Despite its title, Jody Ranck’s recently-published Connected Health: How Mobile Phones, Cloud and Big Data will reinvent Healthcare moves beyond a standard analysis of the connected health market to get to grips with the politics, in the widest sense, that are thrown up by the meeting of technology and health.
It is often said that healthcare is set for a revolution caused by a mix of social media, cloud computing, big data and smartphone ownership (some commentators also like to throw gamification into the mix too), an argument which generally marginalises the role of users. Ranck aims to redress that imbalance. He points to the complex relationship most of us have to healthcare, and how that relationship is central to whether services, such as mobile health, are successful or not.
“When it comes to healthcare, the ‘consumer’ is a weak, over-used and politically facile concept. To move the dial in the healthcare arena, we need more than top-down mandates,” he writes. Users need to feel they have some personal control over their own data in this new era.
“Patients’ rights to control data and use their data in aggregate to find cures, inform treatment patterns, and address health disparities is more of a political and social identity than a consumerist one,” says Ranck. This is where the politics come in but it’s also to my mind about the commercial possibilities of connected health services.
So many of the more interesting mobile health services rely on user acquiescence in sharing data. Issues such as privacy are even more sensitive in healthcare than other industries. Prime Minister David Cameron’s recent speech to a health conference proposed a change in NHS rules so that patient data could be made more readily available to pharmaceutical companies for research. He should tread carefully. Put bluntly, there is tension between users willing to donate to the public good but not being so comfortable with their personal data contributing to a company’s bottom line.
And Ranck is a realist too. Talking about optimistic forecasts for mobile health, he says: “Projections of growth rates, however, do not reflect some of the important barriers that exist in the health sector, such as reimbursement policies, that lag behind technology development. Important cultural shifts need to happen.”
Ranck argues generations of clinicians and policymakers have been accustomed to the present health system, which he characterises as “inefficient and not very patient-centric”. New technology can also shift the balance of power. “It is easy to find doctors who drag out the mythological sacrosanct physician/patient relationship to protest the use of social media and mobiles in the health system.”
He argues that the next generation of healthcare professionals should be better trained to understand technology. Likewise there is a shortage of healthcare expertise in Silicion Valley start-ups, leading to errors of judgement. Ranck says “a major winnowing of the candidates in the mhealth field” of start-ups is likely in the next two to three years.
So what’s the best way forward? Ranck favours global bodies that develop more collaborative models for the health data market. But not every such body meets with his approval. The mHealth Alliance has “essentially been treading water for three years without effective leadership or a business model”. He is more hopeful of signs of global and national cooperation in some of Continua Health Alliance’s work and the Obama administration’s push for Accountable Care Organisations and Health Information Exchanges.
On mhealth, he says service design and socio-political aspects are as important as technology: “The future of mhealth is most likely to take off in a country such as Denmark where there is a strong technology sector and an equally strong social support system that rests somewhere between the rigidity of France and the minimalist USA”.
Returning to the user perspective, Ranck suggests policy questions over surveillance and privacy will become more intense with the development over the next few years of nanosensors that monitor processes inside the body. Data ownership, privacy and security will play a major role in how the internet of things is deployed in healthcare.
His specific policy recommendation is a “global data alliance” whose roles would include acting as a forum for exchanging ideas, as well as a catalyst for new products and services. Such a body might also provide policy advice and bring together a range of parties interested in healthcare and technology including from finance, transport, city planning, agriculture, ecology as well as healthcare. The emphasis here is on public-private partnership. He has criticisms of the both the political left and right. The aim is for a more collaborative approach. As he says, “As one of our economy's most intimate sectors, concerned with the minutiae of our bodies, and as one of the most distant, where outbreaks half a world away can profundly affect our lives, the future of our healthcare system, as well as the global healthcare system, are too important to be marginalised by gridlocked politics”.
The editorial views expressed in this article are solely those of the author(s) and will not necessarily reflect the views of the GSMA, its Members or Associate Members.