DiPP - Healthcare 4.0: A new way of life?

Healthcare has been a recurring theme of workshops organised by DIGITALEUROPE under the banner of the ‘Digital in Practice Programme’ (DiPP). On 23 March, we tried to get our heads around how to collectively agree a better balance between individual and common interest in healthcare.

This is in light of opportunities offered by digital technology in so many forms: Cloud Computing, Big Data, Blockchain, AI, etc. The regulatory framework is gradually adjusting: free flow of data and GDPR are only the most talked about of many steps in this direction. But much more needs to be done if ‘Healthcare 4.0’ is to become a new way of life across Europe.

Highlights:

Summary of the discussion:

In our societies flooded with hyper-connectivity, Big Data, all sorts of apps – in the hundreds of thousands -, sensors and wearables, are we losing controlof healthcare? This question is not overly dramatic. A correct answer will only spur us to move faster towards making the most of the endless opportunitiesafforded by ICT. The 600,000 users of www.patientslikeme.com, or the Swedish app Min Doktor that screens symptoms before sending personalised recommendations are just the forerunners of a more comprehensive array of vital assistance tools to come. Whether you call them Generation Y or Z, our youth won’t settle for the current health landscape. Three sets of action may help meet their expectations: support the transition to eHealth; start at local council level; promote new business models. In short, make government and industry work hand in hand.

Research has identified a wealth of opportunities as well as perceived threats in a clear invitation to enhance the former and assuage the latter. The leading concerns spotted so far include:

• data ownership: patient, doctor, government, company?
• access to technology: license vs acquisition.
• ‘burden of use’ that comes with wearables or other innovative healthcare technologies, for both patients and doctors.
• impact of compromised data: discrimination, surveillance or other negative consequences.
• dehumanizing stigma oftentimes associated with biometrics and healthcare data.

Innovation has always triggered misgivings in humans, way beyond the Luddites: think of regular waves of moral panic in the media business, for instance. eHealth is no exception, but tight cooperation between public and private sectors will facilitate the uptake of data-driven healthcare.

In keeping with the so-called ‘European social model’, policy makers see digital tech as a godsend to move faster towards improved, more cost-effective healthcare in keeping with the goals of the DSM. Faced with mounting socio-economic challenges such as ageing or influx of refugees, policy makers want to provide accessible, sustainable, quality healthcare to all. This requires a 3-pronged shift from intervention to prevention, from fragmentation to individuation, from mere services to value felt. All stakeholders should be heard, starting with people, even before they turn into patients. The trick is to make science, security and people’s concerns pull in the same direction as legitimate money-driven objectives which power healthcare-related businesses. To this effect, the regulatory side combines horizontal rules such as privacy, security, fundamental rights, IP, competition and specific recommendations such as the next Communication coming on the heels of earlier legislation. Effective cooperation within services of the Commission (CNECT, JUST, RTD, SANTE, GROW) is an encouraging reflection of silos breaking up across the outside world.

More precisely, the DSM review identified three health-related priorities:

• Cross-border access to health data
• Personalized medicine supported by state-of-the-art data exchange
• Citizen empowerment, integrated care.

As it happens, technology is available, the regulatory framework is being duly updated but traditional healthcare systems remain reluctant to change: this is, in a nutshell, the frustrating story of e-Health as a 15-year old killer app that has yet to deliver. How to move on to value-based healthcare? We need standards able to measure value: they will make it compelling for healthcare systems to shift from measuring action to measuring value. $40,000 hip replacement is a good start to assess the cost/benefit ration of early diagnosis of osteoporosis, for example. However reasonable it might look, the path that goes from defining value to agreeing standards for measuring it hits a snag as the very notion of measuring is counter-intuitive: who wants to inflict KPIs on herself? Basic psychology thus robs healthcare of incentives to move. However, governments have huge stakes in measuring healthcare, which points to PPPs as a vehicle worth developing.

Business models are another problem. Data is generally deemed to be too sensitive to be entrusted to commercial entities, hence the need for Health Outcome Observatories run as PPPs.

Digital technology is an unquestioned catalyst to make the shift happen from intervention to prevention. With its new business models, the pharmaceutical industry has a huge role to play in this regard too. But ethics must be the substrate on which to build a sustainable $6.5 trillion global healthcare business.

Nurses find policy makers old-fashioned occasionally. Their fixation on data is oblivious to the fact that some data frees them up to provide much-needed bedside services whereas other data is a distraction – if only due to the time spent collecting it for dubious value-, hence a nuisance when it comes to addressing emergencies. Nurses are the unsung heroes of healthcare: they run on top of all satisfaction surveys for inspiring confidence; they hear the real scare of real people, where shame occasionally displaces pain; some clinics are entirely run by nurses, etc. Often seen as the last bulwark against patients turned into data-points, they afford healthcare much of its human face.

This said, by empowering citizens and patients, digital technology is a leading catalyst of value-based health and social care: it is crucial to build trust, at individual, service and system level. Because they are often the embodiment of trust, nurses can coach patients into easier access to digital health solutions.

In short, eHealth, once painted as the killer app of the digital era, is afforded a unique opportunity to make up for lost time by building value and trust through tight cooperation between industry and government, preferably at local level.