Showing doctors the way to lower cost, improved care

One challenge of the United States’ health care system involves keeping costs down while simultaneously improving the level of quality care. Cedars-Sinai Health System in Los Angeles has adopted electronic medical records in accordance with the Choosing Wisely campaign, which offers guidelines on different tests and treatments to reduce wasteful or harmful ones for patients. The electronic medical records have helped doctors by alerting which prescriptions to avoid, and have overall reduced health care costs by $4 million.

The University of Benin Teaching Hospital implemented an Electronic Medical Records system in 2011 that has now been deployed across more than 75% of its services. The system digitally links all hospital departments, including registration, clinics, laboratories and pharmacies, allowing patient information to flow electronically rather than through physical file transfers, preventing medical records from being lost or misfiled as they were in the paper-based system.

An electronic human resources system has reduced health worker absenteeism in Uganda, improving health service delivery across the country. The tool requires workers to sign in and out, pushing them to show up for their shifts and allowing supervisors to more easily reward good performance and adjust staffing levels.

ER staff often have no idea they are sharing patients with other hospitals just a mile away. So they treat those patients completely independently, often repeating tests unnecessarily, assigning them multiple case managers when only one is needed and offering contradictory advice. In Alameda County, hospitals are now sharing patient records of “super-users” to save money and avoid duplicating medical treatment.

The rate of Cesarean sections is on the rise in the United States, despite the higher risks of hysterectomy, hemorrhage, and infection, as well as the elevated expense. San Francisco General’s maternity ward, however, stands as an outlier by following evidence-based medicine that suggests decreasing C-sections and has also shifted from a pay-per-service incentive for the doctors to a salary or shift position.

Digital public infrastructure is helping African countries build more sustainable health systems by replacing fragmented, donor-funded projects with interoperable digital services. In Zambia, for example, the SmartCare Pro electronic health record system uses thumbprints to identify patients and track chronic diseases like TB and HIV, ensuring continuity of care, where it was historically missing.

Researchers from Stanford University have developed a software that uses machine-learning algorithms to identify and flag urgent faxes about COVID-19 cases. While the project doesn't have complete accuracy, it has helped overwhelmed and overburdened health care workers at the health department in Contra Costa County, California work more efficiently.

Rural hospitals across the country often struggle to stay open in states where Medicaid has not been expanded, but a method known as "swing beds" has helped two critical-access hospitals in Georgia to avoid this fate. This method, which allows hospitals to swing beds from "only patients in need of acute care to those who no longer require the emergency department but still needed more treatment before a nursing home," allowed for the hospitals to pay off debt and expand services.

Public private partnerships are helping hospitals in Nigeria provide more efficient care, especially as it relates to maternal health. In Lagos State, the model – which partners a private healthcare management firm with the hospital – has helped better equip facilities so more laboratory tests can be conducted in one place. Although this solution doesn't necessarily solve all problems faced by those seeking care, it has helped to provide a more sustainable model of healthcare in many cases.

Maryland's health care system is based on three pillars – all-payer rate setting, a global budget, and total cost of care – that, together, have shown positive results both for the patients and for the state's hospitals. Although evidence of success with regard to health care costs is limited, the model of incentiving investment in community health and preventive care has shown success in reducing readmission rates for hospitals across the state.