By Robert Hickson 14/10/2018 3


When thinking about the future of healthcare, images of robot surgeons, predictive algorithms, nanoparticles and nanobots in your bloodstream, CRISPR, and wearable or ingestible sensors may come to mind. A future of big technological advances that help get rid of once acute conditions (like cancers, infectious diseases), and improve the monitoring and treatment of chronic ones (like heart disease, diabetes and obesity).

Robot surgeons, diagnostic AI systems, new cancer treatments, and online health are sometimes called “technological disrupters” – they have the potential to displace (or work with) highly trained medical staff, or provide new methods of treatment.

But there’s often more to significant change than just better technology. As illustrated by the problems Watson Healthcare is experiencing.

How do you incorporate such technological advances into a human-centred healthcare system? Particularly one becoming more focused on prevention rather than treatment.

Rebecca Henderson points out that a critical factor is how an organisation organises itself – what she calls “architectural innovation.”  (I prefer “structural innovation” so it doesn’t sound like avant-garde building design). This is

“ an innovation that changes the relationship between the pieces of the problem … It can be hard to perceive, because many of the pieces remain the same. But they fit together differently.”

 

This type of change is often where real transformation happens. Henderson noted that there is often strong resistance to such reorganisation – in both the private and public sector – so real “disruption” is rare.

 

Reorganising from sickness to wellness

The current structure of healthcare centred around hospitals is a 20th Century response to sickness.  We are now under going a shift from, in essence, an industrialised model of “heroic” healthcare to a more “patient-centred” wellness maintenance system.

Atul Gawande highlighted the importance of what he called “incremental care” for improving patients’ lives. He’s now in charge of the healthcare venture set up by Amazon, Berkshire Hathaway and JP Morgan Chase, and it will be interesting whether and how this may influence how healthcare is delivered in the US, and perhaps elsewhere.

Lab 100, part of the Mount Sinai Health System in New York, is exploring pieces of the healthcare problem. It is looking at what it can achieve by focusing on healthy people, capturing a wide range of health-related factors to provide a broader picture of lifestyle, rather than just looking to diagnose a medical condition.

The intent is to show people (healthy or not) a broad picture of their health status and to make that a part of their normal routine, not just when you need to go to the doctor. Much like the BBC’s “How to stay young” series, but on a more comprehensive level. The billion dollar question is whether this approach does influence behaviour.

Will it be scalable, and cost effective? That too remains to be seen. However, the researchers think that as sensors and other devices become more common (and cheaper), then it can move out of a clinic and into workplaces, and possibly gyms, libraries, shopping centres, the home and other places.

 

A focus on the “customer”

There is also a growing expectation that the “customer service” aspects of healthcare will improve, through adoption of better digital services, as we are seeing in other sectors. Technology companies are developing wellness-related devices that may become certified medical grade sensors (such as Apple’s latest watch, and maybe Google’s mirror sensors). These may improve individual awareness of their health status but the bigger challenge will be insuring that such developments don’t further contribute to making wellness something available only to the affluent.

There are low tech approaches as well. Community health workers are making a comeback in some cities and regions to help ensure that people take their medications, and don’t need to go back to hospital.

In New Zealand, the Healthy Families initiative is enabling communities to develop their own approaches to supporting better health. And Healthy Auckland Together is addressing diet and physical activity opportunities alongside health provision. The Ministry of Health’s Healthy Homes Initiative is helping improve housing conditions. Good stuff, how do we go bigger with these?

 

It’s not complicated, it’s complex

Health systems seem to be in continual states of restructuring, usually with no significant positive effect on health outcomes. Despite a range of ranking systems, there is not one perfect healthcare system in the world.

That’s because healthcare isn’t a complicated problem, one where health experts and technologies can find the solution. It is a complex system that requires trying different approaches and perspectives.

An illustration of this comes from a community hospital in Ohio . For the last decade it has been looking at the “neighbourhood as the patient.” It has gone into real estate development, and is working with community organisations to ensure the people in its vicinity have affordable housing, education, safe neighbourhoods, and job training, alongside improving access to healthcare. While it’s been underway for 10 years there are only anecdotal signs of success. However, there is an effort to better measure impacts.

Now that’s a holistic approach, going beyond the traditional community health approach. I expect that good healthcare in the future will be more like this, changes at local and national levels to rearrange how the system operates. New technologies will involved, but they won’t be the focus. The lives and experiences of the communities will be.

 

Featured image by Owen Beard on Unsplash


3 Responses to “Healthcare in the future”

  • Two things – one is the biggest problem confronting the US Health System,currently, is opioid abuse. Now that’s the result of medical intervention in the first place?
    The second thing is structural innovation…isn’t this about keeping communities well or is it about making sure the community takes its medications?

  • Two things – opioid abuse certainly has health outcomes, but it is actually more a social problem. This can be seen by looking at the areas where opioid abuse (as against mis-use or normal use) is prevalent. Mostly, they are low socio-economic areas. Definitely, there is cross-over between access to healthcare and socio-economic status, but that doesn’t mean the opioid epidemic is a health issue per se.

    Its interesting although diverting to note that in the USA the number of deaths from opioid abuse is approximately the same as the number of deaths from gunshots . As far as I know, no government agency is referring to a firearms epidemic (although others may be). This tells you that language matters and what is considered a health problem can be politically based.

    The second – since when did keeping people well conflict with taking appropriate medication? There are plenty of pharmaceutical treatments that help patients avoid intrusive or life-threatening surgery. My own daughter uses a mixture of anti-convulsants to control epilepsy. Wthout these medications its likely she would have died years ago.

    Healthcare should be about appropriate and considered treatment, not philosophically driven treatment.

  • “Communities” don’t take medications; individuals in those communities do. And they take them for a wide range of reasons (to control hypertension, or manage depression, to add to Ashton’s example). Opiods may well be abused (as is alcohol), but not all the opiods used wrongly come via prescription.