Digital Health: Why does it seem like just promises?
It is hard to escape any development conversation without the two holy words ‘Climate Change’ and ‘Digital Health’. Amusingly the two are connected like Siamese twins.
In the context of Digital Health there is more grist to the mill with AI, ML, IoMT, SaMD, Robotics, Personalized/Precision Medicine that make for bleeding edge speaking circuit opportunities. Lost in this melee is the one that matters i.e., Healthcare Outcomes.
Nevertheless, the potential of Digital Health to deliver scale, equity, safety and sustainability of healthcare, and fuel innovation is HUGE and life transforming – both for humans and the biosphere.
The lack of adoption of Digital Health at the delivery side, detracts from the Quality, Quantity and Authenticity (Contextuality) of data being made available. Such data is foundational to make universal healthcare possible, across the private and public divide.
All the higher seductive benefits of exotic technologies that are being evangelized, pivot on the wide and successful adoption of digital health. The lack of quality and quantum of near-real-time data will not let them translate into anything more than a Proof-of-Concept; much less deliver their full benefit.
Why, then, is Digital Health hard to adopt?
Firstly, Healthcare, unlike most other domains is less ‘Coherent’ than other more fungible pursuits like Banking, Finance, Travel, Retail etc. where the greater objectivity in decision making, the greater ‘standardization’ friendliness and the limited number of transaction archetypes make it easy to deploy digital solutions at scale.
Clinical decisions in healthcare on the other hand, bring a very large subjective, customized and individual point of view to the table - whereas the final goal we seek to evolve to is the ideal of personalized medicine!
Secondly, it is probably more appropriate to compare Healthcare to an Organism rather than an Ecosystem. Ecosystems are more finite in nature and predictable in their behavior compared to Organisms that are adaptive and evolving. The fact that the world now talks of determinants of health to be addressed by ‘One Health’ and ‘Integrated Health’ approaches, are clear evidence of this complexity.
Thirdly, care is a life course endeavor and the needs of an individual change with age and stage. There is a need to be mindful of healthcare not being an episodic pursuit.
Given the peculiarities of healthcare discussed earlier; Digital Health can only be adopted successfully when it manages to create interoperability amongst stakeholders that is semantic, near-real-time. A balance between universalization and localization needs to be achieved. The National Digital Health Blueprint in India is a reference architecture that does just that, very elegantly.
A true Open Source approach through the Elastic Cloud is the only possible way to accomplish that equitably, and without making it burdensome to stakeholders.
Linux, Java, Mozilla Firefox, Apache and GNU are great examples of Open Source Innovation for a common good, and the power of enlightened, collaborative ecosystems. Healthcare critically needs this more than anywhere else.
So, what will make the penny drop?
A combination of committed governance and administrations that put public good above all else; some large-hearted philanthropy; a few enlightened business interests; and then of course Healthcare Professionals and Providers who can embrace change with the understanding that they are part of a much larger whole, called public health.
Philanthropy will need to step in to support frugal innovation and ensure persistent support is available to Open Source communities to stay truly open, until a fair and open innovation ecosystem takes root. It will take far lesser sums of money than imagined, given that the change in technology has obviated the need for infrastructure heavy investments in this space. Digital Health is about leveraging existing infrastructure and hardware.
Some enlightened business interests are also needed, that can see beyond the paradigms that they are already invested in and are willing to build profitable businesses based on opensource innovation and embrace the transformation of business models that comes with it. If anything, it has been proven Opensource innovations have spurred exponential growth e.g. Android and the exponential innovation it has unleashed in the use of mobile devices.
Lastly the user of these technologies i.e. the healthcare professional, will have to give up the lone-ranger approach to healthcare for the greater good.
For all stakeholders there is much to unlearn and lots to learn anew.
About the Author
Arun Kumbhat is a veteran Healthcare and Lifesciences thought leader, recognized in the Global top-200 Digital Health Exponentialists. He currently volunteers for a Not for Profit, Libra Social Research Foundation whose core team has played a catalyzing role in India’s transition to a national digital health ecosystem, besides knowledge partnerships with leading Indian academia. He is reachable at arun.kumbhat@librasocial.org
