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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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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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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.

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Much has been said about the impact of emerging technology on modern healthcare. Many entrepreneurs and investors alike are intent on developing disruptive innovations that significantly improve clinical workflows, enable predictive analytics or enable widescale interoperability. While any of these would represent a significant medical advancement, several factors suggest that an even more far reaching disruption may be coming to healthcare for which these advances cannot prevent. I refer to the ultimate demise of hospitals themselves. Consider for example the following facts. First economic factors, policy and regulatory forces are already leading to less care being provided in the hospital and more care provision in the home and community.  Secondly, retail healthcare outlets are rapidly growing in popularity. They exhibit high levels of patient satisfaction, shorter waiting times, lower costs and care quality that is on par or better than similar care provided in hospital emergency departments. Thirdly, hospitals are dangerous places! It has been well documented in the medical literature that many people who go to the hospital, get sick from illnesses they did not bring to the hospital.  In fact, a recent study found that such hospital acquired problems are so common that they are actually the third leading cause of death! Fourth, advances in the computer sciences and broadband networks are fueling a revolution in medical device innovation that is enabling once large bedside and hospital confined medical devices to become miniaturized, handheld, ingestible, wearable, mobile and operable anywhere there is a broadband connection. In fact, some people who 20 years ago required stays in the Intensive Care Unit followed by lengthy hospitalizations prior to discharge are now are able to go home with small portable devices that do the work the ICU based machines did just 2 decades ago! Fifth, advances in robotics are now enabling surgeons located in one place to operate on patients located across town or across the globe. The spectrum of surgeries performed this way will likely increase in the future. Sixth, advances in telemedicine and telehealth are enabling physicians to see, talk to, examine and monitor their patients remotely, lowering the need for inconvenient visits to the doctor’s office or unnecessary visits to the ER or hospital. Seventh, hospitals were in part developed to centralize resources thereby reducing financial costs or improving opportunity costs. In the future, it may do neither. Finally, the emergence of artificial intelligence, and cognitive computing is providing unprecedented levels of data tracking and analytic capacity enabling the generation of insights that are instantly available to medical providers, patients and caregivers alike.

Given these realities then, why would patients, in the future, ever choose, to stay in a hospital? Why would payors insist that covered beneficiaries obtain care in high risk hospitals when lower risk and lower cost options with comparable outcomes are available? Obviously, they wouldn’t. While we are not there yet, it will not likely take 20 years for us to get there. It may not even take 10 years. There is a coming bloodbath for hospitals, as we currently know them. Only those systems that proactively embrace the opportunities these realities portend and innovate on the very notion of what a hospital is and does, will ultimately be able to survive.

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Recently a group of researchers from Microsoft and the University of Cambridge announced the development of a program called DeepCoder. Deep Coder is a combination of an Artificial Intelligence System and machine learning system that can write its own code. Currently, the system is only able to write relatively simple programs, but the developers envision a day when anyone can simply tell DeepCoder what they want and it will then write the code to accomplish the requested task within seconds and without error!

The implications of this technology are simply profound and absolutely disruptive!

Today, much has been said about the potential of using IBM’s Watson supercomputer to solve challenging societal problems across diverse sectors such as security, finance and healthcare. However, to get the benefit of Watson, you have to be able to pay IBM to use the platform. According to recent reports, you will likely have to be able to pay a huge amount of money! (See MD Anderson benches IBM Watson…) Microsoft’s DeepCoder on the other hand, offers the potential, if placed in the hands of consumers, for almost anyone, anywhere and at anytime, to recognize a need or problem and have a working solution developed for it “On Demand”. As the authors point out, this is not meant to replace current infrastructure or personnel, but to augment and enhance current abilities.

In the health sector, the opportunities are almost endless, particularly if we think across the entire care continuum from wellness, to diagnostics and therapeutics, through recovery, chronic disease management and end of life care. Through this system, every problem essentially becomes a “Big Data” problem for which the appropriate code can be written to address the problem!

For busy clinicians trying to understand the potential implications of a new drug for a patient in the office, rather than scheduling a second visit with the patient, prior to which he/she would review a number of textbooks and other digital/print resources in order to make an evidence based opinion, DeepCoder could, write a program that searches the over 26 million research studies available in the National Library of Medicine’s PubMed database, determine which studies apply most closely to the current patient, synthesize the findings from the most relevant studies and print a one page synopsis and recommendations for the patient regarding the best initial dose, on the desktop printer sitting next to the doctor, for his review, faster than the patient can get undressed.

For the aging senior who is diabetic, hypertensive and lives alone, her adult son, who lives in another state, could tell DeepCoder to find the highest quality senior care day program, that offers door to door transportation, meals and is willing to dispense medications, that has an immediate opening and fits within his budget. Since both he and his mother have an Amazon Echo, he could simply tell Alexa what he needs and she then tells DeeepCoder.  A few seconds later, once the program is written, Alexa could then use it as a new personalized “skill”, execute the task, complete the online application after her son’s approval, schedule the in-person interview and send the required down payment to the Senior Care center in advance of the meeting.

While these examples are exciting, they are not yet possible. However it is also true, that is likely only a matter of time before these or something even better become reality in healthcare!