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  • Robert Wachter

Technology will only transform medicine if we get privacy right

The cost of global healthcare is unsustainable. As people live longer they have more chronic diseases, their knees hurt, their cataracts dull their vision and they can't hear very well. It’s pretty clear the human body was not designed to live this long. And yet patients’ expectations are higher, putting greater and greater costs on our healthcare systems.

In response, we have taken our existing healthcare systems and tweaked them to be more efficient. But now it is clear that, to make major headway, we’re going to have to do what every other industry has done to transform itself: turn to new digital techniques and tools.

Healthcare was very slow to digitise

Healthcare was very slow to digitise compared to other major industries, but it is getting there. A decade ago, only ten per cent of US hospitals had electronic health records. Today, only ten per cent do not.

The UK’s National Health Service tried to digitise 15 years ago and the process failed epically: the programme was under-resourced and tried to impose computerisation on staff without getting buy-in from frontline physicians and nurses. The NHS is now making better progress, but there are many remaining challenges.

Digitisation is expensive and the NHS is cash-strapped. Moreover, while computer systems are likely to create efficiencies over time, the experience in healthcare is that they often slow things down in the first years, as clinicians are forced to increase their documentation and adjust their workflows.

Indeed, it can often take a long time for the benefits of digitisation to be felt. That is because people naturally tend to convert what they are used to doing into a digital version of the same process, which is only slightly better. Over the next ten years we will have to introduce new digital processes into healthcare that will produce a system that can respond to the world’s healthcare needs, with better products and at a lower cost.

Digital Health in the next decade

The first big change we will see is that the site of care will evolve from the doctor’s surgery to patients’ managing their care from their home. Diabetics will measure their sugar levels, for example, or a hypertensive patient their blood pressure, and recommendations for how they might change their behaviour or medications will come from artificial intelligence, delivered via devices such as smartphones or voice platforms like Amazon Echo. When the patient needs to talk to a real person, they’ll be on the other side of a screen. The advantage of this is that patients will be able to access care 24 hours a day, 365 days a year, rather than the twice a year when they visit a doctor.

Medical interventions will also change. The US Institute of Medicine estimates that 30 per cent of medical care is wasteful and non-evidence based. Digital transformation carries the potential to help guide physicians – and patients – to make better, more evidence-based choices. For example, when a generic drug will work as well as a more expensive one, the digital system will steer, and perhaps force, patient and clinician to use the more cost-effective approach.

Privacy concerns

One of the biggest obstacles we face in this essential move to the digitisation of healthcare is public concern about privacy. Privacy campaigners have expressed concern over partnerships such as the recent UK tie-in between the NHS and DeepMind, that gave the latter access to the (partially anonymised) records of 1.6 million patients.

However, it will be incredibly hard for healthcare to take advantage of the digital revolution if data can’t be shared. By sharing data we will be able to use AI to analyse the data of millions of patients to reveal patterns and insights that I, as a practicing clinician, couldn’t possibly have discovered on my own. These will guide me to make better predictions, and patients to take the right actions.

In the next ten years we will have no choice but to develop secure ways to share data between health systems and companies with digital expertise.

This is a significant challenge that will involve new methods of de-identifying records, new approaches to patient consent and strong ethical oversight by professionals and patient representatives.

But, building a firewall between healthcare systems and digital companies that have transformed every other industry they’ve touched – largely for the better – will only ensure that we face a future where we are unable to innovate our way out of the fundamental problems facing healthcare today.

Robert Wachter is chair of the Department of Medicine at the University of California San Francisco.


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