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  • Jeff Greenstein

Innovations in primary care will make smartphones a powerful tool for improving health worldwide

Smartphones will make the world healthier. This audacious statement is based on the convergence of three realities: First, smartphones have become incredibly powerful and ubiquitous amongst the world’s population. Second, primary care meaningfully improves one’s health and longevity by virtue of prevention, early treatment and effective on-going management of acute and chronic issues. But lastly, and perhaps most importantly, high quality primary care can now be augmented with deep technology and delivered via a smartphone.

Smartphones Are Everywhere

Smartphones have penetrated the developed world and are rapidly penetrating the developing world. According to a PEW study, 76% of the population living in advanced economies own a smartphone as of 2019 – including 81% in the US and 95% in South Korea. In the developed world, smartphones have become an indispensable resource and tool for convenience across a broad range of topics. While having a pocket-sized phone and camera is a nice luxury, today’s smartphones perform a range of tasks which until recently would have been deemed unimaginable. With more computing power than the computer aboard the Apollo 11 spaceship, smartphones now do everything from shopping and managing finances to translating foreign languages and helping us navigate virtually anywhere on the planet.

In the developing world, it is conceivable that the impact of the smartphone is even more pronounced. Access to phone lines and the information contained on the internet brings communication, information and services to those where the physical infrastructure doesn’t exist and may not exist for quite some time. Instead of laying wire cable for phones or establishing a network of brick and mortar outlets, these opportunities exist within a device in the palm of your hand. Greater internet access reportedly contributes to improved health care, education, gender equality, and economic development. According to Bloomberg, increasing a country’s mobile internet usage by 10 percent results in an average 2 percent increase in GDP, and can even make governments more responsive to civic issues.

Recognizing the power this affords in combating poverty and elevating living standards, the UN recently declared that affordable access to the internet is a basic human right. Referencing the power to improve credit, education and healthcare, Melinda Gates, co-Chair of the Gates Foundation summarized it perfectly, “once they have access to the internet, so many great things come forward.” For those underbanked or unbanked in rural parts of Africa mobile money enables users to transfer money and make payments over their phones independent of a bank. M Pesa — which dominates Kenya with over 80% market share and 28.5 million users — was cited in a 2016 MIT study as lifting 2% of Kenyan households out of extreme poverty. The strong and growing adoption of mobile money might be a strong indicator that people around the world will also turn to mobile modality to receive healthcare.

The impact of the smartphone in areas of global poverty is still in the very early stages. According to PEW, currently only 100 million people living below the global poverty line have access to a smartphone, and over the next decade that number is expected to increase to over 1 billion and encompass 70% of those falling into that category.

The Value of Primary Care

Study after study confirms that access to early and frequent high-quality primary care meaningfully improves health and longevity. Specifically, primary care prevents the onset of many debilitating and sometimes life-threatening diseases and conditions: it treats diseases and injuries early to limit escalation into something more serious, and it offers effective management of chronic issues to enable a productive life. Healthcare can be extraordinarily complicated, but in most cases primary care deals with relatively simple and straightforward issues that can be readily and efficiently addressed.

A great example of primary care’s effectiveness is its mind-boggling potential impact in parts of the developing world like sub-Saharan Africa or regions of India and Asia. In India, it is estimated that about half a million children die each year of diarrhoeal diseases — and as the Washington Post poignantly reported, one doesn’t need to travel halfway around the world to experience the devastating impact a dearth of primary care can generate.

Having access to a primary care provider to treat these diseases would be transformative to the afflicted families and communities. Primary care in both the developing and developed world also increases productivity: it is estimated that in the US alone approximately $225 billion is lost each year due to sick days – either through absenteeism or presenteeism.

Powering Physicians With The Latest Technology

The expanding power and reach of smartphones, combined with deep technology, can be applied to the actual practice of medicine, creating a scenario where high-quality primary care is now available via a smartphone. This marriage essentially puts primary care anywhere there is internet connectivity. However, simply putting a primary care provider (physician, nurse practitioner, physician assistant or community health worker) on the phone to deal with a patient is already a difficult task, due to the cold reality of the dramatic shortage of professionals virtually everywhere in the world. In the US, there is an estimated current shortage of 25,000 primary care physicians, which will grow to 50,000 over the next decade. That problem is nothing compared to what other parts of the world, especially developing countries, are grappling with. As an extreme example, Sierra Leone only has 3 doctors per 100,000 people.

Creating a partnership where physicians are equipped with the latest in sophisticated technology — such as machine learning, natural language processing and artificial intelligence — can lead to substantial increases in efficiency and even quality. Several companies including 98point6, Curai and Babylon Health are pursuing the mission of integrating technology and mobile modality into the practice of primary care. For example, 98point6 is employing AI and deep technology to perform the rote and administrative tasks that consume a disproportionate amount of doctors’ time. Combining these efficiency gains with the use of mobile devices empowers their doctors to treat many more patients wherever they might be located.

Technology augmentation can expand the number of patients a single doctor can manage literally 100-fold. When this possibility is delivered via a smartphone, it enables primary care to be delivered anywhere, regardless of where the doctor is physically located. Furthermore, and maybe even more excitedly, the cost-saving power of technology applied to primary care creates a situation where virtually every person in the world can access primary care without financial barriers. Treating patients remotely is nothing new, but treating patients remotely with the support of artificial intelligence takes things to the next level.

Best-selling author Yuval Noah Harari summarizes the power of this convergence in his recent book, 21 Lessons for the 21st Century: “The benefits for human society are likely to be immense. AI doctors could provide far better and cheaper healthcare for billions of people, particularly for those who currently receive no healthcare at all. Thanks to learning algorithms and biometric sensors, a poor villager in an underdeveloped country might come to enjoy far better healthcare via her smartphone than the richest person in the world gets today from the most advanced urban hospital.”

While the approach is intuitive and the benefits and business opportunities massive, there are nonetheless many regulatory complexities and technological challenges to develop a user-friendly product that delivers the impeccable quality necessary to properly care for patients.

For example, each state in the US has its own rules and requirements governing the practice of medicine, establishing the doctor/patient relationship and the actual practice of medicine itself. On the technology front, there is a dearth of structured primary care doctor/patient encounter data to for a machine to learn. On a more human note, there are subtle but very real nuances in how people across different demographics communicate in natural language that must be factored in. Navigating these challenges are enormously expensive and time consuming, but the benefits and opportunities warrant solving them.

Truly leveraging the power of technology and smartphones to deliver far-reaching and cost-efficient high quality primary care to literally everyone in the world will require innovative thinking and the willingness of both patients and doctors to adopt a paradigm shift. But it will be worth it: enabling people to access that level of care from their smartphone will literally make the world a healthier and better place by enabling everyone to share in the benefits of early and often primary care. Investing in a company that capitalizes on this opportunity might very well create the ultimate “doing well and doing good” investment.


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