Doctors As Case Managers

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“Medical technologies do not match patient’s values, healthcare systems’ architecture, and regulations.” Conclusions from the Financial Times Digital Health Summit “Enhancing the Impact of Innovation through Collaboration” (Berlin, 18th June).

Summary:

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Germany’s digital ambitions

“If you want to gain trust, the technological change needs to make a difference in doctors’ and patients’ lives. Otherwise, there will be a lot of resistance, concerns, suspicions or even conspiracy theories,” said Jens Spahn, Federal Minister of Health in his opening keynote.

In the upcoming years, Germany plans to place digitalization on the top of the political agenda. To advance technological transformation, the German Ministry of Health established the Health Innovation Hub – a platform that enables dialogue among stakeholders and accelerates innovation. Berlin is already one of the most attractive cities for European startups. The new director general for digitalization was appointed to lead the digital track. Till 2021 all patients should have access to an electronic patient record. Jens Spahn plans to change the legislation in medicine. Some of the regulations are outdated and do not keep up with disruptive technologies. Politics must follow these changes, not to block them. Although many doctors see new technologies, like Artificial Intelligence, as an offense, well designed AI supports medicine. Jens Spahn has a definite opinion on data and ethics: “Data can always be used when, in result, the patient can have a better treatment.”

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Not everybody will love transparent healthcare

According to a new research report by Global Market Insights, digital health market valuation will exceed $504,4 billion by 2025. Rock Health‘s estimated that digital health funding increased by 42 percent between 2017 and 2018, reaching $8.1 billion what already has a global impact on healthcare. What pleases startups and tech companies, is also worrying experts: Most of the investments focus on technologies, not on the societal foundations of technological transformation.

Martin Seychell, Deputy Director General for Health and Food Safety at the European Commission, has no illusions: digitalization in healthcare is lagging. The main barriers are the organizational ones. Human factors are equally important. It is not a technological transformation; it is a transformation of culture. Digital health empowers people to manage their health, pushing care from hospitals towards patient’s homes. At the same time, some of the areas of digitalization – like health prevention or strengthening digital skills, for example – are too challenging for private companies. The public sector should take them over.

“A lot of companies on this market do not understand the values of the European healthcare systems. Those who are seeking to enter the European market should take into account the specific relationship between patient and doctor,” suggested Martin Seychell.

Stephan Holzinger, the CEO and Chief Financial Officer at the Rhön-Klinikum, also describes technology-driven evolution critically. He claims that there is no lack of new ideas and products in the area of digital health, but in 90% they are not patients-centric. “We have an old-school education and law. Students come to the market without digital skills. A doctor can enter the health market without knowing how to make the computer on,” says Stephan Holzinger. He also reminds the democratization factor of digitalization: “For ages, doctors made the notes in Latin. Patients could not understand it. It is over. We are entering a level of transparency that some doctors hate. Doctors must understand that they are becoming case managers now.”

Digital health solutions and services that add value require from innovators good knowledge about the healthcare market and medicine. “We need to bring new thinking – innovations made by clinicians, not by tech companies,” says Tony Young that initiated the NHS England clinical entrepreneur training program. It is designed to offer opportunities for clinical, NHS staff, and broader health professionals to develop their entrepreneurial aspirations during their clinical training period. Many of those who joined the program are now successful innovators.

Hospitals 4.0 will keep patients at home

Will the hospitals exist in the future at all? Yes, but definitely, the number of healthcare facilities will decrease significantly. As the costs are rising, the care is slowly moving from hospitals to homes. Hospitals will be integrated with homes to monitor patient’s health continuously. Already today, doctors and nurses should be prepared to operate new technologies, like the AI-driven systems. Although doctors do not have to code, their digital skills must be as high as medical ones.

Connecting hospitals with patients’ homes may turn out less complicated than connecting hospitals with one another. “Traditionally, we applied a very siloed approach. It needs to change to enhance the value of data. Mindshift is required to realize the value of data sharing,” said Jaana Sinipuro, Project Manager at the Finnish Innovation Fund Sitra. Hospitals have to learn how to cooperate with communities and social care; some of the regulations must be changed. Although telemedicine is a fantastic tool for patients, for a provider it’s often trouble. In many countries, public systems do not reimburse telecare services; providers have to build costly 24/7 telemonitoring centers. Who will pay for it?

Putting patients in the center in a digital age means also rebuilding a relationship with citizens. Patients are a valuable source of data and health systems do not take advantage of it at all; they are even not asked by professionals how they feel or what treatment plan fits their lifestyle. It is to be changed, and doctors as care managers will also have a new role: To navigate patients through the healthcare system.

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Patients can benefit most if they cooperate

“If you live with a chronic disease, and you can communicate digitally with other patients, to exchange experiences and stories, or you are able to chat with your doctor via smartphone, that makes a tremendous difference,” says Ilona Kickbush, Director at the Global Health Centre and adjunct professor at the Graduate Institute of International and Development Studies in Geneva. However, new technologies have an even more significant impact on health systems around the world, particularly in developing countries. For example, new cases of Malaria can be traced using a simple mobile phone and GPS technology. A virtual map of new disease cases helps to recognize disease outbreaks and act quickly. The gathered data is available on an open source platform so everybody can make use of it, for research, medicine, or preventive purposes. Also, in this case, cooperation is a critical factor in success. Much innovation comes from the private sector – public health systems, and local or international organizations have to learn how to make partnerships to enhance health prevention.

We talk a lot about what doctors, nurses, or health systems have to do to turn digital health’s promises to real benefits. However, we forget that also patients have to be on board. “As patients, we have an obligation to share healthcare data. It is the only way to accelerate innovation. However, we also have the right to expect that the data is used properly,” says Thomas Harte, Surgeon and NHS Clinical Entrepreneur. What makes data valuable is not data per se but all that we can do with that. Securely processed data can add enormous value to every patient, but patients should also feel that they get something in exchange for donating information. It is like a social pact that has to be established.

“We never should stop experimenting and innovating, but we have to ask ourselves how to get closer to the Universal Health Coverage, making healthcare more accessible,” concluded Anja Langenbucher, Europe Director at the Bill & Melinda Gates Foundation.

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