The first half of the 21st century will be remembered as the time that healthcare managed to transform itself. This transformation is ongoing, increasing in intensity and significantly changing the health and care system—from one largely designed by and for health professionals, to one that better reflects patient needs.
This transformation is taking place globally, with different countries moving at different speeds to deliver more personalised population health solutions aimed at managing the increasing costs of healthcare. Provider institutions are being challenged to transform themselves, health professionals are being encouraged to change the way they work, and health and care systems are still aspiring to manage increasing costs and complexity.
Whether it is the U.S., Europe, the Middle or the Far East, the following drivers are all contributing—albeit in different proportions—to transforming healthcare delivery:
The common factor driving reform is the digital revolution. The advantages of combining databases around people is significant. Not only will this improve care, it will further personalise it as a result. It also advances the potential of achieving the effective utilisation of real-world data. The fact that social and behavioural determinants of health are now being recognised as delivering significant contributions to wellbeing are also starting to be further addressed, with new initiatives around prevention of ill health and promotion of wellness appearing in practically all countries.
The consumer is also becoming more relevant. There is an inevitability that the provision of healthcare would also be viewed by people in the same light as they view the world of retail. Consumers now demand far more participation and involvement in their care, which challenges the system not currently designed to allow such a degree of personalisation.
Moving from an evidence-based system for a population to an evidence-based solution for an individual—with all the nuances that comprises—was never going to be easy. The consumer voice varies in different countries, with the U.S., Canada, Nordic countries and parts of continental Europe being the more notable in the steps taken to ensure the person has a voice that is not only heard, but exerts control.
The media constantly covers stories around how computers will change the way we live from robotics to artificial intelligence to machine learning. Undoubtedly these will all have a significant impact upon people and the care they receive. The number of data points we are now collecting on people—as well as the benefits of mining this data—is becoming all the more apparent. Applications of machine learning focused on radiology, medical diagnosis and personalised, protocolised care are also starting to appear.
Precision medicine was meant to transform the world of health and care—and this is where expectations were potentially unrealistic in terms of pace of change, although initiatives are now starting to appear. There are many countries involved in wholescale genome projects trying to map whole genome sequencing for populations or subsets of populations, such as people with cancer. Molecular typing in the management of infections and molecular genetic testing is starting to revolutionise cancer treatment and disrupt the world of pharmaceuticals as a result, struggling to come up with a business model to survive the world of biologic therapeutics. Furthermore, the newly blossoming interest in epigenomics and the importance of the microbiome increases the levels of complexity and personalisation.
Ageing is the phenomenon we are all struggling with. A child born today in the west has a 50-50 chance of living beyond age 105. Ageing populations create immense challenges to a healthcare system as multimorbidity and care levels increase. Governments are also under pressure as they must ensure pensions, health and social care can be funded for increasing numbers of older people. This pressure is heightened by the fact that the ratio of working age people to the retired in richer countries is projected to halve by 2050—from four to one to two to one. Some countries are particularly challenged and exposed—like Japan and its close neighbours who are all actively planning to adapt to a 100-year life span.
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So where does all of this leave healthcare workers? We are witnessing a crisis worldwide, again exhibiting itself in various forms. Physician burnout and premature retirement are becoming more and more common everywhere. The nursing profession is also under pressure, as are care workers. Shortages in staff are now becoming so significant that they are forcing health and care systems to contemplate changes to both the way care is delivered as well as eligibility.
Doctors are particularly challenged in this environment. They are faced with increasing demand for care, increasing demands for personalised care, coping with the administrative burdens of data input (which in many countries is part of their remunerative structure) and increasing concerns around medico-legal litigation as records become more freely available. All this is not helped by the number of flags they need to manage in clinical data systems, which inevitably lead to a level of fatigue.
One would think that with all this happening, medical education would have changed to accommodate this care transformation. For instance, better preparing and training new doctors in behavioural modification techniques to address social determinants of health. This is not the case at all, and medical schools are struggling to adapt with updated curricula as we move away from medicine by body part to a more holistic and personalised view of health care.
There are ways in which we can make the lives of practitioners better now. We can make the process of data entry better and manage the number of flags that appear on a clinical screen, by better designed and more intuitive software. We can assist the clinicians in understanding that the best way to manage these changes is not to build walls by trying to preserve outdated business models but to embrace these changes as clinical extenders—not as distinct threats. But to do so, clinicians need to be at the forefront of these changes and introduce them sensitively so they can achieve better work-life balance and improved patient interactions as a result.
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Originally published September 20, 2018