Dinosaurs, Cars & Healthcare

Health systems are obsolete and digitalization—chaotic. So what now?

This article is about what we’ve been trying to do for years in healthcare—to move from the Age of Dinosaurs (A) to the age of Cars (B).

Let me explain what I mean.

In the beginning, there was chaos. In healthcare, it is still there

A is where we are now: an old-fashioned, conservative healthcare system. A Mesozoic time period versus the modern era in other industries. In the best possible scenario—it’s a system with electronic health records that are still closed in silos and can’t be exchanged with other doctors. In the worst case—it’s a paper-electronic model with inefficiencies everywhere. It’s guesswork-based medicine because one physician simply can’t remember the records of thousands of patients. Dr. Quinn and House are TV serials, not life.

B is what we dream about: well-orchestrated healthcare through digitalization and automation. Medicine that keeps up with the Holocene era. Some want it predictive, personalized, preventive and participatory. Some expect it to be easy to navigate, like an iPhone. Health for all instead of hell for patients having to fight the disease and a sick system.

The problem is that A and B are about 245 million years apart. The time between the Mesozoic Era and today, when homo sapiens started expecting human-like healthcare instead of a jungle overgrown with dangerous paths.

The analogy of the healthcare system as a dinosaur and digital health as car parts that have to be put together comes from the German Israeli Health Forum for Artificial Intelligence I attended recently. An event I could summarize in one sentence: A call to have courage and determination to send the old health system into retirement.

T-Rex is still alive! Welcome to the living museum

Ran Balicer, CEO of Clalit Health Services (Israel), pictured the conservative healthcare systems as dinosaurs. There would be nothing wrong with that—dinosaurs are lovely animals, the herbivorous ones at least—if the meteorite hadn’t spoiled the fun. And some of them will be really devastating even if they seem small in the night sky: an aging population, shortages of medical staff, increasing patient needs, and rising healthcare costs not translating into treatment outcomes.

But it’s not about stopping the apocalypse. Analog healthcare still somehow works. This is primarily due to the commitment of medical workers, whose numbers are nevertheless shrinking and the pile of hay (money) needed to feed the ancient creature. Simultaneously, the demand for medical services is increasing. A primary school education is enough to predict how this will turn out.

So it’s a creeping apocalypse, so over time, we’ve got used to that (or stopped looking up like in the Netflix hit show “Don’t Look Up”). We’ve done so with climate change for decades. But in healthcare, we don’t have Greta; just burned-out doctors and frustrated patients who’ve given up protesting.

I have a dream of a car taking us into the future

Technologies can help. Wearables track life signs to detect early signs of diseases, restoring the power of prevention. AI looks inside the vast data sets to help diagnose, treat, and keep people healthy, while doctors can finally sit down with their patients, listen to them, and give them a good word they need so much. Imagine the sound of a keyboard replaced by a conversation.

Sounds good, but tech is not just tech. It’s a change. And humans don’t like to change. Dinosaurs weren’t intelligent enough to send a rocket into space and blast the meteor. We are. And we’ve recently experienced a tragic wake-up moment that showed we can’t continue like all is ok.

COVID-19 caused a “tech-celeration,” according to Prof. Dr. Ronni Gamzu, CEO of the Tel Aviv Sourasky Medical Center (Israel). The pandemic shocked us and shook up old habits that were hindering us from achieving the tech-reformation of healthcare: skepticism, the culture of data silos, data overprotection syndrome (data saves lives—debates and moral judgments don’t), lack of motivation (things used to be better), propaganda narrative of skeptics (technology will dehumanize medicine—as if it’s not already dehumanized enough) regulations, fragmentation.

Fragmentation has many meanings: data fragmentation, standards fragmentation, fragmentation in digitalization strategies, fragmentation in technologies.

Wheels of change

We are already so good at med tech. And we used to believe that it would take us from A to B, fixing healthcare at the snap of a finger. That’s an illusion. Separate car parts do not yet make the car. The wheels, bolts, engine, seats and car body stacked side by side will not take us where we want to go.

“Isolated innovations—no matter how amazing all these apps, wearables, EHRs, and AI-based systems are—will not take us to the shift we want,” according to Dr. Susanne Ozegowski, Director General for Digitalization and Innovation, Federal Ministry of Health (Germany).

“And they have to fit one another perfectly if this is to be robust, safe, trusted, comfortable and attractive for the passengers of the car,” adds Prof. Dr. Sylvia Thun, Director of Core Unit eHealth and Interoperability (CEI) at Charité Berlin (Germany). Yes, that’s the magic word: interoperability.

We need a strategy, a user manual to construct the future of healthcare. And then step by step, we have to merge all the tech inventions into one system that will open the path to personalized, patient-oriented, value-based, predictive healthcare.

This will require not only good tech but also a close-knit team of startups, politicians, innovators, physicians, nurses, healthcare managers and patients working together, trying new things, failing, and succeeding—a team united by a joint mission and harmonized, rather than competitive, business models.

We’d better get insurance for this trip

Good and bad news at the end: There will be no one big bang, a sudden disruption, an unexpected extinction of dinosaurs or a miracle done by big tech only because they are big and can tech. This is a utopian tale crafted by technology believers nicely packed in wrapping paper full of Amazon & Co. logos. But it’s a beautiful story because it’s free of that boring stuff like interoperability, ethics and values.

I would like to be wrong, but nuclear fusion won’t solve all the energy problems in one go—and neither will Amazon Care, Apple Care, Google Care, Netflix-Care, Meta Care, Tencent Care, Alibaba Care, nor Name-It-Youself Care rescue broken healthcare.

The health sector is the biggest employer worldwide, an labyrinth—some call it an ecosystem—of politics, collaborations, interests, insurers, devices, medicines, hospitals, medical workers and facilities to provide the most complex service in the world: health and well-being. Yet, they are always very individual on the expectations and not yet on the delivery side.

The dinosaurs are still strong, while the desire for a fast ride is growing. Spoiler: cars break down and roads can be rough.

From the author: If you want to read more about the GIHF-AI Conference 2022, click here to download (for free) a post-conference report.

Credits: an original photo of the dinosaur comes from here. The car: Lancia (Bertone) Stratos HF zero (1970) by Marcello Gandini.

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