Who wins and who loses in a digital health system?

TerryMulligan

One of the more aspirational visions for the future of healthcare is an end-to-end digital health system. One where data is available and utilized to maximize efficacy at each step of the treatment process - from individualized preventative care to diagnosis to treatment to personalized after care (and more).

• We understand the benefits, but what are the unintended consequences of an end-to-end digital health solution?
• Who benefits?
• Who is left out?

Shashi

Hi @bngejane, @SArora, @RahulJindal and @mhackett - You may have some thoughts on the unintended consequences of an end-to-end digital health solution. Join the discussion.

Shashi

Hello @clairecravero, @ClaireM, @dzera and @a1m2r3h4 - Do you have any thoughts on the unintended consequences of an end-to-end digital health solution?

Shashi

@addy_kulkarni - Hi Aditya, As CareNX has implemented a lot of Digital Health and tele-medicine initiative, did you'll encountered any unintended consequence?

@panderekha - You had mentioned earlier that you were working on a program on elderly womens' health, you may have come across some unintended consequence. It would be great to hear your experience.

@pglass - Hi Parisa, George Institute has been working on smart health. We would love to hear any repercussion you'll faced while implementing this digital health solutions.

@preciouslunga - Hi Precious, Baobab Circle has introduced Afya Pap, A personalized Health Management system in Africa. It would be great to hear your experience implementing this digital system. Any unintended consequences you'll faced. Who are the gainers and losers of a Digitized Health System.

Please share your experiences. Thanks.

Shashi

Hi @dykki, @JohnParrishSprowl, @adel1, @zerofive, @synhodo, @dokgva - While attending a webinar on telehealth in India, some experts mentioned connectivity as one the constraints of end-to-end digital health solution - what do you all think, what are the other issues?

JohnParrishSprowl

Access is a loaded issue. Are people able to connect? Is the connection good? Is it affordable or does it compete with other expenses? Can they do so in a space where they feel comfortable talking about health issues? Is there an ability to do follow up, including any needed tests that must be done in person? Do people find the lines secure enough to meet their standards of privacy? Is the health care professional sufficiently mindful of their environment so that it is supportive of the person they are serving (I knew a person who could see family members in the background of the MD making them uncomfortable sharing information)? People on both end need to be educated and trained to learn to do this well. Telehealth offers great possibilities but it is not as simple to implement well as some would think. There are probably more issues, but these are some I can offer at the moment.

Shashi

@JohnParrishSprowl - Thanks John for sharing these details. This helps us in understanding the digital health systems.

Hi @siimsaare, @biki, @JoanneP, @saebipour, @tylerbn - What are the other Issues of having a end to end Digital Health Solutions? Do we need digital interventions for health system strengthening? Share your thoughts.

HeatherSutton

@JohnParrishSprowl That is a solid list of considerations and it really points to the need for trust. Patients need to be able trust their point(s) of contact - whether that be technology, a family member, a community health worker or a public facility. They need to know that their privacy is of utmost importance and that the care they are seeking won't hurt them in the long run.

I also firmly agree with your point that both individuals and care providers need to be educated and trained to do this well.
Thank you so much for your insight, John!

biki

Most countries needs ubiquitous, adequate, affordable broadband to support telehealth and health information exchange in order to increase access to quality care for all individuals at the right place and the right time when it is needed. Technology has been the focus of telemedicine for a long time. However, telemedicine is really about the services—where they can be provided and how they change people’s lives—and not about the uniqueness of the newest piece of technology. Additionally, the implementation of multiple technologies may create huge data flows that are not useful or easily maintained (e.g., continuous monitoring of temperature and blood pressure).

Shashi

@biki - Thanks Biki for sharing your insights. Do you think we need to have some data maintenance / privacy guidelines in such a scenario?

ymedan

I am new to this discussion, yet have been puursuing digital health techology develpment and implementation for quite sometime now. The big premise in my mind is delegating back the responsibility to one's health to the individual. Closed-loop monitoring and biofeedback will enable us to have a "Stage 0" health system and reduce the breadth and depth of medical interventions. Pharma and MedTech will loose, Medicinal Food companies will win.
This will be the transformation from Medicine to Health.

Shashi

@ymedan - Thanks Yoav for sharing your perspective on this discussion. If you know about piloting and evaluation framework for digital health solutions in developing countries, please share it here. Thanks.

Shashi

Hi @Hongsoo, @nothmany, @fbaothman, @Budoff - We are discussing issues of having an end to end Digital Health Solutions. Do you have any thoughts on this topic and the comments so far? Join the discussion. Thanks.

bngejane

Hello @Shashi

Great question, ( @biki data privacy and accessibility, potentially deepened inequality, potential job losses etc all major concerns), curious to hear your views on how we could deal with this data privacy issue, I know connectivity will be addressed by Starlink and other satellite internet companies.

We can potentially approach this issue by also asking the question, who do we want to win in this entire eco-system?

In the mindmap [url=" https://mm.tt/1502648773?t=8HjFOaAR5K"][/url], we prepared we have the patient at the centre. We did it because we are focused on creating the optimum customer experience in all the work that we do.

So the question we are continuously asking ourselves is how can the patient always come first? what are we doing that ensures the patient is the winner, and we are winning alongside them? It's possible, Tesla does it always, they recently said their target is a small profit margin. The rest of the revenue should go to creating a killer product. In such a case customers are not concerned about giving away the data in order to improve the self-driving driving ability of the car.

RDF (Reality Distortion Field)

Shashi

Thanks @bngejane for sharing your thoughts. Great points.
Hi @Stefania, @nowellk, @alafiasam and @acavaco - Is there any other repercussion of having an end to end Digital Health Solutions? Read the comments so far and share your thoughts. Thanks.

tylerbn

Two thoughts this thread has brought to mind - surely not in any order or a comprehensive answer to the questions posed here, however:

Patient identification: health information exchange (HIE) and interoperability of digital solutions continues to be an ambitious target in any system. Unique patient identification or the use of biometrics for linking health records and information across a treatment pathway or referral system is one solution that has limited precedence in my experience. National IDs are not commonplace (though there are examples of this being an option), and duplicate records for the same patients, or potential for fraud, continue to overburden digital solutions.

Private investment and payment models: countries that have advanced the closes to UHC objectives have done so with innovative financing schemes to extend financial protection and coverage to their populations. These schemes are typically designed to cover costs as they are today, and necessarily weight most of the resources behind hospital care, as it is the most resource heavy. I worry that these schemes do not provide an attractive enough financial market for innovative technologies to be developed - private healthcare sectors are weak and unable to grow in environments that heavily finance public systems. I do not think privatizing healthcare is the answer - however it is worth noting the contradictory financial incentives between UHC achievement and investing heavily in new technologies.

Shashi

Thank you for sharing your insights @tylerbn.

ShmuleyG

1. Unintended consequences - reimbursement, health systems, policy.
2. all of system, but at the same time, a change will occur due to the fact that healthcare continues to be an asset-heavy industry (i.e. no true model of HaaS), bricks and mortar, equipment, etc. This will change in the future
3. The doctors - Doctors hold the potential to systematically drive innovation. If you know of models or networks that support or incentivise specifically the medical community, please share it with me.

Hongsoo

Dear @Sahshi, sorry for the late response due to other urgent responsibilities.
Other colleagues have already provided valuable inputs, so I do not have much to add. A few points: 1) the digital divide would matter, which may worsen the current health disparities; 2) data mx. and security issues in an end-to-end digital solution; 3) Medical professions - they need to set up new roles and relationships with citizens/health consumers, which actually requires the whole system change and it often happens (very) slowly in many countries.

stephaniel

Hi @Shashi, I think it's important to think about privacy considerations in an end-to-end digital health system. There are certain tests that I do separate from my regular medical care, for privacy reasons, and for which I do not seek insurance reimbursement. They're not anonymous, but I have the ability to choose when, whether and how to disclose those results to my usual doctors. That's important to me, even though relative stigma where I live is low compared to many LMICs. I think it's quite possible that if there is one "master" security solution, with no alternative paths for certain privacy-sensitive tests or consultations (including mental health consultations and STD testing, among others), you may see people avoiding certain tests or consultations entirely due to perceived and actual stigma in their country. Preserving the availability of alternative paths and carve-outs for especially privacy-sensitive care is important for people's willingness to seek that care.

Shashi

@stephaniel - Indeed privacy is a very important factor in digital health system. Thank you for sharing your thoughts Stephanie. Have you come across any app / platform, which has taken care of privacy factor successfully?

stephaniel

Hi @Shashi - I think it's important to have multiple apps and platforms; that way the user can choose which to use for which services. Some users may prefer to have all of their health care handled through a single end-to-end health solution. Others may prefer to handle most of their care through this solution, but their mental health consults through a separate app, or their STD tests or pregnancy tests through a separate app. On the back-end, these apps could check to avoid duplicate prescriptions for frequently abused drugs (e.g., opioids) - and should notify users that they will check for that - but other than that should be firewalled to protect user privacy.

reubenwenisch

Unintended consequences of an end-to-end digital health solution
Many will not want to talk about it but one consequence is Female feticide.
Why: Because some countries still follow a system called dowry where the parents of the girl pay the boy's parents a huge amount of money. This leads to a tendency of people wanting to get free money instead of giving money based on the gender of the child.
Unless care is taken where of completely either hiding or not collecting such gender health information from the partners during pregnancy this practice will continue in certain countries and innocent lives will be lost.

HeatherSutton

@reubenwenisch ~ Thank you so much for sharing your thoughts and for highlighting this important consideration.