Posted on 4th November
Blog post by Dr. Maria Quinlan, Research Lead at the Applied Research for Connected Health centre at University College Dublin.
At ARCH we work with digital healthcare companies, via a diverse range of research projects, to understand how their innovations can be fully leveraged to provide the best possible care, at the best possible price, to the most amount of people. What I have learned in this process is that bringing real patient-centred innovation to healthcare is a whole-system job – while companies obviously have an important role to play, they alone cannot drive real change. Real change requires innovation across the system; from how we fund healthcare, to the way in which health care organisations provide care, to our expectations as citizens regarding how we receive care.
For new digital health innovations to be sustainably adopted and spread at scale within healthcare requires us all to work together to create the right environment to allow that to happen.
If the aim is for healthcare organisations to innovate and provide truly patient-centred care, then their funding models need to support that approach. When it comes to who funds healthcare, governments tend to be the dominant payors, and their motivations are complex. You only have to look at the polemic debate regarding Obamacare in the US to see how politisied and ideologically driven the funding of healthcare is. Rather than being data-driven with an aim of providing the best care for the lowest cost, funding models can be dysfunctional messes.
Digital health thrives in countries where the eye is kept on the ball of providing best possible care in the most efficient way possible; where the eye is kept on improving overall population health (including prevention initiatives) and on having the data necessary to ensure quality can be measured, understood and best-practice replicated. Value-based, outcome-driven funding models, rather than fee-for-service approaches are important drivers of the uptake of digital healthcare in the markets we have studied. We also found that ROI for digital health often happens over a longer period than many current budgetary systems can accommodate. Thus funding models need to innovate in order to incentivise (or at a minimum not dis-incentivise) new models of care provision.
Allied to the leadership required to align funding models to how we wish care to be provided, healthcare leaders need to accept that transformation is a long-term play - thus objectives need to be realistic and achievable. We have spoken to many senior healthcare leaders who have been involved in successfully transforming healthcare at a systems and organisational level internationally, and their consistent message is that it takes time and effort to fully engage all the relevant players in the healthcare system and to spread new innovations.
Many digital health innovations are by their nature disruptive to how care is currently delivered. While a new technology may in theory be wonderful, in practice if it requires healthcare professionals and patients to fundamentally change their roles, it can be challenging to implement. New ways of working take time and effort to bed-down and many studies find that in order for healthcare organisations to adopt new ways of working requires those organisations to be ‘innovation-ready’ and to have what has been termed the ‘adaptive reserve’ necessary to implement changes. Organisations that are innovation ready have a culture that cultivates tolerance, fosters open discussion, and allows employees time to think holistically and systemically.
Selling into healthcare systems can be a challenging process – there are evidence-bases to prove, procurement processes to navigate and established work-flow processes to change. In no other industry that I have studied is collaboration across a wide diversity of groups as important as in healthcare. Collaboration is hard, fascinating, frustrating and hugely rewarding – it takes an ability to innovate as a company not merely in terms of product development but fundamentally in mindset. There needs to be an open-ness to sharing ideas, to receiving robust feedback and listening to it. Be prepared to iterate based on this feedback and to involve your potential customers and payors (who may or may not be the same people) within your product development.
This kind of business model innovation is not for the faint-hearted but this effort to refine your customer value proposition can save a huge amount of time in the long run.
As researchers in this exciting and emerging space, we are constantly looking to use innovative methods of gathering data that truly reflect how knowledge can be created in the field. Often old methods of measuring the success of an intervention are not fit for purpose when trying to evaluate digital health technologies. When working on projects which are live in healthcare organisations we need to be agile and adaptive with our methods. Traditional methods of ‘proving’ an evidence base often do not work when trying to assess a systems-wide technological implementation which has so many context-dependent variables.
It is a hugely exciting field to be a part of and eHealthIreland’s innovation showcase is a great opportunity to exchange ideas on how we can collaborate effectively to ensure that we do truly innovate across the system, and unlock the value of digital healthcare for all citizens.