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10 January 2019
By Brian de Francesca, Chief Executive Officer, Ver2 Digital Medicine
While there are many very good caregivers (doctors, nurses etc.) and some excellent healthcare institutions around the world; at present, all healthcare “systems” sleep on a continuum ranging from terrible to almost acceptable. There is not one national healthcare “system” that is an Apple, Google or Kenya’s Eliud Kipchoge of healthcare (the world marathon record holder – by far). But we are on the precipice of massive change, opportunity and potential — and those bold and brave enough to see and embrace it — will create a better healthcare future; that will serve as a role model for all others to follow.
How can someone be so bold and brash to blanketly state that at best, only a few national healthcare systems are “almost acceptable” and the rest, much less so? Because, it is the truth — and yes, the truth at times hurts hard. You may push back with: “What about the Americans? The Europeans? The Martians?”
Yes, the Americans have some very high-quality centres of excellence that are unfortunately embedded in a national system costing over three trillion dollars a year — approximately 20 per cent of the U.S. GDP. Aside from being a ridiculous amount of money — it is a system that is not sustainable and will eventually blow up — needlessly injuring and killing many people along the way into the abyss. My friend’s boss is American and currently in the States with a diagnosis of acute gall stones. He’s in agony and has yet chosen to take pain meds and wait until he comes back to Dubai to have his surgery. That’s what he thinks of the healthcare system there. He was made to wait four hours in emergency before anyone would speak to him and said that if this is what would have happened to him five years ago when he was rushed to the emergency in Singapore — he would have died. And yes, many European countries have excellent healthcare quality, costing less than the wasteful U.S. model; except, you may die waiting to get access to that “great quality” of care across Europe. Current healthcare systems fail in one or more of the following areas; quality, cost, access and patient experience.
Sadly, most countries around the world have healthcare infrastructure, staffing and practices that are lacking for a myriad of reasons — mostly caused by self-interested humans, who continue to pretend that medicine is a dark art, only understood by a select group of sorcerers. The origin of medicine is in religion and magic — not science, and this is the origin of its ailments as well. We must imbue medicine with more science, and less magic. By building on the healthcare infrastructures, institutions and illusions created in the past; this tepid minestrone soup of mediocrity will continue into the future — until someone is bold and brave enough to think and behave differently and create a better future.
It is time for the disruption of not merely a piece of the system — but the entire system. The way we currently “do healthcare” is antiquated; however, there is a better way on the horizon that will be built upon new technologies. The future of a better healthcare will not be born in the currently developed countries — but will be designed and implemented in regions that are not hindered by massive legacy systems.Of all industries, healthcare has continually been the laggard when it comes to embracing technology. There are some reasonable reasons for this, and some sad excuses as well. Regardless of the past, going forward, technologies in their broadest sense have the potential to “save healthcare from itself” not by fixing old models — but creating new ones. We are at the dawn of a new age in medicine — if we choose to open our eyes to see the sun rising.
It is well beyond embarrassing that most countries cannot sort out national patient medical records system. The task and technology are not complex — really, they are not. Nothing more than huge relational databases. Somehow Amazon, Ali Baba and others, manage global relational databases — and yet, we cannot sort out country level medical records systems. Are we that incompetent? No, it is a combination of politics, self-interest, a fear of transparency by providers and the normal human resistance to change, that has been holding this first important foundation step back.
Here are two examples of how we can fail:
In 2009, the Americans allocated US$20.6 billion as part of the American Recovery and Reinvestment Act to encourage doctors and hospitals to adopt and use IT systems and migrate from their old paper records to the new electronic health record systems. The programme failed spectacularly — providers took the free money to buy and install electronic record systems — but then neglected or refused to actually use them.
The Brits were quick to follow in being underwhelming. For a country which has only 20 per cent of the entire U.S. population, they wasted nine years and lost 12.7 billion pounds trying to complete one of the largest and ambitious health IT projects that the world had ever seen: The National Programme for IT (NPfIT), which attempted to create a national electronic health record system for the entire UK — and it fell firmly on its face losing its wallet in the process.
Give me 12 billion pounds (or US$20.6 billion) and a “big strong stick” of authority — and I will get all of those disparate health record systems interoperable in 12 months — and that is not even the sort of work that I do. It is not an impossible task. But forget about me — consider what Bezoz or Buffet or Musk or Gates would do with that kind of budget. It’s time to privatise the public healthcare system or hold it to the same standards that shareholders do of private companies. Get the new age experts in — the ones that understand healthcare but more importantly understand technology and are not afraid of it.
There are thousands of smaller examples of healthcare technology incompetence from around the world – health records are only one piece, albeit a very important one, of a very important global digital health ecosystem that is suffocating as it is trying to come to life.
The Rest of The Puzzle
It has been said that healthcare slowly evolves and there are rarely any revolutions in healthcare – and for the most part, this is true. The last revolutionary improvement in the health of the public occurred in during the Victorian Era with the advent of systems for distributing potable water; and removing raw sewage from homes and cities. With this, the health of the public soared. Since then, it has been an evolutionary slog – until now. In addition to electronic health records, there is a large handful of technologies, that when used collectively, will usher in a magnificent healthcare revolution, that will eclipse that of the Victorian era.
Too often, we waste time and energy attempting to understand how something works; instead of being focusing on “what it does.” Very often technology sounds complicated and people get lost in the complexity instead of focusing on the use. For example, most of us cannot comprehensively explain how the Internet works, how planes fly, or especially how sunlight is transformed from heat in the sun to the fat on our thighs — but also, we don’t need to, unless we are designing or modifying these systems. As a user, we only need to know the benefits of them doing what they do (not how they do it). Take blockchain as an example. How does it work? Who cares? It is what it does, that matters most to us. For the very first time in the history of the Internet, we will be able to “trust” data that we receive and access via the Internet — this is all you need to know about blockchain — that it enables the fast and safe “authentication” of data — which is of paramount importance as a foundation infrastructure for a future of digital health.
But There is so Much More
Let’s not get lost in the complexities of understanding how new technological advancements like blockchain work — let’s instead focus on how all the new tech we have at our disposal can work together to provide better, cheaper, faster more accessible healthcare for everyone.
We already have high speed wireless connectivity of everyone and everything to everyone and everything — everywhere, all of the time. This connectivity is becoming more ubiquitous, cheaper, faster and more secure. Humans and all of the following and more, will be continually connected and accessible. Connectivity is an exponential enabler of the following technologies.
All knowledge, data, and information will not only be continually accessible by every human — but every thinking machine as well. All knowledge, plus massive thinking machine power supporting collaborating humans — will result in exponential improvements.
Genomics (sequencers plus) – gene sequencers are getting less expensive and more accessible by the day – eventually, everyone will have their genome sequenced, and be able to predict the future.
Sensors (biosensors, environmental sensor and more) — there are already sensors that can be injected into your body, that can be powered by your body chemistry and to work for up to four to five years — monitoring and measuring a variety of things from blood oxygen levels, to screening the blood for biomarkers related to the findings of a previous genetic screening. These sensors will continually monitor your health and body chemistry and more — transmitting this information outside of your body to powerful thinking machines.
AI (machine learning) has finally arrived. The foundation of healthcare delivery is the “diagnosis.” The diagnostic process consists of: data acquisition, information retrieval and analysis, pattern recognition, and following various algorithms, all of which is better done by machines than humans. The tasks associated with the entire diagnostic process will gradually shift from being performed by humans to machines, allowing humans more time to spend more time with each patient.
Quantum Computers: These are not small or just faster computers — these are machines that function differently. It will take another five or more years for quantum computers to become viable healthcare tools, but once they do they will be putting artificial intelligence on steroids. And you will not need to invest hundreds of millions of dollars purchasing quantum computers, but will be able to gain access to these powerful tools on-line in a software as a service manner.
Blockchain: Forget cryptocurrencies and think fast and secure “trust”, which will serve as the foundation of our digital health future.
The above have the potential to completely alter the entire healthcare landscape — lowering cost, improving quality and access and making life better. But for these magical tools to realise their potential, it will require letting go of the past and that is not going to happen easily in parts of the world with self-interested legacy systems.
That is why Dubai has the potential provide the best healthcare in the world. It has visionary leadership that is investing in a 100-year plan that will see what we consider miracles today unfold.
What Is Needed to Make This Happen?
There is a wrongheaded rumour being globally spread that “The Patients” will not embrace all of this new technology — that they “fear” losing the personal touch of their favourite doctor. This is an ignorant lie. I know from decades of experience with patients young and old from around the world that they want something more than the distracted, hurried interaction with their physician — they want to live healthy lives; and they can get this from a healthcare system that does not hide from the transparency and power of technology and process literacy — but wholeheartedly embraces both. Would you prefer a doctor who is gentle and warm versus one who is direct, gives you facts and has the latest knowledge and technology to save you? When it comes to life or death, everyone wants the best not the nicest. Fortunately, by properly embracing the integrated technologies mentioned above — we can have both.
And here is the secret formula: Patients will not benefit from technology that is not offered by the providers; and providers will not use and offer new technologies for patients, that are not reimbursed by the payers and the payers will not reimburse for anything that is not approved by the Regulators. The technologies briefly described above, when implemented in unison, have the potential to serve as the foundation for the greatest healthcare system on the planet; upgrading everything from medical education and research to healthcare delivery and payment. To do this demands that we completely re-engineer the regulatory function of our healthcare system. Instead of being mere “approver” and maker of rules — regulators must become knowledgeable hubs of innovation. Regulators do not need to employ experts in AI, biosensors, genomics, quantum computers and more — but they do need to formally connect with global experts, so that they can effectively assess and approve valuable new technologies as they come online. Innovation Labs should not be separate entities from the regulatory functions they must be one.
As long as the regulators in this region, wait for a technology to be CE marked or U.S. FDA approved, regional healthcare systems will always “follow” and never lead. There is a real and present potential to take the lead. This region is not hindered and held back by the massive legacy systems and infrastructure of the West. No, it is not a perfectly blank slate but very close to it. Creating the future of healthcare is more challenging than stacking rocks, steel and glass into skyscrapers; doing this will require bold and brave action. But how often, are you given the opportunity to create the best healthcare system on Earth? Fortune favours the bold.
I have often thought, that as someone in the forefront of disruptive healthcare technology and proposing that Dubai can be the city that delivers — what would I say to its leaders if I had the chance? If I had an audience with the ruler of Dubai, a man whom I consider a great visionary and one of the few leaders with the courage, vision and power to embrace the new I would say — don’t wait for the U.S. FDA approval; grab the reigns and lead the way — because, we can.
Highlighting this Dr. Ramadan AlBlooshi, CEO, Dubai Healthcare City Authority – Regulatory (DHCR), said, “The UAE’s advantage in becoming a global leader in the healthcare delivery lies in the agility of its government in responding to the impact of disruptive technologies. In the last five years, the country’s leadership has launched several strategies, including the National Innovation Strategy, the AI Strategy, and Block Chain Strategy with the aim of being at the forefront of this fast-paced industry. Introducing new legislations and developing those that exist across different sectors including the health sector are at the centre of these strategies, and the different government stakeholders are working eagerly to achieve these objectives. Earlier this year, we in Dubai Healthcare City, signed partnerships with several government bodies, which will enable us to integrate our systems through blockchain. We are continuously working to develop our legal framework to be responsive to the changes that new technologies are offering with the aim of enabling the development of the health sector in our country and beyond.”