Preparing for the future of healthcare
Dr. Bertalan Meskó (The Medical Futurist) writes an essay about digital health bringing healthcare into the 21st century.
Dr. Bertalan Mesko, Phd
John wakes up in his apartment in 2031 and grabs his tiny, artificial intelligence-based chatbot device. He takes it everywhere with him all day long as it has access to all his data, habits and digital channels. It wakes John up from light sleep in the morning with a smart alarm that ensures he feels energized for the day. His breakfast is chosen from a database that matches his microbiome and genome sequencing results with the best kind of food to keep him healthy. It notifies him when any of his major health parameters or vital signs change and compares the results to millions of medical studies and the expertise of medical professionals available in the cloud. If there is anything John has to do, he receives clear instructions, with gamification to help him stick to the solution. He is being taken care of while not even noticing it.
Healthcare is facing unprecedented challenges: a growing number of patients with chronic conditions; a global shortage of healthcare workers – 5 million and rising; physician burnout; and the financial discrepancies of care. The revolution in technologies, access to them, and information and the general concept of the Internet, have deepened these challenges in the 21st century.
The major consequence of these is the ivory tower of medicine breaking down. Information, knowledge, studies and technologies had only been accessible within the ivory tower, only medical professionals were granted access. With the expansion of the Internet, patients have started to get access too. Open access studies, technologies available from a distance without a middleman, knowledge shared on curated social networks – all have led to patient empowerment.
Empowered or e‑patients are stepping up, sharing their insights and looking for those of fellow patients, measuring data, keeping track of their condition and becoming engaged in their care. Working with them requires a different skillset, experience with working with advanced technologies and judgment about how to implement technologies into everyday care.
I have no doubt that digital health can finally bring healthcare into the 21st century.
The role of every stakeholder in healthcare is shifting too. Medical professionals are not keyholders to the ivory tower but guides for patients through the jungle of health and digital information. Policymakers have to act faster when regulating new technologies. Providers need to analyze huge datasets to constantly improve the efficacy, safety and cost-efficiency of care. Researchers are turning towards data measured by and obtained from the sensors and smartphone apps patients use.
Digital health technologies that change the doctor-patient relationship and the basics of healthcare facilitate these transitions. Healthcare in the 21st century is open to data and information generated by patients. It is global thanks to access to technologies and remote care provided by companies in other countries and systems, and is centered around the patient and their medical team.
The point-of-care is shifting from facilities to wherever the patient is. If patients are the point-of-care, diagnostics and treatments can be offered from a distance; patients can be involved in their care, releasing the burden on medical professionals; waiting times and costs can be reduced while improving patient satisfaction and the main features of good quality care: personalized, accessible, affordable, preventive and humanistic.
For a seamless transition that benefits patients, it is important to prepare the healthcare workforce, patients and policymakers. The most essential concept here is “patient design”, which means empowered patients are invited to the top decision-making level of organizations and involved in designing processes, products and technologies for them from the first step.
A reshaped medical curriculum is needed to prepare medical professionals for the use of advanced technologies and working with empowered patients. Studies have highlighted the problem of physician burnout worldwide. Unmanageable technological challenges are among the major causes. The future generation of physicians must be trained differently. Guidelines such as the Digital Health Playbook released by the American Medical Association provide key steps, best practices and resources to accelerate the adoption and scale of digital health solutions.
Patients will become active in managing their condition, rather than passive recipients of care. Data from health sensors, wearables and health apps will help to analyze and predict trends in the health of individuals and populations. But only if physicians act as guiding partners.
Patient engagement and chronic disease management are connected in three ways: preventing and detecting the condition; managing the condition with the provider; and self-management. To empower patients to take care of their illnesses themselves, providers need to employ digital health in both the technological and cultural sense. Medical school curricula should emphasize this besides health and prevention, rather than only diseases and pathology, and medical students must prepare for predictive and proactive working environments.
Finally, policy makers need help in creating better regulations for these advanced technologies by involving the communities that create them. A good example is the #wearenotwaiting Twitter movement for patients suffering from diabetes. The initiator of the community, Dana Lewis, and her husband built a so-called artificial pancreas at home and spread the blueprints and knowhow on Twitter to other diabetes patients. She had been using the device for almost two years by the time the US Food and Drug Administration finally approved it.
We must ensure that the expansion of digital health is not the cause of more social health inequalities. Investigating the social implications and consequences of digitalization is ever more important. Higher age and lower-income, lower education, living alone, and living in rural areas have been associated with lower digital health use. Suggested solutions include personalized social support, use of different types of Internet services to deliver digital health technologies, and the involvement of patients in the development of digital health interventions.
Only with this preparation will it be possible to protect the privacy of patients in technology-filled healthcare and avoid ethical issues that would hinder the adoption of digital health.
There are many challenges, but when I look at the global movement of empowered patients, the enthusiasm of some medical professionals and the policies implemented by governments such as those of Denmark or New Zealand, I have no doubt that digital health can finally bring healthcare into the 21st century.