An interview with John Nosta, an innovator, leader of the digital revolution, digital futurist, thought leader.
Why is healthcare so resistant to the omnipresent technological progress, and why are the changes introduced much slower than in other industries?
There is no single or simple answer to this question. Technological progress proceeds unevenly in healthcare and in medicine, and innovations have to be adapted to the outdated reality. Let’s take medical imaging techniques as an example. Medical imaging technologies have to meet requirements with respect to storing data, which, in turn, must be harmonised with data transmission technologies. Data transmission must be consistent with the interpretation capabilities at respective healthcare facilities, and so on. The chain of subsequent relations is long. Especially with respect to radiology, we can speak of tremendous progress throughout the past ten years. An image taken at one facility can be sent to another country for interpretation, which allows us to optimally manage our resources and save significantly. Soon, advanced analytical technologies based on artificial intelligence and machine learning will once more change the models of the present. Once new and successful technologies are introduced, other aspects of healthcare also change.
Nowadays, progress is so rapid that technologies become outdated even before they become widespread and widely available. The nature of healthcare is quite unique. Whereas introducing a given product on the market is a relatively fast process in other industries, it is burdened with complex and time-consuming regulative procedures in healthcare, which are totally incompatible with the life of technological innovations. Another aspect is society adapting to the changes and accepting them. Medicine deals with the life and health of a human being, so the risks posed by the changes are larger. It’s not a surprise that many doctors are afraid of the innovations because they want to be sure their patients get the best and safest care. So, on the one hand we have the legal regulations and rules of adapting technologies, and, on the other hand, we have human nature and the unique nature of the sector.
Artificial intelligence will allow us to detect diseases at such early stages of development that the lines between diagnostics and prevention will become blurred.
When we talk of digital health, we imagine specific changes: digital doctors and nurses, virtual visits, and robots. Do people want such sort of healthcare in the future?
I think a large part of our society doesn’t understand ongoing technological progress and isn’t fully aware of its influence. That’s why they remain so sceptical. When we ask them whether they’d like a doctor in the flesh or a robot-doctor, most would opt for the former. There’s a simple reason for this – we’re used to such care. We value personal contact with a true doctor first and foremost. On the other hand, we have cold and unknown technologies which seem alien to us.
Despite this, there’s no stopping progress. It will come gradually. I’ll give you one more example. Only a few years ago you had to go to a mechanic to discover what was wrong with your car. Today, you simply need the right device attached to a computer, and the problem is diagnosed in a matter of a few seconds. The human body can be diagnosed in the same way, provided there is some access to data. Doctors and healthcare providers will benefit from computer-assisted analysis, and patients will be able to get a second opinion thanks to artificial intelligence. This is about expanding the traditional role of doctors, not replacing it with something new. Obviously, with time, these two aspects of healthcare will get closer and become more similar to each other, more related to each other.
I am sure that doctors will soon no longer be at the forefront of healthcare; instead we’ll have computers, algorithms, and artificial intelligence. Today, we think that doctors have greater competence in assessing one’s health. They see the patient, they can observe their behaviour, listen to their speech. This isn’t entirely true. We have to be aware that machines remember things much more accurately, and detect significant nuances. Artificial intelligence can notice subtle changes in one’s voice, and observe that a few months ago I had used the word “pain” only a few times during my visit to the doctor, whereas today I used it over a dozen times. It’s a significant improvement in analysing all aspects of our health. Doctors have to serve large numbers of patients, and simply won’t remember or detect such nuances, not to mention how much we can learn about an individual’s health with devices placed in or on their body, which continuously measure and analyse relevant parameters.
There are more and more of these innovations: the Internet of Things, health applications, Big Data, 3D printing, and augmented reality. Can any of these be the driving force for changes in healthcare?
The fact that there are numerous and diverse technologies is something good. It’s the free market that drives and accelerates their development. Innovation, progress, and inventiveness are not things of the health sector – they come from the outside. Will one or more of the present innovations be leading in the future? It’s hard to say. Technologies change rapidly. What is brand new today, might be obsolete in a few years. New inventions appearing on the market can change the rules of the game and totally turn the tables. At the same time, I’m convinced that Big Data will be one of the most important trends shaping healthcare in the future, allowing us to better understand the governing mechanisms of health and medicine.
We currently have too much data and too little knowledge. Interoperability and data interpretation mechanisms are lacking, which often makes the data useless…
I wouldn’t worry about interoperability. It’s a small slip-up in the technological evolution which has no strategic effect on the industry. Such functional problems can be solved. Indeed, we have more and more data from different sources, but this is a result of natural developments, given today’s information technologies and the nature of innovation. Innovation is never linear. I’d say the surplus of data is more of a luxury than an obstacle. We must also take into account that interoperability is still being developed, and it’s not standing still. All processes need time. You can’t solve some inconveniences just like that.
What, then, can be a danger for the digital evolution of health?
Paradoxically, I think the danger might not lie in data security, but in some sort of ignorance, a lack of understanding for the innovations. Medicine is a conservative domain, which now faces aggressive changes driven by technological innovations. That’s what fascinates me about digital health: the fact that we’re in a whole new stage and we have to keep our minds more open. We’re facing significant challenges in healthcare, outbreaks of diabetes, Alzheimer’s disease, and mental disorders. Innovations have the potential to cope with these problems in a totally different way, and there are so many urgent problems that putting the significance of technologies in doubt would be simply illogical.
Big Data will help us save many lives.
Let’s come back to the first question. When we speak of democratising healthcare, we often mention examples from other industries. Uber, Amazon, and Airbnb brought a revolution into their relevant sectors. But what if healthcare is so unique that it has no chance for democratisation?
The concept of democratisation cannot be reduced to one entity suddenly overthrowing the whole market and gaining full control over it. To make a political analogy, democracy is the best regime because decisions made by political parties have some support of the voters. Similarly, as a result of democratising healthcare, the patient becomes the partner of their doctor and their caregiver, and gains equal rights; thus becoming involved in decision processes. The patient gains freedom in managing their health. The focus of healthcare shifts onto cooperation. People want to have control over their own health but have to know they won’t have full control over it. The responsibility will be divided between the patient, the doctor, the payer, and the state. True democratisation doesn’t have to result from strengthening the role of an individual but… can result from strengthening the role of computers. Technologies will serve as interfaces thanks to which the patient will gain insight to previously inaccessible and unknown processes.
There’s still one more fundamental question: how do we organise innovative healthcare? What do we need to be efficient in healthcare?
The answer to this question is multifaceted and depends on many factors. One element of reducing healthcare costs lies in early diagnoses and preventive measures. We’ve been talking a lot about prevention, healthy lifestyles, and nutrition but without much result. Technologies might be the missing link to our progress. It will be an amazing achievement if we’ll be able to detect diseases earlier and earlier, not allowing them to develop. For this, we need accurate monitoring of multiple parameters and systems based on artificial intelligence which will be able to analyse large data sets. Today’s system is in a large part reactive. We react to the diseases and treat them, which is very expensive. It may become proactive in the future though, acting at the very first stages of development, blurring the lines between prevention and treatment.
In many interviews, you’ve mentioned that data “will help save our lives.” What do you mean by that?
The ability to analyse different sorts of information and make relevant connections will be crucial. Here’s an extreme example, albeit a bit unrealistic. Let’s assume we can measure how many steps we take every day, and how many times we open the fridge. Then we put these data together with ECG results obtained during sleep. From these three elements, it very well might be possible to calculate the chances of obesity at a given age, as well as other diseases. In other words, we can find unique relations between certain types of data and draw meaningful conclusions from them, which would be impossible without access to data.
That’s why I think Big Data will save our lives. It will help detect health problems well in advance and test the relations between individual elements. It will help us make more accurate prognoses and learn more about the things we cannot predict today. I often point out that Big Data will be our third window to mankind and the world, the first being the telescope, and the second being the microscope. These data are of wide diversity, and they concern not only medical matters but also sociological and societal issues, and so on.
Which of the issues in healthcare fascinates you the most?
One of the issues is Big Data, which I’ve mentioned before. It’s a way in which we can gain a unique insight into various questions of humanity. Another issue is the nature of innovation. It’s not medical or clinical. From what I’ve seen, many pharmaceutical companies approach digital health innovations in a way which doesn’t necessarily lead to optimising healthcare processes. When we analyse the nature of innovation, we have to ask ourselves some questions: Why isn’t innovation linear? Why is it a curve? Why do we see further unexpected changes in a field where innovation is a bit overrated and where innovations seem more like well-balanced changes? This very unique nature of innovation is indeed fascinating.