How doctors and patients can win the 4th industrial revolution, and the 5th one too

There are six technologies that are colliding in sick care. They represent the front lines of the 4th Industrial Revolution.

For example, here are 5 ways 5G is changing sick care and, hopefully, moving it to healthcare.

As reported, in the past few months, you may have noticed the 4G or LTE symbol on your phone screen change to 5G; now, digital health is making the network upgrade too. Last week, Emory Healthcare and Anthem announced they’re building the?first 5G lab?for patient-focused innovation. While the promise of 5G has been around for a while, partnerships like these will test how 5G connectivity—which turbocharges the speed and volume of data transferred over mobile networks—stands to improve key aspects of virtual care, including?remote monitoring,?digital therapeutics, and?real world evidence?for clinical trials. But even as clinicians prepare to adopt?new billing codes?for digital services, care gaps remain for patients who can’t access 5G or any sort of?broadband connection. As the adage goes, our digital health?infrastructure?is only as strong as its least-connected link.

The 4th Industrial Revolution is a mental model created by the leaders of the Joint Economic Forum and describes how physical, digital and biologic technologies have collided and the?resulting challenges and opportunities that presents.

In other words, think of it as the collision of man, machines,materials, data mining, memory capacity and mobile technologies.

Here are seven technologies that are changing the world.

When software, hardware, materials,biologic systems, cloud, AI/ML and other slicktech collides, it creates an interesting situation with certain highlights. Here are some challenges.

Three technologies exemplify the new landscape: new computing architectures, genetic engineering and materials science.

When the agrarian economy evolved into the industrial one, there were three phases that enabled humans to leverage their labor and productivity- those powered by water, electricity and computers/IT technologies. We are now living in the 4th revolution.

Like the industrial revolutions that preceded it , the 4th IR is seen as the cause of the medapocalypse while others see it as part of the creative destruction of the existing system that will result in a phoenix like ecosystem that will fundamentally change how medical care is created, delivered and funded.

Physician entrepreneurs, along with everyone else in the world, will have change how they adapt if they are to surthrive. Industry 4.0 holds the promise of a new era of globalization. Yet while our latest survey identifies companies successfully implementing Industry 4.0 technologies, many senior executives remain less prepared than they think they are.

Klaus Schwab has defined four principles which should guide our policy and practice as we progress further into this revolution.

Firstly, we must focus on systems rather than technologies, because the important considerations will be on the wide-reaching changes to business, society and politics rather than technologies for their own sake. The launch of 5G wireless is an example. While systems consist of people, systems don't care about people.

Example: Sick care cannot be fixed from inside and will depend on the coherence of diverse ecosystems. While STEM has been the buzzword, BMETAL-the convergence of Business, Medicine, Engineering, Technology, Arts and the Law- will be new paradigm for innovation education and training.

It will also require that we rethink how we regulate software as a medical device and clinical decision support systems.

Secondly, we must empower our societies to master technologies and act to counter a fatalistic and deterministic view of progress. Otherwise, there is no room for optimism and positive transformation, and society’s agency is nullified. AI should scale humans, not replace them.

Example: We must change how we educate and train the future workforce. In medicine, that will require a re-engineering of workflow, competencies, structure and processes of delivering care as we evolve from a sick care system to a health care system. In addition, we need to address the socioeconomic divides that are contributing to the "deaths of despair", particularly in white males without a college degree. That will mean rethinking non-college career tracks and retraining programs that are not working.

Here are 5 of the most in-demand sick care jobs. Are women better suited to fill them?

Thirdly, we need to prioritize futures by design rather than default. Collaboration between all stakeholders must play a central role in how we integrate these transformative technologies. Otherwise, our future will be delivered by default. Winning the 4th industrial revolution is a wicked problem.

Example: Design thinking needs to place the patient and?doctors?first. We need to rethink how we educate and train students from P-20.

And lastly, we must focus on key values as a feature of new technologies, rather than as a bug. Technologies used in a way that increase disparity, poverty, discrimination and environmental damage work against the future we seek. For the investment in these technologies to be justifiable, they must bring us a better world, not one of increased insecurity, dislocation and exclusion.

Example: The 4th Industrial Revolution, like the 3 that preceded it, has already produced inequalities in value and wealth distribution that will exacerbate an already contentious global society.

We also need to be wary of the dark side of AI and answer How can we forecast, prevent, and (when necessary) mitigate the harmful effects of malicious uses of AI?

1. Policymakers should collaborate with researchers to prevent and mitigate malicious uses of AI.

2. Researchers and engineers should consider misuse and reach out to necessary parties when harmful applications are foreseeable.

3. Best practices should be developed for addressing dual-use concerns.

4. Developers should expand the range of stakeholders and experts in discussing these concerns.

Ultimately, winning the 4th sickcare industrial revolution will mean 1) reengineering the processes of care, 2) delivering user defined value, 3) doctors and patients saying "no" to unnecessary and wasteful spending as the price for access and quality and 4) creating the future of sickcare work and the sickcare workforce.

Here are some other tactics:

One key to winning the 4th industrial revolution is to speed the pace of digitization and robotics in sick care, not slow it, and do to sick care what it has done to financial services and retail.

The Brookings Institution has recommended nine steps moving forward:

• Encourage greater data access for researchers without compromising users’ personal privacy,
• invest more government funding in unclassified AI research,
• promote new models of digital education and AI workforce development so employees have the skills needed in the 21st-century economy,
• create a federal AI advisory committee to make policy recommendations,
• engage with state and local officials so they enact effective policies,
• regulate broad AI principles rather than specific algorithms,
• take bias complaints seriously so AI does not replicate historic injustice, unfairness, or discrimination in data or algorithms,
• maintain mechanisms for human oversight and control, and
• penalize malicious AI behavior and promote cybersecurity.

The 4th industrial revolution will be won by those with skill sets beyond being a knowledge technician. Standardized, mass market products and services are rapidly giving way to much more specialized, creative products and services in a growing array of markets. Rather than viewing us as indistinguishable “customers,” product and service vendors are increasingly realizing that we are each a unique person with distinctive and evolving needs and that their success will depend on understanding and addressing these needs. Rather than trying to intercept us with ads, they will need to become so helpful to us that word will spread and we will seek them out. Creators, composers and coaches are in demand.

And, they are in demand around the world. Here’s a look at how three countries are combining technology and data to bring patient records into the fourth industrial revolution:

• Australia:?The My Health Record (MHR) is an example of a single digital-health record for the Australian population. Nearly all of us have one. At the moment, it can store data from hospitals, primary-health visits, pharmacy data, and vaccination history. Some pathology groups are already uploading scans onto MHRs. As of April, 83 percent of pharmacies were registered with the system—up from just 33 percent a year earlier, according to the Australian Digital Health Agency. More than 250,000 Australians are hospitalized each year due to medical errors, inappropriate use, or interactions, according to the Pharmaceutical Society of Australia. A single database for pharmaceutical information could help reduce those errors. The MHR could be the foundation for a significant transformation in Australia where data from hospitals, physician offices, and dentists is combined into one electronic record. While the MHR has tremendous potential, it is still in its infancy.
• Estonia:?With a population of just 1.3 million, Estonia was able to build its e-health system from the ground up beginning in the early 2000s—providers had not yet invested in their own electronic systems. To protect patient information, Estonia relies on blockchain technology and authentication with ID-cards, digital signatures, separation of personal data from medical data, encryption of data, and monitoring of actions allowing users to know who accessed their health data. The system has integrated a decision-support system with an e-prescription database, which provides drug-interaction warnings to physicians. An estimated 15–17 percent of prescriptions are changed in response to these warnings.5?In the future, other databases could be connected to the centralized e-health system—including the Estonian genome center—which could lead to more personalized treatment. By the end of 2019, 20 percent of Estonians are expected to get genetic screening.6?The e-health system might also be integrated with environmental data that impacts public health.
• Netherlands:?A nationwide digital infrastructure for the secure and reliable exchange of medical data among providers was completed in 2011. As of 2016, 92 percent of health care providers were connected to AORTA, and about 11 million Dutch people (almost two-thirds of the population) have agreed to let their data be shared among providers.7?The population, however, has been slow to embrace the system. As of 2018, only 2 percent of the population had online access to the patient records kept by their general practitioner. The government has determined changes in culture and care processes might be needed to accelerate adoption of e-health.8?In the future, the Dutch government wants 40 percent of all people (and 80 percent of the chronically ill) to have electronic access to their own medical records. The government has also set a goal of connecting 75 percent of chronically ill people and vulnerable elderly so they can monitor things like blood pressure and cholesterol and share data with their provider.

Higher education and medical education uses a failed business model.?Learning agility and adaptability are now paramount considerations in hiring. Recent neuroscience research suggests that humans may be built for lifelong learning. Business leaders report that social or behavioral skills are now the most in-demand skills with?80% of CEOs reporting talent is their number one concern. One hundred and twenty million people worldwide, with almost 12 million in the United States alone, will need retraining in both behavioral and technical skills. Higher education, including graduate professional education, the world’s workers are calling.?

The record scratches to a halt. Hang on a second?– you’re saying we are in the fifth industrial revolution now? What happened to the fourth?– the internet of things, connectivity, sensors, smart cities and digital twins? Are we past that already?

Let’s check backwards before we move forwards. These are the industrial revolutions we have already had:

• 1.0 was around the 1780s, when steam power was really cranking and making machinery move.
• 2.0 was around the 1870s, when mass manufacturing and division of labor was applied.
• 3.0 started around the late 1960s and was the time of computing.
• 4.0 was around the year 2000, when sensors started getting smaller and more connected. It was dubbed the ‘internet of things’.

Industry 5.0 will be about the robotics we put inside ourselves?– bionic augmentation and the ‘internet of bodies’. It will be powered by purpose, not just profit.

This manuscript draws attention to the dawn of the Fifth Industrial Revolution (5IR) and highlights its potential for addressing a host of issues within retail and service domains.

Here are some examples of medical school AI programs.

Sickcare professionals can win the 4th industrial revolution by following their ABCs:

Attitudes about accepting that medicine is as much a business as an art

Behavior changes to adopt and adapt

Cultural change that balances conformity with creativity, cooperation, collaboration, and complex problem solving

Change is happening faster and it outpacing the ability of many to cope with it. Unless we take control and prepare people, including physician entrepreneurs and their patients?for the future, the cracks in our society will widen.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack and Editor of Digital Health Entrepreneurship