Developed Countries

Preparing for the future of healthcare

Dr. Bertalan Meskó (The Medical Futurist) writes an essay about digital health bringing healthcare into the 21st century.

Uli Knörzer
About

Dr. Bertalan Mesko, Phd

The Medical Futurist and Director of The Medical Futurist Institute analyzes how science fiction technologies can become reality in medicine and healthcare. A physician with a PhD in genomics, he has given courses at Harvard, Stanford and Yale universities, as well as at the Singularity University. He is one of the top voices globally on healthcare technology. Find out more: www. medicalfuturist.com

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.

Uli Knörzer

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.

CALL TO IMPACT
1 Patients must be given a key role in designing healthcare processes, products and technologies. 2 Physicians must be trained to work predictively and proactively, focusing on health and prevention as well as diseases and pathology. 3 Policies must be developed to ensure the benefits of digital healthcare are accessed by individuals across society.
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