Is healthcare spurning the digital dividend?

"We need to recognize that computers in healthcare don’t simply replace my doctor’s scrawl with Helvetica 12," wrote Dr. Robert Wachter, in his New York Times bestseller, The Digital Doctor. "Instead, they transform the work, the people who do it, and their relationships with each other and with patients.

Well, that’s the theory anyway.

Wachter, chair of the Department of Medicine at the University of California, San Francisco, and a member of America's National Academy of Medicine, penned that line more than seven years ago, at what the book’s sub-title hopefully described as the “dawn of medicine's computer age.

He is still patiently waiting for that digital dawn to fully break.

The true transformation of the healthcare industry may still be decades away, he tells me for this Healthcare edition of Transform magazine. We're not taking advantage of the capacity of digital the way a different industry might,” he observes.

This might seem surprising.

Aren't wearables transforming healthcare – urging you to walk just a bit more, or sensing when you've fallen over? Hasn't Covid urgently injected a connectivity and data surge into the system, accelerating access to online services and remote healthcare? Don't AI, the Internet of Medical Things, cloud computing and infrastructure solutions in hospitals all give a digital defibrillation to a global healthcare industry that, even before the pandemic struck, was estimated to have a market value of US$10 trillion?

In a word, no. For Wachter, most medicine remains doggedly traditional. One obstacle to progress: the tight margins many healthcare systems work on, making an investment in digital tools unappealing.

That's sad, because the return on investment may be better care for patients,” he says. But in many healthcare systems around the world, hospitals don't get paid extra if patients get better care. They're paid purely on volume.

An even bigger stumbling block than legacy technology may be legacy thinking: a collective failure of imagination.

Re-imagining medicine

Enter the unlikely figure of Elon Musk.

Wachter says Musk and Tesla single-handedly transformed the electric car industry by creating a high-end status symbol, a computer on wheels. That, in turn, created a market and some buzz, leading other companies to enter the fray and pushing prices down.

Musk himself is famous for seeking breakthroughs by starting from first principles: “You boil things down to the most fundamental truths and then reason up from there,” as he once put it.

Wachter agrees. The healthcare industry needs to fundamentally reimagine the work. “When people first install new technology, we almost always just replicate what we were doing on paper. But fundamentally, you haven’t changed how the work gets done.

And, he says, "We must figure out how to take all of this data that's sloshing around, turn it into meaningful intelligence, then give it to patients and doctors in forms that actually make it easier for them to manage healthcare."

That, he says, is the Holy Grail.

No one's ever found the Holy Grail; the cup with mythical powers supposedly used by Jesus at the Last Supper.

But Wachter remains optimistic. “There's no question that healthcare will be transformed. The experience will be better, safer, less expensive and more patient-centric.”

That’s a view echoed by another interviewee in this edition of Transform, from the largest healthcare employer in the world, the UK’s National Health Service (NHS).

The very senior figure in NHS digital transformation, who agreed to talk to Transform on condition of anonymity, insists that fractured data storage across the healthcare system – and a fear of change – can, and must, be overcome. But aggregating data was easier said than done.

"The NHS is 10% of the UK economy,” said the digital expert. “It has a bigger GDP than Greece. So, if you said to the whole of Greece, ‘We want you to use the following technical and semantic standards to describe everything you do,’ you can imagine that would be quite a complex task.” 

In the NHS the culture was to play it safe and not share data, out of fear of what would happen if something went wrong. 

“So, at the start of Covid,” says our interviewee, “a half-page of guidance notes (was published) to the whole system that basically said, ‘If you are a clinician looking after your patients, and you are sharing data, and acting in their interests and in good faith, then there will be no enforcement action taken against you.’ And that electrified the system.”

Also in this edition:

• Professor Anna Schneider, designer of a major international study into wearables, tells us why she’s optimistic that the trend towards digitalization in health and fitness will continue. She explains how an increase in wearables and apps could help address the challenges posed by aging societies.

• AI expert, Stanford lecturer and serial entrepreneur Jerry Kaplan looks forward to the day when our relationship with healthcare is “turned upside down” .

• Consultant cardiologist Professor Gerald Carr-White pleads for front-line clinicians to “step off the hamster wheel of treating patients” long enough to work alongside technologists in designing the healthcare systems of the future. 

• Frontline video stories from New Zealand, Thailand, Kenya and Ghana show how Huawei technology is bringing solutions to clinicians and staff and improving access and health outcomes for patients. 

• All that, and we’ll even explain why a Daoist creation figure in Chinese mythology is proving to be a key player in AI-assisted drug design research – already contributing to a ten-fold improvement in drug screening efficiency.  

Holy Grails, Daoist legends and Elon Musk: objects of ancient and modern worship all rolled into a single edition of Transform. We hope it contains a revelation or two for you…