This blog is part of a series of my learnings through the Digital Health and Imaging Certification program by IISc-Talent Sprint.
Summary (Reading time ~6 minutes)
- Digital Health: A broad term covering the healthcare system being digitally transformed
- What was holding back the adaption?
- Digital disruption is more disruptive than transformative!
- Healthcare industry: evolution and current state
- Digital Health as an Era in the 4th Industrial revolution
- But transformation is picking up; there are three broad areas with a distinct set of stakeholders; Digital channel for Health, Digital Innovation for Consumers and Digital Initiatives for Social Impact
- Hence to summarize, the Digital Health as defined by WHO
- There is some distinction between mHealth and eHealth, both within consumer-enabled health
Digital Health: A broad term covering the healthcare system being digitally transformed:
Like most of our modern life, the traditional healthcare system is also being transformed. Digital health is the convergence of patient data, connectivity and computing power to increase access and provide personalized Healthcare to improve outcomes at a lower cost.
While finance, retail, transportation, and manufacturing have seen the most disruption, health care has generally been considered laggard. Patients have fewer self-service options compared to other sectors and have less access to trusted information on the quality of care. The digital adaption has been in pockets like online video consultations, intelligent self-diagnosis, and self-management tools.
Many other innovations are focussed on targeting cost, quality, and access. The sector has been slow to adapt because it has been a complex web with multiple stakeholders, dominated by solid legacy practices and significant entry barriers. The trust (or distrust) factor plays an important role. Unlike the wellness-focused daily needs domain, illness-focused Healthcare will be skeptical of the slightest changes. It is also a pretty emotionally charged space; patient and healthcare provider trust is based on historical community experience. In a way, it is like insurance, significantly driven by past experience. Entry barriers are higher than usual, as Healthcare is also closely linked with the perception of good governance, and political systems usually resist any changes to the working status quo.
What was holding back the adaption?
For adoption into clinical practice, evidence of the effectiveness of digital innovations is a fundamental requirement, more so than in any other sectors mentioned above. However, it is a limiting first step. The current Healthcare system with legacy practices will be inefficient in ascertaining the effectiveness of the very innovations trying to change it.
Digital disruption is more disruptive than transformative!
The adoption of the changes is also because the resulting Healthcare constructs might be very different from today. The internet dismantled the communication barriers and demonetized knowledge. Increasing computing capability has created broadband highways leading to humungous data generation and to some early abilities to act on the data insight. The result has been a fundamental disruption of the industries. The components of any industry can be broken down and recombined, sometimes in a totally different way, across sectors emerge. Business models that create 10X business at 1/10X costs. The info-highway effectively decimates transaction costs, demolishes barriers to entry, and obliterates intermediates from the supply chain.
Businesses are evolving to be customer-centric from a products-centric market. Product-centric models had lag to the latest consumer preferences, which was okay as consumer preferences didn’t change instantaneously before the internet era. Acting on real-time consumers’ purchasing patterns and habits info, tailored products & services for individual customers on a large scale becomes possible. Necessary massive increases in processing power are becoming a reality by the cloud.
The customer wins as well with so many choices that can actually cater to her needs. Crowd-sourced feedback systems make choices informed, and any price and quality discrepancies get highlighted on social media instantaneously. More importantly, the self-service options make multi-tasking possible. Multiple digital experiences make digital life so on-the-grid; one can want anything at any time through numerous ways of interaction at convenience.
These are the disruptions that are visibly felt by us. Under our feet, Blockchain is creating the possibility of challenging the significant entry barriers too. With the demonetization of trust, the job of good governance might as well be taken away from current political systems. A truly democratized trustless system and weakened entry barriers herald healthcare possibilities beyond comprehension. But then it is a matter for a separate blog; if you are interested, please see here.
Healthcare industry: evolution and current state:
Before attempting to articulate what is Digital Health is, a brief look at Healthcare system evolution is helpful. The industrial revolution has been accelerating, and the transition can be seen in eras. Along with each era, there came Healthcare improvements. From early stethoscopes to sterilized tools to assembly-line produced tools/medicine to x-rays and microscopes. We grew closer to ourselves than never before, to cut and peek and mend ourselves. However, most of the Healthcare system has evolved only lately, during the early fourth era of industrialization.
From https://www.gs1ca.org/documents/digital_health-affht.pdf accessed on 30 April 2022.
Digital Health as an Era in the 4th Industrial revolution
The ongoing 4th Industrial revolution has created quite a few interacting innovations, big data analytics, artificial intelligence, and even more to come with Blockchain and quantum computing. These aren’t any more step changes, but together can push us into a great leap forward, totally unknown and exhilarating.
Digital health has been described as an era (Rowlands, 2019), a progression along the evolutionary path of information and communication technologies (ICT) in Healthcare, embedded in this rapidly evolving fourth industrial revolution.
A good summary of how the Healthcare sector has evolved as the interplay of different stakeholders is below.
From https://www.gs1ca.org/documents/digital_health-affht.pdf accessed on 30 April 2022.
Dotcom bust in 2000 decimated many digital start-ups, but the innovations came out stronger. An innovation once invented can’t really be un-innovated. From limited corporate support in the early days, the re-born digital trends have helped to develop health information as a discipline, accelerated drug discovery, and more effective procedures. The emergence of E-Health enabled us to comprehend the problem of living longer with some of the lifestyle facilities that were not even available to the ruling classes couple of 100 years age, chronic illnesses, and lifestyle diseases.
Note the 2020+ column, the healthcare system will be more holistic wellness-focused than the current illness/treatment paradigm.
But transformation is picking up; there are three broad areas with a distinct set of stakeholders:
Unlike other industries, Healthcare needs more extensive social mobilization to be effective, mainly for two reasons. First, the trust level of a consumer in the healthcare system isn’t great; the legacy illness treatment protocols aren’t consumer-centric. The complexity of Healthcare and the medical profession is held in awe; they appear almost god-like apart from being costly. The second reason is that it is highly politically sensitive; the buck for any shortcomings stops at governments, hence zealously regulated. Iron-clad entry barriers don’t facilitate innovation.
Given the need for significant alignment between disparate stakeholders, Digital Health’s definition will come from the most critical stakeholder who can drive the emergence of a connected Digital Health space.
The Traditional Healthcare system operates across three physical spaces, hospitals, clinics, and homes. Like other sectors, the digital dimension is evolving to immerse these physical spaces into an all-encompassing Fourth space, somewhat like ether, blurring the boundaries.
Source: Digital-Dimension.pdf (imperial.ac.uk) accessed on 30 April 2022
This Fourth space is led by a distinct set of stakeholders.
Digital channel for Health: Players in the traditional Healthcare system, providers, and payers are deploying digital and social media to improve productivity, quality, and access to services. Broadly providers are hospitals, labs, physicians, and pharmacies. Payers are government, insurers, employers, and employer coalitions and individuals.
Typical examples are follow-up consultations by e-mail, online laboratory results, and mobile access to radiology images.
Digital Innovation for Consumers: This space is being developed by start-ups and established companies in the technology and consumer goods sectors. New digital and social media tools are being developed for patients and their caregivers to manage their chronic illnesses. Online communities provide additional support layers and comfort. New tools also help to understand and manage medical conditions with convenience and lesser cost. More importantly, staying healthy is getting a big push; online communities provide great motivation and benchmarking efforts and progress.
Digital Initiatives for Social Impact: Governments and organizations from the public and private sectors are leveraging digital innovations to target specific populations, promote broad-based campaigns across sectors, and facilitate interactive communications to prevent disease and promote health.
World Health Organization and UNICEF have several initiatives to adopt digital technology in their work. With the influence these organizations have on the Governments, they also provide a broader consensus definition for the emerging Digital Health.
Hence to summarize, the Digital Health as defined by WHO
Digital health: The use of digital, mobile, and wireless technologies to support the achievement of health objectives. Digital health describes the general use of information and communications technologies (ICT) for health and is inclusive of both mHealth and eHealth. [WHO]
There is some distinction between mHealth and eHealth, both within consumer-enabled health
mHealth is a term that refers to mobile applications that are designed to provide information to both patients and their care team. These applications can monitor prescription adherence, log the patient’s heart rate, and track fitness levels. Examples include Fitbit, Google Fit, Samsung Health, and Apple Heart Study.
eHealth as a term, on the other hand, refers to products that are not so much “applications” as they are systems. They are made to deliver health services through electronic means. These systems create the infrastructure to provide health records, patient files, lab results, and general administration needs online. Examples include myhealthrecord and Kaiser Permanente’s online health portal.
A good amount of explanation on differences and nuances is here if you are keen to follow up.
Interestingly you can consider both mHealth and eHealth as subsets of Consumer-enabled Health, which is described as focusing of a health system on meeting and delivering on the consumer’s individual needs, values, and personalized health goals.
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