Think Big, Act Now!

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Several hundred reports, thousands of studies, and positive results from pilot projects – almost everything has been already said about the potential and the advantages of digital healthcare. It’s been said but not yet done. Health IT is not a wizard’s wand, it’s not an answer to the biggest healthcare challenges. However, it can help to transform healthcare, to create an open and transparent system oriented to the needs of patients. This is why the oft stated necessity for democratisation in healthcare still sounds convincing to me. Several conclusions from the HIMSS Europe & Health 2.0 Conference.

When I think about how healthcare is organised in most countries, the first words that come to my mind are “regulation”, “central control”, “providers” and “payers”. And the next one is not “patient”, but rather “beneficiary”. I am perfectly aware that health is a different sector from power engineering or industry. Everyone must have access to care, regardless of their wealth or social position. However, in recent years we have been idly watching the exact opposite: healthcare, by means of subsequent regulations, shuts itself off from the patients. In times when digitisation facilitates dealing with everyday matters – paying bills, shopping, communication with friends – healthcare has reached a stalemate. Hermetic political solutions solidify the conservative way in which health services are provided. And so in 2018 patients still have to take leave from work and spend hours in waiting rooms just to get a prescription. The chronically ill wander around in a sea of information found on Google, as they do not even have access to the basic information on their own health collected in their medical records. Owing to digitisation such absurd solutions will become a thing of the past. At least that’s what I’m hoping for.

It’s not that digital healthcare will be perfect. As is normally the case in nature, the old problems will be replaced by new ones. But healthcare will be more friendly to the patient – open, transparent, safer, more accessible, cheaper, flexible and sustainable. In the process of transformation the technology will build the very much needed communication bridges between doctors and patients, supply information to politicians, advance understanding about factors in the development of diseases. New healthcare will be based on data and proofs instead of speculation and wandering in informational chaos. It will be available 24/7 on a smartphone, not where a hospital is built. Provision of health services and the paternalistic system will be replaced by shared decision-making and engagement of the patient in the process of prevention, therapy and rehabilitation. Nowadays, a patient is just a unit of account in the reimbursement for health services and diagnosis – a beneficiary.

The world, society and technology – they all change. Healthcare also changes. And it is happening at a rate we have never experienced before. However, the real tsunami of change is still ahead of usLucien Engelen, the Director of the REshape Center Radboud University Medical Center, apart from stating great visions, also reminds us about the barriers blocking the road to positive changes: work procedures, politics, reimbursement of medical services, culture, and knowledge. We have to change the way we educate and train healthcare professionals, reform the way we pay for health services, prepare patients for being engaged “health consumers” instead of passive recipients of external orders who have to adapt to the framework of the system.

The way to better healthcare, apart from words, requires actions and real initiatives.

HIMSS conferences are a place where great visions are meant to aid the consequential pursuit of change, regardless of great difficulties. For there is no better motivation and inspiration for action than great goals that may sometimes be very distant in terms of their time horizons. This is where difficult questions are posed, which sometimes lack an answer. For example, when we watch a video with an elderly, lonely person in the lead role, who is only accompanied by a robot. Technology makes us face difficult ethical dilemmas and requires us as humans to redefine our needs and expectations. Any time now we will be confronted with artificial intelligence systems that will not only have impressive medical knowledge, but also emotions that have previously only been expressed by humans. Are we able to trust such systems as much as we do a real doctor? Is a patient with depression less opposed to seeking help in a mobile application than from a doctor not a sufficient reason for us to pursue popularisation of such solutions? Do patients in the world of new communication technologies still have to travel several and in some cases several dozen kilometres to get advice related to trivial health issues? If we really want to place the patient in the centre of healthcare, should the patient not have the right to a consult at any time, whenever a need arises, without making appointments and waiting in queues, which sometimes reach months in length?

This year the HIMSS Europe & Health 2.0 conference for the first time united with the events organised under the Health 2.0 brand, primarily oriented at start-ups operating in healthcare. One has to admit that a mix of the knowledge of different stakeholders / experts and the enthusiasm of young innovators generated some totally new energy. Real digital health solutions, already available on the market or at the development stage, presented at the exhibition, did well to complement the theoretical lectures and declarations on the role of digital health in the process of systemic transformation or the stories on the fourth technological revolution. Start-ups may prove to be the decisive force in the revolution, in which the aim is to regain democracy in health. Their purpose is clear – they want to solve a specific problem faced by the patients (and often their founders). They are determined, and although they are very often defeated by market reality or rigorous law, sometimes they are the ones to break through the previous barriers and established rules. Rome was not built in a day.

Start-ups remind us how a patient should be placed in the centre of healthcare. In recent years a lot has been said about technologies, IT solutions and technical aspects of digital transformation. These discussions manifest new trends: health applications, artificial intelligence, augmented reality, blockchain, patient portals and robotics. And it’s a good thing, as this way we are focusing our attention on the challenges and solutions that are still being developed or the ones that should be developed. However, this fascination with technology way too often caused the patient to be forgotten. The forgotten issues included the patient’s needs, issues, obstacles in access to care, expectations and their daily struggle. This should be the starting point for all the discussions on what healthcare – with the aid of new technologies – we wish to create and what we want to change and how. In the traditional model of the health systems the patient was always on the side, reduced to a medical diagnosis and ICD10 number. Health digitisation is supposed to introduce an entirely new value and approach. This is why it was a good thing that during the HIMSS Europe and Health 2.0 conference there was no shortage of patients themselves on the stage – their personal stories and the talks on their struggles with access to information, in communication with their doctors, and their battle against unfavourable administrative solutions. This, for example, was the case presented by Anne-Miek Vroom, the founder of the IKONE Foundation. On one of the slides she presented the complex ecosystem navigated by each patient. Several dozen people and institutions can be distinguished within it, from the closest family to medical specialists to health market organisations. In the puzzle of a system that is meant to guarantee proper care to a patient there is a lack of any coordination or communication. This is why Anne-Miek Vroom, together with sixty other patients, by means of the foundation, wants to change the system so as to put the patient in the centre of all the activities. Information technologies are necessary for this.

We are only at the first of four stages of health IT.

Access to information itself results in a change in the patient’s role. The rule is simple: if someone is hungry you can give that person ready-made food or teach that person how to fish. Instead of giving the patients medicines and medical services let’s teach them how to navigate the issues related to prevention and health. Let’s reinforce their role, give them a chance to make decisions on the issues on which they have the best knowledge after all – on the issues of their own health.

However, the way to better healthcare, apart from words, requires actions and real initiatives. There are great challenges and work at the grassroots ahead of us. Robert Wachter, the author of the book “The Digital Doctor” leaves no doubts: we are only at the first of four stages in the digitisation of health. This level is the digitisation of the patient’s data. Ahead of us there is still the connection of all the elements of the health system, gaining knowledge from the collected information, and ultimately – utilisation of this knowledge for improvement in the quality of patient care. We’ll have to wait until the fourth stage to reap the rewards of digitisation. There will be years of hard work at the grass roots before we get there.

Old processes + new technology = very expensive old processes.

The coordination of patient care is still in its infancy. IT is an important tool binding the particular elements of a patient’s path in the system, but it is not a solution itself. It is not enough to computerise all the health market participants, the doctors and healthcare institutions, therefore improving communication between them. Politicians also have to be convinced by the new, patient-focused model of care. It will not happen without drastic changes in the way in which medical services are reimbursed. Doctors will also have to learn the new model of care based on knowledge-sharing, cooperation in interdisciplinary teams instead of the one based on individually made decisions. If we digitalize the current processes, we will only strengthen the inefficient procedures without any added value for the patient. This stems from a simple formula: old processes + new technology = very expensive old processes.

Once again: conversations and discussions are not enough. Cooperation and implementation of great visions in specific activities are much more important. It’s not easy, which became evident from the questions of participants in the workshops organised as a part of the conference. They were related to the basics: What should we start with to improve coordination of health services? How to integrate different sources of information? What is most important in the process of digitization of a hospital? What mistakes should be avoided? How to ensure the interoperability of different IT systems? How to implement telemedicine solutions successfully? For global visions to be reflected in local solutions we need education on digital health, especially for those who are responsible for designing new solutions and their users.

The HIMSS Europe & Health 2.0 conference invokes dreams about the potential of digital health and motivates action. Here is an analogy from a video presented by Lucien Engelen during the opening session: an ostrich searching for food accidentally stuck its head in VR goggles. A simulated flight in the skies motivates the flightless bird to rise into the air. It keeps trying all the time, trains, and at the same time all the other ostriches keep on laughing – after all, the birds of this species cannot fly. There is no lack of falls and resignation. However, the determination and the goal in front of the eyes ultimately lead to success. Likewise, all the people in the health sector should dream about better healthcare and implement the solutions – including the digital ones – that will make this goal come true. Let’s keep our eyes set on it, so as not to fall into despair. It is about health and life, after all.

The article has been also published on HIMSS Insigts Blog.

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