Comment Blog 19 June, 2019

Digital Health: Is Success “Around the Corner?"

Has digital health realized its promise? Many say, “No, but, that’s normal. It’s only been ten, fifteen years, since the sector got started, let’s say, since the Richard Granger 2.5 billion pound health IT budget at the NHS. But, now success is around the corner.”

In fact, success in digital healthcare has been just “around the corner” for a half century. Professionals and managers, in all sorts of organizations, public and private, have been introducing digital innovation in healthcare, around the world, since the birth of the modern computer.

Electronic patient records were proposed in various scientific publications in the 60’s. In 1964, Dr Larry Weed introduced the “problem-oriented medical record”, “a well-defined list of a patient’s medical problems”. Yet, in 2019, most of the world’s healthcare systems, including in the US, struggle with the scaling up of the electronic medical record (EMR).  While a few locations around the world have made EMRs a reality for their populations, the recent Kaiser Permanente article “Death by a Thousand Clicks, where Electronic Health Records Went Wrong” reflects the failure that is true in the US and most of Europe. Electronic medical record software has been hugely expensive to introduce, fraught with glitches, frustrating for providers to use, and not made it easier for a patient or family to access the data.

Since telemedicine’s big push in the ‘70’s, thanks to technology, we could have a) done away with most waiting rooms  and b) matched everyone everywhere to the best teams in the world for their particular medical profile. However, if telemedicine is today on the uptake, it’s mostly through the efforts of start-ups and private insurance companies, but not as part of a concerted action to connect everyone to the most relevant professionals.

Mobile health apps got their leap forward with the smartphone and in particular the iPhone app store. But, of the now more than 300 000 apps in healthcare, how many have been downloaded even a million times?

Next we learned to create sensors from head to toe and generated thousands of connected objects for health, which, are also helping ratchet up the data available for AI start-ups. But, where is the scale-up there? Isn’t it time we ask a key question: how do we scale digital health so that everyone can benefit? Where are the scale-up experts?

If we look for where digital technology has scaled up, two examples come to mind. The first is social media. Any patient with a smartphone could, in principle, benefit from the use of the main social media platforms. But this is not an example of the creation of large-scale digital health start-ups. The second would be online physician rating services such as Doctolib in Europe and ZocDoc (rating and appointments) in the US, since they are evaluated as unicorns. While these two companies are rationalizing access to appointments, that does not necessarily imply better care. Moreover, their growth may be vulnerable, as physicians in both Europe and the US have begun to express concern about their perceived monopoly.

So, how can digital health bring better care to the population at large? Where are the scaling-up experts? If our health systems are not themselves economically sustainable, and if we want to avoid the extremes of a myriad of small start-ups or Goliath-like giants, what do we do? Currently we are asking start-ups to fit in to the existing regulatory and organizational model. Could we start from the “scalability” question and work our way backwards to the beginning? It would perhaps generate some new thinking about how we break out of the current cycle that repeats itself with every new technology.