Standing at the side of road hoping to hail a cab is becoming a thing of the past thanks to ride-hailing companies such as Uber and Lyft who have used mobile technology to revolutionize the taxi industry. Now the health care industry could follow suit by using cellphones to connect patients to nearby health workers, guide them to correctly assess a person’s condition and suggest treatment, send reminders to patients to take their medication and attend follow-up visits, and even enable them to pay for medication and visits using mobile money.
Workers in the field of digital health predict the same disruptive technologies which transformed the taxi industry, and also commercial sales (for example, Amazon), have the potential to revolutionize health systems in developing countries, improving health, efficiency, and management outcomes.
This is a view apparently shared by the World Health Organization, which recently announced it had convened an expert committee to create guidelines for countries and implementers on how to use digital health strategies to improve reproductive health outcomes.
Marc Mitchell, president of D-tree International, one of the first NGOs to work on digital health, is a true believer and has a vision in which digital health innovations enable patients to take control of their patient records and choose their health provider from a range of options including private, public, traditional and nontraditional actors, all of which are displayed on a crowdsourced website with user rankings.
However, many in the global health field remain unconvinced, citing a lack of concrete evidence linking digital health innovations to improved health outcomes. For example, a recent review of a large-scale telemedicine and social franchising project in Bihar, India, concluded that the program, which was implemented by World Health Partners, did not improve treatment rates or disease prevention and that participation in the project, among health workers and patients, was low.
Devex spoke to Mitchell about where digital health is headed in 2017 and beyond. He pointed to four crucial health trends which he believes digital health developers will need to embrace if their technology is to fulfil its potential.
What are the major trends which will affect the digital health revolution?
Everyone is familiar with how technology has disrupted the taxi industry, through ride-hailing services such as Uber, and commercial sales, through online companies such as Amazon. Health care will be equally changed by these disruptive innovations and in the long run everyone will benefit, except for those who fail to embrace them.
However, for digital health to enable these changes and really improve health outcomes for people, emerging technologies will need to take into account and address four major health trends in developing countries:
1. It’s not about apps, it’s about systems.
The current vogue is to create apps for everything you might need — for shopping, navigating, and staying in touch with your friends. But the apps that are successful are much more than apps, they are embedded in a system that links the digital world with the physical. For example, Amazon is successful not because it is an easy-to-use app, but because the company has figured out how to get the correct product to you quickly and cheaply.
The same is true of health care — apps that tell health workers what to do only work when they include the supervisor in the system and take into account the motivational factors of the health worker. Apps that tell you a facility is out of stock of key drugs is only useful if a system is in place that can send the needed drugs to the facility in a timely way.
To date, digital health has been too focused on apps and technology and still has a tendency to create apps which only address one issue at a time. So today we are beginning to understand the need to move beyond apps, even good ones, and create systems that will address multiple problems simultaneously.
2. Integration is key.
Today’s health systems are geared towards episodic care and follow-up is usually ad hoc and inconsistent. This is not good care. Furthermore, while the current system is increasingly able to effectively treat simple, common problems such as malaria, pneumonia and diarrhea, it is not geared towards treating the growing epidemic of complex chronic disease such as diabetes, hypertension and depression. These diseases require an integrated health system that focuses on the patient and not just the disease.
The successful treatment of chronic care requires consistent records, seamless transfers across all providers, and a consistency of approach, messages and treatment as clients/patients move from provider to provider depending on the severity of their need. Other social services must also be in place so that all individuals can access needed services. Furthermore, clean water and nutrition become part of the treatment regimen, not just drugs.
Digital health can support this continuum of care in several ways. Providing each health worker with access to a single electronic record can help to coordinate care across different levels of the system ensuring that important questions about preventive care and social protection are incorporated into the care the health worker is prompted to give to the patient.
It can also be used to link the patient to other government programs that are available to support the elderly or other groups that most commonly have chronic conditions. In the same way that we use our cell phone to organize our day, it can be used by health workers, especially at the community level, to organize the different types of care and support that are needed for those with complex chronic conditions.
3. Like everything, it’s ultimately about people.
People don’t want to be cared for by a computer and so even the best technology will never completely replace health workers. But technology can change the way staff work within the health system, and support them with issues of motivation, efficiency, error reduction and interpersonal skills.
A patient wants to be treated as a person, not a symptom, and appreciates the way clinical protocols that are more complete in their assessment lead to better care. As a result, the premium will be on accurate diagnosis and treatment and client centered care and efficiency, all of which digital health can help achieve. In fact, studies have shown that digital health can increase the confidence of the health worker and the respect by the patient for the health worker, and another study revealed digital health can increase the respect by the health worker for the patient.
Health apps that don’t pay attention to the system or the people who will ultimately deliver care, will fail in their goal of improving health care and health outcomes.
4. The role of health workers is changing.
In the present system, health workers control the flow of information; they own a patient’s record and they own the information about a patient’s diagnosis and treatment. However, as access to information about disease and treatment becomes more accessible to patients through technology, this dynamic is shifting so that health workers at all levels are taking on a new role as medical information navigators rather than information repositories.
Under this new system, a health worker’s role is to guide the patient through the correct diagnosis, treatment or prevention strategy, using the patient record as a resource which is shared between the patient and the provider. This system of shared records can support a continuum of care with input by all providers and facilities.
By using blockchain technology, patients have a comprehensive and easy to access log of all their medical information which they ultimately own, but which providers can also access to view and record information. That way a client cannot alter a diagnosis or treatment but can control who sees the record and who writes in it, providing both confidentiality and accuracy.
Another change in the health worker’s role will be the increased use of expert systems by staff at all levels, from doctor to community health volunteer. Information about diseases and treatment is growing exponentially and even doctors cannot remember everything they need to know to provide good care. However, with smart decision support technology, consistently excellent care, which is tailored to the location and training of the health worker, can be provided so the patient gets excellent and comprehensive care and the health worker is more efficient and less frustrated.
Sophie Edwards is a reporter for Devex based out of Washington D.C. and London where she covers global development news, careers and lifestyle issues. She has previously worked for NGOs, the World Bank and spent a number of years as a journalist for a regional newspaper in the U.K. She has an MA from the Institute of Development Studies and a BA from Cambridge University.
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