Healthcare is still analog, dominated by the traditional one-to-one relationship between the doctor and the patient. But that’s changing as more services undergo automation. How can we ensure care that combines the benefits of both models – analog and digital?
That’s a critical question as there won’t only be a digital world. If you look at the patient value chain and integrated care model, you’ll see that digitalization will be present in certain components and has to interact with the physical world all the time. The challenge is how to embed digital care into the patient journey. We are talking about integrated digital health, which includes this connection with the physical world.
We are at the tipping point of digitalization in healthcare. Are there long-term adverse side effects of this technological transformation that we should be aware of?
Digital health also includes the processing of data. There are many benefits of data, but data can also be misused. The other issue is that digital health will lead to a different approach to how we treat patients. For example, we will use various diagnostic instruments. Today, we use X-rays, but we are already experimenting with new diagnostic methods based on AI analysis of biosignals like voice.
But as with every diagnostic instrument, before we implement it, it must be certified, safe, and precise. What’s now interesting about digital health is that it’s not structured—we don’t know exactly how some innovation will evolve over time. The same applies to data and the way we will, for example, include information gathered by wearables.
Digital health will be the basic model of careWe are moving now into different reimbursement models, also driven by digital health. Throughout digitalization, we will also start to use different data sets. For example, as soon as we know about the genetic imprint of a patient, a new question arises: how far are we away from using this information to come up with a healthcare premium? The better you can judge the risk—in this case, the likelihood of disease—the better you can adjust the compensation. These are just a few examples of trends that we have to observe carefully. Although I definitely believe in the huge potential that digital health brings to us, we should also be aware of the downsides and socio-economic and ethical aspects. It’s expected that automation will make healthcare more accessible and affordable. Health bots will be cheaper than seeing a real doctor. Won’t we create two-speed medicine where only wealthy people will afford to see a doctor when bots, AI-driven health assistants will serve people with basic health insurance? That’s exactly what I expect to happen. Digital health will be the basic model of care. It will be a privilege for the rich to have a human caregiver. Is this the right course? I’m not going to judge this. At the end of the day, we come up with an instrument that delivers high-quality and affordable healthcare. That’s the result that we want to achieve. The question is “How?”. If this is a way to create a model in which people who now can’t afford medical care will get access to better services, it will be positive. This is already happening in healthcare. Some of the most modern innovations brought to us through industrialization lead to many inequalities. During the pandemic, the most preferred way of contacting the doctor in high-income countries was still a phone. What is lacking in virtual care to improve the patient experience? Usually, people prefer the phone because it provides anonymity. During a phone call or chat, you keep your privacy; during a video consultation—you sit in front of the doctor. The second aspect is that the diagnostic value of a video consultation doesn’t differ from a consultation via phone so far. But these things will change. We’ve learned to use a video call as a substitute for face-to-face meetings during the pandemic—we adjusted our behavior. Secondly, the future will offer many diagnostic technologies that can be used during a video consultation. For example, mimic recognition, micro-movements of the face. Video will become much more critical in future medicine. The COVID-19 pandemic has accelerated digitalization in healthcare. But when we return to a new normal, the next wave of challenges is on the horizon. What is the schedule for sustainable digital health for the following years? The first thing is that people adapted to digital health and learned how to use it. Second—most countries set up legal frameworks for digital health, including regulations and reimbursement policies. So I expect that this acceleration will continue. The big question now is how we are going to reimburse these new digital healthcare services now. The healthcare ecosystem has always been complex, and with new players from outside the healthcare sector entering the market, it’s getting even more complicated. The system is fragmented and siloed. We can’t talk about the “patient journey” now but the “patient journeys” or “care episodes” that are not connected with one another. How can we change this? And who should lead this transformation? Politicians? Industry? It will be driven in a collaborative model. The caregivers will play a fundamental role, especially as they are not only working in silos but also the financial framework does not stimulate them to cooperate and share data. In order to change it, the reimbursement models must be modified. As long as we stick to the fee-for-service model, we will never get to the point where we start to integrate the system—nobody wants to lose the revenue or volume. Different stakeholders must align to move to new models, like, for example, the value-based approach. It also needs new regulations. It’s not enough that the payer and provider want to collaborate with each other. It requires new incentives embedded in the new reimbursement models. And this should be set up by politicians. As the President of the International Society for Telemedicine and eHealth, you stay close to the innovations and trends. What have you observed in recent years? We are experiencing a heavy acceleration of digital health driven by the COVID-19 pandemic on the providers’ and patients’ sides. The other trend is a massive acceleration of technology, computing power—year-to-year, month-to-month. And this is driving the transformation in healthcare. Imagine a patient who has to walk 5 minutes to see the doctor, and it’s easy to make an appointment. What is the added value of virtual consultation in this case? It depends on how the doctor works. If the doctor accesses the patient’s electronic medical record, uses modern diagnostic instruments—that is added value. So it’s about rethinking telemedicine and how we provide digital health, starting with using different data and tools. The main benefit of telemedicine is not the remoteness of the service. Could you please list the three milestones of digitalization in healthcare that have been achieved so far? Firstly, we can finally use all the technologies in real settings because we have enough calculating power and devices that patients can use. Secondly, patients and service providers have learned how to use digital health solutions. And thirdly, most countries have set up standards and regulations for digital health. That’s a milestone that has been achieved in the last 20 years.
