Digital Health: Challenges
This is the second post in a 3-part series that highlights our passion for digital health and our conviction in backing entrepreneurs who are transforming the industry. Part one can be found here.
Runaway costs in healthcare are a huge concern as discussed earlier. There are valid reasons for the increase in costs, but many fundamental problems also exist in the system that present unique challenges. These challenges, along with the complexity and size of the sector, make it extremely hard to bring about change and create numerous pitfalls such as long sales cycles, too many decision makers, entrenched legacy systems and complicated incentives.
Technology and Process Innovation
Many of the processes and technologies used in hospitals were not built for the high technology and high touch approach that most consumers are used to today. On the technology side, many hospitals run monolithic systems that are difficult to use and offer little interoperability. Processes such as patient referrals and charting are still mostly manual. The result is that physicians spend more time on things like data entry and not patient interaction, which leads to lost information and errors, leading to the very issues that technology was supposed to address.
Poorly Aligned Payment System
Medical care in America is primarily delivered through a fee for service model, in which providers charge for specific services. This approach made sense when one or a small team of healthcare workers cared for a patient throughout his or her life, but makes little sense in a world where healthcare is delivered through a variety of providers such as small healthcare practices, large hospitals, post acute care centers, skilled nursing facilities and home care providers. It is imperative that each of these providers is aware of how the others are managing the patient’s care and share in the risk of delivering that care. However, without proper tools to support information sharing and the right incentives to encourage sharing, fee for service can easily result in redundant tests and procedures as each provider tries to independently provide the best care.
Shortage of Expertise
As the U.S. population ages, demand for healthcare services will soar. Over the next two decades, seniors as a percentage of the population is expected to increase by 50%. This time period will also see a dramatic shortage of nurses, who make up the largest segment of the healthcare workforce. 1.2m vacancies will emerge for registered nurses between 2014 and 2022. Even worse, the country’s nurses are also aging with 1/3 of the current workforce projected to retire over the next 10–15 years leading to an experience and personnel gap as young nurses join the workforce. Bridging this gap is vital and intelligent systems based on automation and AI will play a big role in this transition.
Translating data into outcomes
One of the biggest challenges in healthcare is that the journey from action to outcome is not simple and can take a long time. For example, the A1C test is a blood test that gives the average level of blood glucose. This can help detect diabetes. However, the test result is something a patient cannot easily relate to. How does the result, which can have a margin of error, translate into a diagnosis? What are the the preventative and treatment options and how do each of those actions help manage symptoms? The answers to these questions are not easily available.
For example, what does it mean if my blood sugar decreases by 3 points? Will adding 20 mins of exercise decrease the level by 5 points, 10 points? How will that impact each of my symptoms today and in the future? Studies show that patients often try to please their physicians, but often don’t understand them or forget what the physician said, leading to issues with patient adherence.
As more and more data is being generated through sensors, devices and apps, the hope is that healthcare workers can better understand and support their patients, which should lead to better disease management and eventually lower costs. However, everyone involved in the process has to believe in this vision and accept new processes and technologies to achieve success. It is often difficult to think so far ahead, which is one of the reasons change is hard.
Entrepreneurs, and the solutions they come up with, will be crucial in addressing these challenges and bringing about change. Part three discusses some of these solutions and the changes in the broader healthcare landscape.