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It has not yet been 20 years since the term Digital Healthcare was defined in the year 2000. Yet arguably the most important day in the history of Digital Health occurred on September 24th, 2019, and relatively few in the healthcare sector even took note. On this one single day, five simultaneous, but uncoordinated announcements were made that collectively signaled the beginning of a seismic shift in the healthcare sector.

The first announcement, in Forbes magazine, indicated that analysts at Morgan Stanley are predicting that healthcare may eventually become a bigger business for Best Buy than selling electronics. “Health monitoring services for seniors and other digital health initiatives … could generate anywhere between $11 billion and $46 billion. This study was commissioned because a non-healthcare company wanted to assess its potential ROI in the health sector and they found it to be significant.  The article also sheds light on the electronics giants’ intentions to offer healthcare services, not just sell health related digital electronics. Secondly, Walmart announced its plans to build a healthcare workforce to fill future healthcare jobs at Walmart and Sam’s stores. They will accomplish this by offering 7 health related college degrees and certificate programs for $1 per day. That’s a full bachelor’s degree for $365 per year, to build a healthcare workforce for stores, not hospitals. Thirdly, Humana & Walgreens announced an expansion of their full-service primary care clinics for seniors, some of which are in Walgreens stores.  This partnership, unlike the current versions of the CVS Health efforts located at CVS stores and Minute Clinics, are designed to offer full service primary care. Anything a traditional primary care provider can do in their office or hospital, will now be done in a Walgreens store. Fourth, Amazon launched “Amazon Care”, a 100% virtual health clinic with in-home follow-ups.  Here individuals can see a health provider via a mobile app or website. They can text a nurse on any health topic any time and if follow-up care is needed, a nurse goes to the home. The patient goes nowhere. If medicines are needed Amazon will prescribe medications within a few hours for immediate pick up or in some cases delivery by drone. No hospital involved or needed! And Finally, CVS Health announced the availability of their first purely digital therapy which uses an avatar to provide behavior modification therapy to treat insomnia. No doctor involved. No prescription needed.

Individually, these announcements could appear to be of relatively minor importance.  Collectively they also could be seen as of little importance because they do nothing to fundamentally change the practice of medicine. They do collectively however they do signal an effort, that if ultimately successful, would at scale, represent a seismic shift in the organization and delivery of healthcare. None of these solutions were conceived with the belief that the hospital is a critical or central cornerstone of healthcare service delivery. The fact that all five of these announcements occurred on the same day, by tech companies and payors, suggests the speed and seriousness at which the market is moving, compared to traditional healthcare-initiated practice and policy changes. Finally, the current national and international footprint and consumer reach of the companies involved in these announcements, makes them able to serve large numbers of consumers relatively quickly, should they choose to scale nationally and beyond. Traditional hospital CEO’s, health systems administrators and even astute medical providers should now be able to appreciate the reality that digital technologies will bring significant change to the historic organization and delivery of healthcare in addition to changing the practice of medicine and traditional business models.  Digital Health can no longer be credibly viewed as a fad, an app, or snake oil. In reality, it represents a significant, clear and present threat to the current healthcare system. Only those CEO’s who understand this reality and move aggressively to adapt, stand the best chance of surviving.  The good news is that the end of the story has not yet been written. With the right effort, some traditional healthcare organizations may not only survive, but become health and care leaders in the emerging digital economy.

In our next blog we will discuss the impact of Digital Health on the patient experience and what this will mean for the healthcare sector.

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There is considerable buzz about connected care models these days. It has been said that connected care models are disrupting the healthcare system. However, upon close inspection, the primary use of connected systems in healthcare is to do electronically, what we have been doing live since the beginning of our profession. Connected care (telemedicine and remote monitoring) is a necessary but not sufficient step in the right direction.  This is primarily because it does not change current healthcare delivery at a fundamental level. Rather it enables patients and doctors to “see” each other, without being in the same room. Good? Yes. Game changer? No. On the other hand creating “digital health ecosystems” might be just “what the doctor ordered”. Connecting people, via broadband infrastructure, to healthcare providers AND other resources they need to be healthy (not just data), could for example enable the creation of a “health” system that focuses on all the things patients need to get healthy and stay well. in addition to delivering clinical services it could also help address social determinants of health by also enabling new  educational and employment opportunities.  Because so much of education and business is already shifting to the virtual environment, problems associated with distance and time are rapidly becoming irrelevant. Creating digital health ecosystems could improve health far more than connected healthcare systems could accomplish.

Digital health ecosystems enhance engagement with healthcare services providers and data but also enable opportunities to help improve personal/family financial resources, which itself could in turn facilitate healthy behaviors (i.e. improving dietary options via grocery/meal delivery services, enhancing medication access through online prescription access programs, increased physical activity through connected services like Peleton, improving education via online resources like Coursera, MOOCS and Kahn Academy and improved social support through resources like FaceTime, WhatsApp and Zoom based community meetings etc.) Are these perfect? No. Can they be abused? Yes. Should they totally replace in person interactions? No. But can they be helpful, particularly for underserved populations where nothing else exists or is feasible? Could a digital health ecosystem provide invaluable support and assistance to patients and caregivers “anytime, anywhere, at the point of need” not just at the point of care, wherever the doctor or hospital is located? Absolutely!! Do they add anything helpful to how we currently construct our healthcare systems, connected or not? I think history will one day show the answer is a resounding yes!  We must think differently if we are ever going to achieve different results in Health and healthcare.

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The response from those in attendance at the Colorado Hospital Association meeting where I recently gave a keynote presentation was simply amazing! It was so overwhelmingly positive that I have decided to share some of the presentation with you who were not able to attend. Here is what I believe will be the top 10 effects of digital innovation on hospitals and the health sector for patients and consumers. I would love to hear what you think! Do you agree? What are your thoughts?

Top 10 effects of digital innovation on hospitals

  1. Insurance companies will become Health Companies.
  2. Retail stores, pharmacies & post-offices become health centers.
  3. Your TV (and any other screen) will become your doctor’s office.
  4. Your smartphone will become a health device.
  5. Consumer technology, smart clothes & health apps etc. will assist with health management.
  6. Patients will support each other through social media, VR and AR.
  7. Doctor’s will treat environments not just patients.
  8. Our medicines will tell us when they need to be taken.
  9. Your car will become your ambulance.
  10. Your Home will become your hospital.

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A recent question on social media caught my attention. A well respected and prominent physician entrepreneur posed a question that essentially asked about the qualifications and thereby value of a Health futurist. Most people who responded regarded futurists somewhere between used car salesmen and outright charlatans. It is true, futurist, innovator, thought leader, healthcare disrupter and other terms like these are often over used and meaningless, Not all innovation is disruptive. Many solutions hailed as disruptive, simply not.  Many “visionary” leaders are simply taking the most logical next steps, before anyone else does. Having spent almost the last 30 years of my life in healthcare, I have and continue to see a stunning amount of inability among traditional healthcare leaders to apply anything beyond an incrementalist vision to health innovation and the future. This is true even among many who claim to be futurists and disruptive innovators!! Because healthcare is increasingly becoming a market based and driven sector, continuing to have 17+ year product life cycles (as has been reported to be common in healthcare) to get innovations (new drugs, practice enhancements, care delivery models, etc.) from the bench to the bedside and beyond, is simply not sustainable, especially when other sectors (and increasingly competitors) are moving much faster. Those individuals who have the background, experience and ability to provide more than incremental insights, can help traditional healthcare organizations, practitioners and researchers better understand the perspectives of working under these emerging realities. This knowledge and insight can equip healthcare leaders to make decisions that better align with the broader market and societal forces that are impacting their profession. Ultimately, these leaders will be the ones most likely to be able to pivot and thrive in the healthcare sector of tomorrow, not just the healthcare sector of yesterday and today.

Sure, predicting the future accurately and consistently is hard, if not impossible. However, understanding the challenges and opportunities that will likely present themselves in the future, is a matter of clearly defining current needs in the context of societal trends and thinking through these challenges from multiple perspectives with the explicit goal of conceptualizing previously unrecognized solutions. It is not magic. It is a skill, albeit a particularly complex one, that can be developed, like any other skill. The most difficult challenge to mastering this skill, is the fact that healthcare is a complex and ever-changing system, with many moving parts.  Most people who work in healthcare have specialized skill in one area. Very few have specialized skill in two areas or disciplines.  So while they may be experts in their area, they are limited in their ability to see the issues from the multiple perspectives impacting healthcare.  Also, given the conservative nature of the health sciences, incrementalism is rewarded, in research and practice. As such, many healthcare leaders spend a lot of time staying on top of their field, but they are often not able to keep up with broader societal changes that are impacting their profession. The very thing that made them an expert (specialization) is also making it less likely that they can be the best futurists or the most disruptive innovators. On the other hand, those individuals who are better at “seeing” important societal trends and helping leaders execute effectively, become known as the futurists. The world of health really is changing all around us. If your health organization is interested in surviving, it really has no other choice but to think hard about the future. Fundamentally, leaders have a choice, they can either respond to the future, or help to shape it. Can your organization benefit from a health futurist? Maybe. It really depends on you.

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Telehealth is the use of telecommunications equipment and infrastructure to enable or facilitate health related activities. The use of Telehealth is growing rapidly in the US. As this occurs the types of technologies and the ways in which they are used in healthcare is also rapidly changing. Today, telehealth services are delivered in 4 basic ways. These include a) live video-based interactions between two individuals b) the transmission of prerecorded digital pictures and images c) remote patient monitoring which is the collection and wireless transmission of health information from an individual in one location to someone in another location and d) mHealth which involves the use of mobile hardware (phones, tablets etc.) and software (apps) to enable or facilitate health activities.

The delivery of telehealth services is often organized in one of three ways or models. When a large healthcare system is the primary provider of telehealth services to smaller often rural hospitals, this is called the hub and spoke model of telehealth organization and delivery. Alternatively, telehealth services can be delivered through a network model. In this model health care facilities are connected to each other, creating large networks and smaller subnetworks which work at times, independently and at other times together, to provide a range of telehealth services to patients and caregivers. Thirdly, due in large part to advances in broadband network availability and reliability, telehealth is increasingly being deployed in a “direct to consumer” model where consumers using their own devices can directly connect with health personnel and services anytime, anyplace.

So, what impact will telehealth have on the health sector in the future? Over the next decade we will continue to see tremendous innovation and evolution in the telehealth space. This will continue until most patients and most providers will be delivering health services using some form of telecommunications technology and or infrastructure. Consumer telehealth devices will go far beyond cell phones, tablets and apps to include voice activated systems like Amazon Alexa or Google Home, automobiles and even homes and buildings themselves. There will be tremendous growth in the types of data that can and will be collected from patients.  There will also be rapid growth in the number of ways in which this data can be collected. Many everyday consumer devices will not only capture data and send it somewhere to be analyzed, but these devices will also, in the future, be able to appropriately act of the collected information, in real time without the direct involvement of a healthcare professional or family caregiver.  This is the basis of what are known as “smart devices”.  They are smart because computing power will have advanced to the point where it can be put not only into desktop computers and cell phones but into devices as small as dust or blood cells.  They will not need batteries, because they will be able to run using the electricity generated by our bodies. Finally, they will in many cases, transfer information using low power medical body area networks which will enable the automatic capture and transmission of information from multiple body worn sensors simultaneously and wirelessly. The introduction of 5G networks will enable an era of continuous connectivity (or pervasive computing as it is also known). This will allow patients, caregivers and providers alike to monitor important health information continuously. (in real time, at all times, no matter where a patient, consumer or provider is located). Finally, there will be further evolution in the models of care delivery. Current models of telehealth all require an individual to decide to provide or receive a telehealth-based service. These models of Telehealth can be said to be “active” models because they require a person to do something in order to receive the or deliver the service. In the future, telehealth services will be delivered, in many cases, automatically, as the need arises. At times, patients will not even realize they are receiving health services at all, because delivery or receipt of the services will not require any active action and the spaces in which will live, work and play, will all be connected and smart. In this future, health care providers will oversee the development of the “brains” of these systems but will not always need to be involved in deciding or implementing the appropriate action to address the health concern. Broadband based technologies like telehealth are changing the world in exciting ways that are sometimes hard to imagine. They also have the potential to make the possibility of health a reality, for all.

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GreystonevectorSocietal forces are pushing healthcare out of hospitals and into the home.  Healthcare professionals have new incentives to care about the behavior of their patients, in between hospital visits. Many patients are taking more ownership of their health and healthcare.  Soon one in three Americans will be over the age of 65 and almost 90 million people will be over the age of 85. Approximately 11,000 baby boomers are turning 65 every single day. Most of these people want to continue living independently in their homes as long as possible. These consumers will demand a paradigm shift in which they can receive healthcare services, use educational content and respond to employment opportunities “On Demand”, when they need/want them, not just when the store, office or clinic is open.

In the future, our homes and cars will identify us and unlock the doors by reading our heartbeats. These homes will diagnose health issues and instantly deliver treatments, sometimes before we even know there is an issue. They will use cloud based artificial intelligence, machine learning and smart devices in the home, to prevent serious health problems from ever even occurring.  Residents, caregivers and homeowners will have unprecedented ability to engage, monitor and manage their health and the care of loved ones anytime, anywhere.

Smartcare Communities are about reimagining living spaces into residential networked community dwellings that are optimized for health.

SmartCare community residents who need health services could receive televisits through flat screen TV’s located in the privacy of their apartments. Alternatively, they could walk down to the community urgent care center if they like. Also, residents could even receive in person, robot or avatar based house calls if necessary. Health sensors in the homes along with information from wearable devices like smart watches and other wearables would be collected and insights delivered to residents each morning, by their preferred method, email, text, voice (Alexa), video (TV), to help patients manage their health concerns. This is just the beginning.

The question is though, will the poor and middle class ever benefit from these advances or will they remain in the hands of the wealthy? How will people from underserved populations (rural, inner city, elderly, homeless, substance abusers etc.) be able to purchase these homes? Join us for a special discussion on “Smart Cities and Smart Care at HIMSS18 at the Sands Expo and Convention Center in Las Vegas March 5-8, 2018. Here we, along with 40,000+ others will discuss this and many other important topics in Health and technology. Join us for a fascinating discussion as we create the future of health and care!

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Yesterday CVS Health announced that it has agreed to buy Aetna for $69 billion. If the deal goes through, it should send shock waves through the health care system. CVS is not only the largest pharmacy chain in the US, but it is also the 7th largest company in the US with approximately 9600 retail stores in 2016. But CVS Health has plans to move beyond being just a pharmacy and convenience store to become a bona fide healthcare company. The emerging 3-part strategy is potentially powerful! One part of the strategy is to expand the current offerings of CVS pharmacy’s to included more traditional healthcare services that formerly required hospital or doctor’s office visits. Given that CVS Health already provides healthcare services through its more than 1,100 MinuteClinic medical clinics as well as their Diabetes Care Centers currently located within CVS stores this transition is likely doable. The second part of the strategy appears to be aimed at driving down healthcare costs through creating a virtually wholly owned prescription drug ecosystem, not unlike the IOS ecosystem created by Apple. which is on the brink of becoming the first trillion-dollar and most successful company in the world. The third part of the strategy, which builds on the first two parts, is focused on driving value for consumers. While some may doubt their ability to accomplish this goal, the rising popularity of retail healthcare outlets, the potential for vastly enhanced consumer healthcare experience (little to no waiting lines or delays in seeing providers, easy access to medical facilities located in local communities, lower medication and care delivery costs, familiar, trusted care delivery settings combined with convenience shopping opportunities) strongly suggests that the essential elements are indeed in place. Interestingly, this vision and emerging strategy is in line with that of Aetna the 3rd largest health insurance company in America. Aetna’s CEO, Mark Bertolini took things even a step further last month while speaking at the Healthcare of tomorrow conference where he said that it will soon be possible to provide the bulk of care patients need, in the home and community. So, in the near future, “if you must go to the hospital, [the healthcare system] will have failed you”. In this new world traditional high cost, brick and mortar tertiary healthcare systems will simply not be able to compete on costs, convenience and as the evidence is beginning to indicate, not even quality. Their ability to pivot to a more sustainable care delivery model that substantially improves patient experience and value, will be limited. As such, the classic scenario for disruption, as originally articulated by Harvard Business School Professor, Clayton Christensen, and as applied to the organization and delivery of healthcare by Johns Hopkins experts  Gibbons and Shaikh, is in place and could eventually significantly impact the traditional healthcare system as we know it. Rather than sticking their heads in the sand, CVS and Aetna appear to be embracing the challenges that lay ahead and seizing the opportunities these changes bring. It remains to be seen, if others will join them, or be left behind.

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Face A lot has been said about the disruptive effects of emerging technologies on diagnostics, clinical decision making, therapy and patient engagement. However a new report from the health technology research, innovation and consulting company suggests emerging technologies will have a profound impact on the organization and composition of future health care systems. The report details eight national trends that will drastically reduce the need for hospitals, radically change insurance practices, provide disruptive new business models in health care. The resulting systems will not be located in one centralized area but more virtual and located in consumers connected smart homes and communities that automatically treat the environment not just the patient, sometimes before they or family members recognize they are even sick.

If the authors are right, the healthcare systems of tomorrow will look nothing like the healthcare systems of today, yet these future systems will provide better care, when consumers need it, at lower cost and with higher patient satisfaction and better outcomes. At this point, it is probably reasonable to drop the mic!

To read the full report click here.