Last month, Debating Europe asked you what European healthcare should look like. We discussed some of the pressures the “European social model” is facing during the Eurozone crisis (and with the problem of an ageing population looming), and we asked whether investment in ICT might help maintain quality of care by making healthcare cheaper and more efficient. Some of you were quite critical of this suggestion. Eric Lagally, a health-technology blogger, left a comment criticising the focus on a high tech approach:
There is a natural tendency for companies to focus on those technologies that can be marketed to those who can best pay for them. Do we think that personalized medicine will really benefit everyone? I don’t think so, because we need to provide uniform access to basic health care services to everyone first. Spend the money and technology on reinforcing access to primary health care and, in the long run, the health care dollars will go a lot further.
Do you agree? Will advances in health technology benefit only a select few? Or will ICT help drive down costs and keep Europe’s public healthcare systems open and sustainable? Last week, Microsoft held it’s third annual eHealth event in Brussels, bringing together experts to discuss how technology can be applied to health and launching their manifesto for an eHealthier Europe. Debating Europe had the opportunity to pose questions to some of the policy-makers and experts at the event, and ask them for their thoughts. Paul Timmers, Director of ICT addressing Societal Challenges at DG INFSO (part of the European Commission) agreed that it’s important to be realistic when considering technology-based solutions to healthcare challenges:
Will ICT in healthcare ultimately deliver on all it promises? There are many barriers on the way. There are concerns about how difficult ICT is. Is it user-friendly enough? When we think especially about the older generation, are they sufficiently able to use the technology or can we make it even easier and more accessible?
There are concerns about privacy; what’s going to happen to my data? There are concerns about whether ICT will possibly be used in a way to control patients rather than to truly empower them. There are also concerns about whether it continues to be the interest of the citizen and the patient that are central, or are we actually going to put this in place because we just want to save money or because business wants to do good business?
Despite the challenge, participants were keen to stress the way technology could potentially make healthcare cheaper, and so more affordable and more sustainable. Ed Percy, Business Director-Manager for Healthcare at Logica, a business and technology service company, predicted that further innovations were starting to bear fruit:
We will see large-scale and low-cost sequencing of the genetic code of individuals and so, through comparative genetics, we will be able to identify more and more the genetic basis of some of the diseases people are afflicted with. This will eventually lead to the concept of stratified medicine – or ‘personalised medicine’ – where we are able to then take genetic information; take standard clinical information, collected as part of the encounters that take place in hospitals and primary care; and take information from phenotype projects, like the “citizen science” projects for collecting lifestyle information. And when we mash all of these up, we’ll be able to identify those patients that are at the greatest risk of a particular disease, or who are optimised or best suited for a clinical or pharmacutical trial.
From a consumer perspective, I think we’ll see citizens engaging much more fully through various types of amulets or devices in the healthcare environment. I think we’ll see them contributing information that is useful and can be used by the healthcare professionals. And, from a technology perspective, I think we’ll see technology becoming increasingly transparent.
Others working in healthcare were also keen to stress the possibilities offered by information-sharing through cloud computing. Diogo Reis, IT Manager of the Hospital Fernando Fonseca in Portugal and a consultant for the Central Health Record Solutions of the Portuguese Ministry of Health, had this to say:
Cloud-computing is a very nice solution, because it tends to solve many of the problems of interoperability and storage of information. One of the bigger problems when we try to make systems interoperable is [the question of] where to keep the information. If you keep it in your system and I keep it in mine, there is no guarantee that the information will be the same. But if we keep the information in the same place then we know it is the same… For instance, if [a patient] goes to one place and does a blood test then goes to another place and has to do the same thing again – it’s a problem for the patient, for the doctor who has to wait for results and it creates a lot of costs that aren’t measurable.
Of course, whether or not ICT helps to drive down the cost of healthcare, the increasing complexity of technology may mean some people are excluded anyway. Dr. Antonyia Parvanova, a healthcare professional and Member of the European Parliament, argued that advances in ICT won’t help the majority of citizens unless more people know how to make use of the new technologies:
It’s not only about access to the internet, but also how [citizens] use the technology and what do they understand from everything that’s available. How, from this mountain of information, can they find the right information for them? Especially for vulnerable groups like elderly people or people with disabilities or people with less knowledge of new technology? These two things, health literacy and e-literacy, have to be tackled together and put together.
What do YOU think? Could ICT help make European healthcare cheaper and more sustainable? Or will new technology rather increase costs and only benefit those able to afford more expensive treatment? And even if technology makes healthcare cheaper, how can we ensure that people aren’t excluded because it’s too complicated to use? Let us know your thoughts in the form below, and we’ll take your comments to policy-makers and experts to hear their reactions.
technology always makes everything cheaper, comfortable & faster.
Broad statements about technology aren’t helpful. We need to determine what type of technologies in what type of circumstances. Clearly, healthcare suffers from a shortage of technologies that enable better decision-making mainly arising from poor use of electronic record systems, and these are in the main informational. They depend however on data from devices and from the documentation of clinical work by health professionals, which in turn suggests technologies that are easy to use for data capture, and for busy clinicians to document patient care. Patients, too, need technologies that are simple to use, and intuitive in the main, designed specifically for their use. How many technology design companies see the patient as the end-user and not the health professional instead, so design equipment for clinical adoption, rather than the more disruptive and potentially more beneficial patient use?
Technologies that are fundamentally disruptive entail restructuring of clinical workflow, altering skill mix (who does what) and these are in the main determined by professional regulations, which can frustrate efforts to restucture clinical work itself. So modern technologies are used in old-fashioned ways, in order to comply with professional roles protected by law. Think of the last health profession rendered obsolete by technology?
Widespread adoption of e-health, for instance, could render current notions of the organisation of hospital work obsolete, certainly by unbundling clinical services and shifting them into community or home settings.
Integration of information along the healthcare information value chain can create new types of service providers, but health systems can be quite protective of incumbent and legacy modes of provision and make it very hard for new entrants that act to disrupt (what others would call ‘cherry pick’) patient or clinical mix.
We know from other sectors of the economy, that technologies are embedded in a socio-technological context, and are not just a box of things and devices, but methods, procedures and ways of working. Look at how banking or retail have changed; or just think of the apps on the smartphone, and then wonder why you can’t send your doctor an email.
In the end, technologies replace professional physical skills (like robotic vision for better detection of tumours), and clinical decision-making through advanced knowledge (like putting pregnancy detection into a home use device).
I believe that health care quality and performance should be positioned on four main pillars:
• Cost understanding and control
• Operational and estimated patient flow control
• Optimization of human and non-human resource utilization
• Quality, availability and re-usability of information
If we can make serious progress in these fourth areas there is a real chance to do more with less.
Eric Lagally makes a misjudgement in the dichotoy personalized healthcare vs. uniform access. The fact is that modern medicine is based on statistics. Without personalized healthcare, i.e. without checking whether certain standards apply to an individual, and what treatments are likely to work, you’re expanding gaps in coverage just as much as coverage, but at the same time paying for plenty of treatments which you should have known wouldn’t work, and might in fact be detrimental to the patient.
whene you properly invest and create proper system of manufacturing and distribution, then technology is getting cheaper, the rest is information to the citizens and education
ICT is a tool not a method. Hence adequate use can lead to required results. The problem is: “There is NO Vision”! To undertake an ICT approach without having a Vision of where you are going and what you are attempting to do is a waste of time simply because there will be no interest, you have to do it, there will be no enthusiasm. Without these two elements there will be complacency. Technological progress in medicine is an additional cost factor. Rather than making medical services cheaper to produce, which is true for most other commodities, technological progress adds to the demand for health care and thus has an enormous potential to create exploding medical expenditures.
Remember that health care consumers today are far different from those of the past. They are well-informed, through such vehicles as the Internet and patient support groups, and they want freedom of choice and quality services. In an industry that is consumer-driven, traditional service provision by the welfare state will be less and less acceptable.
As patients demand better services and aging populations need more service, the pressure on the system will increase rapidly. With a smaller workforce anticipated for the future, the ability of health care personnel at all levels to maximize their potential and competence should increase. New paradigms for service delivery will be needed. A market-based approach that includes privatizing hospitals and outsourcing tasks-from ambulance service to laboratory services and emergency care-can increase the quality of health care overall.
By privatizing the health care delivery systems as much as possible one will foster innovation and competition. Privatized health care systems are preferable to government-run and -regulated systems because they allow more experimentation, and because they can adapt more easily to any challenges the future may bring. When the number of young people in a society declines, there are only two ways to keep the system intact: increase the burden on those at the paying end or limit the quality and availability of care for those at the receiving end. In Europe, this often has meant the restricting or denial of the best care available based merely on the age of the patient. Only under a system that allows capitalization-reserving and creating funds for the future through private investment-will the health care sector expand to meet the needs of the future.
We should take into account the special nature of health care, which is partly a moral necessity and partly an ordinary consumer good. The element that is like other consumer goods is vulnerable to overuse when provided free.
Even people with chronic medical conditions spend well under 1% of their life at medical facilities. It is that other 99+% of their life that is when people maintain or return to health. Forward-looking clinicians realize that the most important member of the care team is the patient (or a family member). Technology is enabling a low cost model of Collaborative Care that is available to all income levels. Even low income individuals generally have a mobile device. This allows for communication and care beyond the clinic at a place where people are more comfortable (home).
Of course, there are times when people come in to a clinic but increasingly care is coming to them virtually or in person. In fact, technology is enabling organizations such as WhiteGlove Health and Organic Medicine Now to bring healthcare to people’s home and work. They have all the tools they need. Both of those organizations have no fixed location clinic anymore. Rather, they are in vans and Priuses. Patients are much happier and running a lean operation allows them to provide care very affordably.