The late Dr Warner Slack, a pioneer in health informatics, once famously remarked that “any doctor, who can be replaced by a computer, deserves to be replaced by a computer.” His statement, which was considered at a time radical, has become nowadays closer to reality.
Any doctor, who can be replaced by a computer, deserves to be replaced by a computer
Indeed, digital health is becoming the cornerstone of healthcare transformation and is proceeding at an inexorable pace: incumbent healthcare systems are ramping digital transformation initiatives, digital health ventures are building new care models, and technology giants such as Google and Amazon are creating large-scale cloud infrastructure that can process data on millions of people and can generate insights at an unprecedented scale and speed. These trends are an indicator that digital health has unequivocally become an integral part of the healthcare fabric. A recent research by CBInsight in late 2019 estimated that nearly $15B was invested in digital health in the US alone — a 33% increase compared to the year before. This growth is likely to continue and it strongly suggests that the future of healthcare would evolve to become digital-first.
And it is for good reasons. Digital transformation is hailed as the key enabler to achieve the three aims of a sustainable and efficient healthcare system: improving the individual experience, improving the health of populations, and reducing cost. It has to also account for the often added fourth aim: joy of practice. As an example, a recent comprehensive evaluation study looked at 49 initiatives funded by the Center for Medicare and Medicaid Innovation’s Health Care Innovations Awards. It reported an evident, yet remarkable, insight: 70% of the studied health delivery innovations included digital technology, by far the most widely-used innovation component among those studied such as behavioural health interventions, community health workers, and innovation in medical practice (e.g. medical homes). Information Technology was also the most cost-effective intervention among all of them.
Nonetheless, the inflicting reality is that the backbone of this digital transformation, e.g. health IT infrastructure, is antiquated and remains reflective of the industry it meant to transform: fragmented, cumbersome, user-unfriendly, siloed and expensive. Electronic Health Records (EHRs) are a case in point. EHRs systems are mere electronic carbon copies of their paper-based predecessor, and thus, inherited its flaws and defects. EHR systems’ biggest challenge is still the lack of interoperability, the same thing that they were supposed to tackle in the first place. In the United States, the Health Information Technology for Economic and Clinical Health (HITECH) Act has distributed more than 35 billion dollars to physicians as incentives for adopting EHRs. The projected cost savings were estimated to be at least $81 billion annually. A decade later, and despite the HITECH incentive package of billions of dollars, the impact of EHRs on healthcare efficiency and safety is still elusive and the promised cost savings unachieved. A similar scenario can be seen in the United Kingdom, where the government has announced £4.2 billion in NHS Digital over five years to digitize the NHS in order to “continue a high level of healthcare at an affordable cost”. However, recent studies show that its progress is patchy, and delivering on its promise is unlikely to be achieved with several reports projecting at best a delay of several years.
Added to these inherited defects is the emergence of new challenges. Today, any disruption of the health IT systems systematically affects healthcare as a whole including its most critical services. As a salient example, the emergent global cyber ransomware attacks are becoming particularly effective in disrupting the industry. In May 2016, NHS England experienced one of the worst disruptions of its services in the last decade due to a cyber-attack “Wanna-Cry”: people were diverted from certain A&Es, appointments were cancelled, and surgical operations were rescheduled; putting thousands of lives at risk. The dire consequences of this attack and the poor response of the NHS is illustrative of the inner working of the healthcare industry. It reveals how vulnerable and inadequate IT infrastructure is. It also points out how impromptu the current workforce and processes in healthcare are in this era of global digital ecosystem.
Moreover, with the recent discontent over lack of data privacy and data sharing transparency shows the rising scrutiny of the public about how ill-prepared health systems and tech giants alike are when it comes to deploying data-driven healthcare solutions that protect the individual privacy and do not benefit other players apart from the people themselves.
While all these challenges and limitations are impeding progress, the digital transformation is inevitable. As it has been the case in other industries, digital has the potential to create new models, disrupt incumbents, and generate new value to consumers. However, in the case of healthcare, the potential to transform the industry is largely thwarted by the way technology is currently embedded. The yet-to-be-seen projected benefits cannot be the result of spontaneous evolution but rather require adopting new ways to create digital tools and services and using agile principles to reengineer the healthcare model itself. Yet, most current healthcare players are a hostage of an adverse ecosystem of their own creation; an ecosystem that is harmful to people and in which information technology is not yet considered a mission-critical part.
Conversely, this stagnation of traditional healthcare players might not be as detrimental as we might think of. They might not be, after all, the ones leading the digital transformation in healthcare. In retailing, it was not the incumbents such as Walmart but Amazon, an online company, which devised a complete overhaul of the way people search, buy and have goods delivered. In healthcare, a similar trend is occurring before our eyes. Alphabet with its multiple health ventures (i.e. Verily, Calico, and DeepMind), Apple, and Amazon are making massive investments in healthcare applications that are data-driven and scalable by design, with the hope to become the next health(care) platform, relegating current healthcare players to mere operators.
Currently, without much speculation, the transformation in healthcare is guided primarily by two factions. The first are tech companies that use technology as the foundation of delivering care services with a relentless focus on the user experience and consumer access to acquire market share. The second are visionary healthcare institutions that are investing substantially in healthcare technology and that can execute it well, can hire talent, and can ultimately pivot their business model. This model is exemplified by Walmart Labs, a truly digital entity within Walmart that is driving much of the digital transformation of the retail giant and, as a matter of fact, is adding a line of work focused on health.
In addition, it is likely to see the emergence of a hybrid model. In the last months, we witnessed an increase in the number of strategic partnerships between tech companies and traditional players, such as the recent partnerships between Providence St. Joseph Health and Microsoft Azure or the more recent one between Mayo Clinics and Google.
At Inception Health — the digital transformation arm of Froedtert & the Medical College of Wisconsin, our modus operandi is a combination of strategic partnerships coupled with an in-house engineering team built around hybrid-technology architecture and agile discipline. This, we believe, will be a fundamental recipe to our transformation. Inception Health follows an outside-in innovation philosophy and we have invested heavily to make a structure conducive to fostering key partnerships. Further, a key integrant of our approach is a relentless focus on maintaining the highest trust of people. For this, we focus on privacy by design and we continuously evaluate our interventions following a rigorous evidence-based research through Inception Labs, our academic arm at the Medical College of Wisconsin.
Concluding on Dr Slack’s vision, as a physician, I look forward to being part of any form of integrated intelligent system that uses technology as an enabler of a better care experience to people whether it is in a hospital setting, through virtual visits, or operated by artificial intelligence. It’s really all about being able to care and provide the best support to people. That is the fundamental element of our mission.