Ten attributes of future healthcare according to McKinsey

Tino Martí

In late March, McKinsey published "The next frontier of care delivery in healthcare," an analysis of the trends that will define healthcare delivery in the United States in the coming years, drawn from expert input and led by Shubham Singhal, Mathangi Radha, and Nithya Vinjamoori.

According to McKinsey, there are ten attributes of future health care, defined below and displayed in the accompanying infographic:

1. Patient-centred: this attribute brings together various aspects such as a holistic and personalized vision, accessibility to health services and data, the use of wellness services and user satisfaction.
2. Virtual: the pandemic has triggered the use of remote health and has predisposed providers and patients to new models of care that combine virtual care with face-to-face care in services such as urgent care, scheduled consultation, home care or medication administration at home.
3. Ambulatory: care provided in health centres represents a third of the activity invoiced in the United States. Outpatient care is associated with shorter waiting and visit times and lower complication rates.
4. Home care: care provided at home expands to new models such as home dialysis or home hospitalization. The combination of the above attributes allows the redefinition of care processes.
5. Based on value and risk-taking: the expectation of growth in value-based contracts in the coming years is associated with the prevention orientation of services and the role of primary care.
6. Driven by data and technology: digital health and the use of data for decision-making and personalization of care can change the trend of healthcare costs, improve productivity and facilitate the deployment of value-based healthcare.
7. Transparent and interoperable: new regulations force the publication of rates, restrict the blocking of data between providers and facilitate access to health data.
8. Facilitated by new medical technologies: self-service opportunities for the management of chronic pathologies, remote monitoring, home telemetry or robotics are examples of technologies applied to the transformation of care models that include outpatient, home and virtual care.
9. Financed by private investors: Private investment in healthcare is growing significantly and is geared towards new models of care that take advantage of the trends described above to overhaul the patient experience.
10. Integrated despite being fragmented: the integration of care is based on the coordination of ecosystem agents through technological platforms.

Despite being predictions based on and directed to the United States healthcare sector, most of the attributes described are directly applicable to our European context with certain nuances. It‘s worth retaining as positive the consolidation of new models of care around the needs of the person, the value of care and the possibilities of de-concentration provided by technologies and data. The centrifugal trend toward more ambulatory, home and virtual care draws a substantial paradigm shift in the provision of services with deep consequences on how these services should be purchased, managed and provided. This new constellation leads to prevention and care but requires fundamental changes in the messages that are transferred to health providers.

In the "difficult to transfer" chapter, the increase in private investment in the health sector arouses opposing sentiments. On the one hand, the social centrality of health caused by the pandemic and shaken by technological innovation offers the opportunity to join forces to improve, from within and from outside, systems with a tendency to immobility. On the other hand, the expectation of suggestive returns on investment – explains the investors' interest and can aggravate existing inequalities.

Everything indicates that guiding the future of health care through these consolidated trends will be a challenge full of balances and compromises between the necessary change and the undesirable consequences that will require decision-makers to have a sophisticated compass.

Digital twins in the health sector: objects, people and systems

Tino Martí

A digital twin is the virtual representation of a physical entity that feeds on data captured by sensors. This information offers the status of the equipment in real-time and facilitates the application of artificial intelligence (AI) to identify potential problems, allowing their resolution in advance.

Joining the trend of patient goal-oriented electronic health record

Tino Martí
 

Primary care in our country is in a good situation regarding the use of electronic medical records. The digitization of medical records began at the end of the last century and was fully deployed in the first decade of this. Such is the progress of the clinical stations used today that they are already crying out for a technological, functional, and usability update, but changing the system is complicated and very expensive, so it's easy to expect that change will only occur when the technological version will no longer justify itself.

The patient as a key agent for the exchange of health information in Europe

Tino Martí

Health care between the countries of the European Union is regulated by Directive 2011/24/EU of the European Parliament and the Council, on the application of the rights of patients in cross-border healthcare, published on March 9, 2011, One of the objectives of the directive is to regulate access to patient information. The exchange of health information is important to ensuring quality care and allowing continuity and coordination beyond the borders of the different health systems existing in Europe, whether at national or regional level. 

Management according to Elon Musk. Tesla, SpaceX and SolarCity

Tino Martí

Elon Musk is one of the trendiest entrepreneurs and undoubtedly the most controversial one at the moment. He is the leader of Tesla, SpaceX and SolarCity, three young, ambitious and dynamic companies that show how far they are willing to go to change the world through the internet, renewable energy and the race to Mars.

In 2018, he made it to the headlines for different reasons. First, proposing technical solutions to rescue children trapped in Thailand and end up insulting their monitor. Second, and probably the most popular, with the announcement via tweet to privatize Tesla for $420. In the American financial and stock market context, privatizing a publicly-traded company means repurchasing all its shares. The action elicited strong reactions, and the board of directors concluded his position. Shortly afterwards, Musk again announced problems in the production of Model 3 and wanted to assure the market that he is giving it everything by announcing his strenuous workday: 120 hours per week. To top it off, in a live radio interview, he accepted smoking marijuana. No one can say that he goes unnoticed, regardless of his apparent privacy.

Blockchain and crypto management

Tino Martí

In the 2018 edition of the Mobile World Congress has drawn to a close. Among the different technologies exhibited this week at the mobile fair, the chain of blocks or blockchain has appeared tangentially. Announced as the new revolution in the digital world - which some consider as disruptive as the internet - the block chain is the technology that allows the popular bitcoin crypto currency to work and whose value has reached unimaginable value (exceeded $ 18,000 last December).

But what is really the block chain and how can it be of interest to the readers of Advances in Clinical Management?

Blockchain is a distributed database system that allows transactions between agents to be both secure and anonymous by means of a trusted timestamp in the distributed public registry (distributed ledger). Although its best known application is to carry out operations with cryptocurrencies such as bitcoin or ethereum, the chain of blocks can also be used to manage valuable elements such as certificates, insurance or votes, and is being widely experienced in different sectors such as finance, logistics or food.

The dream team of primary care in Europe

Tino Martí

The WHO Europe has published "Building Primary Care in a changing Europe". It is a very well prepared document written by a cast of first class minds (Kringos, Boerma, Hutchinson and Saltman) based on the information collected in the European project PHAMEU (Primary Healthcare Activity Monitor in Europe) reflecting indicators of structure, process and result of all the countries of the European Union provided by either accredited local points of contact (in Catalonia IDIAP). The project has been funded by the European Commission and supported by WHO Europe, the European Forum for Primary Care, the European Public Health Association and the European General Practice Research Network.

The paper analyzes the strengths and weaknesses of the existing multiple configurations of primary care in Europe, overcoming the usual classifications of Bismark versus Beveridge systems intended to relate their performance and results to develop rankings of countries. The systems reaching the top are considered as possessing an attribute of a "strong" Primary Care.

An interesting exercise based on the published information would be to design the most robust way for creating create a dream team of primary care settings in Europe.

Meaningful use of electronic medical records

If you want to know if something is serious in health policy, check whether a budget allocation has been reserved for its implementation. Therefore I consider relevant that in 2011, the US federal government started a long term incentive program (until 2020) for the adoption of electronic medical records (EMR). The program is called "Meaningful use" which could be translated as meaningful use of medical records. That is, it encourages not the investment in information systems but its use and is measured by various indicators grouped into 3 stages.

Earlier this year Botta and Cutler published "Meaningful use: floor or ceiling?" an article where the process of encouragement was studied from expert interviews and from data from implementing a survey of American Hospital Association. Well, according to this analysis, the "Computerised Physicians Order Entry" (computerized physician orders) increased their deployment when they were encouraged by the "Meaningful use" program and even went ahead in the use of barcodes for drug delivery, action that was not encouraged by the government program (see figure).

Research and Health Policy "to blog or not to blog"

By Tino Martí

That is the question. The strength of the link between research and health policy looks different depending on the perspective. Health services researchers expect a lot more feedback regarding their work in political decisions while the politicians need to be informed about the most effective way to ease the configuration of health policies based on scientific evidence. It’s a difficult transition bridge where the surface is eminently communicative.

In the "Web first" section of the influential Health Affairs, a study on the use of social media and perceptions of researchers has been published and is well worth reviewing (Grande D et al, 2014). During the Academy Health Annual Research Meeting, 215 investigators were interviewed using a mix of techniques (cases, assessment of broadcasting effectiveness and open qualitative questions). In the cases’ section, three ways of communicating research results to policy makers were presented: traditional media, social media and direct contact with decision-makers. Social media includes the blogosphere and the different social networks, particularly Twitter.

Tino Martí generated model

This series concludes (for now) and to end we rely on the participation of Tino Martí, health economist and technologist who has focused his career in the field of health management, innovation and new technologies, particularly in primary care. Together with him we have worked on a conceptual model of innovation in clinical practice.

The model recognises that health care is currently provided in three stages: the health centre, the home and the cloud. The emergence of this third stage together with the possibility of remote assistance from the health centre is facilitating the emergence of new models of care that are challenging clinical practice by questioning the need for physical presence.

The main innovation is the digitisation of medical records and the ability to exchange information between systems. The electronic medical record acts as a platform for both the physical presence in clinical practice and the virtual by allowing the patient to access a subset of data represented by the personal health record and through the glue of services (patient portal). Alongside the systems of informed decisions, these services provide information to the patient and enable them to play a more active role.
The virtual consultation via email, telecare (videoconferencing) and monitoring using cloud connected computers (telehealth), form the communication layer of this model.
Finally, and with a promising yet unpredictable future, we have the patient’s social networks that contribute a relational layer to the model.

Infographic: Virtual Clinical Practice Model (T. Martí, J. Varela)

Not all components are present in all systems (a long way to go), nor is there a standard configuration for virtual clinical practice. Depending on your goals and the technology available, each practice must design and configure the elements that help to complete the personal assistance services or develop substitutes.

Reviewing experiences has provided us with various levels of evidence for effectiveness and efficiency represented below in the coloured bars in each chart element. It’s reasonable to use the existing evidence in evaluating the introduction of innovations in healthcare, especially in a time of scarce resources, but these circumstances should not obscure the fact that innovation is born from experimentation. The existing assessments of the models tend to focus on one element and not the system; therefore we evaluate tools in isolation instead of new models of care.

The introduction of new technology doesn’t usually prioritise on the cost effectiveness ratio, but rather the improvement to the quality and safety of care and the satisfaction of the participants.

As you have seen, we have only hinted at the innovation available from the current vogue of mobile technology and it deserves a separate chapter that we hope to cover in a near future post.