Healthcare 5.0: radical change that we have to go through

27 September 2023
Digital Health
You are envisioning healthcare model 5.0. What are its pillars, and how will it differ from the current one?  Healthcare 5.0 envisions patient-centric ecosystems designed around individuals' needs. This new era of healthcare is driven by digital transformation, shifting from traditional doctor's office visits to accessible mobile app-based solutions. Healthcare 5.0 also highlights the pivotal role of data in unifying non-digital technologies within a patient-centered ecosystem. Data serves as a critical source of information regarding our health status, treatment effectiveness, and the outcomes of preventive measures. Digital technologies go beyond mere diagnosis and therapy; they provide valuable information. Healthcare 5.0 is built upon this foundational understanding, envisioning a future healthcare landscape characterized by a global virtual healthcare system or a network comprising numerous individual ecosystems with data accessibility at its core. To what extent is such a vision realistic, assuming that health systems are huge molochs anchored in models developed before the digital age, inflexible, politicized? The impending bankruptcy of the current healthcare system is an issue that mirrors the looming catastrophe of climate change. Regrettably, a significant part of the population remains unaware of this reality. However, the statistics show the facts: we are living longer (10% of the OECD population will be over 80 in 2050, according to the latest forecasts), our expectations regarding healthcare are rising, and a shortage of healthcare professionals looms. An estimated additional 18 million healthcare professionals will be needed globally by 2030. These factors will only drive up the cost: OECD countries are expected to allocate an average of 10% of GDP to healthcare by 2050. We must begin planning our strategies to address the inefficiencies within the healthcare system. But we have known about the healthcare crisis for years, and nothing has changed. Healthcare is changing enormously: we're witnessing a wave of positive transformations through the introduction of innovative treatments like CAR T therapies, brain-machine interface technologies that facilitate the creation of a "digital bridge" between the brain and spinal cord for paralyzed patients, and the ability to genetically test ourselves to identify risks associated with 52 genes linked to solid tumors. However, you are right. A significant challenge persists: access to these innovations remains limited, primarily due to the healthcare system's outdated structure dating back to the 1970s. From a health economics perspective, what must be changed in healthcare in the next five years, and how can technology help? Firstly, a shift in mindset is essential. The dynamics within the healthcare system must pivot toward prioritizing patient autonomy. Individuals should be empowered with tools and healthcare resources that enable them to make well-informed decisions regarding their health. To achieve this, we must transform the traditional relationship between doctor and patient. Doctors should evolve into consultants, while patients take on the role of decision-makers. Secondly, our healthcare system should emphasize prevention more strongly, which requires a more substantial investment in proactive measures aimed at safeguarding and delaying and/or eliminating sickness. Easy said, but we know that the culture eats change for breakfast. In my book, I strongly emphasize the need for a mindset shift. Real change won't occur if we cling to old habits. I hope that health policymakers recognize this as a valuable opportunity if their mission is to enhance the healthcare system. It is indeed possible, and I trust that my book will guide how to make it a reality. How can the gap between available innovations and their adaptation in clinical practice be removed? Access to innovation should be funded based on the outcomes they produce within a framework of risk-benefit analysis. The requirements of market access pathways should not hinge on whether a given technology aligns with a specific mode of action, whether pharmaceutical or digital. This calls for substantial revisions to legal statutes and a shift in focus towards health and efficiency gains as well as risks the use of technology may incur instead of technical or biological aspects of innovation. In your book, "The Digital Transformation of the Healthcare System," you write that "the growing use of data will allow us to look at healthcare issues and solutions holistically." What do you mean by that? The focal point of data collection has shifted away from the healthcare system. Electronic medical records (EMRs) were initially seen as a groundbreaking achievement, ushering in the era of real-world evidence. In the age of digital transformation, the primary locus of data collection is the patient. ARM predicts that there will be one trillion Internet of Things devices by 2035. It means that the individual is the data factory, especially when patient data can be finally linked with EMRs. On top of that, people still need to be encouraged to share their data. Data can be a lifesaver, as demonstrated by the FINDATA project. Finnish health data are now accessible for research and development purposes. Let's envision a scenario where everyone volunteers to share their data collected via mobile devices for R&D. The potential benefits are immense, especially for future generations, as it could inspire researchers to invest their time and resources, knowing that data would be readily available for their work. You also highlight the need to reshape healthcare systems from "office-centered" to "accessible everywhere." As Internet of Things (IoT) devices that patients use gather health data, we are reducing the necessity for physical doctor-patient contact. Provided we can guarantee interoperability standards, information sharing will be in real-time, allowing healthcare services to be delivered "just in time," thus eliminating unnecessary delays associated with waiting time for doctor appointments. Nevertheless, health is not only about decisions based on facts and data but also about personal contact with the doctor, support, and empathy. In my book, I outline the concept of patient networks, which is grounded in the idea of belonging to a community with shared problems and interests. I believe individuals can gain significant benefits from discussions with both their peers and medical professionals. However, medical professionals should prioritize assisting those with more severe cases. This approach represents a form of equal access based on needs, where those with the most critical conditions should be cared for first in medicine with limited resources. By redirecting less severe cases away from doctors, we can ensure that medical professionals will have more time and empathy for seriously ill patients. There are many barriers to making a vision of Healthcare 5.0 a reality: lack of data interoperability, vast gaps in access and use of technology in society, concerns about data security, and the cost of new technologies like AI. How do we deal with them? That's precisely why I wrote my book! We must collaborate to formulate new regulations that safeguard the transition to the emerging digital healthcare landscape. You tested the assumptions of the Healthcare 5.0 model in a proof of concept study with 320 representatives of the Millenials and Z generation. What did this study look like, and what are the results? Millennials are open to embracing new virtual health systems. Interestingly, I've discovered that past experiences with the healthcare system play a pivotal role in the preference for digital healthcare models in the future. The further analysis of the priorities of responders tested in different hypothetical trade-off scenarios indicated that future circumstances do not influence choices regarding life gains. Still, it's past experiences that instead impact them. Those who did not express interest in the change of status quo of the current healthcare model had some potential trust issues towards digital technologies. Your book highlights the paradigm shift in healthcare during the COVID-19 pandemic. However, I have the impression that as the pandemic threat passes, we are returning to the old thinking patterns. What can be done to make this digital transformation successful for us? I believe that the pandemic exposed numerous inefficiencies within the healthcare system. Now, we have a window of opportunity to implement necessary changes. The increasing interest in introducing new reimbursement models for digital technologies is a step in the right direction. The bankruptcy of the healthcare system is real: an average annual increase in healthcare spending equals 6%, far above inflation for many countries. The clock is ticking. Along with how data will be central to healthcare, we need to ask ourselves how to process and use it fairly for the benefit of all. Do you have any ideas about the fair economy of health data here? Data freedom should be founded on a new culture of sharing for our mutual benefit. Firstly, we must establish the concept of data ownership, ensuring that individuals are fully aware of their role as data owners. Secondly, we should create opportunities for individuals to understand that data sharing operates reciprocally. It's not only about giving our data; it's also about receiving data from others through shared experiences or scientific advances and new insights into our health. Click here to get access to the book "The Digital Transformation of the Healthcare System" by Prof. Kolasa.