E-health? How about customer service delivery first, please?

Picture this: Its 2020, your wearable wellness device (something akin to a Fitbit) notes that your temperature has spiked and your pulse is well over its maximum threshold. Your health implant corroborates this and adds a bit of information about the chemical make-up of your blood. It’s bad. Given your medical history, a heart attack or stroke may be imminent. Your smartphone, which is linked to your wellness device, makes an emergency call to your ICE (in case of emergency) contact, alerts your doctor, and sends for an ambulance, providing ambulance staff with a GPS location, a full medical history and your current vital signs. Your personal and medical insurance information is shared with the hospital you are en-route to, and with the doctor. When you arrive at the hospital, you are wheeled straight to the doctor or team of specialists standing by to treat you.

Pretty picture? Yup. Real? Nope, far from it. It’s inspiring reading about how technology advances — seamlessly integrated electronic health records, smart devices and apps, biometrics, wearables, injectables, implantables and Internet of Things (IoT)-driven solutions — are going to transform healthcare. The reality is that for most of us getting into a hospital the world over can still mean battling our way through a kilometer of forms, standing in line, and waiting, waiting, waiting for a bed, for the theatre, for the doctor….

Trevor Noah’s riff on American healthcare after an emergency appendectomy strikes some parallels with healthcare all over the world.

“How are you paying for this?” “Well, with my life, clearly”

Luckily for Trevor, he had a billboard to vouch for him. He got the surgery.

The ever present danger in an emergency waiting room is that you die in line, not because there are no doctors to help you, but because you couldn’t get your medical aid and payment details entered into an archaic administration system in time, or get the approvals from the medical aid fast enough. And if that doesn’t get you, it might be the broken systems in the hospital for triaging patients or their inability to synchronize theatres, equipment, and skilled resources.

A case in point is how a public hospital, with the help of a bit of media exposure and political will, is dealing with massive backlogs and long waiting periods for cataract surgery and arthroplasty (hip replacements). In a week-long operation blitz it did 150 cataract and 20 arthroplasty procedures. It’s an exercise it says it will repeat to address the challenge.

Is it then just straight-forward process management? The health department suggests it will try to reduce the backlog by, among other things, monitoring theatre times at regional, central and tertiary hospitals, making better use of hospital beds, especially in the intensive care unit, and buying new medical equipment for public health facilities. So yes, its process management… and clunky administration systems.

Can digital technology, including IoT-driven solutions, be used in a disruptive and transformative way to create a seamless patient experience? Throwing more ‘toys’ (albeit very advanced IoT-based, bio and nano devices and information bytes) into the current mix certainly won’t help — the hospital administration systems cannot and were likely never built to handle that level of input.

We need to get the basics right first.

Inside-out or outside-in?

Healthcare ecosystems comprise the hospitals, the practitioners, medical aids and their administration partners, and the national health systems. Looking from the outside in, healthcare systems seem to be bottle-necking unnecessarily. From the inside looking out, there may be much frustration too.

Perhaps it’s because healthcare, being a specialist area, is stuck with an inside-out business strategy. This approach looks at how the business can best leverage its internal strengths and capabilities; it doesn’t ask the customer for input.

The inside-out approach does have merit. As Henry Ford pointed out, if he had asked his customers what they wanted they would have said “a faster horse”. Inside-out is a powerful system if the “why” of the business, like Apple’s “why” (they don’t sell computers, they sell a change to the status quo) is strong enough.

For hospitals and healthcare systems in general, however, this approach no longer serves. While the service delivered is certainly specialized, healthcare is very much about people, and a smarter, more informed bunch of people at that. An outside-in business strategy, which takes its cue from patient needs and builds the capability to meet those needs, is needed for healthcare the world over.

Unfortunately, there is no quick cure. Standards, open systems, collaboration and shared commitment from healthcare ecosystem players will be essential to create a stable platform for digital innovation.

If IoT and other devices are to make an impact, perhaps they will do so outside the healthcare system first, driving personal wellness and preventative care. Without addressing the basics — the administration systems — new technologies cannot begin to add value inside healthcare systems.