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Sustainable Computing How Digital Healthcare can Help the Environment, Reduce Costs, and Improve Patient Service
Nihar Ganju and Michael Walsh


The Healthcare industry is on the verge of great transformation. There has been an increased investment in Healthcare Information Technology (HIT) that will affect all aspects of healthcare services, from costs to patient safety to the security and privacy of patient records. An often overlooked benefit of this transformation is the potential reduction of environmental impact from the healthcare industry. This comes through reduced material consumption and increased healthcare management efficiency.
Considering that the cost burden of American healthcare has reached over $2 trillion, the future of the US healthcare industry will depend on identifying significant areas of wasted resources and streamlining health care processes. This installment of the Sustainable Computing column examines key environmental opportunities that can be addressed directly through existing software solutions and future software innovation.

Paper "Less" Healthcare
It is imperative that the healthcare industry address the amount of resource waste it generates. Reports suggest that in the United States alone, hospitals generate some 6,600 tons of waste per day. Most of that waste—perhaps as much as 80-85%—represents materials that typically end up in ordinary landfills: paper files, cardboard packing materials, glass, plastics, and other types of commercial trash. (See the Practical GreenHealth site at cms.h2e-online.org/ee/waste-reduction.)
The healthcare industry must look to dematerialize many of the activities that produce this waste in order to drive down costs, increase productivity, and minimize the impact on the environment. Healthcare information transformation affords the greatest opportunity to significantly minimize material consumption across the healthcare industry.
Scheduling and Notification. Physicians and hospitals often require patients to schedule appointments by phone and they typically notify patients of standard medical results by mail, on the phone, or in follow-up appointments. Online scheduling systems, e-mail appointment confirmations, and video teleconferencing sessions between patients and physicians could minimize material waste, mail distribution, and travel-related carbon emissions.
Prescreening Materials. Prescreening materials are often delivered to patients on paper when they arrive for an appointment. Even when a physician's office provides the patient with a digital file, the file is almost always printed by the patient prior to the appointment and then delivered to the office upon check-in. This reliance on paper forms is inefficient and results in unnecessary material use, decreased productivity, and unnecessary costs.
Electronic Medical Records. Electronic medical records (EMRs) provide one of the surest means of eliminating material waste in the healthcare industry. Unfortunately, only 15% to 20% of U.S. physician offices and 20% to 25% of hospitals have adopted EMR systems. Barriers to adoption include procurement costs, lack of industry or government certification and standardization, concerns about data security and privacy, and a disconnect between who pays for EMR systems and who profits from them. Yet, cumulative cost savings over the next 15 years from gained efficiency and safety of EMR implementation has been calculated at $371 billion for hospital systems and $142 billion for physician systems.
Physician Patient Records. Physicians maintain ongoing records for each patient. A single patient record file may contain a range of data, such as physician notes, lab results, the patient's allergic reaction warnings, and a history of health problems. Currently, patient charts are largely paper-based, and considerable resources are spent in creating, maintaining, and filing these patient records. The paper based nature makes the charts slow and cumbersome when physicians need fast access to patient data. A potential loss of $5 per chart pull can be attributed to paper-based charts as opposed to when using electronic records.
Computerized Physician Order Entry. Care instructions, laboratory orders, and prescriptions have typically been provided in handwriting on paper. Computerized Physician Order Entry (CPOE) is designed to change the way in which physician instructions are communicated will also transform the process by which a physician arrives at her instructions—this is especially true for scenarios where the CPOE is integrated with a clinical or diagnostic decision support system. Considerable evidence indicates that CPOEs help to reduce medical errors and adverse drug events. Limiting adverse events and medical errors and, in turn, limiting related legal costs can prove to be a significant source of savings. CPOEs can also help reduce material waste, especially in hospitals, and improve patient safety.
Paperless Billing and Claims Management. Over the past decade, there has been significant growth in paperless billing utilization by hospitals and insurers in a number of North American and European countries. But the full potential of paperless billing and claims management has not been realized (and in some cases, technology is not the limiting factor):
  • Hospital discharge papers and insurance billing releases are often signed on multi-copy paper rather than digitally.
  • Insurance providers often mail patients an explanation of benefits for processed claims as paper statements delivered by mail rather than through secure electronic delivery to a patient healthcare system.
  • Unlike most insurance medical and prescription policies, reimbursement claims for programs such as U.S. Treasury Health Savings Accounts (HSAs) often require patients to mail a paper copy of the receipt itemizing the covered expense to the program administrator for claims processing.
  • Pharmacy receipts for prescription and non-prescription medicines are physically provided at checkout on paper rather than through secure electronic delivery to a patient healthcare system.
Physician Collaboration. Delivering specialized healthcare services requires collaboration between healthcare providers. When providers are geographically separated, they need an efficient means of communicating. In the past, most communication between providers occurred through written files, faxed notes, and telephone calls. Unified communications provides a better option—it streamlines communications, increases efficiency, reduces costs, and increases collaboration.

E-fficient Healthcare Management
For obvious reasons, it's impossible to drive out all material consumption by the healthcare industry. It therefore is important to consider how the healthcare industry can better manage the materials required to render health services. Improving efficiency eliminates waste and minimizes the environmental impact of the industry. If properly implemented, it can also cut costs, increase productivity, and improve quality of life for patients.
Chronic Care Management. The key to reducing the financial and environmental impact of chronic care is to enable healthcare providers to prevent chronic conditions from becoming acute ones. Patients with chronic conditions such as diabetes, hypertension, and asthma currently account for up to 75% of all healthcare expenses, with much of that money spent when people lose control of their health problems and end up in a hospital. If people can be kept out of a hospital or if treatment at a healthcare facility can be managed to avoid emergency situations through the use of remote health monitoring systems, the healthcare industry can avoid costly emergency room visits and minimize the environmental impact of healthcare itself. In the end, it is estimated that the potential financial benefit of such prevention could double the estimated net savings that can be realized through EMR systems.
Priority Care Management. One of the greatest challenges to a physician is keeping up to-date on the needs of his patients. In the past, physicians conducted regular rounds of their patients to receive updates and relied on phone calls when they were off-duty. But mobile solutions just coming to market can constantly monitor patients and provide real-time updates to physicians. These services can help physicians make more efficient use of their time and provide them with the ability to remotely issue urgent care instructions if a change in a patient's status demands immediate action.
Rural Health Management. Unified communications and mobile devices allow rural physicians to remotely monitor and interact with patients. These technologies assist physicians when planning travel requirements and allow them to eliminate unnecessary trips. This in turn frees up physician time and resources, letting physicians deliver a higher level of service by freeing-up critical time and resources. In the end, rural physicians can expand coverage to additional patients and devote more of their time and resources to higher priority care cases. This is especially valuable to physicians in underserviced communities.

Nihar Ganju is an experienced systems integration consultant and a computer sciences graduate of JHU. He currently attends FSU College of Medicine where he is exploring how technology can play a more signifi cant role in medicine.

Michael Walsh is the Senior Environmental Communications Manager at Microsoft. He can be reached at micwalsh@microsoft.com or walshtechnet@live.com.
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