ACADEMIA: DRIVING FORCE IN DIGITAL HEALTH
JULY 10, 2019 @ 8AM
Industry 1.0 kicked off in 1784 with mechanization, steam power and weaving loom, while industry 2.0 in 1870 focused on mass production, assembly line and electrical energy. Industry 3.0 showed a glimpse of 4.0 with a focus on automation, computers and electronics in 1969 and now, industry 4.0 focuses on cyber physical systems, Internet of Things (IoT) and networks which impacts the economy and the way businesses are run globally.
Societies and lifestyles are changing that they are digitally connected at all times. This affects each and every one of us.
Four main effects
The revolution has resulted in a shift of customer expectations whereby they are more demanding.
“We see data-enhanced products that build around data which means more collaborative innovation and new operating digital models happening,” explained Dr Mohammad Asif Khan, the Dean of Perdana University – School of Data Sciences at the 4th Industrial Revolution in Healthcare conference.
Mohammad went on to explain that there is a shift in Abraham Maslow’s hierarchy of needs which centres around physical needs for communication which is the motivation behind human needs.
“The top part has various motivations – such as self-actualization, feeling of accomplishments, the need to belong and be loved and the need for safety and security. For us to proceed to the next level – our psychological needs – the previous levels of needs must be met first. Today, we see a shift in Maslow’s motivation where there are WiFi and battery. Without these, a person might even lose the motivation to eat.
The disruption that has been brought about by the industry revolution – the technological changes are artificial intelligence (AI), robotic development, data sciences, IoT, cloud, bio technology, big data and drones.
Academia - big stakeholder in digital health
Innovations in digital health is centred around big data to drive innovations. Algorithms and AI encapsulate big data and strike the value to identify the key attributes of the data that could be used to drive innovation. We also have sensors that come in to drive innovations in terms of health applications, telecare, telehealth and research.
“By 2025, genomics alone would be the largest generator of data. These are largely contributed by personal genomics because the cost of sequencing the genome right now is about USD8400 and by 2025 – it is expected to come down to USD100. In the further future, it’s estimated to be even cheaper. When it becomes penniless, then everyone would start thinking about sequencing your genome.
Exciting time in healthcare
It is an exciting time in healthcare, where we see a change in models between the old world and the new world – where payments are outcome based, incentives are based on value and not volume, the focus is on population health and the role provider provide the continuum and information is going to be predictive.
“The opportunity in digital health is very demanding with USD233 billion in 2020 and as other industries – we go through this usual cycle. Technology trigger at the peak and a trough of disillusionment and then we would come back. Digital health would go through the same but the market is huge and there are lots of opportunity.
Opportunities for growth are tremendous which include:
While this is the case, there are a number of obstacles which include data silos, secondly – resistance to change. Technology has advanced much further away, so there is resistance to change because a lot of those have not been validated.
“We are very much research based – research culture. Before we adopt things, we want it to be proven that they are really effective. A drug goes through numerous vigorous testing before it gets approved, whereas applications are just sent to Google or Apple with some basic testing and it is uploaded. So how do we know that it is reliable?
Thirdly, intellectual silos. While collaborations are happening, it is done in silos. Budgetary silos are yet another concern, apart from proprietary health management systems.
“We are logged in by systems that cost an enormous amount that they wipe your budget. This makes it difficult to get out. Evidence and validation are necessary as we don’t want to jump into some innovation without having seen its value, impact which also concerns data privacy and data protection. We need to work around these and see how we can address these challenges.
Monetising health applications is yet another obstacle. When money is involved, it is also crucial to weigh how these health applications provide return on incentives or investment that has been made.
Lastly, locality specific issues. Different places present different problems which makes it impossible to apply what has been done elsewhere to Malaysia.
“We should also learn from the mistake others have made and what was proposed to overcome those issues.
“There are catalysts to help us overcome these such as:
Role of academia in digital health
The role of academia in digital health can be classified to clinical care, community service, education, research and discovery.
“Challenges working with academia are the slow time scale for specific reasons, difficult collaborations with lots of interest and regulatory requirements to be taken care off and also the research culture. If you come up with an application – and you are trying to sell it to them – they wouldn’t purchase it until you’re able to convince them that it actually works. So, this makes it difficult to penetrate the academia or have the academia adopt digital health information and move at the same pace as with technology.
“One of the problems is that it is highly regulated, so changes can’t be made overnight. There are also issues of accreditation where the bodies involved makes it very difficult for curriculum to be changed as quickly as desired. This results in slow adoption of digital health. However, we see progress through the introduction of elective/selective courses and engagement with industry. There is time taken where doctors actually do interdisciplinary work where they get to ask on other developments. However, there is a limit to this.
“Doctors – they already have learnt a lot and there you are asking them to learn so much more. So, the way to move with this would be through the expansion of allied health where doctors get support through other practitioners.
You also see situations like precision medicine – for example taking off so rapidly that people are able to look into informatic analysis on the go. This would be of benefit if it could be analysed in real time for doctors who are in their ward rounds to make decisions quickly.
Academia – one of the biggest employers of conventional and digital labour
“Most workforce are in academia with a major shift towards digital labour which is further facilitated by gig economy with more people connected to the internet. The market for this is growing rapidly at a rate of 25% per year. One of the big motivations is to reduce the cost of healthcare services.
Academia – contribute to the development of a digitized hospital network
“Lots of academic institutions own a large number of hospitals. This is where there’s a push towards digitalization with a complex ecosystem with various clinical and business processes comprising of numerous sub-processes.
“The key is to deliver the right information and resources at the right time to point of care. However, the significant barrier to development and adoption of digital health are design and technical concerns, privacy and security, cost and liability issues, productivity, patient and physician interaction, lack of time, workload and threatened clinical autonomy.
“Nevertheless, we need to create the necessary infrastructure and processes to meet these challenges.
Sharing of information
According to Mohammad, academia is one of the biggest keeper of medical data.
“Warming up to the idea of digitalisation and slowly sharing clinical information and patients’ medical histories are concerns that need to be addressed. An integrated, inter-operable healthcare information system will allow hospitals to provide the best possible treatment for clinical problems and maintain medical and administrative records, including diagnosing and treating patients online.
This would improve patient mobility while providing convenience – leading to better outcomes.
Developing research in academic and clinical area
Meanwhile, Mohammad highlighted the need to focus on research by exploring and testing the use of various advanced devices in digital health.
“Develop research networks though partnership within and between academia and industry – for screening, detection and management of health issues. The network becomes a source for a wide range of research. This can improve the quality of learning and teaching.
If these goes well, it can facilitate the setting up of centres for digital health innovation to assist researchers, patients and physicians in developing new technologies and validating the developed tools through industry collaborations.
Telehealth / telemedicine
Telehealth / telemedicine is another area with significant growth especially with academicians visiting and helping those in remote areas.
“Off course, there are issues concerning coverage, payment and other policy issues which limit the complete use of telehealth, thus a more flexible approach to add new telehealth services is advocated.
Collaboration with industry and technology accelerators
Although academia has existing relationship with large IT vendors, new partnership with technology accelerators play a significant role in introducing academia to early-stage start-ups.
“Create areas of continual development and innovation, improve health outcomes, reduce costs and enhance patient experience,” said Mohammad.
He also emphasised the need for academia to explore new business models to monetise their efforts in digital health.
“Cost of clinical research studies need to be balanced through sharing agreements with industry partners. New inventions from research can be claimed for patency and commercialized through digital health partners,” he added.
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