Stand clear of the moving platform
The arrival of digital platforms in healthcare offers the promise of better clinical outcomes, after two decades of false starts
With the development of innovative digital health applications that need to be connected and integrated to improve patient care, the time is now right for digital platforms to disrupt healthcare.
In the mid 1990s, James Clark had a big new idea. Flushed with his success as the founder of the Netscape web browser, the Silicon Valley entrepreneur - broadly revered as one of the fathers of the internet - saw the possibilities offered by new technology to radically shake up the US healthcare industry. He imagined using the internet to streamline and improve efficiency by seamlessly connecting patients, doctors, hospitals, pharmacies and payers. After all, he calculated, the sector wasted USD300bn annually, and who wouldn’t want to make those kinds of savings?
Unfortunately, the industry didn’t share his enthusiasm, and four years after launching, his company Healtheon was bought by WebMD. And while WebMD has empowered patients through the provision of information, reference material and access to health communities, it did not continue Clark’s grand vision. Fast forward to 2020 and the typical patient experience doesn’t look that different to 25 years ago.
Clark’s idea was ahead of the times, but far from irrelevant. 1996 technology just wasn’t compelling enough to encourage a complex and fragmented system to adapt to new ways of working. There simply was not a sufficiently big prize for all the stakeholders. Clark was focusing on transactional efficiency and not in the core of the healthcare system: better clinical outcomes. Not because Clark was obtuse (he was one of the brightest) but simply because that was what the state of the art offered at that time. In the complexity of the healthcare ecosystem, cost is only one of the variables, and, for many of those involved, not even the most important. Each of the myriad players in this elaborate network – the different health care providers, clinics, payers, regulators and patients themselves, at regional, national and local levels - has different needs, different resources and different drivers. It is hardly surprising that the challenge to connect them was far greater than Clark envisaged.
Digital platforms – for that is what Clark’s idea was, in essence - have revolutionized life in many areas over the past decade. A digital platform uses an underlying technological and governance structure to connect and integrate different actors into an ecosystem of which they form part. Seven of 2019’s top ten companies by market capitalization had a digital platform business model. Companies like Facebook, Amazon and Google have changed the way we live and work for good. And yet in healthcare, until very recently Clark’s vision seemed as far away as ever. In fact, when the World Health Organization produced their Classification of Digital Health Interventions in 2018, to provide healthcare players with a common language, any mention of digital platforms was conspicuous by its absence.
But a combination of structural factors and the advent of new revolutionary technology is about to change that. Longer life expectancy and the growth of chronic diseases are putting unprecedented pressure on the healthcare system. And at the same time, better data collection technologies allow for a revolution in the prevention and treatment of chronic conditions.
Data is the essential fuel of clinical practice. The doctor, working with the patient, makes sense of a clinical situation by incorporating objective and subjective data into a single view. Based on this diagnosis, a clinical plan is designed and periodically monitored. The weak spot in this process is that it operates on a centralized sick-care model. Doctors see patients once symptoms have become evident, in the confines of their offices and during a limited period of time. The diagnosis and monitoring exercise, therefore, necessarily involves extrapolation of limited datapoints into real life conditions.
Modern technology brings the potential to expand diagnosis and monitoring beyond the doctor’s office and to collect clinically relevant data remotely and continuously, through apps, wearables and devices. However, this is of little use in and of itself if that data cannot be integrated with other information sources and fed back into the doctor-patient relationship, via the clinical practice workflow. Here is where the problem arises: the healthcare system wasn’t built to deal with the massive amount of fragmented and inarticulate data flows that this new technology promises. With diverse data residing in siloed repositories, in a number of formats, without connection to the clinical workflow, the impact that it can have is minimal at best. And even if there were a way to funnel the data back to the doctors, the deluge of information would be overpowering. Doctors require new ways to deal with it.
Reenter Clark’s dream. By connecting and integrating different players, the 2020 version of a digital platform can enable historical and real time data exchange, information flow and on-demand interactions, making the health ecosystem infinitely more efficient and effective than its physical world counterpart. For patients, a digital health platform can provide a single source for multiple, pre-vetted digital health tools and services and easy access to new innovations, without requiring a huge investment of time and resource. A digital platform enables patients to manage communication and information flows with multiple stakeholders, thus saving time and improving the patient experience. Other stakeholders benefit too: on open platforms, medical technology companies can easily plug in their applications, and continue to innovate in collaboration with other players in the ecosystem, while ensuring that their services reach their target market.
But the real magic happens at the doctor level. Platforms and associated big data analytics and AI tools can not only provide them with the information they need, but also help them make order from chaos by pre-digesting that information in intelligent ways, clustering it into actionable chunks. Through patient data aggregation from complementary digital health products and the application of advanced analytics, the digital platform can provide doctors with a holistic and “always-on” vision of the patient, and thus help improve care decisions and quality, particularly in chronic disease sufferers.
An example of just what can be achieved when different actors integrate and collaborate across a digital platform is the University of Texas (UT) System’s Diabetes Obesity Control pilot project. The university brought together a local primary care provider and various digital health products, all connected across a cloud-based information interchange, to deliver a remote monitoring program aimed at improving diabetes control between doctor visits (see Exhibit 1). The platform offered multiple digital health products to care providers and patients, while at the same time enabling interoperability between those products, and integration with traditional care services. It provided doctors with access to a remote patient monitoring service, facilitated coordination across care teams and provided them with an integrated view of patient data. The results were convincing: the patients in the pilot showed not only a reduction in their glycated hemoglobin measurements, critical for diabetics, but also a reduction in hospital readmission rates (see Exhibit 2). At last we see compelling reasons to adopt a digital platform: lower costs, as Clark predicted, but now paired with better clinical outcomes.
Fragmented healthcare information is fragmented care. We are moving from a healthcare delivery model that is centralized and only available at the doctor’s office or hospital to one that is networked and decentralized. A problem crying out for a digital solution, would say Clark, who famously described the internet as “a collection of things - of numerous communications networks that all speak the same digital language”. By connecting and energizing the system through a digital platform, disparate pieces of information will finally be able to be knitted together to create a single strategy of care that is coherent and appropriate over time.
Dr Lynda Chin, who ran the UT pilot, is in no doubt as to the importance of digital health platforms to improve efficiency in the healthcare industry and ameliorate chronic patient care. “The challenges of healthcare are so big and complex that no little solution is going to solve them," Chin says. "We do need these innovative technologies to fill the gaps – but what we don't talk enough about is how do you integrate that back. Because the patient is not going to get what they need if it's not integrated and connected through every other component.".