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Pushing and pulling healthcare into the cloud


Peter Coffee Profile picture for user Peter Coffee July 8, 2014
Summary:
What has to come is an open health platform and ecosystem, not something defined by only a single vendor or alliance, but by the universal connections that the largest buyers of health services will demand from their providers to reduce the frictional costs of providing benefits.

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Developed economies around the planet are seeing a rising “dependency ratio”: the number of persons over age 65 per person aged 15-64. This reflects, and is compounded by, the perverse success of medical science in preventing or curing causes of youthful and/or rapid death. The most notable result is that more people are living long enough to develop cancer or Alzheimer’s Disease: conditions that may require many years of costly care.

The resulting, spiraling growth of financial and human costs is hugely apparent in the United States, where residents over 65 generate one-third of the nation’s healthcare costs while representing only a tenth of the population. That ratio seems certain to increase further, with more than three-fourths of U.S. old-age medical assistance spending already going to patients with five or more chronic diseases even as this decade began.

Compared to healthcare delivery, therefore, it would be difficult to imagine a problem that is more universal; more massive; or more in need of the high-leverage changes in behavior that we see being enabled and adopted by a connected and collaborative world.

Against this backdrop, the question is how to connect the raw data of medical devices and procedures to the lifestyle guidance, caregiver workload management, and research opportunities and necessities that will mitigate short-term problems and perhaps lead to long-term breakthroughs.

Medicine, like most other industries, readily harvested the low-hanging fruit of the early decades of IT: even as early as the 1950s, observes a new study by McKinsey & Company, “healthcare payors and other industry stakeholders also began using IT to process vast amounts of statistical data” – in addition to automating “highly standardized and repetitive tasks such as accounting and payroll.”

In recent years, though, subsequent waves of IT adoption have been relatively slow to break onto the shores of hospitals and doctors’ offices. McKinsey’s study identifies persistent myths in the medical establishment: perceived patient reluctance to trust digital systems with sensitive personal data, and belief that older patients—those who represent a disproportionate share of the business, if one may call it that—are the most averse to unfamiliar technologies and processes.

Digital well-being

McKinsey’s research rebuts these notions: “Across all the countries in our survey, more than 75 percent of respondents would like to use digital healthcare services,” they report, adding that “older patients (those over 50) want digital healthcare services nearly as much as their younger counterparts.” There is, then, a combination of push and pull: the powerful push of growing costs, and the pull of patient preference for improved convenience and for guidance with their increasingly complex choices.

CX50 Compact Ultrasound
In this environment, it’s no surprise to find analyst groups like IHS projecting that medical providers will “increasingly employ remote communications and monitoring technology to reduce costs and improve the quality of care”; that “the global telehealth market is expected to grow by more than a factor of 10 from 2013 to 2018… The number of patients using telehealth services will rise to 7 million in 2018, up from less than 350,000 in 2013.”

It sounds as if it’s going to be exciting, as soon as we understand the implications of “telehealth.” IHS defines the term as “the use of medical devices and communication technology together to monitor diseases and symptoms,” but that alone is not enough. What’s missing from that definition is the “so what?” – that is, the delivery of that medical information in an understandable context, presenting it to both caregivers and patients in ways that change their behavior.

Building the bridge—from raw data, to improved response and more favorable outcome—is very much the vision of initiatives like the alliance of salesforce.com and Royal Philips, announced in June. The initiative begins with two proofs of concept: Philips’s applications “eCareCoordinator” and “eCareCompanion,” designed to facilitate in-home management of patients with chronic conditions.

This vision is not merely driven by cost concerns, even though salesforce.com and Philips report that similar applications have reduced the duration of hospital stays by 20 per cent; there is also evidence of mortality reduction, on the order of 26 per cent, which won’t surprise anyone familiar with statistics on hospital-caused illness.

What has to come next is the emergence of “an open health platform and ecosystem,” as described by salesforce.com chairman and CEO Marc Benioff: not something defined by only a single vendor or alliance, but by the universal connections that the largest buyers of health services will demand from their providers to reduce the frictional costs of providing benefits.

The New York eHealth Collaborative, for example, mounted in 2013 a Design Challenge for the Patient Portal for New Yorkers: the winner of that challenge, Mana Health, was further selected by Healthcare Access San Antonio in the state of Texas, based on what Mana co-founder and executive chairman Raj Amin calls a “platform to plug into all the backends.

The nearly ubiquitous connectivity of the modern world is not collaboration, and is certainly not “care,” unless and until it becomes a means of timely and accurate access to reliably secure and appropriately confidential data. Technology provides growing opportunity, but the ample and growing incentives for both providers and patients will have even more force and effect in making it happen.

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