Next Generation Ecosystems
Connecting medicine, evolving care
If digital medicine is going to live up to its promise of improving the lives of chronic disease sufferers, health ecosystems need to get smarter
In a 2019 study, professional services firm Cognizant asked healthcare professionals what an effective chronic disease management solution would look like. Care providers answered that it would connect patients and providers, offer a support system, provide near-constant, highly personalized information and immediately incorporate patient feedback.
Of course, what the majority of patients and healthcare professionals actually get is something rather different – and light years away from the ideal proposed by the interview respondents.
Medicine, and particularly care for chronic disease, has long been a team effort. The “ecosystem” - understood as a community that interacts and co-evolves within a specific environment - surrounds and provides a patient with several care options, including doctors, nutritionists, health coaches and, more recently, remote monitoring systems, new applications and digital tools and services. A patient generally interacts with various different agents in this ecosystem, which nowadays may include several independent digital solutions. On their side, the doctor interacts with other care providers, products and services for each patient that they see.
However, this current ecosystem is inefficient at best. It works essentially as a patient-centered hub, with disease sufferers interacting on a one-to-one basis with the different agents, and the patient or doctor themselves as the “architecture” over which data is shared and diverse actors connected. Without a doctor’s goodwill or a patient’s legwork, it is not much more than a set of disparate parts. Outcomes, understandably, are suboptimal.
As chronic disease becomes a greater problem worldwide, the faults in the current healthcare model become more apparent. The evolution and management of chronic disease depend as much on what happens outside of the doctor’s surgery as inside, as they are at least partially driven by lifestyle and behaviors that cannot be thoroughly tested during an appointment. But typically, healthcare works to a centralized, sick-care model designed to deal with acute conditions or emergencies, that just isn’t set up to monitor and support patients as they go about their daily lives. This is compounded by the fact that many patients suffer from multiple chronic conditions.
Over the last few years, technological innovation has delivered new digital health applications and tools that promise to change the game, offering the opportunity for physicians to monitor the health of a patient continuously, and giving patients the chance to participate more actively in the management of their condition. But with an ecosystem that remains connected in only the most primitive way, these new tools can’t make much of an impact. They remain disparate, providing isolated data points, and adding to physicians’ already overwhelming workflows with a lot more data – but no real information.
The good news is that the health ecosystem, as ecosystems tend to do, is starting to evolve. Over the next years, we expect to see the digital health ecosystem mature over four stages, from today’s patient-centered hub, to intelligent ecosystems that make sense of data from multiple sources and use analytics and AI to suggest therapies directly to disease sufferers (see exhibit 1).
The first step, clearly, is to find a way to connect the disparate actors and services so that they can start to exchange information.
This is already happening with the development of the first digital platforms, enabling healthcare providers and applications to interchange data more easily. This makes life simpler for both doctors and patients. It also resolves a problem for payors, giving them direct access to multiple service providers, facilitating automation and reducing costs. Additionally, moving new applications and tools to a platform makes access easier for patients and care providers who would not have had the time, expertise or resources to contract them on a one to one basis. Developers themselves benefit enormously from a connected ecosystem that enables them to scale up far more quickly than if they were obliged to sell their services to individual buyers.
But, although a substantial progression, the “connected ecosystem” has serious limitations. It facilitates the flow of data but does nothing to turn this data into useful information. The healthcare professional remains overwhelmed with data that they do not have time to make sense of; the patient receives few, if any, benefits in terms of improved care.
The quantum leap comes at the third stage in the evolution of digital health ecosystems, when they become “smart”. At this point, the constant generation of scattered datapoints becomes organized, integrated – and actionable – information. Systems predigest, unify and cross-validate data for doctors’ consumption, enabling them to swiftly make sense of the situation. With access to the key variables in a patient-centered control panel, it is easy for doctors to pre-program event-driven interventions and alarm systems to alert them to important developments. For care providers, this is a game changer. It means insight into a patient’s lifestyle and behaviors, it means previously unimaginable information that can help them make better decisions without drowning them in numbers, and fundamentally it means more time to spend with the patient, offering support and answering questions, rather than trying to make sense of insufficient and fragmented data.
One of the greatest benefits will be the chance to understand diseases and symptoms in the moment, rather than in the artificial confines of the clinic. Imagine a disease with symptoms that only arise over a long period of time or under specific circumstances. What are the chances that a doctor would be able to observe those symptoms in the brief moments they share with a patient in an examination room? By extending care into everyday life, doctors have the chance to analyze diseases from a completely new point of view and to intervene at the right moment. Rather than relying on anticipation or speculation, they can execute real-time corrections supported by real-time data.
But this is only the beginning. We believe that digital health ecosystems will evolve beyond smart to become truly “intelligent”. How so? Next generation ecosystems will be able to use big data technologies and artificial intelligence to suggest innovative therapeutic solutions that are precisely tailored to a patient’s need. The intelligent
ecosystem will not only provide the patient and the doctor with valuable feedback; it will be able to suggest courses of therapy and provide health professionals with programable decision algorithms to cope with even the most complex cases. But critically, far from replacing doctors, AI and algorithms will provide them with advanced technology that enables them to become better care providers.
This may sound futuristic, but many of the technological building blocks are already in place. However, the pieces need to start working in unison for digital health ecosystems to evolve in a way that really does live up to this promise of access, integration and intelligent care.
Business is a team sport; science is a collaborative endeavor; medicine is built on partnerships. It is worth reconsidering the words of James Moore, who first developed the idea of the business ecosystem. He believed that an ecosystem was necessary in moments of innovation, when “a substantial solution to a customer need may require the participation of dozens or even hundreds of contributors, each of which is master of fast-moving, complex and subtle developments in its own domain” – a concept that he referred to as “distributed creativity”. The emergence of business ecosystems was, for Moore, a recognition on the part of companies that, “they can’t change the world alone”. The hope is that, as digital health ecosystems evolve, together the different players can make a real change, for doctors and care providers, and particularly, in the quality of life of patients themselves.