Clayton Christensen defines disruptive innovation as "a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors." As industry stakeholders are re-evaluating all aspects of care delivery and the need for care delivery redesign, they understand that every interaction with patients, regardless of setting or media, must be executed with compassion, empathy, humility and mindfulness. As patients gravitate toward consuming healthcare remotely and in new settings via telehealth, mHealth and retail clinics, the landscape of traditional in-patient and acute care infrastructure will be repurposed and re-imaged to exceed future standards of care, patient experience and provider expectations. Such disintermediation in healthcare has lagged other industries, i.e. financial, retail, media, etc. While it is now occurring, albeit in a rather disproportionate and inconsistent manner, healthcare executives are taking measures to balance competing forces and oppose the status quo to be change agents so that the patient emerges as the ultimate beneficiary.
Digital health transformation is at the center of healthcare disruption, enabled and accelerated by the confluence of six forces:
(1) Necessity and urgency for care delivery redesign, value-based payments and continuous remote monitoring of chronically ill patients
(2) Standard APIs, like FHIR, that provide seamless data access and semantic interoperability for powering digital health solutions and applications
(3) User-centered design approach that enhances user experience and promotes user adoption
(4) Big Data solutions, like Apache Spark, that power Internet-of-things, machine learning, edge analytics and real-time stream processing
(5) Distributed applications and smart contracts using Blockchain that provide advanced information security provisions to protect patient privacy, including user authentication, identity management and secure transactions.
(6) High performance, cloud-based platforms that allow organizations to migrate from asset-based IT infrastructure to a subscription-based delivery model
Hence, the healthcare industry is now immersed in digital transformation — connected devices and solutions which allow for the rapid exchange of information among patients, providers, payers and caregivers. As value-based care models become more pervasive, care delivery will become less episodic and more continuous, compunding the unprecedented proliferation of digital health solutions. Today’s digital health solutions are centered around apps for smartphones and tablets that facilitate and automate more frequent and appropriate interactions to keep patients connected in the ambulatory setting. Common features include:
(1) Connection with remote sensors and monitoring devices for disease management
(2) Integration with patient clinical and demographic data to deliver contextually and clinically relevant information to patients, including reminders, notifications and alerts, to avoid adverse events and eliminate care gaps
(3) On-demand, seamless access to the proper healthcare professionals via text, phone and/or virtual visits
(4) Information to patients on disease prevention, healthy lifestyles and wellness
(5) Recommendations and guidance for at-risk patients to appropriate clinical, ancillary or public health services
As the trend for digital tools is moving toward mobile platforms and cloud-based services, innovators and designers must also consider how to enhance and enrich features and capabilities, so that the tools remain adaptive, flexible, simple and convenient. Through IT modernization, next-generation (Big Data) database solutions and analytic platforms enhance our ability to extract actionable clinical intelligence from ever-increasing volumes of health data and move toward systems for cognitive computing, simultaneously running on millions of connected devices. We’re just at the dawn of a digital transformation in which mobile and wearable devices are commonplace. But gaining traction are implantable devices, cyber pills and smart tattoos that can send constant streams of physiological data for near real time analyses.
Digital health requires a dedicated, highly skilled, multi-disciplinary teams of clinicians, researchers, technologists, data scientists, IT architects, solution designer and developers to guide, build and deploy solutions that yield measurable, impactful results. It requires making investment decisions based on the business case and a well-defined, complete set of evaluation criteria that align with strategic goals and objectives. It requires visionary leaders who champion innovation, make the tough decisions to execute, and persevere, often amidst adversity from conflicting stakeholder interests, with a sense of purpose, accountability and transparency.
The purported benefits of digital health are improved patient interactions and care coordination, increased provider productivity and efficiency, and encouraging behavior change for healthy lifestyles. The key to success is knowing how to appropriately engage users, based on necessity, urgency and personal preferences. i.e how, when and where to maximize frequency and depth of engagement so that digital health becomes ubiquitous to the patient experience.
These circumstances necessitate that both payers and providers leverage their vital information assets to improve clinical, operational, and financial performance. The recent trend toward payer-provider mergers, partnerships, and joint ventures seeks to address fragmented healthcare delivery, emphasize patient-centered care, and promote care coordination. With the expansion of high-deductible health plans and emphasis on healthy lifestyles and wellness, there is also more focus on patient-generated data and the consumerization of healthcare. Aligning the goals and incentives among payers, providers, and patients sets the stage for data sharing, integration, and harmonization and coordinated Big Data analytics strategy. To be successful and competitive, stakeholders must share data to leverage analytics for (1) risk stratification and identification of high-cost or high-risk patients by using predictive models; (2) performance monitoring and evaluation of key quality measures; (3) development of longitudinal patient records; and (4) establishment of market-based models for bringing greater price transparency, measuring variation in cost and quality, and delivering predictable outcomes.
Blockchain technologies are also driving innovation in healthcare. Blockchain embeds transparency, security and trust into transactions via smart contracts that are stored permanently and made available to all stakeholders through a peer-to-peer distributed ledger. Moreover, distributed applications can be deployed on the Blockchain, with data exposed and consumed via APIs. The result is a paradigm shift toward more secure, streamlined transactions, especially for claims processing.
A common practice among healthcare experts is to collect as many health data as possible to explore and discover the “unknown unknowns,” especially for research in genomics and clinical informatics. Big Data requires high performance, scalable technologies designed to extract insights from very large volumes of disparate, multistructured data by enabling high-velocity capture, discovery, and analysis. This is now possible with scale-out, clustered compute platforms such as Hadoop and Spark, which utilize low-cost, commodity hardware for collecting massive amounts of data for low-latency batch processing and real-time analysis. In conjunction with clinical data warehouses, NoSQL and in-memory databases, and data discovery and visualization tools, it is feasible to establish a unified analytics platform over a multi-tenant environment with domain-specific enclaves to evolve from systems of record to systems of engagement. As these systems and the standards governing them become more mature, it will be possible to analyze data more efficiently—to identify adverse drug interactions, misdiagnoses, missed routine exams, healthy lifestyle recommendations, disease prevention, and others. The scope of analysis can range from the individual patient level to the entire healthcare system to several healthcare systems connected via a single insurer.
The promise of Pragmatic, Elegant Disruption is becoming a reality in healthcare, and the pace of innovation is accelerating; but this landscape requires a methodical, deliberative approach to achieve desired results. To be successful, the following components are essential:
- Realization that the status quo will not be sufficient to exceed future standards of care and stakeholder expectations;
- Visionary leadership that empowers, inspires, and is not afraid to fail;
- A collaborative environment that promotes free exchange of ideas among all stakeholders.
- A culture that encourages ingenuity, intellectual curiosity and imperative to “push the envelope”
- Multidisciplinary teams of specialists who guide, build, deploy, and scale solutions;
- Leveraging cumulative effect of continuous improvement, incremental advances and adjacent technology.
- An imperative to share data with safeguards for privacy and security; and
- Agile delivery model & lean start-up approach for iterative, rapid deployment of solutions.