Digital transformation is very big business these days. That’s why there isn’t a big C consultant in town who 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 terms of 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 it’s the great white whale of transformation markets. That is if you can manage to get a harpoon into 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.
No surprise then that all the bigger firms have well funded, well-marketed healthcare innovation divisions, ready and waiting, or, in the case of groups like Accenture, already executing on some of 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 with the smart insightful people, who’ve already done the transformation in other mega markets like finance or simply have insights you just can’t get yourself.
And you plan ‘our’ future in health.
What could go wrong?
A lot. Or shall we just call the $2 billion we’ve spent so far on the MHR, where we find ourselves in a classic ‘too far in to stop now’ funding paradigm, a learning experience?
No matter which way you look at it, the sorts of rapid transformational changes that digital has thrust upon the likes of travel, finance, advertising and marketing in a relatively short amount of time, just don’t look like they are going to happen that way in health.
Health is resisting digital transformation in a manner that people should stop to think about more carefully. It’s the last big market 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 a well defined US HMO, vertically integrated and controlled or the odd tiny Scandinavian country aren’t good place markers for how digital health will unfold.
Australia, the US, Britain, Canada are logarithmically more complex than any of the working systems you see in the perfect decks used to sell the future of health by various parties.
Healthcare is too complex for it to travel the transformation route of most of the services markets before it. And that’s before you add to the problem, that society, politics, and the culture of power and influence is being disrupted in a way that must be going to impact on how health eventually does transform.
Timing is everything in innovation.
Healthcare is already a significantly fraught and mixed up venture in Australia. Federal versus state systems and funding that don’t dovetail, primary versus tertiary interoperability institutionally disabled, regulation that can’t keep up, high, the fear of consumers that accompanies the risk and that of the power brokers in government who want to mitigate it, the culture of medicine and doctors, patient data, privacy and ownership of that data, huge systems legacy and, an unstable and near paralysed political system which act like they are perfectly happy to keep going this way in health.
Now add timing.
Major step changes in how human capital has been deployed – the industrial revolution and the information revolution (underpinned by Mohr’s Law) being key examples – have always resulted in concomitant changes to the political and social structure. As healthcare starts to shift on digital, we are also experiencing a major shift to how human capital is deployed.
We are moving towards an economy and probably political and social structures where individuals are empowered to conduct successful microenterprises and control many aspects of their lives which they couldn’t in the past. At the center of this change, we can now connect the dots on data if we wish. But even more, we can control our own data, and how it interacts with the various evolving and intelligent systems that are increasingly serving us.
So far ownership of data has been a moving feast for us punter consumers (patients) . One which some of the global digital distribution platforms have thus far feasted on – Facebook, Google, and Amazon in particular. But ownership of data is becoming much easier for us, and as it does, the power of individuals will grow. That power will be most effective when individuals collaborate. And this is already happening in a manner which must scare the daylights out of some of society’s traditional power structures such banking.
Who would you trust to optimise your investments or your travel plans? The Commonwealth Bank and Flight Centre, or individuals who have the knowledge and experience to truly help you, who you trust via peer recommendations you trust, and who you soon will be able to interact with on a peer to peer basis.
If you apply this rapidly emerging dynamic to health 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 – aka, the current incarnation of the MHR. Or would we be happier gathering this information ourselves, storing it somewhere (probably on the cloud) with someone we trust (Apple?), and only using it’s when its useful to us, or, indeed, when someone is prepared to pay us for it?
The promise of blockchain and FHIR (the web sharing health data standard) make such a situation now entirely feasible.
The FHIR community has two core values – collaboration and community. That is also at the heart of this change.
Consumers and patients aren’t going to put up with their data being siloed in big institutions and corporations much longer because they won’t have to put up with it.
And that shift in the power dynamic, added to all the other digital technology changes impacting health are, eventually, going to cause quite a revolution.
As far as the transformation of markets is concerned, we simply haven’t been here before.
No amount of ‘smart people’ gathered in a room pontificating about the combination of applying rapidly evolving digital connectivity, with the social, economic and political changes we are witnessing as a result of the empowerment of individuals with emerging technology, can hope to give you, as a healthcare provider, be it a single GP, or major healthcare delivery institution, such as a hospital, or even an entire state government’s health department anything resembling a sensible view of where this is all heading.
Which is one reason health care is starting to resist the charms of the smartest people in the room. Even their business models are rapidly breaking down as digital platforms allow any of their more capable employees to break away at a moments notice and set themselves up in competition.
What does this all mean for the future of healthcare?
It is honestly hard to tell. The thing is, we are in unexplored territory and anyone who doesn’t tell you that is selling you something you probably don’t need.
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 to the people that are in charge of changing our health system. The next Wild Health Summit is Nov 20 at the Seymour Centre in Sydney. You can buy tickets HERE with a WHICH50 reader code here for a 20% discount. Your Code is WHW50.