Fred Hersch is a medical doctor (MD/MPH) and technologist. He is passionate about global health and the role of (design led) technology in transforming health care delivery for the better. He was an early pioneer in the tele-medicine space co-founding MedTech Outreach Australia (2002) and developing one of the first web based tele-medicine platforms. Following a short stint in Academia (Research Fellow in Healthcare Innovation at Oxford University), he now lives and works in Bangladesh where he is the Chief Medical Officer for Telenor Health, a new business focussed on large scale digital health products and services for resource poor settings. He shares his outlook on the advances pending in digital health. Views are his own
Back in 2012 I wrote about how mobile technology was changing health … one sms at a time. Well, a lot has happened since then. Facebook had it’s 1 billion user day (yes, 1 billion active users on 1 day, most of them on mobile), Google took a page out of sesame streets book (becoming alphabet) … and global leaders ushered in the Sustainable Development Goals positioning technology, yes, technology, to play an even greater role in our future health and well-being. So with both new years just behind us, here are my thoughts on the most exciting current and emerging technology trends for global health. For the tech natives, I offer a little primer and some good readings so please follow along.
Telemedicine seems to have been around, well since, the telephone really, but it’s taken until 2015 for it really to come of age. Why? Because you and me and patients everywhere are now demanding it. Technology has disrupted every other (social) service … it’s been only a matter of time that convenience came to medicine and last year it did, albeit mainly in the US where according to Deloitte 1 in 6 consults were virtual and growing. In the US, UK and Europe, there has been a small explosion in video based consulting services (here, here and here to name a few) where a virtual doctor is literally on demand. And it’s not all video consults on your smart phone, especially in developing countries where basic telephone based health advice plays an important part in the health care ecosystem.
In Mexico, MedicallHome, pioneers of tele-phone based health care, have been providing 24/7 access to qualified health professionals via subscription models for over 15 years. A spin-off of this model, consejosano (www.consejosano.com) specifically serving Hispanic speaking Americans was recently recognized as a new Innovative Solution by the prestigious Commonwealth Fund.
Further afield, in countries like India, Bangladesh, Ghana, The Phillipines, Pakistan (just to name a few), phone based advice to a registered medical professional for a few cents a minute provides an important first contact point where access is extremely limited (in Bangladesh for example there are 3 doctors / 10,000).
Given the chronic global shortage of healthcare professionals, tele-health and tele-medicine is set to play an ever expanding role in virtual primary care provision and chronic disease management in the years to come all around the world.
The smart phone as an affordable connected platform
It’s hard to conceive the impact the humble mobile phone has had on the world let alone it’s evolutionary relative the smart phone. Given that the first iPhone rolled out in 2007, less than 10 years ago, it’s affect on society has been nothing short of transformational.
And it’s only getting started. The race is on to connect the un-connected. That is, the 4 billion people in the world who are not on the internet. How? Through ever cheaper smart phones offering mobile internet providing yet again, unprecedented opportunities for patient led democratization of healthcare. As Dr Eric Topol, leading proponent for digital health and celebrated author says, “Wherever there’s a mobile signal, there’s a potential for better healthcare”.
So how is the smart phone enabling this shift? Here are 3 simple ways (I’d love to hear your top 3 .. leave a comment)
1. Better access to information delivered in an easily digestable form – whether that be SMS, voice recorded messages, in-app notifications, app based maps (for finding services nearby) and now via messaging platforms using natural language processing (see next section)
2. Digital therapeutics like those from startups like omada health or janacare focusing on chronic disease prevention or SMS based smoking cessation programs (which have shown strong evidence in a number of trials and meta-analyses)
3. Providing tools for health care workers to better assess, manage, refer and follow up with patients. This is a rapidly growing area and includes exciting new developments in connected devices and smart use of those sensors packed into the smart phone.
These are just some of the ways in which smart phones are powering the future of health and doesn’t even touch on the possibilities from rapidly growing wearables market and the evolving Internet Of Things (IoT)
AI, machine learning and the rise of the virtual health assistant.
This “data rich environment” is creating new previously unimaginable opportunities for creating personalised, accessible and affordable health care for everyone. Welcome to the future of digital health, one in which algorithms, driven by machine learning and artificial intelligence drive greater engagement, enhance behaviour change (the cornerstone of effective prevention – primary and secondary) and create the (data) backbone for new products and services that meet the needs of the entire population (not just those of us lucky enough to have access to decent quality care).
And that future is here.
Today there are a number of start-ups, such as UK based your.md working on building the “siri” equivalent specifically for health. With IBM Watson Cloud, launched last year, IBM is working with a number of health care partners to apply it’s super-computing prowess to solving some of the biggest problems in health. Read more about it here.
And over in China, Baidu (the Google equivalent) is building similar AI capabilities.
It’s an exciting future and scary too. There is no doubt that important ethical questions are arising, especially around patient privacy and responsible use of data. Governments and regulators, have an opportunity to really drive the adoption of open systems and fostering innovation across the healthcare eco-system unlocking the potential for entrepreneurship and new (disruptive) approaches to flourish.
There is much to be hopeful for.
Health care for all remains an elusive goal. While those of us in the OECD countries continue to bemoan the universal access most of us enjoy, the rest of the world is burdened by high out of pockets expenses and generally very limited access to poor quality care. Technology is not in itself going to be the panacea. Health care is personal and we will always need that human touch. Technology enabled Health care, where we are able to better manage these scarce resources whilst using smart systems to drive more personalised, accessible and affordable care for all will be a key driver to achieving the health related Sustainable Development Goals and is a digital future I can get behind.
Have a thought about digital health, please leave a comment.
Fred Hersch is a medical doctor (MD/MPH) and technologist. He is passionate about global health and the role of (design led) technology in transforming health care delivery for the better. He was an early pioneer in the tele-medicine space co-founding MedTech Outreach Australia (2002) and developing one of the first web based tele-medicine platforms. Following a short stint in Academia (Research Fellow in Healthcare Innovation at Oxford University), he now lives and works in Bangladesh where he is the Chief Medical Officer for Telenor Health, a new business focussed on large scale digital health products and services for resource poor settings. Views are his own
(Image by Paul Sonnier available at: https://commons.wikimedia.org/wiki/File:Digital_Health_Infographic.jpg)