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BusinessDay www.businessday.co.za Thursday 29 April 2021
INSIGHTS
TECHNOLOGY @ WORK: HEALTH CARE
Digitally-delivered offerings improve accessibility of care
like WhatsApp have allowed service providers the opportunity •toPlatforms provide more affordable and accessible services, writes Lynette Dicey
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n years to come Covid-19 will be remembered not only for its losses, but also for the gains it precipitated — many of which are steeped in technology and have resulted in considerable wins for patient care and private health care. “The decision of the Health Professions Council of South Africa to allow phone or video consultations with doctors and other practitioners during the Covid-19 crisis resulted in a flurry of online health care consultations, which has served the upper end of the South African health care market particularly well,” says Patrick Lubbe, CEO of the National HealthCare Group, a fully accredited health care administrator and managed care organisation. “Unfortunately, with the cost of telecommunications being prohibitively high in our country, many South Africans are still left out in the cold. This is where more affordable communications platforms,
Patrick Lubbe … way to connect. such as WhatsApp, which is used by the majority of internet users, can fulfil the desperate need for connectivity.” Popular platforms like WhatsApp have allowed health care service providers the opportunity to provide more affordable and accessible services, he says, explaining that National HealthCare Group has been leveraging mobile communication and chat commerce technology so that patients can have virtual or
face-to-face consultations with a GP through a product called MediClub ConnectTM. “This primary health care offering differentiates itself through delivering health care using a cellphone and a series of WhatsApp prompts to pinpoint potential health care issues. The low-cost service provides members with online interactive access to doctors and nurses on WhatsApp, physical consultations with doctors on referral, and all prescribed medication along with other key services for a maximum of R95 per employee a month. It gives members an effective way to connect with a health professional from home,” says Lubbe. Pointing out that affordability is a huge factor for business, Lubbe says it is worth noting that for less than the daily minimum wage, workers can now have access to private health care for an entire month. “It makes economic sense that employees at all levels of an organisation should have access
to quality primary health care. It is also creating opportunities for general practitioners joining our growing network by openingup an untapped market.” The past year has delivered some tough learnings for many local companies, not least of which was the need for safe, quality primary health care services. Practical and userfriendly technology applications which provide the benefits of private medical services to the low-cost segment of the market make sense in this environment, says Lubbe. The uptake of a tech-savvy yet simple solution was almost instantaneous as it was fulfilling a considerable need for more accessible health care, while empowering individuals to monitor their health closely. The virtual medical consultation service, which was launched at the height of the Covid-19 pandemic in May 2020, went on to reduce the cost of primary health care cover beyond all expectations for corporate clients and their employees.
Pandemic highlights role of technology in patient health The adoption of digital technologies was accelerated by the Covid-19 pandemic in most industries, including in health care. Although the health care industry has been slower to adopt digital technologies than some other industries, the pandemic forced it into the future with the result that several new medical technologies were rolled out at scale in a relatively short space of time. Telemedicine was the biggest winner. Research firm Forrester says health care providers must prepare for a “new virtual-first mode of operation”. It predicts that virtual health care visits represent a $46bn opportunity for health care providers and insurers in 2021 in the US alone. In fact, says Forrester, virtual care will become part of the core operating model for health care organisations to the extent the word “virtual” will fall away. Although Covid-19 was the driving force behind the greater demand for virtual care, Forrester says consumers will demand it going forward given that they have become accustomed to the convenience it offers. In a local context, telehealth solutions allow people convenient access to care even if they live in remote rural areas. However, health care providers need to understand that virtual care is not a stopgap measure which means workflows must be optimised like any other care setting. Innovation and Digital Business Manager at Siemens Healthineers Darryl Petersen agrees the pandemic has highlighted the role technology plays in bringing together patients and providers. “It acts as an enabler for optimised efficient care, assists with streamlining processes and supports care providers with analysis and outcomes.” Large technology providers that have not traditionally competed in the health care space, he adds, are increasing
Nicolette Mudaly … holistic view. their footprint in this area. Data-driven health care has significant potential for improving treatment options and patient outcomes. Consultancy firm Bain predicts health care’s big data market will reach nearly $70bn by 2025. The challenge, however, will be to ensure the ability to transfer and process one health care organisation’s data to another organisation. Digital patient monitoring has seen an uptick during the pandemic driven by the greater adoption of wearable technologies and assisted by at-home diagnostics and remote clinical monitoring. Petersen says the device market is growing exponentially, in the process putting the responsibility and the power of monitoring one’s health back into the hands of patients. “I had a personal experience where monitoring my heart rhythms using my smart watch saved my life, with the result that I got cardioversion done in time to prevent a stroke or heart attack,” he says. Wearables are likely to have even more purpose in the future with wearable continuous glucose monitors due to become the norm for diabetes patients. Nicolette Mudaly, head of Product Strategy at Altron HealthTech, says a single patient digital record allows a health care practitioner to have a holistic view of a patient’s history and therefore make a
more accurate diagnosis and prescribe more appropriate treatments. “A single digital record could even reduce health care costs by avoiding duplicate tests as a practitioner would have sight of a previously conducted test,” she says. Bertalan Mesko, author of The Guide to the Future of Medicine, believes that artificial intelligence (AI) has the potential to redesign health care completely. In 2020 it was reported that Google’s DeepMind artificial intelligence had outperformed radiologists in detecting breast cancer. The benefit of AI in health care, explains Petersen, is that it helps generate actionable insights to improve treatment quality and health care organisation efficiency. “In radiology, for example, AI can act as a companion to increase productivity and quality in diagnostics for chest CT scans and x-rays, brain MRIs, prostate MRIs, radiotherapy and Covid19 test, among others.” He adds that robotic process automation, on the other hand, assists by freeing up teams from mundane, monotonous, often easy to automate tasks, and creates consistency and
3D PRINTING ALLOWS FOR IMPLANTS, PROSTHETICS AND DEVICES TO BE CUSTOMISED TO EXACT PATIENT SPECIFICATIONS accuracy for processes, as well as creating opportunities for fine-tuning existing skills as it lifts the burden and time spent on smaller tasks and allows more focus on more complex tasks and procedures. According to Mesko, robotics is one of the most exciting fields of health care. In recent years developments in this area have included surgical robots, disinfectant robots and the first exoskeleton-aided surgery
in 2019. Virtual reality has similar potential and is already being used to train surgeons. According to a Harvard Business Review study published in 2019 surgeons trained on a virtual reality platform performed 230% better than surgeons who were trained traditionally: they completed the procedure an average of 20% faster and completed 38% more steps correctly in the procedurespecific checklist. The study concluded that virtual reality may offer an important educational tool to augment surgeon training and continue to offer patients the very best care. Another technology positively impacting health care is 3D printing which allows for implants, prosthetics and devices to be aligned and customised to the exact specifications of a patient. 3D printing is also now being used for cranial and orthopaedic implants and custom airway stents as well as for complex open-heart surgeries. Technology is being increasingly utilised in the hospital environment. Mudaly says time will tell whether health care costs are positively or negatively impacted by the increased use of technology although, in theory, improved efficiencies should ultimately lead to cost savings. “There is no question the use of technology in health care is leading to improved quality of care and better patient outcomes,” says Mudaly. “It’s about things as simple as improving the communication and flow of patient information through a patient’s health care journey or, at the other end, through the use of AI clinical decision-making tools based on clinical best practice. Interoperable platforms and technologies are growing as more people understand the power of leveraging individual capabilities and information for a more valuable insight or offering.”
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Significant shifts in care globally Health care is undergoing an unprecedented rate of change currently triggered by the Covid-19 pandemic. Of interest right now, says Ryan Noach, CEO at Discovery Health, are new technologies including biotech and genetics, including the recent Covid vaccine design; wearable sensing; and digital health care, where data and connectivity are opening up a world of intuitive, broad health care access. “The Covid-19 pandemic triggered significant shifts in health care globally, driven through two main dynamics. First, the sudden elevated health risk exposure for all consumers and health care professionals and, second, the stark urgency for broad access to high quality health care,” says Noach. Digital health technologies provide an immediate solution to both of these needs, allowing health care practitioners to consult with their patients remotely, protected from repeated high viral load exposure, and also allowing extended reach to every corner of the globe, wherever there is broadband connectivity. “While digital health solutions have expanded and become more popular in recent years, the health care system has remained a laggard across industries for its relatively slower adoption of digitisation,” says Noach. “Telemedicine consultations have been available to health care consumers for some time yet, pre-Covid, represented a very small proportion of the total health care consultations.” This has changed rapidly. Since the start of the pandemic,
reports Noach, the Discovery Health digital platform for online doctor consultations saw a 35fold increase in virtual consultations. This experience is exaggerated in more digitally advanced markets. In the US, McKinsey reports the growth in provider remote consults has been 50 to 175x between 2019 and 2020; equally from the consumer perspective, the percentage of US consumers using digital health has grown as exponentially from 11% in 2019 to 46% in 2020. In 2020 Vodacom and Discovery Health joined forces to offer free virtual consultations to all South Africans. Effectively, says Noach, this was about placing free access to a highly competent general practitioner in the palm of every cellphone user in the country, at a time when the world most needed professional health care advice.
TELEMEDICINE
“Typically, digital services are embraced by younger consumers within the millennial and generation Z age groups. Interestingly though, telemedicine is especially relevant to those at a higher risk of severe Covid-19 illness, and those in remote, underresourced settings. This makes it highly relevant to a broad spectrum of demographic groups including those with lower traditional digital uptake such as older consumers and low socioeconomic status communities.” He maintains that digital health care is extending its value way beyond just telemedicine. “These virtual
Ryan Noach … highly relevant. consultations have become the ‘gateway experience’ into a world of connected care extending from professional advice to diagnostics and even digital therapeutics. Essentially, these technologies facilitate ondemand access to high-grade clinical and diagnostic consultations anytime, anywhere; better chronic health care delivery and management with live, two-way virtual communication channels between patient and health care provider; and high quality, hospital-level acuity care offered in the comfort and safety of one’s own home.” This dovetails, he adds, with the explosion of remote sensing technologies, characterised by the popular and iconic Apple Watch. However, personal sensing now extends beyond day-to-day lifestyle activities, to highly sophisticated remote ICU monitoring. “Through the peaks of Covid-19 waves in SA, Discovery Health was able to
empower treating doctors to provide our members with high quality care at home, including remote pulse oximetry — monitoring oxygen saturation levels in the blood,” says Noach. “Subsequent data analysis has demonstrated that in this group of high-risk individuals who were digitally monitored at home by their doctors working remotely, mortality rates were 48% lower than a comparable cohort of individuals who chose not to be monitored remotely.” Home monitoring allows for early discharge from hospital or even avoidance of hospital admissions, through “hospital at home” solutions. These have been led globally by Brigham and Women’s Hospital in Boston, US where a large ICU control room has been bespoke designed to support travelling nurses for home monitoring of patients who would otherwise be hospitalised. “Consumers are now acutely aware and wary of the risks of hospital acquired infections,” he says, adding Discovery Health has launched a HomeCare business which is supported by six integrated telemetry devices for remote monitoring across the Discovery Connected Care platform. Health care funding models have been adapted to remunerate doctors differently, and to avail insured health care benefits, to ensure high access and affordability of these services. “Going forward, digital health tech will play a vital role in meeting the needs of ever-more engaged, informed and connected patients who want faster, safer, affordable, realtime access to care,” he says.