthcare. A patient can act differently than a consumer. The healthcare branch is also much more strictly regulated than other sectors.
  • In closing, the healthcare sector- depending on the country- is often publicly financed.

The answer

In the Netherlands, many healthcare facilities will say that they aren’t noticing the influence of large tech companies very much. That is true. That is the very reason why now is the correct time to take action. Ask yourself if you, as a healthcare provider, know enough about the digital needs of your patients. Research how tech companies can contribute to affordability, accessibility, and staff choice within your healthcare facility. Broaden your horizons and don’t be surprised by the development speed of tech companies.

By: Walter Kien (manager Healthcare IG&H) en Arvid Glerum (consultant Healthcare IG&H).