Digital Technology for Analog Healthcare?

Technology is evolving at a faster pace than ever before. Everything and everyone is online. Powerful technologies like IoT, Analytics, Blockchain have proven their competence in retail, transportation, manufacturing, automotive, etc. However, the healthcare sector is yet to witness any significant positive disruption.

So, what is the problem? When it comes to healthcare, technology seems to be the least of our worries. I believe that the landscape of healthcare is much more complex than any other. The problem gets accentuated by consumer’s unwillingness to treat healthcare as any other requirement. In India, the sector seems to be balancing between the three tenets of affordability, accessibility and effectiveness. Ideally, a healthcare solution (online or offline) should be able to cater to all three. But, currently all modes of delivering healthcare seem to favor two over a third. If you want quality healthcare, you will have to wait in long lines at a large hospital. If you want to get a quick consult, you will have to make do with the nearest clinic and the available physician who might or might not be a specialist for your condition. The new age digital solutions don’t seem to be doing any better. Solutions like telemedicine have been around for quite some time. But, they have not been able to bring the transformation this sector needs. The problem starts with the basics of healthcare and goes up to Government regulations and laws.

1. Basics of healthcare: We might be able to build the most powerful analytics algorithms capable of predicting any health issue well in advance or we may even build AI powered solutions that can take into account the most unpredictable and complex factors. At the end of the day, the doctor’s word reigns supreme. An individual might humor any predictions but is least likely to act on them unless the same have been validated by a practicing physician. Apart from this glitch, there is the factor of ‘not worrying until you have to’ or as the medical students are taught ‘when you hear hoof beats, look for horses, not zebras.’ This essentially means that all HCPs (Healthcare providers) will cover all their doubts before disclosing any worrying information to a patient. Healthcare analytics turns this rule on its head. When we are trying to predict an illness, we are going against the basic tenets of practicing medicine. When IoT offers real time monitoring of patients who do not understand the full meaning of the readings, it can create more problems for the attending physician than it solves. Hence, digital healthcare will need to explore channels that do not conflict with the existing principles of healthcare delivery. That gives way to our next issue at hand…
2. Shortage of HCPs (Healthcare Providers): At present, there are only 0.65 doctors,1.3 nurses and 1.3 hospital beds per 1000 people in India. The desired requirement by 2034 for every 1000 people is 2.5 doctors, 5 nurses and 3.5 beds.[1] In the US alone, the Association of American Medical Colleges (AAMC) estimates a shortage of 91,500 physicians by 2020 and up to 130,600 by the year 2025. WHO estimates a shortage of 4.3 million health workers worldwide. [2] Now this is the problem that digital healthcare is trying to solve. Bridging the gap between the supply and demand of the health workers. So, how is this factor an impediment in the adoption of technology. This should be the one driving it, right? Well, healthcare does not present opportunities like other sectors where e-commerce and internet fuelled solutions swoop in on the demand and supply gap. As elaborated in point number 1, doctor’s words reign supreme. Even for developing powerful algorithms, no amount of secondary data can replace the physician’s inputs. The solutions trying to connect patients in remote locations to a small pool of expert physicians also get limited and tied down by the availability and capability of the physicians. The technology might be able to support thousands of patients in a day but a physician can cater to only so many patients at a time. While these solutions have helped to increase the throughput of patients to some extent, they are still bounded by human capability. As a result, a lot of organizations are developing solutions that help the physician reduce the time s/he needs to spend on each patient. That is a good approach but it is again bounded by the availability of the small pool of physicians. It also brings us to the next problem!
3. The ‘art’ of practicing medicine: There is a reason why it is called ‘practicing’ medicine. Even with voluminous knowledge available, it still isn’t exact. The decided course of treatment might vary from one doctor to another. During the course of treatment for an injury, you may come across physicians whose plans of action vary from surgery to physiotherapy. A lot depends on the physician’s experience. As we all know, medicine is a field of continuous learning. This creates problems for technologies that focus on giving the exact answers. An analytics algorithm may predict surgery after statistical sampling of several past cases. A software powered by machine learning might factor in your genetics and suggest you go for surgery basis your family history and inactive lifestyle. A physician might just look at your age and willpower and decide that if you are ready to bear some pain, physiotherapy will be all that you need!! So, technology didn’t help, did it? It has to be the doctor’s word based on her/his past experience, intuition and patient interaction to decide the way. This is just one example. A lot of physicians feel that not every individual needs to keep track of every basic vital all the time. A lot of those vitals captured by wearable fitness bands have little or no bearing on actual health. The accuracy of such self use vital capture is also an issue. These vitals might not be an authentic information for a diagnosis if and when anything goes wrong.
4. Information Security and Laws: This one does not need much explaining. It is very evidently a big problem for digital healthcare. In a world where ‘data is the new oil,’ [3] healthcare data comes with its own unique challenges. A lot of countries have strict laws regarding the usage and storage of this data. In such circumstances, the patient might decide against disclosing information and that in turn, affects the validity of analytics and AI based predictions. But, it is still easier to develop solutions inside the framework of defined laws. The real challenge is from the developing and under developed countries which are in dire need of healthcare reforms but do not have any exact laws governing digital healthcare. A digital solution operational today might become non-complaint a few years later when definitive laws come into the picture. Whether it is IoT devices monitoring the vitals or an analytics algorithm predicting problems, the basic question around ownership and usage of the data remains.

I have not taken into consideration the complex web of health insurance and pharma players in this analysis. This is regards to basic functioning of the healthcare sector- the relationship between a healthcare provider and an individual seeking medical care. If the insurance and pharma industry stakeholders are brought into the picture, the issue snowballs into a very big problem. Each of them- hospitals, HCPs, insurance, pharma are deeply invested in the ecosystem. Each one wants a positive disruption but does not wants to be the one paying for the experiment. None of these stakeholders are ready to drive adoption of a technology that has yet not proved its worth for healthcare. So, where do we start?

Conclusion: Human health is analog. Till now, we have been trying to make the digital mimic the analog by feeding it as much information as we can get. Logically, that IS the way forward. That’s how we convert analog to digital. However, to increase the technology adoption rates, we will need to do a little more than that.

The academia and the industry need to be aligned for delivering value. The teaching and practice of medicine will have to make some room for digital methodologies. In order to bring a real change, the technology industry will have to look beyond ‘over and above’ services. Currently, there are two distinct models- illness care and wellness management. Wellness management is a B2C model where solutions cater to individual health and fitness. Illness care solutions are for the B2B segment- insurance, hospitals, HCPs. The solutions cater to helping the primary providers. I also feel that despite our immense improvements in technology every day, healthcare industry is yet to see a truly innovative solution that solves the problem of HCP crunch in a way that makes any impact. There have been innovations in small pockets- better devices, better IT systems, healthcare delivery at home, better emergency services, etc. The real challenge is to utilize these improvements to build a solution that doesn’t trade off but provides all - effective, affordable and accessible medical care.



[1] Business Today, January 2015 [2] https://en.wikipedia.org/wiki/Physician_supply [3] https://www.forbes.com/sites/perryrotella/2012/04/02/is-data-the-new-oil/#454d6e917db3