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The Case for Digital Healthcare for the Public Good

We are currently witnessing a technological revolution that will fundamentally alter the way we live, work, and relate to one another. In scale, scope, and complexity, the transformation will be unlike anything humankind has experienced before.

The Future of Humanity Institute at the University of Oxford surveyed academics and industry experts who had published papers in the domain of Machine Learning. They agreed that within 35 years, AI-powered robots will exceed the performance of even the best surgeons.

Eventually these intelligent machines will perform all of the core services of our current healthcare systems, and will perform them faster, cheaper and more accurately than humans. During the last 12 months, dozens of studies demonstrated that algorithms can outperform physicians in specific areas. Currently, most of the focus lies on imaging modalities; this is where AI technology has made the fastest progress.

These intelligent services will eventually allow humans to protect and improve their health, while healthcare providers will be able to prevent, identify and cure diseases well before patients show any clinical symptoms.

These systems will be delivered over the internet, and will be will be accessible to anyone with internet access.

These technologies could be a game changer; we could build a world where everyone who has access to the internet also has access to expert medical knowledge.

Currently, the vast majority of the investments in these new technologies is being driven by the private sector. In the US and in China, billions of dollars have been invested in startups. Together these startups are building the foundations of these super-intelligent machines, though each of them currently focuses on a specific domain of healthcare. Major internet platforms like Amazon, Alphabet and Alibaba — none of which are European — have started significant investments in the Digital Health sector. Consolidations through mergers and acquisitions appear likely.

Looking at the state of our current healthcare systems, an infusion of innovations which have the potential to disrupt the industry is at least partially positive. This is especially the case in the United States. In the US, healthcare facilities are largely (approximately 80%) owned and operated by private sector businesses, and healthcare costs account for 18% of the GDP. Life expectancy has been on the decline for two years, and the country seems to be desperate for innovation that increases outcomes and access while lowering costs.

But…

Not everyone sees that we are entering a different game, as the core of healthcare is digitized and privatized. As with other data-driven platforms, it is expected that consolidation will lead to monopolies. Thanks to their access to the large data pools with cohorts larger as the population of the US, these platform providers will be able to deliver the most accurate services for the lowest price. Zebra Medical Vision, for example, is a company that uses algorithms to examine medical imaging scans for one dollar each. If Zebra Medical Vision continues to receive funding, and is able to pass through what Peter Diamandis (Singularity University) describes as the Phase of Deception, it is reasonable to expect that they will dominate Radiology Diagnostics. The end game could be similar to that of Google Search, which has a net market share of 74.54%. It will be impossible for latecomers to compete;having access to the best data will define whether you lead or lose.

While that may not be a huge problem in the area of search, it is a massive problem in healthcare:

  • Healthcare diagnostic services — and the valuable data that drive them — will be consolidated into a handful of global-scale private providers.
  • The availability of data that is relevant for clinical research, will not be evenly distributed and reflecting on the actual investments, end up in private hands.
  • The “Big Data” phenomenon has the potential to amplify inequalities in healthcare, rather than resolving them.
  • If data is transformative for healthcare, what are the consequences for the public healthcare systems of those countries which have less access to data?

What’s the answer?

Startups alone are not the solution to digitize our healthcare systems. In our current public healthcare systems, University Hospitals in Europe, have been responsible for clinical research, and they should continue to be responsible for it. They will need, however, to adapt to these new changing realities. For example,

medicine has been a clinical science supported by data, but it is becoming a data science supported by clinicians. How will our institutions adopt to these new realities?

It’s difficult to wrap our minds around the blistering pace of innovation that is about to come. But it’s certain that the winners and the losers in the emerging data-driven healthcare systems will be determined by their ability to get access to large data cohorts and the quality of their data science teams. Consequently , it is not unfair to say that clinical research and digital service provision can no longer be separated. Our university hospitals must build digital platforms, where they publish their clinical knowledge not only in a paper, but in an API as well. APIs can make research results actionable and globally accessible through the internet. Should university hospitals stick to old models, they will be doomed to failure, and will be unable to save us from a further privatisation of the healthcare sector in Europe.

If we want to keep our clinical research in public hands, European governments must set-up a Marshall Plan for Digital Health, investing now and in with gusto to build global, to build global universally accessible platforms which run on a non-profit model.

These platforms can borrow the positive aspects from the typical Startup model (agile, culture, risk-savvy) without the bad (private, closed system, monopolist).

According to a recent study of PWC, 64% of all German citizens trust University Hospitals most when it comes to managing and protecting personal data. Which indicates that these university Hospitals are the ideal platform provider.

The platforms could use initial investment to develop and refine services while offering them for free in developing countries. Once the services reach the necessary level of accuracy, revenue generated in Europe and other developed countries could subsidize access in poorer countries. With the resulting increasing and improved healthcare access around the world, immigration pressure on Europe would decrease. “Digital Health as a Global Good” would also support the Millennium Development Goals (MDGs)criteria established following the Millennium Summit of the United Nations in 2000, following the adoption of the United Nations Millennium Declaration..

Europe could secure its position as a medical research leader by using health data to support research into new treatments and platform development for public — rather than private — gain.

The Result

Europe becomes the leader of a world which provides universal healthcare access — and keeps this valuable new public good in public hands.

How Can We Get European Governments To Act?

Today, some actors across Europe are starting initiatives intended to provide a counterweight to Silicon Valley in healthcare. But their efforts are not likely to succeed because they aim to build networks — not platforms. Platforms scale, unlike the linear, people-driven growth of networks. Successful platforms can dominate and set rules for an entire industry. In 10 to15 years, the technological cost of maintaining a platform will be negligible compared to the benefits.

We need a targeted effort to build a movement with the goal of securing a €250 billion European Public Investment over ten years to build platform-driven healthcare platforms. To put this in perspective, in 2015, nearly €1058 billion of general government expenditure was spent by the EU Member States on ‘health’.

It would cost approximately €50 a year per citizen over a period of ten years to build a global public healthcare system, supported by intelligent machines, that would dramatically increase access to high-end healthcare services, be inclusive for all and help the world’s prosperity through a healthy global population.

I would appreciate if you would discuss, share or comment these thoughts. They are the result of workshops and discussions we had in our futur.io faculty, and will be the narrative we build creating desirable futures.

Bart de Witte - views are my own.

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Replies to This Discussion

Great discussion sis but if we cant take care of this planet how do people think we will be able to take another planet or allowed there!!!!

xxoxoxoxo

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