2017 / 8 January

Digital Health: 2030

The following article has been submitted as part of a collection of stories from Global Shapers about their views of Digital Health in 2030. The full collection is being collated and submitted to the World Economic Forum.

For the last few days I felt dizzy and fatigued. At night, I get cold sweats and feel nauseous. It makes work tiring and my neck and shoulders are always aching when sitting for the day. After doing some research on the net I decided that I have the flu but when nothing improved for a couple days someone convinced me to see a doctor. As I don’t need a specialist, I go to the local health clinic. I need time off work, so I arrive at 8:30am and start to fill in paper work. I fill out my personal history, but have no idea about my family history. I don’t even remember my blood type — why is that important? There is a long line of people waiting so I start to make small talk. The woman next to me has been using Google to assess her symptoms and is convinced she has cancer, even though she can’t tell me which one specifically. The lady on my other side has found a lump in her breast and needs to understand what that means for her. The guy across the waiting room has not been to the doctor in five years. During that time he has always been thirsty and always had a dry mouth but recently has started to feel constant pain and numbness in his feet. All of these people need some kind of medical attention, but they’re all before me in line. This could take a while and I only have the flu.

Sure enough, I leave three hours later with a prescription for antibiotics. The doctor was obviously tired, having seen twelve people before me. He quickly scanned my poorly filled out paperwork, asked a couple of additional questions and confirmed my suspicions. However even after finishing the course, my symptoms persisted.

Of  the people I met while waiting for the doctor, it turns out the first woman, who diagnosed herself, didn’t have cancer, but needed to exercise a bit more to reduce her blood pressure. The second lady had a benign cyst and needed to monitor it for herself over the coming months. The guy across the waiting room had stage two diabetes, which could have been prevented, if he was better informed of symptoms. As for me, I left with an undiagnosed heart attack. The overworked health clinic didn’t have time to look beyond my flu-like symptoms, particularly as I did not know our family had a history of heart disease and that my AB blood type put me in a higher risk category. Surely the clinic should have had that information;  however I was assessed on a single piece of paper. You could say that I should have known what to ask for if my own research was done through a validated source. What I do know is that somewhere along the way, the system failed me and I suffered as a consequence. For every one of us, the experience should have been different.

The above story was true in 2016. The world of health changed and now in 2030 is very different. Fifteen years ago, the principles of patient and human-centered care were just beginning to be developed, implemented and understood. The benefits of outcomes-based care were slowly gaining traction, but no one had truly realized what it all meant for the future and how dramatic this change actually was. These days every individual is empowered to follow their own health journey. It is the new normal.

It is important to define the role of ‘digital’ in the context of health. Earlier in the 21st century most people considered ‘digital’ to be a website, an app or some kind of electronic or wearable device. But in 2030 people understand that ‘digital’ is an enabler of system design, predictive trends in population health, preventative and proactive health management and individualized care. It is all encompassing.

To understand how things have changed, it’s necessary to look more broadly at how other markets have shifted and why the transformation of healthcare has taken so long, but has been so impacted. Thus to get us to 2030, we must first look at what and who revolutionized the industry.

In 2016, healthcare was at a tipping point. At a time where consumer demand for personalized information and ownership was dragging the industry in a certain direction, consumers were also simultaneously surrounded by the “billion dollar app experiences” created by Facebook and Instagram, the booming shared economy and meteoric rise of start-ups. Thus, the idea that a consumer could receive a poor experience in the management of their health was no longer acceptable. There was a disconnect and it created discord.

Fueled by the internet and age of Dr Google, consumers were armed with greater access to information and an awareness of what that meant within the context of their own health. They were able to draw their own conclusions. However a majority of those conclusions were based on assumptions and alignment to the experience of others. Critical and supporting insights to validate these assumptions were not available or not easily understood. It was a case of consumers making a best guess to what resonated most. It was personal, but not credible.

The traditional ways of working in health care were still dragging their feet, kicking and screaming in the face of the future. Paper-based records, non-transferrable management and an overburdened system meant that the interactions and engagement between provider and client were disconnected. The traditional notion of the family doctor disintegrated in the late 20th century, but nothing had adequately filled its place. As options for care were rising, the understanding was lacking that individual information and shared health data were needed to support continuous care. Instead, data remained locked in a back room and this attitude did not change as the digital revolution started. Records were still kept in one place — this time a digital filing cabinet. Sharing across providers was a struggle, and often denied completely. While the health provider was still the source of diagnosis, the outcome was often dictated by snippets of information. It was credible, but not personal.

In 2030, what had changed?

Behind the scenes the driving force of innovation was the understanding of the value and importance of healthcare. These forces were not coming from the IT and health record providers, but from the consumer providers like Apple and Google. Their focus shifted from the development of wearable devices tracking steps and calorie counters to chronic disease management tools and medical grade devices. As brands, they were finally able to tackle the dirty side of health. Their development was happening quickly, continuous improvement mandated and consumers remained at the core.

This shift was important because it introduced the field of healthcare to industries that traditionally sat outside of the sector. Suddenly, user experience designers, developers, product designers and marketers were collaborating with healthcare professionals and consumers to understand what was important and why. Beyond consumer interactions, digital strategists and system designers started to look at the whole picture and understand that things weren’t just flawed at the coalface, but rather the entire experience was broken. What was needed wasn’t a single app or another wearable device but an understanding of the whole puzzle. However, with so many pieces missing it was difficult to know where to begin.

Entrepreneurs flocked to healthcare, enticed by the trillion-dollar market. A market that was so flawed and so broken that more opportunities arose than anyone could really understand and many people saw big buy-outs ahead. The long-lasting irony is that there is no fast money in health. It is a slow burn because regulations and requirements demand adherence. Sloppy development is just as bad as sloppy data management but consumers would continue to use only the best. Over time, the mavericks of the industry were weaned out because they either burned their cash or burned their attention. Those who remained were the ones who genuinely sought to change the industry. The move towards patient centered care required a generational shift; what became clearer was that this was a technological generation, not a human generation.

Organizations like Google and Apple were able to revolutionize the market not only because they had the money but because they understood how to identify market needs and how to build products that addressed these. They were experts in data capture, analysis and implementation. They were not only able to throw some of the best minds to the problem and reap the rewards, but were able to do so in a considered and concerted manner. The industry didn’t require disruption in the established sense — it required systematic overhaul from every angle. And that overhaul needed to be lead from outside the sector.

Over the next few years, organizations like these started to roll out their products. There was an initial skepticism to the idea that these enterprises could dabble in true health management, but their products integrated so neatly into people’s lives that it soon became a non-issue. As other sectors expanded into virtual reality, proximity-based interactions, Bluetooth connectivity and the internet-of-everything, the mobile device quickly became the mobile health record. Every interaction from the moment a person woke up, all the way through to how they programmed their sleep, was captured, tracked and reported back.

In 2030 this transformation has been supported by the full implementation of effective school and tertiary education strategies, as well as the development of effective algorithms for ensuring that medical information delivered via devices is evidence based. It has given consumers the power to be as proactive or disengaged with their health as they chose. Ignorance is no longer an excuse. It is all a matter of choice.

With this shift in consumer mindset, the health service providers too had to change their behaviour. The fear within the industry was that digital tools would replace workers, but that was borne from not being consulted in the redesign of the process. As system designers and digital strategists started to understand the full picture, they quickly realized that health service providers were as important a customer as the actual end consumer. Without their involvement and uptake no product would establish and maintain credibility and traction in the market. They were critical to success but often overlooked.

Therefore, to understand the change in healthcare beyond the consumer, it is important to analyze how the world of the provider has shifted.

In 2016, health providers would often subvert the system because for them too, it was broken. Photos of patients were shared readily for second opinions, a quick search on WebMD was used for additional information and younger doctors would band together and splinter out trying to create their own products. Some worked, most failed.

The really good products succeeded because they accurately mimicked everyday behaviour while introducing innovation that only technology could. Whether it was immediacy, accuracy or efficiency, these products solved a real problem, thus they attracted users. Most were acquired by bigger organizations as the system began to overhaul itself. And in 2030, like the end consumer, health providers could use their devices to get all the insights into their patients, on the spot and with clarity. They could identify health trends at both a population and an individual level.

Like consumers, they held the accumulation of humankind’s entire knowledge in their hands. Many would argue that this made the role of the health provider redundant. The truth, however, is that the role of the health provider is not becoming redundant. It’s becoming redefined. While the technology had shifted, the human generation had not. Even in 2030, humans are not yet ready to be diagnosed, let alone entirely managed, by artificial intelligence.

Therefore, this redefines the role of the health provider to one with softer skills. The multiple years of study are no longer focused on books and deep knowledge. The years of study are focused on understanding the human impact of diagnosis and being the supporter of the consumer when needed. This role is perhaps more important than it has ever been.

A more consumer-driven, efficient and predictive health system means that more people can be attended to. It means that health providers are expected to act more like coaches and mentors, enabling consumers to find, meet and maintain their health goals. Furthermore, they are still required for human intervention and for identification of edge cases.

Even in 2030, digital health is only as strong as the data that enables it. Machine learning and predictive algorithms get progressively smarter but they work with pre-defined datasets. There will always be a role for the identification of health issues that sit outside the norm, or that have not yet been truly understood. Individual DNA and genome modeling will introduce more data than ever before, but still within that is a need for a truly expert interpretation of the outputs. Therefore there are human capital requirements both for improvement of the data coming in and the interpretation and meaning coming out.

Thus specialist areas of data science started to play a greater role in healthcare. As it was in 2016 (with a generalist or a specialist), in 2030 there is the health advisor and the health analyst. Both play critical roles in the future of health, and these roles are enabled by digital innovation similar to consumers being enabled by their mobile devices.

The final aspect to consider and one impact that is still a “work in progress” is the onus of responsibility and liability.

In 2016 it was commonplace to sue a doctor or a hospital for poor health outcomes. It was becoming all too easy to shift blame and demand compensation from the government. Many of these cases were due to human error, others were due to patients not sharing the whole story, and others to complications that could have been resolved had clearer health records been provided. This meant that often lower-touch approaches to healthcare were adopted by providers to reduce the risks of misdiagnosis or the accusation of poor treatment. This resulted in even poorer health outcomes because health providers no longer had the power but still held the responsibility. Similarly, consumers lacked power as it shifted back and forth in a constant state of flux between providers, regulators and consumers. It was a data hot potato and no one was willing to hold it for too long.

In 2030, that power sits in the hands of the individual. People can share or hide as much information as they want. Thus a policy and legislation change was needed to say that a person could choose not to share some information, but no healthcare provider was liable for mistreatment borne of that decision. Power shifted to the individual due to the system redesign and the services that were created to meet their needs and expectations. Therefore people started to be engaged in their health journey and it shifted from a reactive experience to a proactive one.

This shift was initially consumer driven, then provider driven and finally implemented at a government level. The biggest barrier to changing healthcare between now and 2030 was the immovable object of government. This wasn’t from lack of their desire but from lack of understanding of the role government needed to play. As the technological revolution started to occur, government tried to play the provider role. It invested millions of dollars trying to play the ‘everything to everyone’ hand and quickly became nothing to anyone.

Blocked by layers of bureaucracy, legacy systems and skepticism of open source products, government’s attempts to dip its toe in the water of technology provider spectacularly backfired. And with that, they were overtaken by smaller, more nimble innovations.

Burned by their poor decisions and financial losses, government had to rethink its role and eventually understood it was required to play the infrastructure role. No organization can compete with the infrastructure of government if it’s set up correctly, but that infrastructure is essential for organizations to thrive.

So the final big shift to allow individual healthcare empowerment in 2030 was at the government level. This shift was important for multiple reasons. Firstly, it enabled and mandated data sharing and access across all providers, thus changed the business models of major organizations. Second, it blurred the lines of ownership between agencies and there was no single department responsible for one single person. Government was responsible for all people. Third and finally, it changed how individuals interacted with government and the support they could receive. With power in the hands of the consumer, they too held the onus of responsibility.

A lot has changed in 2030. To get there required a shift at three levels: the consumer, the provider and the government. Consumer driven healthcare is happening now and it’s happening quickly. Health providers need to understand the impact of this and not feel alienated. Health providers need to be understood as customers in a system redesign. The role of the health provider will be redefined, but certainly not made redundant. Government will be the slowest mover but the biggest piece of the puzzle to get right.

Most importantly, with consumer driven health care, the onus of responsibility will shift to the individual and the ability to lay blame on others will be reduced. Empowerment and enablement will be the key themes. These changes will not happen from within the system. They will happen from outside pressures, lead by different minds to those that caused the system to become so broken in the first place. And there will be resistance.

Health is the last bastion of innovation because it’s the most complex and one with the potential to make some of the greatest impact. It will provide a purpose for those with the skills required to make these changes; these skills will be the ones that overhaul the system. Importantly, these skills will come from no single person but will require a shared agenda for success. The picture painted above depends on widespread collaboration, communication, decision-making and innovation. Digital can enable humanity to achieve all of this.


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