[PERSPECTIVE by @katharinajanus] ON VIRTUAL HORIZONS

When I was invited to deliver the opening keynote at Cornell’s Virtual Care Symposium in NYC this past week, I took some time to reflect on what virtual horizons in global patient care look like considering major advances in digital health, a global pandemic, and last but not least, artificial intelligence. While I was working on the storyline of my talk, I realized that – as it happens frequently in a highly specialized world – the grand narrative is missing that integrates medical, management, and information science. However, the digital revolution is a grand narrative that touches upon all aspects of life. It is made possible by science and innovation, but we have to keep in mind that

Technology is going to outpace validity & reliability – we will be able to do many things with the tools at-hand but have to ensure that we put them to a meaningful use that provides valid and reliable answers to our questions.
The revolution is going to be procedural, not outcomes-driven – while drug and other innovations have an immediate impact on patient outcomes, digital tools will often (not always) impact the process of care delivery in the first place and then possibly (and hopefully) outcomes in the second place.

Consequently, the elevation of global patient care then comes from “within”: medical education, connectors & collaborations, and most importantly the integration of digital & analogue solutions in global ecosystems will be key.

This trend is not new: Since the late 19^th century a growing demand for remote healthcare services has evolved to which scientists and medical experts have consistently provided the best solutions available to them. And the technology used to deliver telemedicine is constantly improved and refined, which reflects the world’s growing appetite for on-demand, remote, and mobile data. Finally, the Covid-19 pandemic has acted as the major “facilitator” to replace on average 58% of face-to-face consultations with telemedicine within days/ weeks (for example from 13,000 telemedicine US users weekly pre-pandemically to 1.7 million per week by 04/2020).

Various solutions have since then provided evidence that telemedicine “works” for the management of chronic conditions like diabetes, asthma, cardiovascular diseases, and ophthalmology, resulting in reduced hospital admissions and lower all-cause mortality for heart-failure as well as enhanced quality of life. The challenge lies now in leveraging these effects post-pandemically and integrating digital solutions with regular care. This concerns the extension and/ or integration of emergency authorizations into regular care, addressing conflicting and sometimes perverse incentive and reimbursement schemes and tackling regulatory restrictions (for example the limit of 30% remote consultations for statutorily licensed physicians in Germany).

If we aim at elevating global patient care in the digital age, we have to keep in mind though that its impact differs considerably around the globe: While digital solutions are being perceived as “nice-to-have” and are rather efficiency enhancing in the developed world, they have a much more fundamental impact in enabling access to care and supporting health equity in the developing and emerging world where no or little healthcare was accessible before.

Global impact of digital health solutions:

Challenges and considerations in the implementation of digital tools are much more complex in the developed world than in developing/ emerging countries due to data security & privacy regulations and concerns about the reliability & accuracy of digital tools. Professional & cultural resistance to the adoption of digital solutions among patients and practitioners have deep roots and need to be addressed to enable implementation.

In this respect, training plays a huge role – not only training doctors to understand and use technology meaningfully, but also training technology experts and developers to understand and assimilate what the doctor/ scientist does. A lot of reverse learning must happen too, and developers should prioritize designing for use & user-friendliness instead of “fanciness”.

From the providers’ perspective there is usually only one patient pathway solved and nobody is concerned with how the combination of digital and analogue health can be applied to a specific patient. Doctors believe that the digital health “bubble” is mostly concerned with itself as Daniel Amrein, the head of Asklepios Kliniken Hamburg GmbH, recently mentioned to me. Nobody thinks about how you can make digital health solutions available and accessible to those who are supposed to use them and 60% of questions that concern 90% of care remain unanswered. Who can really “do” digital care successfully and how to integrate digital & analogue solutions in global ecosystems?

Rahul Sharma, the head of emergency medicine at NYP-Weill Cornell Medicine and founder of the Center for Virtual Care, is raising awareness to move from “bedside manner” to “website manner” in medical care provision. In this shift we have to keep in mind that previously non-healthcare companies like Amazon are entering healthcare and positioning themselves at the interface to the patient to leverage data (and cross-selling). These companies will never run a hospital and just focus on low acuity care (and data capturing/ evaluation) but influence the implementation of digital solutions and most importantly the integration of them into current healthcare settings to a large degree. Traditional medical providers need to make sure that this role or at least its coordination is not taken off their plate to ensure that patient care is both technologically advanced and deeply human-centric.

In our ecosystem design approach, we usually take on three roles to support this integration process:

The role of the investigator in organizational and network design to create complementary partnerships globally or in defined local/regional areas (“House of Health”).
The role of the matchmaker when carefully selecting partners and evaluating contextual factors to develop the strategy and prepare the implementation/ set up pilots.
The role of the “provider whisperer” when designing the network of relationships among organizations to allow for a symbiotic interplay and to leverage synergies offline and online (“omnichannel”).

What will the future of global patient care in the digital age look like?

Connecting people and organizations digitally and physically (omnichannel) will create opportunities that are scalable and sustainable in the long term.
The integration of virtual and augmented reality in patient care will support behavioral change, treat for example phobias, and create simulations.
Potentials for global networks of digital healthcare providers will arise, especially in developing and emerging markets.
We will have to emphasize the need for a balanced and fully integrated approach – combining traditional (analogue) and digital methods.
Digital health has the potential to bridge global health disparities, addressing deeper ethical and justice issues.

Remember that it is not about the destination: elevating global patient care in the digital age is a perpetual journey of rediscovery.

As always, I am curious to know what you think in the comments or directly by email. As my audience you are the most important people that make a difference.

Take care, be safe, and enjoy what you can. Stay tuned for any updates https://www.linkedin.com/in/prof-dr-katharina-janus-b391321/

#perspectivebykatharinajanus #enjoystrategy

Sincerely,

Prof. Dr. Katharina Janus
President & CEO, ENJOY STRATEGY, Paris
Founder, Center for Healthcare Management, Paris
https://enjoystrategy.com/
http://katharinajanus.com/