It is no secret that the United States healthcare system is the most expensive in the world. We spend approximately $10,000 per person annually. While about 27.5 million people don't have healthcare in the U.S., waste has reached astronomical levels. The aging population is going to put an increasing strain on the healthcare system. Unnecessary waste needs to be understood and reduced to make it affordable for more people.

Waste in healthcare is not just one problem, it is many different problems with enormous price tags. The Institute for Healthcare Improvement [IHI] recently published a paper called "Trillion Dollar Checkbook" that identifies the many sources of waste and the costs associated in an effort to inspire healthcare institutions to eliminate waste. Let's look through some of the areas laid out by the IHI and talk about some technological solutions.

Harm and safety events cost hospitals about $6.2 billion per year. From infections to medication mistakes, checklists could be used to further reinforce procedural accuracy. Better staff scheduling could help reduce fatigue and burnout that lead to mistakes. Overdiagnosis, another cause of harm, can be helped with the use of wearables. A patient may be exhibiting acute symptoms in the clinic, but measurement over time would help to identify more accurately what diagnosis should be and what treatment would be appropriate.

The IHI found waste from expired pharmaceuticals to cost $790 million annually with the Department of Defense having a stockpile of expired drugs worth over $13 billion. Better supply chain management would reduce these costs. Blockchain technology is well suited to monitor a drug's journey from manufacture to prescription. All stakeholders would benefit from the shared access to the status of any one drug to be able to anticipate need and eliminate stockpiling that leads to waste.

Time wasted with EHR systems is another source of avoidable waste. The article uses an example of how the Veterans Administration [VA] saved 1.5 hours of providers' time per week by eliminating "low-value notifications". This led the IHI to estimate a savings of $1.5 billion per year if low-value notifications were eliminated nationwide. While this is a great savings by just eliminating a distraction, an actual overhaul of the EHR to improve navigation and overall user experience would save even more time. The addition of voice recognition and dictation assistance could reduce or wipe out data entry time. Interoperability would eliminate waiting for records of patients moving between multiple providers. What time and cost savings would be added to the $1.5 billion from these additional improvements?

Operational waste from activity that does not provide value for patient care was estimated to cost $20.9 billion. Utilizing Lean practices can identify and eliminate unneeded processes by enabling front line employees to make changes. Employee empowerment can improve patient care and increase employee morale. This bottom-up method improves the organization through the individuals' efforts.

Burnout and turnover have been a growing problem in healthcare waste. The estimated cost to replace a physician is $1 million. The IHI estimates that a 30% reduction in avoidable turnovers would result in a $22.5 billion reduction in waste. Burnout is a complex problem that has multiple contributing causes, including some of the aforementioned problems of EHR obstacles and operational waste. Also previously mentioned, burnout can be a waste contributor, causing increased mistakes and organizational waste. Other inefficiencies of the healthcare system including regulatory documentation, payer requirements and the lack of supportive technology also cause both waste and burnout. A significant financial and organizational effort will be needed to improve the environment for providers and have a meaningful impact on burnout and its associated negative impacts.

There are many more areas of waste. We addressed about $52 billion in this article out of an estimated total of $760 billion to $935 billion, just scratching the surface. We are also well aware that while technology can provide some solutions, it is also a major cause. What other solutions do you see? What other areas do you want to address? Where do we begin to get a hold of waste in healthcare?