What Would We Do In Healthcare With A Lot Of Money?

Suppose we have an infinite amount of money at our disposal to help create a democratic, rationalised and optimised healthcare system in the country. What would you choose to improve first? Which are the most important steps towards people’s long-term well-being, and what are the cornerstones of development?

With governments struggling with handling the burdens COVID-19 had placed onto the healthcare systems, money flows down the drain countlessly. In the UK, the NHS has spent ￡10.8m to date on its contact tracing app – and yet, according to a report, the NHSX couldn’t say if the app will be able to successfully trace infections. The UK was also on the focus of our recent article about the failure of digital health transformations, but many other countries follow close. 

Source: vizhub.healthdata.org/fgh/

Instead of measuring how much would be enough to spend, let’s take a turn and have a look at what changes would be needed for a country to meet digital challenges and truly be able to provide accessible and equitable healthcare. We defined three levels of adoption based on the amount of money needed to implement the suggested changes. These are:

($) No additional funds required

($$) Some investments are needed

($$$) A massive amount of investment is necessary

Let’s have a look at these required changes.

$ – OUR RECOMMENDATIONS: create feasible government policies 

Such policies need to declare and establish the following steps in healthcare:

Step 1: policies to empower patients

Step 2: prepare healthcare professionals for step 1

Step 3: ensure privacy throughout the steps 1 and 2.

1. Implement patient design in government and medical associations

The importance of involving patients in promoting health development cannot be stressed enough. The way Prof. Stefaan Bergé redesigned his whole hospital department based on the book, The Guide to the Future of Medicine, covering patients’ suggestions, is extraordinary, but it should be the norm, not the exception. 

The FDA involves patients through its Patient Engagement Advisory Committee that advises “on complex issues relating to medical devices, the regulation of devices, and their use by patients.” And even the most prestigious medical magazines like the BMJ have their own patient advisory panels. This step can be uncomfortable as patients would be able to step into the ivory tower of medicine; but if medical professionals and healthcare decision-makers could adopt this mindset, they could benefit hugely from it.

2. Support cultural change in healthcare

The essence of change in healthcare is not a technological, but a cultural issue. In order to embrace this cultural transformation of digital health, mindsets need to change. And it needs to go from top to bottom. But still, physicians need to be the guiding lights in this change, and the sooner they change the way they think, the better. Therefore, medical education needs to ensure that students meet artificial intelligence, surgical robots or 3D printing in healthcare settings during their curriculum. More importantly, they don’t need to know the actual technology but need to have the skills to make their own assumptions in the future – possibly using technology as support. This is the only way for them to return to their ultimate goal and field of expertise: healing.  

3. Protect patients’ data privacy

It is no utopia: the small country of Estonia has already succeeded in protecting the privacy of its patients. The Estonian government did manage to secure people’s genetic and healthcare information with blockchain technology. This also helps the transparency of the data protection process as “it allows authorities and even patients to get to know who looked up individual health data” – as we wrote earlier. Measures like this help build trust in governmental bodies and actions, and ensure these sensitive data are in safety.

$$ – OUR RECOMMENDATIONS: chip into technology & education

This step would require some financial involvement, primarily from governments. To meet the goals described above and take the leap into real 21st-century healthcare, governments need to ensure they support people’s digital health literacy. 

Step 1: elevate digital health literacy and ensure equal access to available sources

Step 2: educate from the elementary level to medical school

Step 3: create a hub for innovative startups

Step 4: ensure data privacy

1. Digital health literacy

As a first step, the administration should cultivate an ecosystem of health-oriented citizens by encouraging a public discussion on digital health. Once again, Estonia is a great example: their digital health initiative even states “good health is our nation’s most important asset.” Their tri-fold approach consists of 1. human-centred healthcare 2. health-supporting choices and 3. A health-supporting environment.

2. Educating people from early on

The U.K. also put its footsteps next to education. Its school-based program aims for an overarching target: “if we influence children in the right way that can change the whole family’s approach to health.” Including learning about a healthy lifestyle and health consciousness as early as from primary school has the possibility to make long-lasting, real lifestyle changes in children – as well as their families.

3. Equal access

It is also important not to forget about those who easily fall behind. The Australian Digital Health Agency helps bridge the digital divide “that precludes many Australians accessing improved health services.” Their initiative supports people’s understanding of the benefits of the digital health system with a mentor network supporting seniors, culturally and linguistically diverse people and people with disabilities. Their online resources offer easily comprehensible education materials.

4. Medical education

Investing in medical education also has widespread long-term effects. By adding advanced technologies to the medical curriculum, states can increase the digital literacy of medical professionals. In order to be able to integrate technology into their medical practice, these students must meet new methods and digital innovations in their education. We wrote an entire article about the principles of 21st-century medical curriculums and about my pilot “Lessons in Digital Health” course at Semmelweis University.

5. Create digital health start-up hubs

Other countries took a slightly different approach. While having a high level of health understanding in the country, Israel developed a blossoming MedTech startup scene the government also pushes in its far-reaching agenda. Their startups are incredibly technology-focused and the country is heavily investing in promoting them. They successfully created an innovation hub and developed “a thriving innovation ecosystem by providing various tools to support industry R&D” as they explain.

6. Use federated learning to protect privacy

This branch of artificial intelligence offers the chance for a safe way to handle patient data in hospitals and in medical trials. While its uses in healthcare are still relatively new, federated learning can open up a wider use of patient data throughout countries and institutions with ensuring data privacy at the same time. This is a safe investment for any government that wants to step up its game in digital health solutions.

$$$ – OUR RECOMMENDATIONS: heavy investment into the future

Yes, I know it’s na?ve and futuristic, but there must be a third tier that looks farther into the future as we at The Medical Futurist envision. We wrote about these concepts many times, and we recommend any government willing to take a deep dive in healthcare development to look into the possibilities of investing in these options. They might cost dearly, but these payments are clear investments into the lives of future generations. 

Step 1: build seamlessly working, safe hospital environments

Step 2: bring in remote diagnostic and care solutions like telemedicine or health sensors an integral part of healthcare

Step 3: ensure safe and accessible own data handling for patients

1. Ensure cybersecurity over hospital systems

In order to protect our medical facilities and the patients within, governments need to set adequate policies and guidelines in place to address both the social and technological components of this issue.

2. Make hospitals paperless

There is no place for paper and handwriting in a well-functioning hospital. Therefore hospitals need to invest in correct measurement of needs and processes, buy the necessary hardware and software, have a system for electronic health data, train personnel and standardise processes by getting a certification.

3. Connect hospitals to the homes of patients

Staying in bed is super boring and depressing. There also isn't any therapeutic reason behind it in most cases – taking this a step further, in most cases people don't even need to stay in a hospital – they can heal comfortably in their homes. The future is when the patient becomes the point of care, and healthcare is invisible.

4. Make telemedicine, health sensors, genome sequencing and A.I. top priorities in investments

For a technology to be successful, it should integrate into the practical reality of healthcare. By helping those startups and companies that address the real-life needs of patients, governments can support a forward-looking healthcare. However, it's not an easy task to accomplish, as such ventures can go miserably wrong; not to mention those that flew way too close to the sun.

5. Make sure that every patient can access all their data regardless of it being a medical record, a genome sequencing database or prescriptions digitally

A crucial point to the future of healthcare is patient access to their own health data. (It's even a bigger issue in the case of a deceased person.) But empowered patients have their advantages: they aim to be the expert of their own condition because of social media and technology – and their own data. Thereby they are also more informed over their health. Through interoperability and other measures, governments can ensure a much more seamless care experience for patients and a better service in case of an emergency.

In this article, we did not assess how each country’s healthcare system operates. We also did not evaluate the insurance structures or how much medical professionals earn or should receive. This is our view on how the future could be optimally built if these steps are taken, and how, with various levels of investments, a country can get the most out of its healthcare.

We would take these steps now. This is the way.

Dr. Bertalan Mesko, PhD is The Medical Futurist and Director of The Medical Futurist Institute analyzing how science fiction technologies can become reality in medicine and healthcare. As a geek physician with a PhD in genomics, he is a keynote speaker and an Amazon Top 100 author.

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