Digital transformation is the recent trend in healthcare space, where people have started leveraging digital assets. It is the process of introducing digital technologies in all aspects of healthcare business – payer operations, provider operations, member interactions, etc. It is more of a cultural change and enables improvement in business agility, thereby improving operational excellence and patient experience, and reducing costs.

Driven by the need for value-based care, the healthcare industry is seeing a major shift towards digital transformation. Digital transformation is aimed at bringing an enormous impact on a member’s health and quality of life in a positive way.

Digitalization helps in:

• Better customer experience by enabling personalized healthcare experience with integrated patient access and clinical information exchange
• Full visibility into cost-effectiveness and outcomes
• Real-time access to relevant patient and clinical information at the point of care for more immediate analysis and decision making
• Retention of members/customers, enabling health plans to expand their markets

Main trends of digital transformation are:

• Internet of Things, Remote Health Monitoring, and TeleHealth - Involves the exchange of data between various applications or devices (health monitoring devices, wearables such as Fitbit) to connect patients and providers. This helps in real-time tracking of vital statistics and medical information of members.
• Smart Hospitals – Real-time integration of EHR systems to exchange real-time data; reduce emergency-room waiting time, and track availability and accessibility of hospital facilities.
• Cloud Migration – Most of the stakeholders are looking forward to legacy platform modernization and are inclined towards Cloud migration to materialize the benefits. Cloud enables secure storage and exchange of data which is a mandate for healthcare data as it deals with PHI of members.
• AI/ML and analytics – Digitalization enables AI and advanced analytics that helps in performing analytics on predictive analytics, telemedicine, precision medicine, population health analytics, etc. It helps in the effective use of structured and unstructured data to build an effective analytics model, which helps the industry shift towards proactive/ preventive care.

Challenges in digital transformation:

• Regulation and legal compliance: Regulations can constrain technological progress, particularly in heavily regulated industries, like healthcare. The more restrictive the regulations, the more difficult it is to take advantage of technological advances.
• The complexity of the healthcare industry: A healthcare ecosystem is much more complex than any industry. It consists of a variety of parties, factors, and conflicting interests – security, HIPAA compliance, customer demands, data privacy, employee needs, costs, and so on.
• Dynamic customer expectations: Customers want convenience and control over their healthcare. In today’s digital marketplace, they genuinely expect it. At the same time, they require more control over their data and their privacy.
• Skill sets: As mentioned, many organizations consider their workers to be more digitally mature than the organization itself. However, a more granular view of this topic reveals a more nuanced problem – as healthcare becomes more digital, the need for specialized digital skills will increase.
• Culture: To survive in the digital era, organizational cultures should become more digital, more innovative, and more open to change. However, as with any other change project, transformation initiatives are complex, long-term affairs.