21st century citizens and healthcare

The VitalSign Series: Why have an English doctor from the United Kingdom and a Canadian technologist from Australia come together to write a blog series? Because healthcare and technology are equally complex, and it’s challenging enough to stay at the forefront of one industry in this rapidly evolving digital era — let alone two. In the VitalSign series, Ben Bridgewater, MD (the English doctor) and David Pare (the Canadian technologist) join forces to present a point of view on health systems in the 21st century and demonstrate the extent of what is possible. This is the second blog in the series.

In our recent blog, “Reimagining Healthcare in the 21st Century,” we started to explore how healthcare needs to change to better fit  the modern era. We called out a number of areas which are becoming increasingly important to facilitate the necessary transformations. Here we will pick up the transformation that is already occurring in citizen behaviours (and here by citizens we include the sick, the well and those responsible for delivering care).

Many citizens are now “digital first” when it comes to their interaction with most industries including banking, insurance, retail and transport. This is unfortunately not the case when it comes to healthcare and it makes sense to explore the reasons why.

Source: The 21st Century Human Upgrade Programme, Leading Edge Forum

We introduced the Leading Edge Forum (LEF) 21st century human model in our last blog and it requires a deeper dive here. People use the capabilities described in the LEF model in their role as consumers: They rapidly assimilate and develop the necessary digital tools and abilities to order their weekly groceries or buy cheaper car insurance. The data suggests that the penetration of social network use on mobile devices is enormous, and so people clearly can be digital first when there is something in it for them.

Why isn’t healthcare more digital?

In general terms, people use digital approaches to drive personal operational efficiency. It is much more time effective to shift money around on your mobile banking app than to visit a bank in person. Most of us are recipients of digitally enhanced customer intimacy through retail websites such as Amazon. Given that these attitudes and capabilities are embedded these days, why are they not more used in healthcare?

Well it takes two to tango. Citizens are not yet driving digital-first healthcare at scale (although there are some emerging services which are tapping into a consumer need such as HealthTAP and Kry). Healthcare providers are, for the most part, not providing digital-first services ubiquitously. For example, doctors are just starting to prescribe mobile apps and wearable devices to help monitor your health between visits, rather than a pamphlet for you to read when you get home.

Why do citizens seem to have a different take on the need for digital-first services in healthcare compared to other industries? It may come down to the issue of digital trust. If we draw parallels with banking, people are happy to use digital approaches to drive operational efficiency for their finances. Most people trust the banks to keep their money and identity safe. But when it comes to personalised and detailed financial advice, they seek out trusted advisors. In healthcare, it should surely be the same.

How can healthcare accelerate its digital transformation?

On a basic level, the healthcare industry needs to accomplish two things in order to become more digital first: improve availability and establish trust. Basic operational efficiency elements, like healthcare scheduling or repeat prescription reminders and delivery, must rapidly become digital first. Meanwhile, digital channels for supporting clinical diagnosis and treatment will have to earn citizens’ trust.

It is interesting speaking to people, who are ill, about their perspective on using digital approaches to gathering information. Some just try to consume everything they can find on the web, but many are anxious, both about the disease and about navigating “non-curated” information, which is now widely available. It seems likely that a professional-first approach, supported by a “prescription” of digital support and therapeutics will be the next stage in evolution. The effort to establish digital trust, then, can piggy back on the existing trust already placed in healthcare and organisations for their medical expertise. This approach will require digital to be more widely recognised as an important channel by medical professionals.

Trust is of course a very personal concept and acknowledging the rights and preferences of citizens is not one size fits all. Imagine for a moment the case of a 16-year-old girl who is seeking oral contraception from her family doctor. She may not trust the physician in their prescription and may go to the Internet to check out the medication that has been chosen for her, but her most trusted group may well be her peers. Her “digital trust” will come from asking her social network for their opinions on her options. This may be a challenge for the existing healthcare model, but this approach needs to be recognised as a legitimate and appropriate avenue of patient decision making, and professionals and organisations must provide curated information to help support these behaviours. Of course, the security and sanctity of personal healthcare data must be absolute, and healthcare providers need to ensure they fulfil this part of the contract.

Digital trust is as important for the clinician as it is for the citizen. As an example, there are currently over 200,000 health and wellness mobile apps available on various platforms. It is almost impossible for clinicians to know which ones are good for their patients. To meet this need for a trusted source of information on mobile apps for healthcare, www.iMedicalapps.com employs clinicians to review and curate healthcare apps. They even created a mobile app (iPrescribeapps) to support a clinician when prescribing a mobile app for patients. This is a great example of an organisation establishing themselves as a trusted digital brand for use of health mobile apps by clinicians and patients.

Additionally, it is worth saying that concepts of illness and wellness are changing. A typical human journey in the developed world often starts and ends in a hospital. If we are lucky, we can avoid all but transient interactions in the interim. Services are well configured in the historical model for providing healthcare, but we know these services are becoming increasingly challenged by aging populations and an increasing burden of chronic disease, driven by people’s behaviours. Healthcare is recognised as a sector with well-established providers and payors. Wellness care is only just starting to be; and by wellness we include physical, social, emotional, financial and career as your wellbeing isn’t purely defined by how healthy you are. These domains play directly into the behaviours that drive better or worse health outcomes, with consequences for individual and healthcare services. Digital-first approaches to driving more holistic wellbeing and behavioural change need to become increasingly recognised as part of the landscape.

Finally, not only does this shift from volume-based to value-based care require new models of care and technologies, it also requires clinicians to be great at performing clinical activities as well as great users/promoters of technology. It will no longer be sufficient to know the human body, clinicians will need to learn how to use the digital tools that will allow them to provide better care to their patients. Mobile apps, wearables, monitoring devices and 3D printing are examples that are already available today and clinicians will need to understand and use these technologies to stay relevant. We will elaborate on the role of the 21st century clinician in a world filled with 21st century healthcare delivery organisations in a future blog.

Ben Bridgewater, M.D., was the director of global advisory for DXC’s Healthcare and Life Sciences Build organisation. He is an expert on health informatics, national clinical audit, clinical governance, healthcare transparency, patient-experience measurement and digital transformation in healthcare. He is now chief executive of Health Innovation Manchester.



David Pare is the chief technology officer for DXC Healthcare and Life Sciences in Australia and New Zealand. He is an innovative thinker with 20 years of experience in business and technology management consulting, helping organisations through their digital transformation.






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