Revolution or evolution, or will we even notice?

Now that I am retired from corporate life, I have time to think — how ironic is that statement?!?

But truthfully having time has given me the gift of being able to step back and look at a situation with fresh eyes.

And so I looked at the evolving landscape of digital health and its impact on health service delivery, health outcomes and the health of our nation in general. We all observe the gradual march towards pervasive EMRs in doctors’ offices, acute care hospitals and everything in between. We hear that such tools are essential if we are to be able to deliver integrated, person-centred care. Oh, and heaven forbid, be incented to deliver health services and not simply silo’d care services. And further that individuals should be equipped with tools and information that enable them to act as full participants in their own health, at the time and place of their choosing. All of this is good.

Now let’s look at the health technology marketplace. Historically this has been dominated by a handful of deeply expert players in one or other aspect of care delivery, be that acute care based CIS, primary care EMRs, or interoperability solutions. All of these “traditional” solution providers have evolved from a long lineage of deep healthcare expertise and focused solutions. And they continue to evolve and bump into each other as they strive to extend their solutions to be system-wide.

But wait, the tech giants are declaring they have an idea for a better mousetrap. Witness AWS, Oracle, Microsoft and Apple, and their various assertions that the interoperability challenges of assembling complete health records, including individual contributions, can be overcome with an underlying cloud-based “tech stack” that promises patient data security. And that in turn will lead to each of us being “in control” of a personalised care plan that emphasises health over care.

How these tech giants intend to engage is not all that clear to me. Today they each in various ways are partners to the traditional health solutions vendors; whether providing underlying database technology or cloud infrastructure. However I sense their aspirations are greater than simply being supporting actors.

But will they stick to it? Healthcare is highly complex and difficult to change – as we in the know, know. We have seen several tech companies come and go from the industry over the years as they realise just how complicated (and perhaps twisted) the health system really is. Too often when the reality of the challenges of transforming healthcare hits, the relative simplicity, pace of change, and generally more lucrative transformation opportunities in other industries emerge, their focus shifts.

In truth I fail to see how they could succeed without meaningful collaboration and true partnerships with the traditional vendors. And perhaps therein lies the most likely answer – the marriage of advanced enabling tech and a deep understanding of the complexities of a rapidly integrating health system.

I guess I am favouring the evolution argument…

However…

Consider the Amazon, JP Morgan and Berkshire Hathaway initiative. These companies want to use tech to take control themselves and remove the “middlemen” as they call them in order to reduce administrative costs, high prices and importantly inappropriate usage for their employees and hence one of their highest cost elements. They don’t trust the system or traditional vendors to do this. Furthermore when they have applied the solution to their own organisations they will be looking to commercialise.
This then starts to look like a revolutionary approach.

Then there are the innovative start-ups (not that all innovation has to come from start-ups). If they can get to scale and attach to the traditional health system, either through partnerships or acquisition, they too can be disrupters.

Oh, and then there is blockchain. Blockchain has been applied to financial transactions for some time now. The question is whether it is a fundamental underlying technology that can finally address some of healthcare’s more vexing challenges related to data exchange and access.

It is clear to me that blockchain has a place in healthcare. However I doubt it will be a ”silver bullet” – indeed healthcare is too complex for such a notion. There are clear examples of good use cases that can propel data integration, exchange and secure access forward. These will be essential to manage those that live with chronic illness, to reduce the administrative burden on the system; to truly allow patients to be integral parties to managing their care; and ultimately to enable a system based of payment for health outcomes.

Perhaps the most important thing that blockchain can enable is trust. However it will require diligent application and strong governance before care providers and patients alike will be comfortable with their data being accessible and usable across the care continuum.

So, is it evolution or revolution? I don’t really know but suspect more the former than latter. Either way we are in for exciting times ahead – perhaps representing the most opportunity for a fundamental change than ever in recent times.

Shifting the paradigm to ‘health in a digital world’

I recently had the opportunity to hear Zayna Khayat, a leading and inspirational health Futurist, speak. She said many things that stuck with me – the most impactful being her view that we should eliminate the term “digital health” from our lexicon. Rather we should talk about “health in a digital world”. I love this pivot! This is the frame we should all be using when we think about the impact that enabling tech can have on health services delivery. We don’t think about digital music or digital phones or digital banking – they are just things we do (bank or call) or enjoy (music). We don’t think about the delivery mechanism (digital). And so we must start to think about health in this way, and not fixate on digital as something new. It is merely the way we deliver services in the current day and age…but that’s a topic for a future article…

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