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The cost of global health care is unsustainable. As people live longer, they have more chronic diseases, their knees hurt, their cataracts tarnish their vision, and they do not hear very well. It is clear that the human body was not designed to live so long. Yet, patient expectations are higher, resulting in ever-increasing costs to our health systems.
In response, we took our existing health systems and tweaked them to make them more effective. But it is now clear that, to make significant progress, we will have to do what all other industries have done to transform themselves: to turn to new digital tools and techniques.
Health care has been very slow to digitize compared to other major sectors, but they are doing it. Ten years ago, only 10% of US hospitals had electronic health records. Today, only 10% do not do it.
The UK's National Health Service attempted to digitize 15 years ago and the process failed: the program did not have enough resources and aimed to impose computerization on staff without obtaining the participation of physicians and front-line nurses. The NHS is now making better progress, but there are still many challenges ahead.
Scanning is expensive and the NHS is running out of money. Moreover, while computer systems are likely to generate efficiencies over time, the health care experience shows that they often slow things down in the early years because clinicians are forced to increase their documentation and adjust their workflow.
Indeed, the benefits of scanning can often be time consuming. This is because people naturally tend to convert what they are accustomed to doing into a digital version of the same process, which is only slightly superior. Over the next decade, we will need to introduce new digital processes in healthcare that will produce a system that can meet global health care needs, with better products and at a lower cost.
The first big change we will see is that the care site will move from physician surgery to managing patient care from home. Diabetics will measure their blood sugar, for example, or hypertensive patients, their blood pressure, and recommendations on how they might change their behavior or the drugs would come from artificial intelligence, delivered via devices such as smartphones or voice platforms like Amazon Echo. When the patient has to speak to a real person, he is on the other side of the screen. The advantage of this is that patients will be able to access care 24 hours a day, 365 days a year, instead of twice a year when they consult a doctor.
Medical interventions will also change. The US Institute of Medicine estimates that 30% of medical care is expensive and does not rely on evidence. Digital transformation offers the opportunity to help physicians – and patients – make better, more evidence-based choices. For example, when a generic drug will work as well as more expensive, the digital system will steer or even force the patient and clinician to use the most cost-effective approach.
One of the biggest hurdles we face in this critical step of digitizing health care is the public's concern about privacy. Privacy advocates have expressed concern over partnerships such as the recent link between the NHS and DeepMind in the UK, which has given the latter access to the (partially anonymized) recordings of 1.6 million patients.
However, it will be extremely difficult for healthcare to take advantage of the digital revolution if the data can not be shared. By sharing data, we will be able to use AI to badyze the data of millions of patients to reveal trends and insights that I would not have discovered on my own. This will guide me to make better forecasts and encourage patients to take the right steps.
Over the next decade, we will have no choice but to develop secure ways of sharing data between health systems and businesses with digital expertise.
This is a major challenge that will involve new methods of file disidentification, new approaches to patient consent and strict ethical oversight by professionals and patient representatives.
However, setting up a firewall between the health systems and the digital businesses that have transformed all the sectors they have touched – largely for the better – will only ensure that we find ourselves in a better position. a future where we will not be able to innovate to overcome the fundamental problems facing the health sector today.
Robert Wachter is director of the Department of Medicine at the University of California at San Francisco.
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