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‘Digital technology is future of healthcare’US healthcare expert stresses need to understand human behaviors
  • By Marian Chu
  • Published 2018.06.21 12:11
  • Updated 2018.06.21 12:11
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The advent of artificial intelligence and big data is fundamentally changing the way industries operate. In healthcare, the changes have been slow but remain imperative for both physicians and patients who need to provide and receive better care.

Digital technology is coming to sweep the healthcare industry, and it is going to profoundly affect the way physicians treat and interact with patients, according to Dr. Steve Steinhubl, digital medicine director at Scripp Translational Science Institute, associate professor of genomic medicine at the Scripps Research Institute, and cardiologist at Scripps Clinic.

Dr. Steve Steinhubl, digital medicine director at Scripp Translational Science Institute, explains how digital technology will change the course of healthcare, during a recent interview with Korea Biomedical Review at Samsung Medical Center in Seoul.

Steinhubl, who specializes in design, development and management of clinical programs built around novel capabilities of digital technologies and big data, noted that patients in the current healthcare system are not getting the treatment they need, caregivers are dissatisfied with their role, and the cost of care is unsustainable.

“The current healthcare system is good at taking care of patients when they are sick but not good at keeping them well. Digital age healthcare system would be more provider-enabling, patient-focused, and be more precision medicine-focused,” Steinhubl said.

Despite the benefits of digital technology, the healthcare industry has been slow to adopt the changes, leaving both patients and doctors fumbling to achieve positive health outcomes, the U.S. healthcare expert said. The frustrations regarding a broken healthcare system in the U.S. has incentivized the industry to make the first move, he added.

“Healthcare really lagged behind to make digital technology a part of it. At the end of the year, the tech companies were investing in healthcare, and some of the biggest companies are saying that healthcare isn’t going to fix itself, we’re going to do it ourselves,” Steinhubl said.

Powerhouse brands such as Amazon, JP Morgan, Berkshire Hathaway, and even Apple are taking matters into their own hands because the system isn’t changing on its own.

“Apple said they’re going to build a healthcare solution for employees and roll it out to the rest of the world. All these large, for-profit organizations are creating brand new healthcare systems built around digital technology – they’re doing it out of frustration, and it’s going to have a huge impact,” he said.

In an interview with Korea Biomedical Review, Steinhubl outlined how digital technology can revamp a broken healthcare system and which and how digital healthcare should be implemented.

Question: As a physician, what are some problems you face while treating patients and how can digital technology and Big Data help the physician?

Answer: Almost every day when I care for patients, there’s a question on my mind: Is this the right thing to do? Almost every decision we make, there’s a risk for a side effect and potential for it to being beneficial. We’re never sure if this person is going to have a side effect or have a response that we want them to have. We have some general population-based guidance around that, but we only have our own experience to guide us.

In cardiology, I have to decide between doing a multi-vessel coronary intervention and sending the patient to bypass surgery. What’s the best choice? Part of that decision is going to depend on how good of an interventional cardiologist I am as well as how good of a surgeon our surgeon is. It’s going to depend on that patient’s age, medications, and their comorbidities. Right now, it’s kind of like a gut decision.

Healthcare is almost always an ongoing guessing game. However, the more information we have from other people’s experience – that’s what Big Data gives us – it gives us access to knowledge that goes well beyond just my own experience and what patients I’ve seen. Big Data can help guide us to the best decision for that person.

As we learn more and more about the patient’s genetics and how it affects the drug efficacy or wound healing, that can help us learn even more information. As we get more data, we’ll keep getting better and better. We’ll get more and more precise and precise in our management.

There’s almost no part of healthcare where big data cannot make a positive impact. We can better understand the natural variation in both general physiologies. We can learn about response to illnesses and most important response to therapies. By having all that data, we understand variation between individuals.

Q: In the U.S., you talked about how completely unrelated industries are re-engineering the healthcare system using digital technology. Can you rate the progress of change?

A: Progress of change in the U.S. has been extremely slow compared to other industries but having said that, I say in the last five to 10 years, that’s starting to change. But it’s doing so outside the healthcare industry. Change is happening through technology companies and health insurers.

There is resistance to change because all of our healthcare systems are built around this sickness care model, and it’s very difficult to change. In the United States, cardiology brings in a lot of money into hospitals by doing many procedures. So we’re financially rewarded very well for bringing patients into the hospital to do echocardiograms, stress tests, and heart catheterization.

If we don’t have to do any of these things and if we can just monitor someone at home with a wearable device – and that’s a big if – that’s a lot of lost revenue for a lot of healthcare systems. That’s very challenging.

Q: Then what would be the incentive for doctors who stand to lose financially from digital change?

A: The honest answer with the most systems in the U.S. is the doctor won’t have any. That’s why the system has to adopt it and build the infrastructure.

But if your doctors are like ours, they probably don’t feel that they don’t have enough time with their patients. Patients may also want to spend more time with their local doctor and ask them questions without feeling like they’re being turned over.

I think what will eventually what will happen is doctors will embrace digital technology because there are only two commodities that are important – money and time. If you can give back doctors time with their family or even their patient, they would very much embrace digital technology. But that’s hard to implement for an individual doctor unless they’re in individual practice. So it has to be the system that they’re going to implement a strategy for digital technology.

Q: Physicians’ resistance to digital technology such as telehealth has been strong in Korea due to the potential loss of revenue as well. Do you see improvement happening in this area?

A: I think it has to get better. The solution has to work toward better care for patients. Every doctor wants that. But consider that every practicing doctor has put a lot of time into their training and education. They essentially don’t want to be unemployed.

What it would take in Korea - where the government is the payer – is the government has to look at medicine in a very different way. In essence, the government has to be a bit transformational.

The payer would really have to restructure healthcare so that it doesn’t affect the pay of the doctors while at the same time allow them to take care of many people - and do it more effectively. In the end, patients would get better and more convenient care.

Q: But you mentioned that technology alone cannot transform healthcare and understanding human behaviors is important.

A: For digital technology to be installed in healthcare, it requires a much deeper understanding of behavioral sciences: How do we encourage patients to do what we want them to do?

One of the most frustrating things to me is that many of these good solutions to healthcare are based on the assumption that people want to be reminded throughout the day that they have a chronic condition. We have studies that show that it’s just the opposite.

Almost all of these solutions don’t help, though. A solution where your phone alerts you or reminds you to take your medication doesn’t help because people want to turn it off. That buzz is a reminder that you’re sick and you’ve got a problem. A lot of these developed solutions create more work for the person.

We have to figure out more passive ways to allow people to manage their disease. The solution should allow them to monitor themselves if they can. If they don’t want to, then allow them to track things less obtrusively. If someone is already wearing a hearing aid, for example, if the aid could also monitor heart rate, respiratory rate, and oxygen level as a backup, then it’s going to be more effective. That’s why smartwatches are more popular than the fitness bands because if people are wearing a watch anyway and it happens to measure their steps, then its fine.

In general, medical application and device developers are rarely thinking about what it is the patient or healthcare consumer really wants and needs.

yjc@docdocdoc.co.kr

<© Korea Biomedical Review, All rights reserved.>

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