3/n: Digital Health – Layers of the landscape

Posted by

(Reading time ~ 8minutes)

  • What are Digital health tools? 
  • Collectively, these tools are transforming illness-protocol drive the Healthcare system into a wellness space.
  • A more fundamental perspective on Digital Health constituents
  • Layer 1: Healthcare infrastructure tools – this is where the body meets the Healthcare.  
  • Layer 2: Middleware Health services – This is where the mind meets the Healthcare infra. It helps to split this space into two parts.
  • Layer 3: Consensus Governance:
  • The consensus framework also creates entry-barriers
  • COVID pandemic accentuated digital capabilities for this layer
  • Where does Insurance fit into this change?

What are Digital health tools? 

Like in other sectors, the information and communications technologies (ICT) have been blurring the traditional roles of provider, receiver, enabler, and payer domains in the Healthcare sector. More specifically, Digital Health is how the ICT personalizes Healthcare. The Digital Health tools that have the customer in focus and interact with them digitally can be summarized as below: 

Digital Health Tools

Source: https://www.iqvia.com/insights/the-iqvia-institute/reports/the-growing-value-of-digital-health, accessed on 1 May 2022

Collectively, these tools are transforming illness-protocol drive the Healthcare system into a wellness space: 

The ICT is generating large amounts of information, currently relatively unstructured. As the computing power becomes cheaper and the cloud takes hold with increasing bandwidth, we will find ways to gather and analyze this large volume of data. In an ideal world, the real-time data harnessed by the Digital Health tools will provide continuous bio-marker information. The current illness treatment protocols will benefit significantly from this continuous feedback. The treatments can be hyper-personalized when combined with social, behavioral/psychosomatic, environmental, physical agility, fitness level, and other biomarkers.  

But what is transformative is that these ICT tools are embedded in day-life, and the bio-markers provide live health feedback. This feedback enables novel ways for wellness protocols. We could be moving into proactive health interventions from reactive post-illness protocols that are truly personalized. One example of how a specific sub-protocol of clinical trials can benefit is as below:

Digital Health Use in Clinical Trials for Patient Monitoring

Source https://www.iqvia.com/insights/the-iqvia-institute/reports/the-growing-value-of-digital-health, accessed on 1 May 2022 

A more fundamental perspective on Digital Health constituents: 

The above-mentioned Digital Health tools are conspicuous and provide comparable experience in the hyper-customized service concepts in other sectors; digital disruption is way more pervasive in the healthcare sector. 

Digital disruption, in general, breaks up the components of an existing industry and recombines them, sometimes with elements of completely unrelated sectors, to come up with transformative structures. The resultant structures will bring in the ability to re-wire to reduce costs, better analytics, and the capability to hyper-personalize. 

Drawing on insights from following Bernard Lunn from Daily FinTech (I highly recommend reading his blog book on Blockchain, it has converted me from a skeptical to a HODLER), the Healthcare sector can be seen in terms of three layers:

Layer 1 – Healthcare infrastructure

Layer 2 – Middleware services

Layer 3 – Consensus/protocol governance

Layer 1: Healthcare infrastructure tools – this is where the body meets the Healthcare

These are the nuts and bolts, plumbing, or foundation bricks of the Healthcare ecosystem. These tolls are like diagnostic tools that prick you, poke you, crawl inside you or look into you with invisible sights and so on. Highly specialized and usually away from the comprehension of most of the common folk or even healthcare specialists. Like Doctor doesn’t need to know magnetic resonance theory and physics behind the fMRI machine.

Almost every constituent in this space is transforming rapidly with the help of exponential growth in computing capabilities. Liquid biopsy, 3-D printing, bio-compatible materials, nano-robots, gene-sequencing, and many other tools enhance the slicing and dicing of us to the micro-level. 

New kids on the blocks will be digital sensors or implants hooked to the web. The emerging quantum capabilities are even hazy, like quantum microscopy or cubits being able to model molecular interactions reducing the drug discovery cost to fractions of the cost today. We are gaining mastery over physical (or quantum in future?) infrastructure needed to peer within us beyond the imagination of current building blocks of legacy healthcare infrastructure.

Layer 2: Middleware Health services – This is where the mind meets the Healthcare infra. It helps to split this space into two parts. 

The first one is the Healthcare Provider Mindspace – collective intelligence of the Healthcare sector. Or this is the current Healthcare provider and payer ecosystem driving the current illness protocols – putting together a professional collection of infrastructure tools and diagnosing the health conditions for necessary illness treatments. 

We can loosely map most of the legacy Healthcare sector manpower and recent ICT applications in this layer. Doctors, lab technicians, payers, including insurers, and hospitals, amongst others, form the collective current Healthcare intelligence. 

Digital innovation brings in higher efficiency, enhances capabilities, and reduces costs through better administration. In addition, the medical research feedback loop has significantly benefited from the web leading to quicker drug discovery and assimilation or faster adaption of new illness investigation protocols.

This is the Digital Channel for Health, as I wrote in my last summary of learnings

The other space is the Consumer Mindspace meeting the Digital Health ICT apps. Most of the high octane Digital Health activity is in this space, sometimes much to the resentment of the Provider Mindspace; HealthTech meets the FinTech layers.

Web services, digital monitoring, diagnosis tools hooked to the web, mobile-based constructs for medication or health monitoring, AI/ML efforts to comprehend large volumes of personal data, and the fintech layer will create hyper-personalization of Healthcare. This is where the promise of transforming the current ill-ness-driven protocols into proactive life health partnering with individuals is shaping. 

Layer 3: Consensus Governance

This is our collective mind trying to develop a democratic Healthcare system as we evolve. If you plan to take an active role in this exhilaratingly evolving structure, you will benefit significantly from being close to this consensus governance space.

Principles of Good Health Governance

As I wrote before, the route to hyper-personalization is through the necessary initial mass collection of data. We are individually gifted thinking beings, but under the hood, we are constructs of mother nature with common physiology (including our lizard brain part). The hyper-personalization driven by Digital disruption is based on a relatively shallow external layer of our upbringing and financial and social conditions. As a species, we will need collective data to understand our common physical better at the micro level before adjusting to superficial personal factors. But then that is our life, isn’t it? We really are pretty superficial beings harping on hyper-consumerism (you might strongly disagree based on your age and philosophical convictions :))

This is where our collective mind will be needed. We have significant biases within our current healthcare structure that we need to address. As we understand ourselves better, there is a real danger of perpetuating these biases between race, gender, economic status, etc. Ironically, this danger is accentuated by the very driver of change, the digital disruption. Ethical ML/AI will be a separate class in the course with broader considerations. 

To enable the mass collection of data, we will need consensus on gathering, recording, storing, and exchanging the data from Healthcare protocols. And these protocols themselves are evolving rapidly. Along the way, given the very intimate interaction with the masses, this sector also will be politically sensitive and can even be a tool for political agenda. 

Primarily this layer will use digital innovations to target specific populations, promote broad-based campaigns across sectors, and facilitate interactive communications to prevent disease and promote health. Linked to this primary objective, other areas that need consensus will be identifying and addressing the biases in the Healthcare protocols, evolving sense of fairness, and, most notably, balancing personal data privacy with the need for collecting mass data.  

For example, HIMSS prescribes principles of good digital health governance as in the picture [Digital Health: A Framework for Healthcare Transformation].

The consensus framework also creates entry-barriers 

You may not have realized it, but the enforcement power of this layer depends upon creating entry barriers. Regulations around certification of medical devices and professionals, conducting Healthcare operations, data governance, etc.; with a multipolar political world, the consensus will be hard to come by. 

COVID pandemic accentuated digital capabilities for this layer

The clout of this sector was put to the test in the COVID pandemic. Governments and WHO leveraged digital tools to monitor the pandemic and responses globally. For example, the Arogya Setu, a contact tracing app supported by the Indian Government, was downloaded 215 million times and helped the largest vaccination drive with 1.8 billion doses. In addition, the digital tools were very effective in influencing the social distance, masking, or encouraging the vaccinations. While this helped significantly handle the pandemic, the digital proliferation also brought forward the deep distrust in the healthcare system; conspiracy theories abound. 

Future could be even unexpected

Our finance protocols driven by geographical and political boundaries are already being threatened by Blockchain. Basically, the trust makers, governments controlling the consensus and financial consequences; are staring into an alternative peer-to-peer mechanism. If you are interested, more details are here

Blockchain opens possibilities of alternative structures for the trust essential for an effective Healthcare system. For example, with API-driven protocols, robust decentralized peer-to-peer structures might evolve. But, more importantly, a secure mechanism to own personal data and flexible access control becomes a significant enabler. 

Where does Insurance fit into this change?

Insurers and reinsurers create risk-sharing platforms; it is their raison d’etre. But, more importantly, insurers play a significant role as payers in Healthcare setup.

Life and Health Insurance is all about managing the financial outcomes of the ill-health or unfortunate death and, as such, has current illness protocols at its core. As Healthcare progresses into a wellness place, the very demographic events that life insurance covers and the financial impacts of these events will be transforming. Insurance will need to adapt to preventive protocols and the resulting health outcomes.

What usually is not well understood is that both Healthcare and Insurance need information pooling. Getting a good grip on the average outcome at sufficient granularity is essential. Way to hyper-personalization won’t happen first without having collective data. 

Insurers/reinsurers already influence the Provider Mindspace, influence policymaking, and are crucial supporters of digital adaption. Increased efficiency, transparency, and cost savings directly increase the business opportunities for insurers.

Like other services in the BFSI sector, customer expectations of hyper-personalization of Insurance in real-time with multi-channel support will push insurers even closure to Digital Health. One can even say the InsurTech solutions will be a wrapper around HealthTech, seamlessly merging with customers’ digital lives. 

For parametric short-tail Insurance, it will be easier to adapt. But by nature, the long-term life Insurance space might struggle, as the very tools that are helping to personalize the Insurance will affect life expectations.

My takeaway:

Introduction Digital Health was the first module in the Digital Health and Imaging course. It was pretty overwhelming at first, but a holistic sense is slowly emerging now. Personally, for me, having this thee layer structure serves as pegs to construct a structured picture of this fast-evolving space. 


I currently work full-time at Swiss Re, Bengaluru. The blogs and articles on this website www.balajos.com are the personal posts of myself, Balachandra Joshi, and only contain my personal views, thoughts, and opinions. It is not endorsed by Swiss Re (or any of my formal employers), nor does it constitute any official communication of Swiss Re.

Also, please note that the opinions, views, comprehensions, impressions, deductions, etc., are my takes on the vast resources I am lucky to have encountered. No individuals or entities, including the Indian Institute of Science and NSE Talent Sprint who have shown me where to research, or the actuarial professional bodies that provide me continuous professional growth support, are responsible for any of these views; and these musings do not by any stretch of imagination represent their official stands; and they may not subscribe/support/confirm any of these views and hence can be held liable in any vicarious way. All the information in the public space is shared to share the knowledge without any commercial advantages.