Putting people at center stage

It’s the healthcare team’s responsibility to be innovative and advocate for their patients and communities in new ways. This includes looking for creative solutions to provide patients seamless access to care and information sharing. Physicians must not only utilize the power of technology to connect with their patients, but should be encouraging all patients to take a more active role in managing their care. Healthcare is a team sport that needs both the medical team and the patient’s participation to produce positive outcomes.

– BRIAN DONLEY

MD, Chief of Staff at Cleveland Clinic

Healthcare professionals and institutions may need to change, but the other essential agent in the shift to a more holistic, technologydriven approach to ‘health’ care (as opposed to ‘sick’ care) is the general public. More active monitoring and health management, particularly outside the formal healthcare infrastructure, requires not only more sophisticated devices but an informed, engaged population that uses or interacts with these devices regularly and in the right way; shares relevant health data with healthcare professionals; and uses this data (or healthcare professional recommendations based on the data) as a catalyst for lifestyle changes that improve health for the long term. Encouragingly, many experts already see signs of this shift emerging – with mixed implications for healthcare professionals.

There is a trend towards more consumerfriendly (health) services, engagements and initiatives; people are becoming more demanding about what they want and how they want to be treated,” says Dr. Mechael. “Before the doctor was God and we listened to him or her – but with the democratization of health people are becoming aware of their rights and the quality or care they want to receive.

As with healthcare professionals, in many cases there is an apparent distance between public awareness of connected care technology and the role it actually plays in people’s lives. In the survey, the general population cite healthcare professional recommendations as the top overall factor (44%) that would convince them to use connected care technology (such as health-related trackers and home health monitoring devices), followed by the government subsidizing or paying for the technology (42%) – though the latter tends to be a bigger motivator in emerging markets (46%, versus 39% in developed countries), where disposable incomes are lower.

Yet the survey also shows a significant number of people don’t necessarily follow healthcare professionals’ advice, even where they are more likely to have the necessary resources. Overall 16% of those with cardiology issues surveyed whose doctors recommended they start tracking their heart rate did not do so.

Like healthcare professionals, the general public seems attuned to the potential benefits of connected care. About three-quarters polled overall say it is extremely or somewhat important to improving diagnosis of medical conditions (76%), treatment of medical issues (77%) and healthcare services for the elderly (78%), while smaller majorities see connected care technology playing an important role in improving the overall health of the population (70%) or daily healthy living (63%).

Why did you first start tracking your heart rate?

The proliferation of wearables would seem to offer curious, health-conscious people plenty of opportunities to incorporate connected care technology into their homes or daily routines. However, over half polled (55%) say they have not used any connected care technology to monitor their health indicators independently of a healthcare professional in the last 12 months. Surprisingly, despite the costs at times associated with these devices, usage rates are significantly higher in emerging markets, where 57% of the general population surveyed have used connected care technology in the past 12 months, versus 37% in developed countries.

This could reflect people turning to devices in countries where medical care may not always be readily accessible. But it also suggests that though cost is a concern (50% of the general population polled feel connected care technology is likely to make healthcare somewhat or much more expensive overall in the long term), it is not necessarily the main consideration in connected care technology adoption for the general population – just as it is not necessarily the main factor for healthcare professionals.

Percentage of the general population who have used connected care technology to monitor any health indicators in the past 12 months

No robot doctors, please

The research indicates changes in awareness and mindset could play a more critical role in empowering people to seize the opportunities offered by new technologies and use them as a basis for a more active approach to health.

First, it is important to recognize that while people clearly see the potential of technology in healthcare and in the management of their own health, they do not necessarily want it to take over. Health can be a delicate matter and the ‘human touch’ that healthcare professionals provide will be valued, no matter how sophisticated technology becomes – a point that healthcare professionals fearing technology-linked job loss or obsolescence may want to keep in mind.

When asked what artificial intelligence (AI) tools or technologies could have the most impact on improving healthcare, the highest proportion of the general population polled (25%) chose an AI-fuelled app or wearable that could automatically track key indicators and make related suggestions; only 11% see potential for remote appointments with hologram doctors and just 10% chose fullscale robot healthcare professionals (though South Korea was relatively keen with 25%selecting this). Viewing (and promoting) technology as complementary to, rather than a substitute for, the skills of healthcare professionals, could do much to assuage concerns and boost adoption among members of the public and healthcare professionals alike.

Some professionals have also pointed out that technology and the human touch needn’t be mutually exclusive, if, for example, technology reduces the number of people visiting healthcare professionals for minor matters that could be addressed through self-monitoring and diagnosis, allowing healthcare professionals to devote more time to more serious cases.

For me technology enables the human touch. If you see 30 patients in an afternoon, there’s no human touch; there’s just hand-shaking,” says Dr Witkamp. “But if you can replace these 30 patients with four patients that really need your help, that’s definitely a human touch. And I think that will be the main role of the healthcare professional in future.

Another issue that needs to be tackled is knowledge, which, as evaluated by people themselves, seems decidedly mixed.

About a quarter (24%) of the general population polled overall claim to be knowledgeable about connected care technologies. The rate is typically even lower in developed countries and particularly Europe, falling to 9% in Italy and 8% in Germany. Even in the UAE, which ranks highly in connected care adoption, only 48% of the general population claim to be knowledgeable.

Yet, among the general population polled who have used any connected care technology in the last 12 months, 81% claim to somewhat or completely understand how to properly use it, and 77% to understand how to interpret the results from the technology. Interestingly, 76% of healthcare professionals who have had any patients share information from connected care technology with them in the last 12 months believe that their patients understand how to properly use the technology, and 67% say their patients understand how to interpret results from connected care technology.

At the very least, these differences indicate more needs to be done to both introduce connected care technologies and illustrate their correct use. Around a third (31%) of the general population surveyed say training on connected care technology would encourage them to use it. This highlights the importance of simplicity and user-friendly design.

To be able to see the shift that everybody is talking about healthcare needs to move into the homes of people and patients,” says Ms Riggare. “And that means technology needs to be designed differently to current standards. If we want people to be able to take care of themselves, they will need technology that is designed for them as primary users, and we also need reimbursement systems to support that.

The biggest opportunity in healthcare is investing in developing self-care models,” Ms Riggare adds. “If it’s done right, I feel very strongly it has the possibility to transform things.

Which of the following Artificial Intelligence (AI) tools and other technologies do you think would have the most impact on improving healthcare today if they were available?

Taking ownership, building trust Within institutions and among healthcare professionals, the ownership and management of patient data also represent possible stumbling blocks for the general public. Only 23% of the general population surveyed who used connected care technology within the last 12 months claim to completely understand when to share data from connected care technology with a healthcare professional, or the easiest way to do so.

Healthcare systems and healthcare professionals could also do more to ‘lead by example’ through system integration. Among the general population surveyed who had visited healthcare professionals for a variety of conditions, only a minority (32%) experienced their medical records being automatically shared between healthcare professionals – 33% in the case of artery disease, 29% with arrhythmia, 33% with heart valve issues, 40% with cancer and 28% with high blood pressure – though records needed to be shared in the vast majority of cases.

As noted earlier many healthcare professionals hope to see patients take an active role in this process, and indeed a significant number are; among the general population surveyed respondents with any health issue, over a third (36%) say they have shared some or all of their records themselves. The survey highlights a clear opportunity to make people more involved stewards and sharers of their data. The majority (76%) of the general population surveyed feel they have some or complete ownership over their medical records, though this rate slipped to 62% in Germany and 57% in the UK.

Patients should be responsible for their healthcare records, but at the same time to be fair to them they need to have access to the records,” says a cardiologist in a private institution in Singapore with 10 years’ experience. “Rights to data and authority to control its movement are non-existent at the moment. Right now nobody is responsible for information that is transmitted.

Most of the power currently lies with the physicians and the specialists, and I think we need to hear the patient voice more,” says Dr Perel. “I don’t think we are listening and involving patients enough. However, not all patients might want to have that power.

Trust is a key factor in encouraging people to monitor and share their health data, particularly because many people see it as sensitive. When asked what they would least want to be made public if their account or data was hacked, 55% of the general population surveyed chose health data versus just 28% for e-mail and 17% information from social media accounts.

How much ownership the general population feels they have over their medical records
What information the population would least want to be made public if account or data was hacked

Encouragingly, the healthcare sector enjoys relatively high levels of trust when it comes to personal data compared to other industries. Overall 44% of the general population say they trust the healthcare industry the most with their data, compared to 35% for the banking industry, 20% for the insurance industry and a mere 5% for the retail industry. Levels of trust with personal data in the healthcare industry tend to be even higher in countries with high levels of connected care adoption and healthcare system integration, such as the UAE (55%), Singapore (51%) and Sweden (55%); but are lower in the US (39%), Germany (36%) and emerging countries like Brazil (35%) and particularly Russia (20%). Cultivating a degree of trust in healthcare systems with personal data – whether through more robust data protection regimes or disclosure on data practices – and ensuring people know the ‘entry points’ at which their data should be interacting with these systems could ensure more data is put to use, as well as reduce inefficiencies and duplication within institutions.

Reimagining incentives

Even as technology promises to make selfmonitoring easier, just as with recycling waste a decade or two ago, the adoption of a more prevention-focused healthcare mindset and new behaviors will likely have to be cultivated through a mixture of obligations and rewards.

Most people are aware of the need to plan for retirement and elect (or indeed, are compelled by their governments) to put aside some amount of retirement savings – in the US 69% of workers report they or their spouses have saved for retirement, for example.20 Yet the idea of ‘investing’ – not necessarily financially, but by changing lifestyle or habits – to ensure this retirement is a healthy one tends to receive less focus. This is also true of governments, who in many countries continue to spend a higher proportion of GDP on pensions than health services despite the fact that an aging population will bring pressure on both fronts.21

Connected care technology has produced some notable successes in terms of people assuming more responsibility for their own health. ‘e-Patient Dave’ cites the example of OpenAPS.org, an open-source solution designed by a community of people with diabetes that puts artificial pancreas system technology within the reach of anyone with a compatible device.22 OpenAPS can communicate with a wide range of insulin pumps and glucose monitors to keep a person’s blood glucose in a safe range, and is designed to serve as a bridge between stand-alone insulin pumps and proprietary APS systems that are still years away from regulatory approval.

Something new is happening,” ‘e-Patient Dave’ says. “Digital health information is enabling patients with a problem increasingly to act on their own, with or without a physician’s cooperation.

Mr Sonnier sees some potential for ‘gamification’ in the health context, such as mobile games that can help detect the onset of Alzheimer’s and motionsensitive consoles designed to get people off the couch. “It’s not a prescription, but it’s a method to keep people moving,” he says. “All this drives behavioral change.”

Many experts agree some sort of incentivization – whether financial or social in the form of ‘peer pressure’ – will be needed to encourage people to take a more proactive health role.

The moment you mention incentives people are more eager,” says a radiologist with one year of experience in South Africa’s public healthcare sector. “With the incentives, whoever collects more data will probably be more motivated to live healthily.

People can support each other,” Mr Spurr says. “There are many community-driven health initiatives where people have been brought together to promote healthy living, particularly driven through social media initiatives.

Incentives “need to be targeted properly to the right audience,” says Dr Bernaert. “Monetary incentives help behavioral change but there’s not enough understanding of behavioral triggers; health is very personal. There’s a need to combine behavioral analytics with social media and social interests to target value propositions that appeal to (individuals) and not necessarily their neighbors.”

Employers are also emerging as a major potential contributor to change in this regard. More workplaces are encouraging effective health planning and incentivizing staff to adopt healthier lifestyles, in much the same way many support employees’ financial planning. The corporate wellness market – which includes things like workplace health risk assessments, fitness, nutrition and smoking cessation programs – in Asia Pacific alone is expected to more than double from 2015–2024 to US$7.4 billion.23 Successful employer health promotion initiatives may provide a model for the adoption of broader, more ambitious healthcare incentivization programs at a national level – a process to which connected care technology can contribute by facilitating monitoring as well as the measurement of outcomes.

The Cleveland Clinic strives to keep all of their patients healthy, which includes their own employees. Cleveland Clinic employees and their legally married spouses who are enrolled in the employee health insurance plan can earn up to 30% off insurance premiums. To attain the incentives, those with a range of chronic conditions such as diabetes, hypertension or obesity, can enroll in programs to help them meet personalized medical or nutritional goals. Those who are already healthy can earn the discounts by reaching physical activity goals, such as consistently going to the gym or achieving a certain number of steps per month. These programs have helped Cleveland Clinic keep premiums down and encourage patients to get or stay healthy and be in control of their well-being. Prior to this program healthcare costs were increasing over 7% a year, but just this past year (2016) Cleveland Clinic started to see a decline in spending at a rate of about 2%.