The eHealth revolution: Vitally important, long overdue

In a perfect world, COVID-19 would not have caught us off guard. Instead, we would have detected the first cases using artificial intelligence, sounded the alarm, and triggered a carefully orchestrated cascade of events: Data on patients and the virus would have been made available to stakeholders across the healthcare sector, driving a globally coordinated response. Those infected, and everyone else, would have been instructed on how to protect themselves and to contribute to slowing the spread of the disease. Healthcare facilities would have seamlessly transitioned patient flows to isolate those infected from the rest and replaced human workers with robots wherever possible. And like hospitals, social life, commerce, work, and the industry would have been prepared to adapt to the new normal.

In that perfect world, we’d already be at the tail-end of a full digital overhaul of the healthcare system. Not with sci-fi technologies such as 3D printing of live organs, the full reversal of paralysis, or gene-editing babies, but simply with technologies that are already available today: dedicated smartphone applications, teleconsultations, electronic patient records, widespread adoption of wearable medical sensors and connected medical devices, hospital robots, highly secure Big Medical Data, and perhaps even transport drones. Thanks to their data-driven response and open and transparent communication, governments, guided by science, not politics, would have gained the trust of their citizens, who would be eager to contribute to halting the spread of the virus to keep it from morphing into a fullblown pandemic.

An obvious question remains: would such a technocratic utopia be desirable? Compare it to where we stand today. After initial attempts to contain the virus in Wuhan, China, the virus spread to all four corners of the globe. Some countries, in particular those affected by the SARS outbreak in 2002-2003, responded on cue, successfully quashing the virus through aggressive testing, quarantining, and contact tracing. Others failed catastrophically, causing infection rates to surge for months to come. At the time of writing, almost 40 million cases have been diagnosed, close to 30 million have recovered, and over one million have died from the disease as its hotspots have traveled from Asia to Europe to North and later South America. These numbers are likely dwarfed by undiagnosed cases of the disease.

“Digital technologies can address many of the weaknesses of today's healthcare system.”

A stress test for the global healthcare system

While it is far from over, COVID-19 has been a harsh stress test for the global healthcare system. And, let’s face it, it came out humbled. Not that that should have been a surprise. Despite tremendous victories over the past decades – eradicating smallpox, reducing child mortality, including in the developing world, making AIDS a largely manageable disease, and improving the survival rates for cancer to name a few – healthcare services are, by and large, seldom described as a paragon of high quality, efficiency, equity, affordability, and accessibility. Yet, according to an assessment of the impact of the digital transformation of health services by the European Commission (EC), these five points describe the goals they should aspire to.

According to the World Economic Forum, the pandemic revealed a number of gaps in global healthcare systems, in terms of funding, access, a shortage of healthcare workers, and insufficient research capacity to develop a coronavirus vaccine without hampering ongoing research into other pressing health challenges. In an article published in the Journal of Public Health, researchers have lamented that the pandemic exposed the “hollowness” of the notion of equity and collaboration between the Global North and South. And fissures opened by the pandemic left scars outside of the healthcare sector as well, contributing to the rise of the Black Lives Matter movement in the US, fueling social movements in South America, and uniting an eclectic mix of activists in anti-mask and anti-lockdown protests in the world’s capitals. When the healthcare system coughs, society catches a cold. Digital technologies can address many of the weaknesses of today’s healthcare system at every step along the patient journey, with an estimated global economic impact of $1.6 trillion by 2025 according to McKinsey. They offer new ways to connect patients with their caregivers, to improve acute care by directing patients’ immediate needs away from overfilled emergency rooms to online consultations, and even to move care away from hospitals and clinics to people’s own homes. They can help patients with special needs reclaim lost autonomy and encourage patients to play a more active role in their own health and wellbeing.

Why technology has failed to stick

What, then, has kept the healthcare sector from adapting to the digital age? In a podcast by McKinsey recorded before the pandemic, two of the firm’s senior partners took stock of the challenges facing global healthcare systems. From one side, they argue, healthcare systems are confronted with societal and demographic challenges of an aging population and the shift from infectious diseases to long-term chronic conditions often caused by a poor lifestyle – diabetes, cardiovascular and neurological diseases, cancers, and obesity. From the other, they are under pressure due to the constantly rising cost of care, partly explained by the shift in prevailing pathologies, but also by the rising costs of treatments and personnel.

In the healthcare setting, they argue, the competitive pressures that forced other industries to modernize and adopt technologies to increase their efficiency have failed to act, be it fore motional or pragmatic reasons. Consequently, more affordable and efficacious treatments often failed to replace well established yet more expensive ones, effectively disrupting the technological disruption that leads to efficiency increases in other industries.

Scaling up local successes

Accelerating the pace of technological adoption in healthcare is critical. But because of the way we are wired, it’s also a hard sell. As Matthew Herper, a columnist at STAT News, put it: “We tend to overreact to problems that are facing us right now but underreact to long-term threats that build slowly. [...] We panic, but we don’t prepare.” Face masks are a case in point. Toilet paper is another.

But prepare we should, and not just for the next pandemic. With the abundance of technological solutions that are already available to alleviate pressure on the healthcare system, improve the quality of care, realign it with today’s needs, and bring down costs, the sector’s digital transformation is vitally important and long overdue. Not only in developed countries, but in the developing world as well. A collection of isolated pilot studies and full-scale deployments scattered around the globe show how locally applied technology has already improved healthcare in both expected and unlikely places.

On our roads, for example. The EU has mandated that all new types of cars produced after 2018 feature an emergency call system, eCall, that automatically sends vital information such as location, the direction of driving, and the number of passengers to emergency services in the event of an accident. It is expected to save thousands of lives each year by speeding up emergency response. Or on our wrists. In Scandinavia, it is increasingly becoming expected for people with dementia to wear GPS trackers to keep family members and caregivers informed on their whereabouts when they leave their homes. These trackers, like those worn by lone workers, are typically equipped with inertial fall-detection sensors that can send out alerts in the event of an accident.

Around the world, the COVID-19 pandemic saw the adoption of teleconsultations and other forms of virtual care surge, as people seeking medical help stayed clear of medical facilities for fear of contracting the disease. In India, there was a 500 percent increase in teleconsultations in the early months of the pandemic, 80 percent of which were first time users. As a result of positive experiences, support for telehealth and mobile health has increased throughout this initial phase of the pandemic, to where it has become palatable to a majority of those surveyed, if not their preferred channel.

Ground-based and airborne robots have proven themselves in a variety of medical use cases. Today, drones are regularly relied on to fly blood to remote sites in Rwanda and India, AIDS tests to clinics in Malawi, and quarantine-related supplies in China. Hospital robots disinfect rooms, replenish supplies, and lug clean linens to patient rooms. And care robots can support disabled or elderly patients at home or in the clinic, while robotic avatars can let bedridden patients, old and young, partake in social activities and school classes.

In any other sector, solutions that demonstrably improve the quality of service while cutting costs would flourish. For reasons we’ve already outlined, this hasn’t been so in healthcare. But if the COVID-19 pandemic has shown us anything, it is that, when pressed, we are able to find the societal willingness and the financial means to overcome our resistance to change and adopt new solutions.

"When pressed, we are able to find the societal willingness and the financial means to overcome our resistance to change and adopt new solutions.”

With new technologies come new opportunities

Ever since the advent of information technology, analog and then digital sensing, wired and then wireless technology, the healthcare sector has, at least at the margins, sought to leverage these to its benefit. But the current confluence of innovations, their affordable cost, and their increasing ubiquity across society have changed expectations. Whereas in the past, they would have been seen as futuristic enhancements to a well-established system, today, it’s the absence of digital initiatives to improve the sector’s efficiency and performance that can seem difficult to wrap one’s head around.

How is it, for instance, that in this day and age many medical professionals still take notes on paper, which they later have to transcribe in digital form, before storing them on closed servers? Instead, they could directly take notes using smart devices, from where they would be aggregated with all other relevant clinical information in electronic health records (EHR), also referred to as electronic medical records (EMR). These could be securely shared between medical professionals within and across clinics to facilitate collaboration, allowing easy access to up-to-date, complete information on patients, and assisting in the delivery of faster diagnosis and safer care with fewer medical errors. Efficiency gains could further let medical staff spend more time treating patients and less time taking care of administrative tasks, in the best case leading to overall cost reductions.

Then there are distributed ledger technologies (DLTs), which offer a means of securely managing databases of interoperable electronic health records while ensuring the privacy and confidentiality of sensitive data. Additionally, by formalizing the governance of personal health records, DLTs could act as a framework to manage consent and permissions for data use, making patients the ultimate owners of their own health records. Most implementations do not store the healthcare data in the ledger, but rather metadata regarding ownership of and access rights to that data, be it for care or for medical research. The need for such technology will only continue to grow as users capture and eventually hope to mine an increasingly rich and diverse health dataset for insights.

As artificial intelligence algorithms become increasingly capable, they too will find broad application across the healthcare industry, with the main benefits falling on robot-assisted surgery, virtual nursing assistance, and administrative workflow assistance by 2026, with a total savings potential estimated at US$ 269.4 billion, according to an article published in Forbes. Rather than replacing human caregivers with AI, it’s far more likely that AI will augment the current medical workforce by supporting diagnosis, decision making, and medical interventions.

And just as artificial intelligence augments practicing medical professionals, mixed reality could transform medical education, allowing students to explore human anatomy through the practice of virtual dissection. Doctors could use it as a powerful communication tool to explain surgical procedures to patients. And in the operating theater, surgeons could rely on mixed reality to guide them through complicated interventions. Researchers from the German university of Duisburg-Essen have also evaluated the potential of augmented reality to help employees correctly deliver first aid in the event of workplace accidents – a concept that could easily grow out of the workplace and into a more diverse set of scenarios.

The road to the future is rocky

The opportunities digital technologies present to improve the delivery of primary care are huge. Still, the obstacles that need to be overcome are considerable. Some of the pushback is coming from within the establishment. Doctors are often reluctant to accept the increased transparency in terms of cost, quality, and performance that a more digital healthcare system would bring. And because of the opaque pricing schemes used today, those well versed in long-established procedures have little incentive to switch to more modern ones, even if they are cheaper. Ultimately, as a report on promoting a digital transformation in healthcare by McKinsey points out, going digital would require leaders in the pharmaceutical and medical technology industry to reassess their culture and mindset, their organizational structures, and their governance.

There’s resistance coming from outside the establishment as well. Often, it’s customers who, not always without reason, lack trust in national health authorities or feel uncomfortable with having their entire medical history stored on a database, where it could become the subject of the next big data leak to make the front pages. The security, privacy, and confidentiality of their data is not something they take lightly. And resistance comes in other forms as well. One point discussed in the McKinsey podcast referenced earlier on is that the recipients of healthcare are often uninterested in studying available options and appear at the clinic willing to follow the first course of action that they are presented with.

Systemic issues are at play as well. For all the benefits they may bring in increasing the transparency, availability, and the quality of healthcare, the financial return on investment that they deliver is not yet clear. With healthcare budgets constantly under pressure, finding ways to get a positive ROI will be essential to boosting the adoption of digital healthcare technologies, in particular in less wealthy countries. As a result, the digitization of healthcare could deepen the digital divide between developed and developing countries. According to an OECD report, development finance could play a critical role in strengthening health systems that have been weakened by the ongoing pandemic.

“The ongoing transition from volume-based to value-based healthcare is demonstrating how digital technologies and new healthcare models can achieve a positive ROI.”

The ongoing transition from volume-based to value-based healthcare, seen, for example, in the US, is demonstrating how digital technologies and new healthcare models can achieve a positive ROI. Rather than compensating doctors for the treatments they prescribe in a fee-for-service model, value-based healthcare ties fees to measured patient outcomes, with the objective of improving performance metrics and reducing healthcare cost. Data sensing and analytics are the key enablers of the assessment of clinical outcomes that these approaches build on, as are well defined, standardized quality metrics that outcomes are measured against.

Without good governance, good digital healthcare will remain elusive. Building trust in national authorities is always difficult. With poor governance, it’s all but impossible. The same is true for tasks such as aligning demands and requirements from relevant stakeholders to build and run a secure and interoperable nationwide electronic health record database. Or for

“How much countries are ultimately able to benefit from the digital revolution of their healthcare systems will likely be predicted by how well they are governed.”

bringing down the costs of medical procedures and essential, life-saving drugs, and for managing available medical resources, be it personal protective equipment, hospital beds, intensive care units, or medical specialists nationally or internationally. It’s encouraging that the World Health Organization reports that 58 percent of its member states have an eHealth strategy and that 87 percent of them have already implemented at least one national mHealth initiative. How much countries are ultimately able to benefit from the digital revolution of their healthcare systems will likely be predicted by how well they are governed.

Hard-earned achievements will likely pay off

In a world that is more connected, volatile, uncertain, complex, and ambiguous than ever, being able to adapt nimbly to changing circumstances, be it a slow-moving demographic change or a fast-moving crisis, will only become more essential. For all the suffering it has caused, the current pandemic may turn out to be a shot across the bow, a warning call that will force us to get serious about putting health on the global agenda and preparing for potentially worse calamities that lie ahead. If, as a result, we move boldly, not blindly, closer to the perfect world described in the opening, with a public health system that is eager to innovate and integrate new ideas to improve service while bringing down costs, we may not have to wait for future generations to thank us. We’ll thank ourselves.