Looking for directions to digital health?
Updated: Sep 28, 2020
Are you looking for a new world - to undertake Real World Evidence (RWE) research through a more integrated digital health approach – providing tangible benefits over existing observational study methods? If so, you are probably looking for direction and the right vehicle/s to help you get there. Then, maybe, this old joke is more helpful than you might think!
Healthcare delivery in all the developed economies is extremely complex and is currently undergoing significant change, (even before COVID 19). How should industry find its way to engage: and through what vehicles or collaborations? They could choose to work with the healthcare providers, (the Clinical Organisations, Hospitals and Academic Institutions), with the Payers, (the Insurers or Government bodies), or is it possible to work with the patients and healthcare consumers themselves? Our experience is the solution is to be found somewhere else...
Michael Porter and Thomas Lee in the 2013 Harvard Business Review stated - “We must move away from a supply driven health care system organized around what physicians do and toward a patient centred system organized around what patients need. We must shift the focus from the volume and profitability of services provided physician visits, hospitalizations, procedures, and tests to the patient outcomes achieved.” This is the backdrop to a change all health services are trying to address. The difficulty for them is that it’s almost impossible for individual health suppliers to do it. They can pay lip service to putting the patient at the centre, but their service is usually only one component in a whole chain of services that the patients see. So, patients will continue to be passed from one service, hospital, clinic or clinician to the next. The individuals or institutions can't do too much about this. This is how we have built and organised health delivery: cutting a complex problem into more 'manageable chunks'.
And of course, the data infrastructures mirror their organisations. They form information silos servicing workflow, individual physician treatments, activity and organisational audit. It isn't joined up, it isn't holistic, it certainly isn't patient centric, and it struggles to even solve a lot of the existing supply side problems. These institutions also don't have the funding, scope, control or incentives to address the wider problems of wellness or the broader patient and family perspective, and certainly not industries RWE needs. So, this is not the ideal place to start from.
So, what about starting with the payers? Strategic bodies such as governments or health commissioners are best when they're creating environments and making basic digital infrastructure investments. For example: setting standards, creating regulatory bodies, and developing policy frameworks - such as the UK’s NHS Long Term Plan for health. They can fail badly as demonstrated by the NHS National Program for IT, (2005 to 2011) when they try to get involved with more direct 'top-down digital health' initiatives. In April 2007, the Public Accounts Committee of the House of Commons issued a damning report on the digital health initiative at that time, which concluded that, despite a probable expenditure of 20 billion pounds "… it is unlikely that significant clinical benefits will be delivered by the end of the contract period.” As a more generic commentary on digital health related infrastructure projects, a British Medical Council (BMC) report* said in 2012: "Medium and even small scale (digital health) implementations often struggle to succeed, but there is good evidence to show that this is only exacerbated in the context of the larger scale, more standardised implementations if pursued as part of a national or regional modernisation strategy." The BMC concluded: "The tensions and potential trade-offs between achieving large-scale interoperability and local requirements is likely to be the subject of continuous debate in England and beyond with no easy answer in sight."
Strategic bodies do want to address societies wider wellness needs, but they are also caught up in having to simultaneously solve both implementation issues as well as their supply side problems. They are certainly not focused or even well equipped, to help improve industries need for RWE services. So, again – this is not such a great place to start an integrated digital health journey!
If everyone agrees the patient should be placed at the centre, Patient Advocacy Groups must be a better place to start. In the UK there is a well-developed charitable sector whose sole reason for existence is to represent the best interests of their population. These charitable groups are ideal organisations with which to work: to discuss needs as well as develop and test ideas. They can also benefit from the commercial revenues that digital health and RWE offers. Importantly, these are also organisations the public trust to protect their interests. Therefore, If you can combine 'the appropriate advocacy group' with the 'right commercial healthcare agency', who can; co-ordinate stakeholder relationships, understand national healthcare delivery, apply necessary policy agendas, ensure relevant Information Governance, impose epidemiological research methods and analytical techniques, integrate digital process and assess the relevant data sources required for linkage - then - your direction of travel looks more assured.
The new world of integrated digital health requires both breadth and depth of understanding in multiple domains. It requires new ways of working and new collaborative partnerships. DaSH Global are uniquely placed to deliver on the promise of new digital health platforms combined with new methods for RWE research…and we think we know how to get there!
*Cresswell et al. BMC Medical Informatics and Decision Making 2012, 12:15 http://www.biomedcentral.com/1472-6947/12/15