12 November 2018
Calling time on healthcare’s digital carpetbaggers
Digital transformation is very big business these days. There isn’t a “Big C” consultant in town which hasn’t locked onto big business and government in some way to take the more cashed-up (and sometimes senseless) on a journey with their teams of “smartest people in the room”.
Healthcare has been, in relative terms, a slow starter in the digital-transformation game. It’s a complex market fraught with regulation, risk, emotion, culture legacy, rapidly changing technology and fragmented and legacy-bound data and systems.
But most firms see the size of the prize. And it’s a whale of a market, if you can manage to get a harpoon into it. It’s much bigger than the finance market, when you think about it. If you put the federal department of health together with each state health department, and sprinkle in some cross-governmental agencies, you have a corporation that makes Telstra look like a minnow.
It’s no surprise then that all the bigger firms have well funded, well marketed healthcare innovation divisions, ready and waiting. And in the case of groups such as Accenture, some are already executing on the major mega transformation projects, like The My Health Record (MHR).
This all makes sense, right?
You get your best government or big business heads in a room – the ones who manage on a day-to-day basis so don’t have much time to look to the future – with the smart insightful people, who’ve already done transformation in other mega-markets, such as finance, or done some health stuff overseas in bigger markets, or simply have insights you just can’t get yourself, and you plan “our” future in health.
What could possibly go wrong?
Actually, quite a lot. And some of it already has.
Or shall we just call the $2 billion spent so far on the MHR, where we find ourselves in a classic “we can’t stop now we’ve spent too much already, pour more into it,” funding paradigm, a learning experience?
No matter which way you look at it, the sort of rapid transformational changes that digital technology has thrust upon the likes of travel, finance, advertising, marketing and other services-based markets, in a relatively short amount of time, just don’t look like they are going to happen in health.
And, as a point of fact, they aren’t.
We are failing to get digital traction everywhere in health. Which makes some of that “Big C” consulting experience and insight you’re paying for, or thinking of paying for, potentially useless. At least for now.
Healthcare is resisting digital transformation in a manner that people should think about much more carefully. Especially before they spend several hundreds of millions more dollars on transformational health projects which look great in a consulting presentation pitch.
Healthcare just isn’t playing ball. It’s the last big market to plunge into the digital-transformation rabbit hole, and it’s already quite a bit lost down there.
If you audited all the major health transformation projects around the world you are going to see vast amounts of red ink. There are some rare exceptions, but they don’t offer that much hope to governments or big institutions, or even small ones, because the successes are exceptions resulting from change being practised in well defined, small, vertically integrated health ecosystems, which are far less complex, and which almost always have some form of centralised control in play.
You can see elements of success in some health maintenance organisations in the US, where the principal is in control of nearly every aspect of the patient value chain.
And to a lesser extent, you can see it in small, centrally run Scandinavian countries.
Australia, the US, Britain, Canada and the like, unfortunately, are logarithmically more complex than any of the working systems you see in the perfect marketing decks used to sell the future of healthcare.
And, even though tours of the highly digitally geared and vertically integrated health organisations in the US are compelling and exciting, these examples are not a relevant comparison with most country-wide healthcare systems.
Healthcare is simply far too complex for it to travel the transformation route most of the services markets have taken. Timing is everything in innovation, and in healthcare, transformation is turning out to be more than everything.
Healthcare is already a massively complex and a fraught venture in Australia. There’s federal versus state systems that don’t talk to each other; We have primary care and tertiary care interoperability that is institutionally disabled; We have the fear of consumers that any change to healthcare might threaten access or affordability or quality of health service. And we have powerbrokers in government who are protective of their patches. And then there’s the culture of medicine and doctors (we’ve done nothing to prepare doctors for the future); patient data and the privacy, ownership and use of that data. And, finally, we have an unstable and near paralysed political system which is pretty happy to leave things as they are.
Now add in the timing.
Major step-changes in how human capital has been deployed have always resulted in concomitant changes to political and social structure. We are likely to be witnessing another major shift to how human capital is deployed today, towards an economy, and probably political and social structures, where individuals are empowered to conduct successful microenterprises, and control many aspects of their lives they couldn’t in the past. Think of banking, SMSFs and travel for a start.
There is probably an intellectual who could tell you the detail of this change and why it is occurring, but it has something to do with us being able to connect the dots on data, control our own data, and, most importantly, how that all interacts with the various evolving and intelligent systems that are increasingly serving us. Trust in data is huge in this equation.
So far ownership of data has been a moving feast for consumers (and patients), one which some of the global digital distribution platforms have thus far gorged themselves on – think of Facebook, Google and Amazon, in particular.
But it isn’t hard to see that ownership of data is going to become easier for all of us, and as that happens, the power of individuals will grow.
That power will be most effective when individuals collaborate. And that is already happening in a manner which must scare the daylights out of some of society’s traditional power structures, such as banking institutions.
Who do you trust to optimise your investments or your travel plans? The Commonwealth Bank, Flight Centre, or individuals who have the knowledge and experience to truly help you, who you trust, and who you soon will be able to interact with on a peer-to-peer basis. And if you have a good or bad experience you are going to rank that accordingly, and share it with your community. No big bank or travel agent required!
If you apply this dynamic to healthcare, you can ask some pretty telling questions about where things might be heading.
Do we trust the government to hold a centralised honeypot of our health data and release it to us when they see fit, such as we have with the current incarnation of the MHR? Or would we be happier gathering this information ourselves via our mobiles, storing it somewhere (probably on the cloud) with someone we trust, and only using it when it’s useful to us, or, indeed, when someone is prepared to pay us for it?
Technologies such as Blockchain and FHIR (the web sharing health data standard), if they meet their promise, will make all of this feasible in healthcare. In fact, some of the leaders of the development community in both these technologies are opposed to the sort of platform-based control of data and services that the “old world” of Facebook and Google want us to continue to live by.
The FHIR community has two core values: collaboration and community. The community wants to set innovation free by making all the systems you share data with “open source” so the community can build applications using collaboration.
Of course, there’s a bit of dreaming in this picture. But as a consumer, it sounds much better than what the CBA is offering me, or, for that matter, the Australian Digital Health Agency.
Consumers and patients aren’t going to put up with their data being siloed in big institutions and corporations much longer.
And that shift in dynamic, added to all the other digital changes affecting healthcare are, eventually, is going to cause quite a revolution.
If you add this to the already stubborn complexity of healthcare systems, we have a convergence of factors which renders making sensible predictions nearly impossible.
We simply haven’t been here before, in any market.
No amount of “smart people” gathered in a room pontificating about the combination of applying rapidly evolving digital connectivity can hope to give anyone working or administering healthcare a sensible view of where this is all heading.
Which is one reason healthcare is starting to resist these charming folk. Even the consultancy business models are themselves rapidly breaking down as digital platforms allow their more capable employees to break away and set themselves up in competition to their former employers.
What does this all mean for the future of healthcare?
I’m really not at all sure. But if you are an individual healthcare provider, or an organisation of any size, and you want to change, then being aware of these macro changes to economic and social power, the distribution of information and data, and technology, will potentially make you more likely to modify your approach to making changes.
You can’t just ring up McKinsey or some familiar and comfortable sounding consultancy brand, because you know they’ll help, and you’ll never get fired for using them.
That’s not going to work anymore.
Jeremy Knibbs is the publisher of The Medical Republic and the content director of Wild Health, a summit series that attempts to have issues like those raised in this article aired and discussed by the people that are in charge of changing our health system. The next Wild Health Summit is November 20 at the Seymour Centre in Sydney. For tickets, CLICK HERE and use promo code TMRF for 15% off tickets