A smartwatch costing $399 can measure your heart rate, blood pressure, and transmit real-time data. A nutrition app on a smartphone can plan your diet. An online site can fix an appointment with a doctor. Robots can assist surgeons in performing advanced surgery with the procedure streamed live from the operation theatre. Artificial Intelligence assures analysing X-ray, MRI scans and lab reports with complete accuracy, diagnosing diseases early on.
The digital era of health seems to have dawned. Yet, the real-world problems of healthcare remain, across rich and poor, rural and urban areas, developed and developing nations. The much-heralded revolution has barely impacted the accessibility, affordability and quality of care.
To begin with, a tech entrepreneur and a healthcare provider have different temperaments. Tech mavericks take risks with products and customers, tolerate failure whereas doctors are risk-averse, conservative and have a low tolerance for failure. A popular tech entrepreneur like Zuckerberg can apologise for his mistakes and continue business as usual, but not a health tech entrepreneur when lives are at stake. Losing a customer is different from losing a life. The tech ethos of building a working model, testing it, failing fast and iterating again is at loggerheads with medical ethos—start-up psyche anathema to the field of medicine. Couple it with myriad regulations and red-tape, and no wonder healthcare providers are slow to embrace innovations.
Digital health technologies exert immense power, bringing excitement and trepidation in equal measure. The signs are visible: they are introducing new models of care and delivery, changing expectations as well as behaviour of both patients and doctors; they are throwing even more data with umpteen sensors and monitors, adding to confusion; and they are also committing new mistakes, as they are not foolproof, making stakeholders anxious.
And other anxieties too exist, the most important is dehumanising a highly humane profession: doctor and patient relationship, considered sacrosanct, continues unchanged for thousands of years. Just as digital tools changed our behaviour in the social realm, they will do the same in a professional doctor-patient setting. Already a computer is seated inside the clinician’s examination room, gobbling huge amount of data, in some cases suggesting treatment by a decision support system. The busy clinician typing details in an electronic database already feels guilty for not giving full attention to the patient, who at the same time feels a lack of empathy and human touch in the whole interaction.
Another important dimension to this relationship is the power dynamic. As the digital tools empower patients to monitor their own health parameters, the availability of information is shifting the power from the provider to the patient, slowly eroding the power hierarchy. The care providers though are reluctant to accept the shift. To be fair, many of us as patients still want healthcare providers to continue as authority figures and be passive recipients of care rather than an active participant.
The present model of healthcare with one clinician for each patient cannot scale up due to the shortage of trained personnel. Medical education is time consuming and doctors cannot be produced in an assembly line fashion. If digital health has to do the greatest good of the greatest numbers, then we have to focus it on areas of maximum impact: public health for preventive purposes and primary care. And this doesn’t need cutting edge inventions, but smart digital health solutions using the power of the IT platform, exploiting its most important attribute—scaling. For instance, deploying video telemedicine, point-of-care diagnostic devices, clinical decision support system for use by frontline health workers would pay enormous dividends.
Seldom a month or two goes by without hearing about a path-breaking innovation in healthcare that should ideally improve health outcomes, but it often fades into oblivion. The innovators since time immemorial suffer from the classic fallacy that a good product will automatically sell itself. After all, they are solving a customer problem and fulfilling their needs. The history of businesses is replete with brilliant products that are commercial failures. Beyond a point, sustainability depends on profitability and healthcare is no exception to the rules of businesses. At the same time, in the sole quest for profit, if digital technologies increase the cost of healthcare, then their unaffordability would rule out their adoption. Or else, leaving large numbers outside their ambit, the digital tools would only perpetuate the existing health divide.
Only when digital systems and health systems enmesh, a new digital health ecosystem will evolve, bestowing its benefits. For this to happen fast, the digital industry has to restrain its hubris and exuberance, while the health sector has to shed its conservatism and break its self-imposed confines. Otherwise, the much-awaited revolution would continue to hobble, wobble and stumble, betraying its promise.
Prashant K Singh is Director, Coordination and Strategy, at the Public Health Foundation of India. – First Post