Health’s Tower of Babel. Is technology-driven connected healthcare wishful thinking?
All health data, collected by the doctor and the patient, stored as an electronic medical record, interoperable and available when and where it is required. This is the vision for connected healthcare. Technology is slowly linking all the dots in healthcare, but digitalisation cannot automatically merge data silos or create a harmonious data exchange ecosystem.
The non-binary nature of people
“You cannot connect the dots looking forward, but you can connect them looking backwards,” said Steve Jobs. This is very true in healthcare, where new, technology-based solutions or strategies are often created in a “digital bubble”, without including the components of the healthcare environment, the patients’ and the doctors’ needs, or the social determinants of care. One of these elements is the specificity of the decision-making process by doctors and the priorities of healthcare systems.
When the Microsoft’s supercomputer Watson won the TV game show “Jeopardy!” in 2011, the audience was impressed, but the defeated champions, Ken Jennings and Brad Rutter, felt rather confused. The same is true of doctors interacting with the ‘Watson of oncology’, but in this case it is not just a game, it is a conflict of competences. The medical version of Watson offers guidance for the treatment of 12 cancers, this revolutionary technology analysing billions of reference medical data sets from worldwide sources to identify best treatment outcomes or prevention scenarios. This great innovation from computing power is incomparable with human cognitive performance. It should be welcomed in healthcare, but the greatest issue is the human factor. The algorithms are so complex that doctors fail to understand why this machine gave such specific recommendations. From this point, the incomprehension causes an avalanche of mistrust and undermining of the ability of AI to make decisions. At the end of the day, it is the doctor who is responsible for the patient’s health and life, not a machine. This case shows how technology is dependent on our approach and regulations that are not well adjusted to the technological innovations. The decision making process by doctors is very complex and, what’s more, human beings have emotions that are not scalable, an added layer of difficulty.
Tech companies want to move fast and break things. However, in healthcare this strategy often fails.
Could connected health be analog?
Those who are waiting for “technology to make connected healthcare real” should first answer the question: why have we not yet managed to create a connected healthcare system based on paper medical records? Is the lack of free data flow the issue? Already decades ago it was practically possible to create, for example, printed patient’s records. Paper was invented around 100 BC, a printing press sometimes between 1440 and 1450. In a book, owned and stored by the patient, every doctor could note the most important medical facts like prescribed medicines, laboratory tests and diagnosis. If the patient was obliged to present the book to every doctor he or she visited, it would already be a revolution in care, a long awaited tool to track drug interactions, avoid the duplication of laboratory tests or introduce the continuity of healthcare. Not to mention the benefits for the patients and the healthcare systems. The obligation to keep all notes in a patient’s medical book would not be something completely new. In many countries patients — from their early years — have vaccination books to record whether the children have been vaccinated. I am aware it is far from being a golden standard: the patient could lose the book (but digital data can be also lost or stolen) or simply forget it when visiting a doctor (which also happens in the case of health insurance cards). However, these problems are solvable. Connected healthcare is also a question of how healthcare is organised, the mindset about the patient and the role of information. Of course, digitalisation opens completely new possibilities. Data can be standardised, exchanged freely and stored in a safe way. But is digitalisation really the revolution that is indispensable to make healthcare connected?
Connecting people, changing strategies
If we want to change things, we need to change strategies first. Digitalisation can’t do it for us even if the power of technology to make revolutionary changes is not a subject of discussion. Tech companies want to move fast and break things. However, in healthcare this strategy often fails. Connected healthcare needs good strategies first, political leadership, legal steps, education of physicians and patients, and, most challengingly, a radical mindshift. It must become a core philosophy in medicine and health prevention, otherwise many new issues, like human-machine interactions, interoperability or data safety, will block the implementation of the connected healthcare principles.
So when will healthcare be fully connected? I asked Dr. Eric Topol this question. Here is what he told me: “I don’t know that healthcare will ever be “fully connected”, acknowledging that patients don’t have all/much of their medical data and the digital divide across the world. And issues of concern, like privacy and security, largely remain unaddressed. But we must strive for this in a world when AI tools/analytics can help promote each individual’s health, relying on having all their inputs for meaningful output/advice.”
We must strive to make healthcare connected with help of digitalisation.