Innovation in Health and Care - Pritesh Mistry

Healthcare needs to learn from tech

Pritesh Mistry -

The tech sector is coming to revolutionise health! Can existing health technology providers and healthcare organisations move quickly enough to adapt or in 10 years time will the current state of the art in healthcare delivery feel like using a flip phone today? There are lessons healthcare providers and health technology providers need to learn from the tech sector, but they may not be the ones that initially leap to mind...

It used to be augment but now it's replace

During the early tech revolution in Silicon Valley the culture was an optimistic driving force focusing on the use of technology to change the world for the better. The phrase “the bicycle for the mind”, coined by Steve Jobs, inferred that like a bicycle augments a persons physical capability to travel similarly a computer can augment a persons cognitive functionality.

the computer is the most remarkable tool that we've ever come up with. It's the equivalent of a bicycle for our minds

However sometime between the the PC being in nearly every home and the present day Silicon Valley the culture changed from augmenting human capability to arguably being more destructive by aiming to replace people and using business models that auction off attention, invade privacy or isolate the socio-economically deprived segments of population. Over the last 5 years alone we’ve seen

Tsunami of shifting expectations

‌‌The internet and the smartphone have resulted in substantial changes in the expectations of individuals when it comes to healthcare systems and clinical teams. People are now more informed than ever before but also now have access to consumer technology that functions seamlessly and enables monitoring of health conditions such as cardiovascular disease and diabetes.  Patients, carers and the public are potentially better able to manage their own health if they can purchase these digital solutions. However, there remains a huge disconnect between the technology used by consumers and that generally found in the healthcare system - patients expect them to be the same. Clinical teams are jarred and frustrated by the difference in the IT capabilities in healthcare organisations compared to in their everyday lives outside of the healthcare system. There is public, governmental and system expectation on the need to improve the IT in the NHS. Its important that we don't lose sight that in creating a more digitally enabled NHS we need to avoid repeating the errors of the tech sector.

Scale at all costs

The approach of the tech sector is to create a potential solution launch and then iterate or fail fast. The advantage of this is to develop a technology and then modify the functionality until it matches the real need. If the solution successfully meets a need then tech companies often prioritise scale - that is once a solution is found the focus is on spreading the tech. In the rush to scale tech companies often do not stop to consider the negative use cases for their technology, after all making changes to mitigate for any negative behaviour might also make it more difficult to spread the tech. As mentioned above, the negative impact of tech is well documented with examples for bullying, addictive behaviour, repression, tracking, targeting and other negative behaviours which are slow to be addressed. These are serious issues with substantial negative implications. In healthcare even a minor oversight could result in serious implications for people’s lives, health and quality of life. Healthcare needs to have a more considered approach to utilising tech. Healthcare technology providers and healthcare organisations need to learn from the tech sector.

A cynical approach to health technology design

After the WannaCry cyber-attack cyber-security remains high on the agenda for the NHS. However, we rarely discuss the potential for malice, ill-intent and bad behaviour. Tech in healthcare needs to prioritise safeguarding and safety netting against those with ill intent. Trust is important in healthcare and ensuring an ethical approach can enable trustworthiness. In healthcare we need to be able to have trust in the technology - trust that the developers have fully examined how the technology could be misused and they have mitigated against these posibilities. Health technology providers need to ensure the tech has been developed with appropriate safeguards to protect people, especially those that are most vulnerable. The safeguards may go above and beyond those documented in regulatory guidance but by doing so can create trust where its not always possible.

One overlooked lesson

The tech sector has many lessons to teach us in the move to increase the use of digital tools in healthcare. The rapid pace of change and agile approach to developing and improving tools are the obvious ones that come to mind. However, one of the most important learnings to take from the tech sector is to plan to mitigate against ill intent. This could mean moving slower to ensure correct design with safeguards in place as well as specifically employing people to consider potential misused of technology. These checks need to be robust, transparent and thorough to ensure clinical teams are confident in digital tools and that they don’t pose additional danger to people who are potentially already in vulnerable positions. Transparency of testing, findings, mitigation approaches and safeguards will provide clinical teams with more confidence and increased trust in digital tools.

We are seeing a substantial investment from technology companies aiming to revolutionise healthcare. Solutions are being provided through app stores, direct to the public and to healthcare organisations. On the flip side the NHS is being driven to digitalise with the aim of improving health and care provision. In short the tech sector is coming to revolutionise health but the healthcare system is becoming tech enabled at the same time. Which of these will achieve it’s goal of using digital to revolutionise healthcare provision and what will be the impact on individuals, privacy, populations and health inequalities remains to be seen. However we need to clearly set out our expectations on how the tech needs to be developed to mitigate against misuse - this is one of the most important lessons the tech sector can teach healthcare.

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