24 February 2021.

What is ailing our health system?

Our health system is actually a success story. Advances in medicine and living standards have doubled life expectancy worldwide within the last hundred years. We owe this success largely to improved hygiene and two key inventions: vaccines and antibiotics. However, increased prosperity has also changed our lifestyle — unfortunately not for the better: We exercise too little,  eat too much, and too unhealthily.

This global phenomenon is also affecting countries other than Switzerland (e.g. the USA, China, Mexico and the Arab Emirates). Key factors include vices such as smoking or excessive alcohol consumption. With this behaviour, we make ourselves sick and overwhelm our health system. More than 80% of health expenditure in Switzerland is spent on treating chronic diseases, which could be largely avoided or delayed if we adopted healthier lifestyles. Our health system successfully treats illness, but struggles to prevent them. Health care costs are therefore rising immeasurably and no trend reversal is in sight.

How can digitalisation help improve healthcare?

Digitalization can improve healthcare in five ways. First, it can support behavioral change. For instance, apps or digital chatbots help people live healthier lives. Second, digitalization can make the healthcare system more efficient. For instance, electronic patient dossiers can prevent tests from being carried out more than once simply because different physicians are unable to access data. Third, digitalization can democratize medicine. This happens, for example, because patients can now obtain detailed disease and illness information on the internet. Fourth, we believe that digitalization can improve medicine. Today, medical knowledge doubles every 70 days, meaning doctors make better decisions when supported by digital assistants. Finally, digitalization offers the pharmaceutical industry great opportunities, among others through the use of artificial intelligence.

Which chronic diseases did you examine? And why?

We focused on the five most common chronic non-communicable diseases: cardiovascular diseases (e.g. heart attacks or strokes), respiratory diseases (e.g. asthma), diabetes, cancer and mental diseases (e.g. depression).

What can digital innovation do about these five diseases?

We identified many different patterns how digitalization improves healthcare systems. For instance, digitalization can help develop new cancer therapies: Systematically recorded patient disease data (real-world data) can be analyzed using artificial intelligence. Technological advances also enable discovering new therapeutic approaches. Yet digitalization can also facilitate disease diagnosis. Studies show, for example, that artificial image recognition is already so advanced that it can rival radiologists. But it is also evident that patients prefer a doctors’ diagnosis to an algorithms’. Our book covers many other fields of action how digitalization transforms healthcare systems.

Which research method led to these insights?

We took a broad approach and looked at hundreds of companies and organizations, from patient associations through start-ups to large enterprises. For each case study, we identified how they are changing the health system based on information technology. Over many iterations, we clustered the case studies into 25 impact patterns. Our book presents these 25 patterns, as well as exemplary “mini-cases” of start-ups and innovative companies.

How can the cost pressure in the health system be countered?

Digitalization can help make the health system more efficient. Our position is quite clear: These efficiency gains should not come at the expense of the quality and humanity of medicine. Digitalization can make medicine cheaper AND better.

How might this be done?

Here is a simple, concrete example: You change dentists. Even if your previous dentist x-rayed your teeth, your new dentist will repeat the procedure because he or she has no access to the existing images. Digital patient files enable storing important diagnoses digitally, making them readily accessible to several doctors. This saves costs and increases quality: A new x-ray costs another CHF 150 and unnecessarily exposes patients to more radiation.

Let’s turn from costs to care providers: Would the digital pill also alleviate shortages in hospitals and other care facilities?

Absolutely! This approach has great potential. In Switzerland, doctors spend about half their time on administration. A lot of time is invested, for example, in documenting services in the form of reports and billing codes. Specialized speech recognition systems could perform these tasks instead, thus significantly alleviating doctors and nursing staff.

What answers does your research provide with regard to the pandemic? Care staff are currently severely challenged. What can digital innovation do in a crisis like this?

We finished the book at the beginning of the pandemic and consciously decided not to go into it too much. We instead explore how digitalization can benefit the prevention and treatment of chronic diseases. Pandemics, on the other hand, are driven by infectious diseases. Of course, digital technologies can also be applied in pandemics, by tracing infection chains via apps or by connecting healthcare teams across the world. However, we will only be able to better assess the benefits of digital tracking apps after the pandemic. Right now, tt is still too early for that. What is clear, however, is that the coronavirus pandemic is an incredible catalyst for the digital transformation of medicine.

To conclude: What does the digital future of the health system look like? How can it become digitally healthy?

While we are seeing changes in the sector, there are many encrusted structures that are only changing slowly. Courageous pioneers like Estonia or Finland are needed, where many processes are already digitalized at the national level.  If Europe and Switzerland want to continue playing a leading role in medical research, medical databases and research at the intersection of digitalization and medicine must be promoted at the European level. At the moment, China is leading the way at great speed.

A summary of the research results was published in “Die Digitale Pille” (Campus Verlag). The study was headed by HSG researchers Elgar Fleisch, Andreas Herrmann and Annette Mönninghoff, as well as by HSG Honorary Professor and Roche Chairman Christoph Franz.

Image: Adobe Stock / denisismagilov