Digital Transformation and Uberization: Threats or Opportunities for the Healthcare Sector?
While it has become commonplace to speak of the digital revolution, it is clear that the development of connected and communicating devices, along with the rise of new online services, is giving rise to radical innovations that are shaking up the economy.
Roxana Ologeanu-Taddei, University of Montpellier and David Morquin, University of Montpellier
While it has become commonplace to speak of the digital revolution, it is clear that the development of connected and communicating devices, along with the rise of new online services, is giving rise to radical innovations that are shaking up the economy.
The example of the self-driving car is undoubtedly one of the most prominent in people’s minds, raising new challenges: technical reliability and safety, and above all the sharing of responsibility among industry players due to the entry of new players—companies entering a new market—such as the major internet companies, including Google, Apple, Microsoft, Amazon. New services are being tested, such as communication between connected or autonomous vehicles and home devices, as well as remote control of certain appliances.
With regard to new online services in France, the platform economy, in sectors as diverse as passenger transportation (BlaBlaCar, Uber), lodging (Airbnb), the crowdfunding (Kisskissbankbank), or parking (Mr. Parking), renders existing models obsolete, particularly in sectors where exclusive practice rights were guaranteed by professional licenses.
The rapidly changing environment and its impact on health
Although the healthcare sector is better protected than other economic sectors by strong barriers to entry—due to government regulation and strict professional oversight (the National Medical Council)—it too is undergoing this dual transformation: the emergence of new connected products and new services via specialized platforms that connect users.
Already, in private practices as well as in hospitals, information technologies have been integrated into doctors’ daily practice: prescription support software, clinical decision-support systems, secure professional messaging, software for managing appointments or home visits, and above all clinical software—including the electronic health record—which enables the organization and storage of the patient’s medical information necessary for diagnosis and care.
The digitization of medical information, far from being limited to the medium used to store information, is transforming healthcare professions by changing the ways in which information is exchanged and coordinated among healthcare providers, enabling the emergence of new telemedicine practices and justifying the need for specific technological skills to implement them.
Health apps for patients: Are primary care physicians losing control?
On the patient side, new medical information websites offer free, more personalized advisory services, such as Mesvaccins.net, a site designed for travelers and published by an association of travel medicine experts that includes several medical professors. Using a series of questionnaires tailored to the destination country and the traveler’s medical history, it provides targeted vaccination recommendations, as well as an electronic vaccination record that can be validated by a healthcare professional (such as the patient’s primary care physician), along with medical information for healthcare professionals and a software solution for managing vaccination centers.
Furthermore, there are currently more than 750 French-language health apps, ranging from diabetes management to monitoring various health parameters and therapeutic education, such as Mission Phosphore, developed by Sanofi and designed for patients with chronic kidney disease to help them better manage their treatment and make the best dietary choices.
Doctors are encouraged to familiarize themselves with these apps in order to advise patients; however, there is currently no regulatory framework for evaluating the medical benefits provided by these apps, unlike the existing processes for medications or medical devices.
Two possible responses can then be considered: the doctor prescribes these apps based on advertising claims and industry lobbying, following models familiar inthe pharmaceutical industry, or the doctor disengages completely, leaving the patient to choose based on the more or less opaque criteria of rankings by consumer magazines and websites, as Doctissimo suggests for diabetes management apps.
or by using an additional app to search for the best health apps based on user feedback.
In both cases, the attending physician may lose control over a significant amount of personalized information and medical advice that could influence the quality of patient care. Could this phenomenon go so far as to call into question the physician’s role regarding diagnostic skills and therapeutic choices, as current discourse on the role of big data suggests?
From the connected patient to the self-reliant patient?
For now, big data projects using medical data (Electronic Health Records, telemedicine software, and connected biomedical devices) are still in their infancy, due to difficulties in data sharing, linked in particular to the lack of interoperability among existing software and the lack of harmonization of terminology standards, in a context where the sector is fragmented and siloed.
Furthermore, the processing of computer data—including big data—requires a redefinition of responsibilities and professional roles. Indeed, medical information is governed by law due to medical confidentiality. In France, it is the physicians in the Medical Informatics Departments (DIM) who are responsible for processing this personally identifiable information within each facility, which is necessary for analyzing activity and reimbursing costs related to patient care by the National Health Insurance. What about anonymized medical information? Who, then, owns this data, and who can be responsible for processing it, programming this processing, and using the results of automated processing?
For now, Apple and IBM are outlining a new model in which big data from Apple’s smartwatch would feed into IBM’s artificial intelligence program, called Watson. Internet giants possess both the financial capacity, the technological expertise, the agility required for innovation, and a global customer base to experiment with new expert system models that could foreshadow the advent of “automated” doctors or “autonomous” patients, as announced in the foresight report published by the University of Oxford. However, while big data analysis can establish a diagnosis and a treatment plan for a given individual, the question of how to share medical responsibility with software developers remains to be defined.
New healthcare services: a Trojan horse for the commodification of healthcare
Software publishers and pure-play internet companies aren’t the only drivers of change. Healthcare professionals themselves are using technology to create new services. For example, the iDoc24 and Epiderm apps offer paid remote consultations with a dermatologist, based on photos and symptom information provided by patients. Another example is the Expenli website, which allows users to ask doctors questions online 24 hours a day, or DirectoDoc, which enables patients to use their smartphones to request a callback from their primary care physician, who then calls them back for a telephone consultation when available. Another site published by a medical association, Deuxièmeavis.fr, offers patients a second opinion on a specific medical condition, outside the fee schedule set by the CNAM. Do these types of sites signal the rise of a paid service model, similar to that pioneered by numerous smartphone telemedicine apps in the United States?
Paradoxically, the restrictive regulatory framework governingthe practice of telemedicine is fostering the emergence of paid medical services outside the reimbursement system, allowing for the exploitation of the Internet’s potential and meeting the demand for the convenience and accessibility of standard medical care. Recently, the French Medical Council highlighted this contradiction, calling for regulation of the sector while ensuring flexibility for telemedicine, which, through the digitization of patient records, has become an integral part of doctors’ daily practice.
Uber in healthcare?
Beyond medical services and health information, new matching platforms are targeting specific markets, such as online medical appointment booking and patient transportation.
When it comes to online medical appointment booking, several players are competing for market share: Doctolib, KelDoc, Dokiliko, and Allodocteurs. Among them, MonDocteur.fr, which was acquired by Doctissimo, the health brand of the Lagardère group, stands out by offering an additional service: it has just partnered with Uber to allow its users to book a driver to take them to their doctor’s office.
However, the platform’s business model can only remain on the fringes of the healthcare sector, since this model requires the existence of a competitive market with numerous service providers (taxi drivers for Uber) and the definition of a standard service (passenger transportation for Uber). These conditions are not met by medical services, as France is facing a shortage of doctors and medical services cannot be standardized on a large scale. Unless certain doctors abandon their practices in favor of online consultations, or unless app and online service providers outsource medical expertise to doctors located abroad—a scenario that is unlikely due to labor market regulations. Furthermore, medical prescriptions, which entail the prescriber’s legal liability, are not offered by existing apps and services outside the framework of telemedicine.
But Uber offers an innovative service (accessibility and flexibility of ordering), which stands out from the existing service—perceived as inadequate (expensive, restrictive, impractical—since orders often must be placed in advance)—provided by players in a monopoly situation. It is indeed the provision of an innovative service that must remain the goal of the digital transformation of the healthcare sector.
On the healthcare system side, we can envision accessibility and ease of use at the heart of innovation for patients, such as e-prescriptions, which have been implemented nationally in several countries—including the United Kingdom, Finland, and Sweden—to facilitate the transfer of prescriptions between doctors and pharmacists and allow patients to view their prescribed and dispensed prescriptions.
From the doctor’s perspective, whether it involves telemedicine applications and services or the use of predictive algorithms that analyze Big Data to suggest diagnoses and treatments, the question arises of redefining the profession: what part of the profession cannot be automated? What part of the profession can only be performed face-to-face? In which situations are the doctor-patient relationship (listening, psychological support) and the clinical examination particularly indispensable compared to other digitized information?
Avoiding the Kodak Syndrome
Digital technology is driving change in the healthcare sector, which may lead to resistance from stakeholders within the system—including healthcare professionals, regulatory bodies, and public and private institutions—who are reluctant to challenge the status quo and redefine the rules of the game to accommodate new entrants. However, the “besieged fortress” mentality risks leading to theKodak effect : the persistence of a business model that had proven successful (the sale of 35mm film) while ignoring changes in the business environment and the impact of technology, which ultimately led to Kodak’s bankruptcy.
For the question facing healthcare stakeholders is not whether to move toward regulation and/or deregulation, toward fee-based or free services, or toward the use of information technology or its rejection, but how to use digital technology as an opportunity to better care for patients by offering them new services, rather than simply accepting the technology and models proposed by software vendors. The sector’s digital transformation must involve an analysis of the risks and challenges associated with the various technologies used, just as is done for autonomous vehicles.
Roxana Ologeanu-Taddei, Associate Professor, HDR, Information Systems and Healthcare Management, University of Montpellier and David Morquin, M.D., Montpellier University Hospital, University of Montpellier
The original version This article was published on The Conversation.