The maturity of digital health?
20 February 2017
Posted by: Heather Smith
Smart Health magazine – Feb. 2017
The maturity of digital health?
By Julien Venne, strategic advisor, ECHAlliance, firstname.lastname@example.org
Over the last 20 years, the healthcare sector has been trying to adopt and integrate the digital technologies, without being really successful. It is like if healthcare was one of the latest impregnable fortress, sealed to the digitalisation of the world.
Some are saying that it’s a question of human nature… admittedly change is difficult, but the health professionals would-they be strange humans, who refuse to adopt digital tools, at the opposite of the rest of earth population?
Or is it the responsibility of the policy-makers and their administration who should re-design the system and are by nature very slow to change?
Or it is because Health requires obvious specific precautions, and norms & standards are barriers to innovation?...
We could continue for a long time but the objective here is not to list the problems but to reflect on the solutions, and to discover if the Digital health is becoming more mature and could be simply called “health”, just as it is for banks where nobody speaks anymore about “e-banking”.
We can observe a few trends, relevant for this purpose.
DATA REVOLUTION! We are for sure in a data-driven world: media, politics, economy, culture, leisure… all sectors are using data to re-invent themselves, self-adapt to the (new) population needs and expectations, for the best and the worst… Healthcare has been conscious of this evolution since many years giving the number of reports, conferences, etc. on this subject. Unfortunately, too often, digitalisation has been understood as the use of informatics in existing processes with massive investment plans of equipment supported, sometimes, by basic trainings for professionals. Obviously, the digital transformation should drive a comprehensive re-design of the system, the workflows, the organisations, the people, the facilities, their strategic objectives and other key performance indicators.
Big Data, Artificial Intelligence, Machine learning… are buzzwords used by all (not always wisely) in every context. Big Data in its classic definition combines the “3Vs”: variety, volume and velocity; Healthcare is a good candidate as field of application: it integrates a large number of parameters and types of data and it requires often real-time analysis and decisions. Using or not Big Data, the artificial intelligence covers 2 different dimensions. First, the traditional algorithmic approach, which is teaching to the device or machine to react to data following a pre-defined scheme. It has been (and still is) the approach for tele-monitoring of chronic diseases: some data are collected from the patients (devices, phone calls…) and other sources (EHR…), an algorithm is applied to these information and instructions, alerts… are given to the patient her/himself and/or to the health professional. The second more recent approach is the machine learning, which pretends to teach to the machine to analyse data, detect patterns and manage to learn from them in order to define strategies of actions. Scientists got inspired by the proper human brain and have built neural networks, able to “think”. Then, we can diversify (real-time or not) data sources, such as clinical data coming from healthcare providers and payers, personal devices (smartphone, wearables…) from the patient but also information related to the genome of the person (more and more services of gene sequencing such as 23andme in USA), or smart cities’ data (traffic, air quality…), of from internet navigation and social networks (Facebook, twitter…) profiles… The list of data sources is endless.
PREVENTION = NEW HABITS? The other important element to take in account is from the healthcare system itself. As everybody knows, the official WHO definition of health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. It would be naïve or foolish to say that the European healthcare systems have been designed following this definition. Most of EU countries still have disease-oriented systems, like “sick systems” instead of “health systems”. But even if the current part of healthcare budget dedicated to the prevention in Europe is around 2 to 3% in most of the countries, innovative solutions are developed for a more integrated care, supporting the citizens in multiple dimensions in order to preserve their health and wellbeing (and not only cure a disease).
As everybody knows, humans are not rational: smoking kill, smokers know that and keep smoking. So, the prevention can’t be reduced to campaigns raising awareness about health risks related to a specific behaviour. The challenge is to make people understand what is wrong in their lifestyle, decide to modify some aspects and adopt new habits. Neurosciences combined with social sciences have developed models around behaviour change and one of the current main question is how to include these technics and methods to healthcare. How to trigger a change? How to motivate people? How to reward a “good” behaviour? And how to engage people on a long-term basis?
The media, the marketing experts and the economists have developed number of methodologies and tactics in order to influence the consumers and the current largest companies, the GAFA, have deployed such tactics to support their expansion, attracting and retaining billions of users, and changing literally our lives.
The question of the role of public systems and insurers in these new approaches is still a question.
HUMAN TECHNOLOGIES. Nevertheless, technology can help and more tech-savvy, digitally educated people are looking for simple solutions to manage their health and wellbeing, using the same principles as the rest of the today’s services: “personalised” and “engaging” services “available anywhere, anytime”.
In order to increase their impact, healthcare systems have thus to use the same channels that people use every day, such as the mobile devices. The mHealth sector has expanded exponentially the last years, with 250,000+ mHealth apps in 2016. The market, evaluated at US$ 10,2bn in 2015, is expected to reach US$ 31bn in 2020. However, the majority of apps downloads are related to fitness activities (54% in 2016). The other pain point is that currently the app retention rates (e.g. the number of people keeping using the app on a long period) are very low. Some companies have understood this trend and propose to the citizens to integrate all health- ir wellbeing- related information and personalised support programmes (stop smoking, weight loss, mental health, nutrition…) in one single app. It is the case for instance of Sharecare, which present itself as the “Facebook of health info”. Sharecare merged in 2016 with the wellbeing programmes and disease management expert company, Healthways, and is offering now a 360º support to users from wellness to healthcare in one app.
Beside mobiles, new technologies are emerging in the consumer market and are promising tools for health and wellbeing. During 2016, Virtual Reality (VR) has entered in consumers’ homes with star products from large players such as Oculus (Facebook), HTC or Sony (PlayStation). The interesting piece with this technology, generally associated with the concept of games, is that it delivers an immersive experience that can generate (quite-real) emotions and feelings. In terms of behaviour change, this kind of tool is powerful as it can simulate (in a credible way) an experience, a habit, a behaviour, and work on it. It could be for a training purpose for professionals or in a treatment approach where a therapist will try to correct the behaviour in a safe environment. For example, the Los Angeles Children Hospital has developed a serious game in order to train their paediatricians and nurses to react in front of what they call “high-stakes, low frequency events”, which are by definition not frequent and not easy to simulate. Another example is the start-up Mindwave Ventures in London, which has developed several VR contents for patients having phobias (germs, crowd) or addictions. Gamification strategies could be used also in order to increase the adherence of people to specific programmes, re-enforcing the meaning of a specific action, or stir up curiosity of the player/user.
So, the maturity of Digital health will be reached when it will be natural to use digital for health-related activities, to have access to our personal data in real time, to receive personalised advices from your health professional, to adopt a healthy lifestyle today to avoid a disease tomorrow, and to be able to improve our wellbeing as we do for other areas of our life.
Then, taking decisions about our health will be a daily banal activity, supported by data and behaviour change programmes, through usual digital tools and channels. Health will then use the digital to become intrinsic.