Future of Digital Health

Future of Digital Health: For a world that is learning from a pandemic, what lies ahead for the patient of the future?

The future of digital health pertains to a myriad of technologies put together. Whether it is Artificial Intelligence (AI), advanced health sensors, genomics or  robotic surgeries, or all of them put together, digital healthcare is very much technology-based only on paper.

What really matters in digital healthcare is how much of a cultural transformation can digital health and traditional healthcare go through.

The typical doctor-patient relationship as part of its legacy hierarchy could be transformed into an equivalent partnership between the two. It involves a passive patient turning into a proactive e-patient, or a physician simply changing into a medical guide within the plethora of medical information around.

This kind of transformation is far more beneficial and essential, as compared to the futuristic technological advancements. These developments in technology would only complement this cultural shift. While these cultural changes were initiated by technology and innovation, however, they are not driven by technology directly.

Dr. Bertalan Meskó, Director of The Medical Futurist Institute, says,

“Assuming that the patients are given 20 state-of-art technologies for them to use, there is no way all the huge chunks of data can be analysed and uploaded into the medical records without the help of a physician. There won’t be any significant improvement in healthcare and disease management unless there is an equivalent patient-physician partnership established.”

Simply putting it, the future of digital health signifies that the doctors are going to come to the patients themselves, for the Points-of-Care. The patients will have direct access to treatment, diagnosis and monitoring coming to them wherever they are, with only the doctors approaching them, but not the vice versa.

North Star for Healthtech companies

The lines drawn by healthcare companies tinkering with digital health should have to be strictly around establishing a ‘Point of care’ mechanism. If these companies develop something that does not support this form of a long-term goal, they might actually be going against the fundamental nature of digital health.

• Besides, patient design is something that can help healthtech companies align themselves with the vision of digital health fully.
• Only if and when the upcoming products are appropriately in-line with what the patients really need for diagnosis, would the healthtech companies be successful in their business as well.
• This involves keeping the patients a part of the highest-level decision-making processes at these companies.
• Imagine a patient-design advisory board consulting frequently with the CEO or Founders’ office directly.
• If companies have something like it established, they are bound to develop products and services highly aligned with the clinical needs of real-life patients for their treatment and disease management.

Dr. Bertalan said,

“You’d be surprised with how much certain categories of patients can contribute to the table, if they are brought on to this advisory board. Some have an economics background, some come from science, some are scholars who publish papers and journals for medical practice. While it might seem like a strange concept involving patients in chronic diagnosis, treatment design and even building technologies, it is indeed a reality in some markets.”

He adds that there are thousands of patient contributors who actually end up becoming keynote speakers at healthtech forums and conferences. Some go on to publish notes and papers in medical journals, have been very vocal about their medical needs on social media. 

This goes to show that a strong sounding board to the CEO need not necessarily involve healthcare professionals and experts but also patients.

Hospitals and Digital Health

Many hospitals market themselves to be paperless and contact-less. But even in 2020, there is still a large room for improvement and optimization. While the transition takes time and is understandable, it need not mean that the future of healthcare should solely be about shiny, bigger or more modern hospitals.

• The objective for these hospitals should be around providing healthcare at the comfort of a patient’s home and wherever they are.
• The patients should not have to visit the hospital unless they want to meet the medical professional in person or have access to any equipment like MRI and CT which they would not have at home.
• While the larger picture is about bringing healthcare to the patients directly but not the vice versa, the obvious steps forward would be going fully paperless, using 5G technologies to connect the devices and so on. 

As for India, 80-85 percent of medical consultations are now going online and telemedicine is on the rise. Of these, around 50-60 percent of patients are happy and satisfied with the treatment and diagnosis. While this is a huge shift as compared to the pre-COVID times, a holistic overall adoption of these trends is yet to fully play out in the country. We will also see the rise of verticalized, full-stack tele health platforms across indications such as mental health, oncology, cardiology and chronic care gain momentum as deeply focused points of care providers. The benefits to patients would be standardization of care, cost effectiveness and ease of care.

Roadblocks in Digital Healthcare

With so much buzz and noise around using AI in healthcare, there is only a small set of stakeholders that truly understand the real impact and application of it. When policymakers, investors or the innovators don’t understand the true application of AI in healthcare, they tend to overhype it and suddenly, every company is using AI.

• Rejection from the medical professionals is touted to be a major roadblock when it comes to digital health. It is not because what’s going on, but most medical professionals and physicians have not received any formal education when it comes to digital healthcare. Digital health is a part of the medical curriculum in only 5 or 10 universities worldwide.
• Another obvious roadblock is the lack of regulations. Imagine Mark Zuckerberg having to explain how Facebook worked to the senators in the United States. The same set of policy makers would also have to understand how something like Artificial Intelligence can be applied in the medical fraternity and digital healthcare. This is a natural transition that takes its shape and progress only with time.
• Another roadblock is that many ethical standards are still missing in today’s world. These technologies in healthcare have become accessible to the world so rapidly, that the healthcare professionals haven’t had the opportunity to get accustomed to them while digital transformation was happening.
• Due to the excess in technology, there seems to be a financial and a biological gap that gets bigger within the societies, which is clearly not acceptable in healthcare.
• There is an infrastructure issue, where a primary healthcare physician from rural Hungary or rural India might not get the necessary access to Artificial Intelligence
• The other factors impeding the formation of some revolutionary companies in healthcare in India are disparate incentives for all stakeholders involved, time taken to build trust, and the lack of sufficient and reliable evidence to support the cause for widespread adoption, lack of cohesion and lack of standardization of care.     

Many patients go online and read a lot about these technologies and tend to formulate their own plans for diagnosis. Further, they might expect the medical professionals to act accordingly as well.

“It is not a mere product-based service that you want to get done by the physicians but a partnership at a very basic level. It cannot be a way of healthcare where the patients demand service from the doctors.”

The real opportunity for startups comes only with their capacity to derive meaningful conclusions from the enormous amounts of data coming from health trackers and devices. While there have been many first tries, the success rate has been quite low, owing to the many challenges and roadblocks for these companies to scale smoothly.

Managing a pandemic in the future

If there is one thing that COVID-19 has pandemic is bound to teach humanity, is it be better prepared when similar outbreaks arise in the future. A healthcare startup BlueDot from Canada, in its report, shared that the outbreak is fast spreading in China even before the World Health Organisation (WHO) has reported it.

The startup’s outbreak risk software helps and mitigates the exposure to these forms of infectious diseases using Artificial Intelligence.

It goes to show that healthcare organizations, governments and public health officials would have to rely on these AI-based systems in the future to prevent similar outbreaks from reoccurring. Telemedicine should have been a norm already a decade ago, but is becoming the new normal only now.

What will a patient from the future look like?

The step zero would be to go online to find forums and groups for peer support, second opinions and finding information and questions about the health issues people have.

With all the smart devices available, it’s about time people start measuring their sleep quality, fitness activity, genome sequences, and start to gather data around the possible medical conditions they are at risk for. Based on this data, they would want to consult their primary healthcare physician and prepare a preventive plan and necessary measures.

There will be greater emphasis on translating discussions to actions in value based healthcare. In India, the translation would be through insurance companies actively managing and tracking their catchment population’s health and enabling them with customized insurance products to take proactive care measures outside the hospital setting. With the current private insurance penetration less than 10%, and touted to grow more than 30% in the next few years, we expect to see comprehensive insurance care management plans in India. 

While these steps are really small with respect to the larger scheme of things, the real patient from the future should be able to access healthcare cross-borders.

“It might sound like a big thing, but a patient’s healthcare records and data must have to be in his or her country’s native medical records. People themselves might not be able to cross the borders for healthcare, but Data can. Just like goods and services are now being shipped and transported all around the world, globalised healthcare access should become a thing of normalcy for the future patient.

• If there is a cancerous tissue sent to a startup in Belgium that specialises in sequencing the DNA of the tumorous sample, they would simply use a cloud database in the US to identify if there are any matching clinical trials pertaining to the condition.
• Based on the mutations in this cancerous tissue, if there is a clinical trial in a French pharma company on a Spanish island, they would look for the patient’s specific genetic mutation and the subsequent medicine.
• This means that the patient would get a precise medicine-based customised treatment plan for the cancerous tissue without having to meet anyone from the native or national healthcare system. 

We believe that AI applied in diagnostics, digital therapeutics, drug development and remote care management will enable holistic, proactive and personalized care outside of the hospital setting.

The Privacy Conundrum

Without a patient’s data in place, there cannot be such a thing as revolution in AI or digital health advancement. With patient data coming in from various sources like digital health records, fitness trackers, genetic tests, online choices and lifestyle habits, there is also a level of privacy breach also involved equally.

• As long as the patient makes a choice on how much of this privacy he or she is willing to give up in exchange for a longer and healthier life, it does hold right under ethical standards. However, the situations are very different from country to country, with plenty of corresponding restrictions, and hence it is an ethical bet at the moment.
• So it is imperative that enough policy makers, medical professionals and public healthcare officials get to understand what is really at stake, to ensure that the ethical nightmares do not turn up.
• However, the patient would not want his or her relationship with the primary healthcare physician to be remote-only. There is a certain level of trust and understanding built between the patient and the medical professional which only humans are capable of building. 

While this is possible only by meeting with the doctors in person and in real-time, the possibility of healthcare being remote is completely ill-advised.

“While healthcare will not and should not move to a remote-first approach, it is critical that all the stakeholders involved should understand that a certain cultural transformation is necessary to improve digital healthcare.”

For Entrepreneurs building startups in Digital Health

●        Patient Design

Any founder, even thinking about developing a product or a business model in healthcare and digital health, would want to embrace the philosophy of inculcating a patient-advisory board reporting to CEOs.

●        Point-of-Care

Digital health is making the patients the points-of-care, and healthtech founders would want to make this a part of their business thesis. Any product or service the team is coming up with, would have to be in complete alignment with the Point-of-Care philosophy.

●        Cultural transformation

Understanding that the typical hierarchical model of a patient-doctor relationship can be broken down into an equal partnership is what should amount to the impending cultural transformation.

●        The Regulatory Challenges

Despite the fact that it is very hard to develop healthcare solutions passing all the regulatory barriers, it is important that founders consider the possibility that healthcare has to be a globalised system. The more global approach an entrepreneur has, better are the company’s prospects to spread its products and services to more countries. In India, with the advent of NHM, EMR integrations, data access and insurance upsurge, starting healthcare companies in India will become easier in the future.