Data needs to be used purposefully for patients, but there are many obstacles to surmount first, says Sarah Cartledge.
One of the few positives of the pandemic was the development and acceleration of digital healthcare creating remote consultation as the future of healthcare. In this session Dr Niti Pall and her panel explored the future of global digital healthcare, its continued funding, development and opportunity.
Emma Sheldon MBE Consultant and Former Specialist Lead of the NHS Export Catalyst Project at Healthcare UK, Dr Mwenya Kasonde Global Health Consultant and Thought Leader, Dan Morris Partner and Digital Health Lead at Bevan Brittan, Dr Senait Beyene Senior Advisor to the Minister of Health at the Ethiopian Ministry of Health, Simon Swift Managing Director at Methods Analytics, Stan Shepherd Group CEO at Instant Access Medical, Dr Anushka Patchava Expert Advisor, Artificial Intelligence and Blockchain at the United Nations and Deputy Chief Medical Officer at Vitality, and John Hubbell, Chairman at HealthEdge Innovation Inc and the Environs Group, formed the expert panel.
As digital solutions enter the healthcare environment, it’s clear there are a plethora of options for governments and providers to consider. And while many solutions have been invaluable during the pandemic, there is the much wider debate around data and security, interoperability, collaboration and financing so that more solutions come to the fore and aren’t lost in the digital wilderness.
How to use data purposefully for patients
The starting point for this part of the discussion was confidence in the data. Emma Sheldon felt that patients are beginning to be more accepting in the data behind their treatment, while practitioners are more comfortable with patient care data to inform patient flow and decision making. Anushka Patchava gave credit to the pandemic as the digital catalyst in healthcare, with higher percentages of the population now accustomed to telemedicine. The answer for Dan Morris lay in the solutions that simply kept the world turning during the crisis, supporting administrative roles, remote working and shared care records.
There was a recognition that the usefulness of data depends on the local context, particularly relevant to countries in Africa where the challenges include poor resources, lack of power and telecommunications systems, and huge distances. Dr Senait Beyene from Ethiopia noted that people are more interested in the legitimacy of the data, rather than the data itself.
Dr Mwenya Kasonde from Zambia stressed you cannot digitise a facility that has no electricity. But she also observed the huge advancement in mobile penetration on the continent. “You cannot improve what you cannot measure,” she said. “Timely, accurate and secure data really are the foundations for making very much evidence-based decisions and importantly, allocating resources effectively and of course, tracking communities left behind. We also need to think about the status of health information systems, research technologies, and other types of data that reflect the accountability to meet the needs of marginalised people, specifically in emergency and non-emergency contexts.”
She also referenced Safaricom, a Kenya telecoms company that has partnered with the M-TIBA platform to allow customers to set aside funds for healthcare only via their mobile phone. “You can imagine the data that has been generated from such innovation and, of course, the ability to track marginalised communities which are often the ones that suffer the most in terms of healthcare needs,” she said.
The benefits of patient-centred data
Stan Shepherd, MD of Instant Access Medical, highlighted the importance of personal care records that would allow patients to be in control of their healthcare data in the same way they have access to their banking and shopping data. “The data needs to be patient-centred and then patients can choose whether to make it available for research and public health benefits,” he said. In addition, the patient can correct the errors and make the data easier to clean.
By allowing people to see how their behaviours influence their health, the opportunity opens up for the focus prevention and wellness rather than sickness. For John Hubbell, digitisation of healthcare records would allow the physician to spend more time on healing the patient rather than on administration.
“One of the key areas is data fluidity,” said Vitality’s Anushka Patchava. “How do we enable data fluidity to flow between the payer, provider and tertiary care? If we can crack that and give patients the access to control our data, we can better resource our health care systems. She agreed with Stan Shepherd that doctors do not have a holistic view of patient’s data in the way that major retailers do. If we can crack that with the data, it will lead to much better health outcomes.”
Dr Senait stressed the need to consider the perspective of digital literacy, even though patients want to be involved in their treatment and management. Not everyone has a smart phone so other solutions have to be available. Dr Shepherd agreed, saying that everyone has a right to access their data and technology should not be a barrier, while Niti Pall referenced a satellite telecommunications client who is investigating a satellite solution to bring capability to regions in Africa with no internet.
From a legal perspective Dan Morris acknowledged there have been gains made in data sharing as a result of the pandemic. He felt that patients would accept the use of commercialised anonymised health data under certain conditions and requirements where it’s for the greater good. He agreed with Dr Senait that where the data is lacking in transparency there would be less willingness to cooperate. “That is quite clearly because data and the security of data raises some questions about security, trust and indeed equity. Unless we address those issues, the regulatory and legal framework is never going to get to grips with data sharing.”
Funding considerations
Investor John Hubbell addressed the issues around money being poured in to innovation and potential in start-ups, but less funding being directed towards the actual functionality of these fledgling businesses. He cited statistics that show 90 per cent of all angel investment and 75 per cent of venture capital investment fails in the second year, so many good ideas never make it beyond this time frame. To combat this he has spent the past two years designing a fintech platform that puts the analysis of the money of the right places, rather than looking at the potential.
“We are putting together an innovation scorecard. We invest once we are comfortable with the analysis process and the validation or verification of the business opportunity and the viability of the valuation of the business,” he said. The huge failure rate of start-up businesses requires the investment at an early stage to be made into the vision and the problem they are trying to solve, then commercialisation in a safe fashion.
The market tends to be frothy and excitable, felt Simon Swift, and as a result money is not being used purposefully and is actually being wasted. “Unless we have an intervention which can impact on somebody’s risk, then we’re all wasting our time and money,” he said.
Role of government and policy makers
He went on to say that investors should require innovators to measure the impact of their solution as governments pay for value impact. By using data exhaust to measure the value that’s being delivered, the government can know that policies are benefitting the citizens. Niti Pall and others recognised that many countries, even middle income ones, don’t necessarily have the data for measurement.
Anushka highlighted the problem of what she called the 5 Ps – politicians, providers, payers, physicians and pharma – acting territorially. “At the end of the day, if we have clear collaboration across the system, we can create the full user experiences that deliver and create value for healthcare, for governments and for the consumer, which is the patient.” Value-based pricing can offer new innovations opportunity and the environment to thrive.
Stan Shepherd commented that most payers pay for processes rather than outcomes.
Dr Senait considered the most important thing that the government should do is engage the private sector and investors, including private providers, in the development of strategies, standards and regulatory products. “We strongly believe that the private sector is a key player in the digitisation process as a whole, so the government will actively support start-ups and new innovators, even if they’re not registered as businesses, particularly in response to COVID,” she said.
Dan reiterated the need for a change in regulation and legislation before digitisation can become truly integrated, with the emphasis on data protection legislation reformation in the UK. For Mwenya the issue is at a completely different stage in Africa, citing a recent WHO score report that found up to 90 per cent of deaths go unreported on the continent. If deaths are not registered, then how can countries make policies that respond to the pandemic, she asked.
Conclusion
There was consensus that digital healthcare is here to stay, but many of the panel foresaw huge policy changes from governments as vital to its success. Collaboration was again mentioned as key to moving forward, through partnerships and sharing information in a constructive and productive manner.
For Mwenya, the issue of interoperability in African countries is a big obstacle to both healthcare digitisation and the goal of universal health coverage (UHC) by 2030. Regulation and standardisation is thin on the ground for developing countries, felt Dr Senait.
The world has to be digitally prepared for the next pandemic, but it also has to address the fallout from the current crisis in terms of reduction of workforce due to burnout and the burden of other diseases that have been pushed to the back of the queue.
Anushka elaborated on the new concept of phydigital, the coming together of physical and digital solutions. “Phydigital is actually a way to not only generate cost savings, but you can also create effective and more effective health outcomes through nudging, through communication, through empowering patients and consumers. With that data and their own health behaviours, I think it will it will take off.”
She stressed the importance of challenging ourselves to come up with new business and pricing models to support entrepreneurs, particularly given the inevitable economic, social and environmental consequences of the pandemic. With more emphasis on consumer input, there will be changing models as patients learn to conduct tests at home and take advantage of the huge wearables market.
“The last word is the digital economy is going to be an increasingly important role in building back better systems and increasing economic growth and ultimately sustainable development, “ said Mwenya. And for Stan Shepherd the outcome was clear. “If digital health solutions are not available for patients, they will create their own and the systems will have to follow.”