Healthcare  and  Technology:  a  difficult  marriage    

   by  Beatrice  Shepherd,  B  Spot  Consulting    Despite  the  many  advances  in  technology,  one  of  the  most  important  parts  of  our  lives  –  healthcare  –  continues  to  be  a  cautious  and  slow  adopter.  This  is  not  because  of  the  shortage  of  relevant  technologies  (quite  the  contrary,  a  lot  of  innovation  geared  at  this  space  has  taken  place);  rather,  it  is  due  to  the  healthcare  industry  itself,  which  is  difficult  to  work  with  due  to  its  complicated  legislation,  resistance  from  healthcare  institutions  and  professionals  and  the  tight  funding  conditions  that  most  public  healthcare  institutions  are  subject  to.    It  is  also  the  case  that  outside  the  large-­‐scale  and  traditional  IT  environment,  the  healthcare  industry  lacks  a  strong  collaboration  model  with  the  world  of  technology  innovation.    Investing  in  healthcare  needs  to  take  a  long-­‐term  perspective  and  requires  great  knowledge  of  the  inherent  challenges  that  will  be  faced.    The  high  tech  industry,  on  the  other  hand,  has  little  patience.  Tech  companies,  including  those  that  are  excited  by  recent  big  data  opportunities  should  be  warned:  it  takes  a  battle  to  get  your  teeth  into  the  healthcare  sweet  spot.        

My  health  records  to  not  belong  to  me    One  of  my  biggest  frustrations  with  healthcare  is  the  fact  that  my  health  records  do  not  actually  belong  to  me.  Each  time  we  go  to  a  doctor  or  dentist  they  keep  our  records.  Every  time  you  go  visit  a  new  doctor,  a  new  layer  of  information  about  our  health  is  being  created  and  stored  somewhere  else.  In  some  places  it  is  stored  in  digital  form  and  in  other  places  it  is  still  handwritten  and  stored  in  a  paper  copy  file.  There  is  no  exchange  of  information  between  healthcare  institutions  and  professionals  and  there  is  no  tracking  system  of  our  state  of  health.  My  family  and  I  have  lived  in  5  different  countries  over  the  last  15  years.  My  2  kids  have  been  born  in  2  different  countries  and,  consequently,  many  different  doctors  and  clinics  have  stored  our  medical  records.  Thankfully,  we  are  very  healthy,  but  I  still  went  to  the  trouble  of  retrieving  all  those  records  from  past  doctors  and  dentists.  Now  we  have  a  box  of  papers  at  home  with  our  health  history  that  I  now  need  to  find  the  time  to  sift  through  and  organise.  I  really  wish  

I  could  use  software  to  help  me  do  that  for  me  so  that  each  time  I  required  medical  assistance  of  any  sort,  the  records  would  be  uploaded  to  any  device  of  my  choosing  and  the  analytics  capability  would  use  (for  example)  my  medication  records  to  cross  reference  with  new  data  on  that  sickness,  prevention  techniques,  availability  of  healthcare  institutions  and  doctors  specialised  in  that  sickness  that  are  near  me  and  so  on.  To  create  such  a  software,  or  service,  is  not  that  difficult  from  a  technical  perspective,  so  why  do  we  still  not  have  it?      

Healthcare  habits  have  changed  over  time    Our  grandparents´–  and  even  our  parents´  -­‐  generations  were  not  as  “mobile”  as  we  have  been.  Many  of  them  knew  their  doctors  all  their  lives  and  trusted  their  judgments.  While  this  may  still  the  case  in  smaller  towns  and  villages,  in  larger  urban  areas,  this  doctor-­‐patient  intimacy  is  now  practically  impossible  because  of  the  large  volumes  of  people  living  in  cities,  the  staffing  model  that  hospitals  use,  and  the  constant  financial  pressure  the  industry  is  under  which  leads  to  cut-­‐backs  and  staff  changes  and  a  greater  and  greater  push  for  efficiency,  sometimes  at  the  expense  of  quality.  While  the  reality  of  the  healthcare  industry  varies  country  by  country,  we  all  sometimes  end  up  having  to  wait  for  days,  or  weeks,  or  months  for  specific  treatments  and  we  do  not  know  who  will,  in  the  end,  treat  us.  This  change  in  “the  way  things  are  done”  means  that  the  responsibility  for  managing  our  health  (and  for  keeping  our  healthcare  records  in  order)  falls  squarely  on  us  as  individuals.      

Current  legislation  complicates  matters    

The  second  challenge  is  legislation.  In  Europe,  because  of  the  data  protection  act,  we  have  the  right  to  obtain  our  health  records.  However,  doing  so  is  not  so  easy  in  practice.    For  example,  in  the  UK  we  need  to  apply  to  the  health  authority,  wait  for  their  decision  (21  days)  and  then  hope  they  actually  have  it  stored.    Only  then  do  you  get  another  date  when  you  can  go  get  what  you  need.  In  my  case  half  of  the  records  that  are  held  at  2  different  hospitals  in  London  were  never  found.  What  a  hassle!    There  is  also  the  whole  issue  with  storing  that  information.  If  we  just  keep  it  in  a  box  in  the  attic  then  that  is  fine,  but  if  we  want  to  make  good  use  in  order  to  manage  our  wellbeing  then  the  problems  start.  The  danger  of  our  health  records  being  stolen  (in  the  digital  world)  or  accidently  exposed  publicly  is  real  and  for  companies  this  is  a  major  legal  hurdle  and  potential  embarrassment.  I  suspect  this  was  the  real  reason  why  Google  gave  up  on  their  idea  of  Google  Health.  Google  Health  was  a  personal  health  record  service  that  started  in  2008  and  was  closed  down  in  2011.  The  service  allowed  Google  health  users  to  store  and  manage  information  including  health  conditions,  drug  allergies  and  lab  results.  Once  entered,  Google  Health  used  the  information  to  provide  the  user  with  a  merged  health  record.  Google  Health  could  import  medical  and/or  drug  prescription  information  from  doctors,  clinics,  etc.  Google  Health  was  an  opt-­‐in  service,  meaning  it  could  only  access  medical  information  volunteered  by  individuals.  It  did  not  retrieve  any  part  of  a  person's  medical  records  without  his  or  her  explicit  consent  and  action.  The  official  reason  Google  gave  for  

abandoning  the  project  was  the  lack  of  widespread  adoption,  but  the  more  likely  reason  was  the  company´s  fear  of  getting  into  trouble  with  the  law.    The  company,  which  makes  money  from  data  about  us,  probably  has  figured  out  that  they  will  not  able  to  protect  privacy  -­‐  think  of  all  the  NSA-­‐related  scandals.  So,  either  people  did  indeed  not  trust  Google  and  the  service  consequently  failed  to  attract  enough  customers,  or  Google  realised  that  it  was  risking  too  much.      

Healthcare  is  a  nightmare  for  business    One  very  common  problem  I  have  faced  in  my  consulting  work  in  the  healthcare  industry  has  been  the  lack  of  collaboration  with  other  industries,  including  IT.        While  technology  companies  move  fast  and  rapidly  create  new  products,  services  and  solutions,  the  healthcare  industry  moves  more  slowly  due  to  its  bureaucracies,  legislation  and  public-­‐private  tensions.  While  these  industry  characteristics  are  something  that  the  large  medical  devices,  IT  and  communication  solutions  and  integrator  players  have  learnt  to  deal  with,  niche  and  innovate  players  are  often  off  the  radar  screen  and  unable  to  get  their  voices  heard.    In  fact,  these  inherent  challenges,  can  lead  these  types  of  companies  to  prioritise  other  industries  to  focus  their  technical  and  commercial  efforts  on  and  so  it  happens  to  be  that  the  healthcare  industry  can  end  up  missing  out  on  potentially  very  interesting  and  innovate  ideas  to  improve  its  performance.          

Big  data  breaks  through  the  silence    In  the  last  couple  of  years  we  have  witnessed  a  massive  jump  in  investment  in  technology  to  be  used  in  healthcare.  According  to  Mercom  Capital  Group,  USD  3  billion  was  invested  in  big  data  technologies  to  be  used  in  healthcare  in  2013.  That  applies  to  all  disciplines  from  pharma,  medical  devices  to  personal  healthcare  management.  There  is  no  doubt  that  big  data  has  created  enormous  opportunities  to  improve  healthcare  disciplines  as  well  as  make  lots  of  money  for  tech  companies.      Yet,  by  way  of  example,  while  there  are  already  100,000  new  mobile  health  apps  available,  you  will  need  to  hold  you  breath  because,  on  the  23rd  of  July,  Federal  Trade  Commissioner  Julie  Brill  expressed  concern  about  the  way  apps  on  smartphones  and  mobile  devices  are  collecting  sensitive  health  data,  and  how  some  of  that  information  may  then  be  shared  with  third  parties.  So  this  is  just  the  beginning  of  a  long  journey  for  tech  companies  to  bring  their  innovating  health  ideas  to  the  market;  a  market  that  is  protected  by  its  incumbents,  which  is  very  emotional  because  this  is  not  about  buying  new  smartphone  but  about  fiddling  with  our  health  and  which  is  highly  regulated.  Pharma  in  particular  is  very  aggressive,  so  if  you  have  an  idea  that  would  chop  down  the  number  of  people  taking  aspirin,  you´d  better  think  twice  if  you  want  to  start  that  battle.      Theoretically  it  should  be  easier  to  bring  innovations  to  the  healthcare  industry  in  the  US  (compared  to  Europe)  because  it  is  predominantly  private.  However,  reality  tells  us  something  else.  Anne  Wojcicki,  the  CEO  of  3andMe  from  Silicon  Valley,  learnt  the  hard  way.  For  $99,  the  company  could  analyse  key  components  

of  a  person’s  DNA  from  a  vial  of  saliva.  The  FDA  prevented  selling  that  service  because  by  selling  consumers  a  test  and  health  reports  that  outlined  their  chances  of  getting  dozens  of  diseases,  plus  their  likely  response  to  various  drugs,  23andMe  was  effectively  selling  a  medical  device  and  that  requires  explicit  approval.    The  FDA  said  23andMe  hadn’t  come  close  to  providing  enough  evidence  that  its  test  provides  accurate,  reliable  health  assessments.  Now,  Ms.  Wojcicki  needs  to  resolve  this  issue  with  the  FDA,  something  that  should  have  been  dealt  with  from  the  outset  and  certainly  before  launching  a  TV  ad  campaign.      

What  business  model  to  apply?      The  next  challenge  is  with  the  business  model.  How  to  sell  it?  There  is  a  danger  that  an  app  for  mobile  phones  or  tablets  organising  and  managing  our  health  records  and  wellbeing  will  be  misused  and  marginalised.  So,  while  the  service  provider  route  is  the  fastest  way  to  market,  it  may  not  be  the  most  effective.  The  other  option  is  to  take  an  example  from  the  pharma  industry  and  collaborate  with  some  of  the  stakeholders  listed  here:  lawmakers,  medical  professionals,  healthcare  institutions,  the  public  sector,  the  insurance  industry,  other  healthcare  providers,  medical  devices  players  and  patients.  While  this  is  no  doubt  a  much  longer  and  more  complicated  route  to  market,  it  will  surely  lead  to  more  sustainable  results.  Decisions  on  how  to  package  and  price  the  software  and  services  will  be  a  walk  in  the  park  compared  to  the  business  model-­‐related  issues.      

Re-­‐educating  patients    Lastly,  but  not  less  importantly,  there  is  the  need  to  educate  people  to  be  in  control  of  their  own  health  and  to  use  technology  for  that  purpose.  We  are  so  used  to  the  current  system  and  to  our  blind  obedience  to  the  healthcare  system  (“the  doctor  said  …”).  This  habit  is  something  the  pharma  companies  leverage  when  promoting  their  drugs  though  doctors  (in  many  countries  receive  bonuses  from  pharma  companies  to  suggest  to  their  patients  to  use  their  products).  It  will  take  quite  a  bit  of  effort  to  re-­‐educate  people,  increase  awareness  and  change  habits.  Again,  in  order  to  be  more  effective  it  could  be  done  in  collaboration  with  other  organisations,  especially  in  the  public  sector,  where  there  is  a  strong  interest  and  driver  based  on  the  potential  for  cost  savings.        

Pioneers  are  out  there  already    Apart  from  Google  there  are  dozens  of  other  companies  coming  up  with  technology  solutions  for  people  to  manage  their  health.  One  of  the  latest  and  most  exciting  propositions  comes  from  a  start-­‐up  called  BaseHealth.  This  San  Francisco-­‐based  company  came  up  with  health-­‐management  software  that  integrates  diet,  exercise,  genetic  tests,  and  medical  records,  then  calculates  a  patient’s  risk  for  more  than  40  diseases  —  including  type  2  diabetes,  lung  cancer,  and  Alzheimer’s  disease  —  and  suggests  ways  to  lower  the  risk  of  developing  them.    Also  Apple  and  Samsung  and  a  growing  number  of  other  companies  will  be  offering  services  to  manage  our  healthcare.  While  the  healthcare  industry  

may  be  a  nightmare,  it  is  also  a  potential  goldmine  for  business  and  hopefully  we  will  eventually  have  the  ability  to  make  choices  about  robust  solutions  that  are  accepted  and  endorsed  by  the  industry.  It  is  high  time  to  use  the  technology  we  already  have  and  use  it  to  keep  us  improving  in  an  aspect  of  our  life  that  is  fundamentally  important:  our  own  and  our  families’  health.      For  more  information  please  reach  out  to  beatrice@bspotconsulting.com  Follow  on  Twitter:  @BeatriceSpot    “Opportunities  for  technology  companies  in  the  healthcare  market”  presentation  free  to  download  will  be  available  in  July  at  www.bspotconsulting.com