Reimagining Healthcare in the 21st Century By David Pare and Ben Bridgewater, M.D.
Reimagining Healthcare in the 21st Century. Different industries find themselves at varying stages in the disruptive cycle. Some such as retail and banking have been transformed beyond recognition and are now truly digital first. Others, such as healthcare, continue to follow 20th century models. Although digitisation is happening in areas such as radiology and home care, it is mostly confined to the back office rather than being widespread at the forefront of care delivery. Working with organisations from various industries globally, DXC has identified three main questions that are top of mind in the push to realise digital transformation: Are we maximising the benefits and savings of new technology, and is our core IT set up to benefit our customers (patients) and our organisation? Is our organisation set up to reach citizens (both patients and the healthy) and exploit the potential enabled by faster innovation cycles as a result of digital approaches? Are we moving in the right direction with our business model and truly delivering products, services and experiences that customers (citizens/patients) want and need in a digital world? About the authors David Pare is the chief technologist for DXC Healthcare and Life Sciences in Australia and New Zealand. He is an innovative thinker with 20 years of experience in business and technology management consulting, helping organisations through their digital transformation. Ben Bridgewater, M.D., is the director of global advisory for DXC s Healthcare and Life Sciences Build organisation. He is an expert on health informatics, national clinical audit, clinical governance, healthcare transparency, patient-experience measurement and digital transformation in healthcare. Why have an English doctor from the United Kingdom and a Canadian technologist from Australia come together to write a whitepaper? Because healthcare and technology are equally complex, and it s challenging enough to stay at the forefront of one industry in this rapidly evolving digital era let alone two. Here, David Pare (the Canadian technologist) and Ben Bridgewater, MD (the English doctor) join forces to present a point of view on health systems in the 21st century and demonstrate the extent of what is possible. 2
We find that there are far more similarities than differences when it comes to digital transformation across industries. Healthcare is not as different as many who work in it would have you believe. We believe that healthcare would benefit from the same approaches that have been shown to be successful in other industries. This starts with transformation of the individuals leading and working within the sector (both managerially and professionally), and here it is useful to consider the Leading Edge Forum (LEF) 21st century models, including the Human Upgrade Programme i. The 21st century health organisation needs to develop a compelling personal digital brand and purpose, upgrade digital tools and abilities, exploit digital to enhance productivity, collaborate at speed, lead by example, and listen, learn and apply value-based leadership. The LEF has also defined the characteristics of successful 21st century organisations, and it is illuminating to review healthcare providers against this model. While the objective to keep people well and treat disease is inspiring, unfortunately most providers remain in the 20th century with their digital brand. For example, hospital websites are usually portals for displaying chosen content to patients, rather than a bi-directional channel of patient/citizen engagement and activation. This is in stark contrast to organisations in more digitally mature industries. In this current landscape, many hospitals still aim to provide the majority of clinical services in-house rather than leverage digital remote approaches for clinical and support services. Yet digital approaches do exist, such as teledermatology services that provide online services, as for example, the Royal Free London ii service demonstrates. 3
21st Century Human Alignment 21st Century Organization Sensing starts with the individual Upgrading digital tools and abilities Exploiting digital to amplify productivity Personal brands support organizational brands Outside-in approach to assets and capabilities 360 digitially optimized product and service portfolio Developing personal brand and purpose YOU LIFESTYLE Collaborating at speed Talent is the primary asset; everything else follows Optimizing productivity leads to optimized projects Inspiring digital identity and strategy Adaptive execution Listening and learning Leading by example Collaborative behaviours lead to agile organizations 21st Century Leadership behaviours send powerful signals Proactive, haptic sensing Value-centric leadership in an uncertain world 20th Century Human 21st Century Human Digital profile assessment and skills focus Reputation Learning/reading Life infrastructure Personal organization Communicating Serving Health Skills and capabilities augmented and upgraded by digital Developing personal brand and purpose Listening and learning Upgrading digital tools and abilities Exploiting digital to amplify productivity Collaborating at speed Leading by example Lifestyle and wellbeing Version 1.0 What is your assessment score? Upgraded Version 2.0 Digital Master Source. The 21st Century Human Upgrade Programme, Leading Edge Forum Of course, healthcare services should be for the benefit of those who need them, not for professionals, the organisations or their employees. That means organisations must acknowledge and gear their capabilities towards the rights and preferences of citizens, ensuring consent for data sharing, including what can be shared with whom and for which purpose, backed up by rigorous security and audit trails. Organisations and their IT departments must earn the trust of citizens and ensure that they remain trustworthy by using effective technology approaches. 4
Precision Medicine and Technology Tied to the 21st century model and a citizen-centric approach is current thinking about precision (or personalised) medicine with the objective of ensuring that care delivery is targeted to the specific characteristics of the individual and his or her disease. Digital approaches and artificial intelligence (AI) underpins precision medicine, and it is common to consider this from the perspective of genomics, cancer cell lines and customised therapeutic regimes. However, the diseases creating the greatest impact on population health and the health economy are those directly related to western lifestyles. As research in the field iii is starting to show, social and behavioural characteristics are probably more important in determining health outcomes than genetics. Evidence is also starting to show that these factors can be modified using digital approaches, including social network activation with the application of cognitive behavioural therapy and coaching. These new approaches to digital therapeutics iv are likely to become among the most important factors in optimised products and services delivered by a 21st century healthcare provider. Although the pace of technology change is growing at unprecedented speed, the pace of change in the delivery of medical care remains slow. The typical medical innovation cycle v from basic research to practice change is an average of 17 years. But digital approaches can dramatically shorten this time frame by using agile methods and approaches, more akin to product life-cycle management approaches in Silicon Valley start-ups than the traditional medical model. The 21st century health organisations will need to become much better at ensuring that research and development (R&D) are implemented quickly, effectively and at scale 5
21st century citizens and healthcare Many citizens (and here by citizens we include the sick, the well and those responsible for delivering care) are now digital first when it comes to their interaction with most industries including banking, insurance, retail and transport. This is unfortunately not the case when it comes to healthcare and it makes sense to explore the reasons why. People use the capabilities described in the LEF model in their role as consumers: They rapidly assimilate and develop the necessary digital tools and abilities to order their weekly groceries or buy cheaper car insurance. The data suggests that the penetration of social network use on mobile devices is enormous, and so people clearly can be digital first when there is something in it for them. Why isn t healthcare more digital? In general terms, people use digital approaches to drive personal operational efficiency. It is much more time effective to shift money around on your mobile banking app than to visit a bank in person. Most of us are recipients of digitally enhanced customer intimacy through retail websites such as Amazon. Given that these attitudes and capabilities are embedded these days, why are they not more used in healthcare? Well it takes two to tango. Citizens are not yet driving digital-first healthcare at scale (although there are some emerging services which are tapping into a consumer need such as HealthTAP vi and Kry vii ). Healthcare providers are, for the most part, not providing digital-first services ubiquitously. For example, doctors are just starting to prescribe mobile apps and wearable devices to help monitor your health between visits, rather than a pamphlet for you to read when you get home. Why do citizens seem to have a different take on the need for digital-first services in healthcare compared to other industries? It may come down to the issue of digital trust. If we draw parallels with banking, people are happy to use digital approaches to drive operational efficiency for their finances. Most people trust the banks to keep their money and identity safe. But when it comes to personalised and detailed financial advice, they seek out trusted advisors. In healthcare, it should surely be the same. 6
How can healthcare accelerate its digital transformation? On a basic level, the healthcare industry needs to accomplish two things in order to become more digital first: improve availability and establish trust. Basic operational efficiency elements, like healthcare scheduling or repeat prescription reminders and delivery, must rapidly become digital first. Meanwhile, digital channels for supporting clinical diagnosis and treatment will have to earn citizens trust. It is interesting speaking to people, who are ill, about their perspective on using digital approaches to gathering information. Some just try to consume everything they can find on the web, but many are anxious, both about the disease and about navigating non-curated information, which is now widely available. It seems likely that a professional-first approach, supported by a prescription of digital support and therapeutics will be the next stage in evolution. The effort to establish digital trust, then, can piggy back on the existing trust already placed in healthcare and organisations for their medical expertise. This approach will require digital to be more widely recognised as an important channel by medical professionals. Trust is of course a very personal concept and acknowledging the rights and preferences of citizens is not one size fits all. Imagine for a moment the case of a 16-year-old girl who is seeking oral contraception from her family doctor. She may not trust the physician in their prescription and may go to the Internet to check out the medication that has been chosen for her, but her most trusted group may well be her peers. Her digital trust will come from asking her social network for their opinions on her options. This may be a challenge for the existing healthcare model, but this approach needs to be recognised as a legitimate and appropriate avenue of patient decision making, and professionals and organisations must provide curated information to help support these behaviours. Of course, the security and sanctity of personal healthcare data must be absolute, and healthcare providers need to ensure they fulfil this part of the contract.
i ii iii iv v vi vii The 21st Century Human Upgrade Programme. Leading Edge Forum. 2017. https://d1xjoskxl9g04.cloudfront.net/ media/assets/lef%2021c.pdf Royal Free London. NHS Foundation Trust. https://www.royalfree.nhs.uk/ services/services-a-z/dermatology/ teledermatology/ Leveraging the Social Determinants of Health: What Works? PLOS ONE. August 17, 2016. http://journals.plos.org/plosone/ article/file?id=10.1371/journal. pone.0160217&type=printable Is Digital Therapeutics the Next Big Thing in mhealth? mhealth Intelligence. Eric Wicklund. https:// mhealthintelligence.com/news/ mhealth-spotlight-set-to-shine-ondigital-therapeutics The answer is 17 years, what is the question: understanding time lags in translational research. Journal of the Royal Society of Medicine. https://www.ncbi.nlm.nih.gov/pmc/ articles/pmc3241518/ HealthTap. https://www.healthtap.com/ KRY. https://kry.se/en/ viii imedicalapps. https://www.imedicalapps.com/ Digital trust is as important for the clinician as it is for the citizen. As an example, there are currently over 200,000 health and wellness mobile apps available on various platforms. It is almost impossible for clinicians to know which ones are good for their patients. To meet this need for a trusted source of information on mobile apps for healthcare, www.imedicalapps.com viii employs clinicians to review and curate healthcare apps. They even created a mobile app (iprescribeapps) to support a clinician when prescribing a mobile app for patients. This is a great example of an organisation establishing themselves as a trusted digital brand for use of health mobile apps by clinicians and patients. Additionally, it is worth saying that concepts of illness and wellness are changing. A typical human journey in the developed world often starts and ends in a hospital. If we are lucky, we can avoid all but transient interactions in the interim. Services are well configured in the historical model for providing healthcare, but we know these services are becoming increasingly challenged by aging populations and an increasing burden of chronic disease, driven by people s behaviours. Healthcare is recognised as a sector with well-established providers and payers. Wellness care is only just starting to be; and by wellness we include physical, social, emotional, financial and career as your wellbeing isn t purely defined by how healthy you are. These domains play directly into the behaviours that drive better or worse health outcomes, with consequences for individual and healthcare services. Digital-first approaches to driving more holistic wellbeing and behavioural change need to become increasingly recognised as part of the landscape. Finally, not only does this shift from volume-based to value-based care require new models of care and technologies, it also requires clinicians to be great at performing clinical activities as well as great users/promoters of technology. It will no longer be sufficient to know the human body, clinicians will need to learn how to use the digital tools that will allow them to provide better care to their patients. Mobile apps, wearables, monitoring devices and 3D printing are examples that are already available today and clinicians will need to understand and use these technologies to stay relevant. Learn more at www.dxc.technology/ services About DXC Technology DXC Technology (DXC: NYSE) is the world s leading independent, end-to-end IT services company, helping clients harness the power of innovation to thrive on change. Created by the merger of CSC and the Enterprise Services business of Hewlett Packard Enterprise, DXC Technology serves nearly 6,000 private and public sector clients across 70 countries. The company s technology independence, global talent, and extensive partner network combine to deliver powerful next-generation IT services and solutions. DXC Technology is recognized among the best corporate citizens globally. For more information, visit dxc.technology. www.dxc.technology 2017 DXC Technology Company. All rights reserved. MD_6974a-18. September 2017