(REF DT28) Digital Transformation for Health for the SDGs, Convened by HSE, Ireland

The Digital Transition for Healthcare – Stay Left, Shift Left [DT 28]
A paradigm, policy, platform and prescription for wellness and better health

Prof. Martin Curley, Director Digital Transformation and Innovation, HSE
Declan Kirrane, CEO, ISC Intelligence in Science

The broad adoption of Digital Health as a paradigm, platform and a policy will be fundamentally important to the achievement of SDG #3; Ensure Healthy Lives and promote wellbeing for all at all ages.
Introduction – Why?
All around the world healthcare systems are facing increasing pressures and demands. Well developed countries are facing epidemics such as Diabetes or Obesity while developing countries struggle to leverage diagnostics and access to medicines. All health systems have struggled to cope with the Covid 19 pandemic but there has been a benefit in that many health systems turned to digital solutions to cope. Despite the progress many countries have runaway health budgets with rates of growth which are unsustainable. Arguably Digital is the best Medicine for our sick healthcare systemi. Leading physicians such as Erik Topol and Robert Wachter have written about the creative destruction of medicine and digital doctors respectively but how do we make the digital transition of healthcare as quickly and sustainably as possible. Michael Porter and Elizabeth Teisberg have long advocated for redefining healthcare using value based competition. In this context a new paradigm is emerging, Open Innovation 2.0 which helps enable structural transformation of an Industry through digital technologies and trust based co-opetition1.

In the past the arrival of a single disruptive technology such as railways or the internal combustion engine drove dramatic societal change and benefit. Today we are at a unique point in history where we have multiple digital disruptive technologies all showing up at the same time. Technologies such as Cloud Computing, Mobile and Social, Artificial Intelligence and the Internet of Things create opportunities to radically transform healthcare. According to the OECD Healthcare is a decade behind other industries in digitalizing https://www.oecd.org/health/health-in-the-21st-century-e3b23f8e-en.htm but the time is now to harness these digital technologies to help lengthen life expectancy and provide more effective and cost efficient care. Covid 19 has been a big bang disruptor forcing the healthcare industry to adopt digital solutions – necessity is the mother of invention. Digital technology can be a democratizing force for achieving health equality with digital solutions enabling remote diagnostics, consultations and more effective medicines for all.
The opportunity: The Digital Dividend
Digital Technologies create the opportunity for the dominating paradigm of healthcare to change. Today’s healthcare systems are reactive and focussed on trying to restore health to ill people. The opportunity exists to shift resources and focus to keep well people well or helping treat people with
chronic conditions mainly in their homes or in the community. With digital technologies it is becoming possible to offer citizens equivalent or better care in their homes than in a hospital or clinic and at lower infection risk. Acute Hospital services consume much of healthcare systems budget but basing the healthcare system on secondary care is inefficient – there is a higher return both financially and in terms of patient outcomes by applying a proactive healthcare approach, for example monitoring citizens proactively to detect chronic disease emergence allowing for earlier more holistic interventions.
What? – Stay Left, Shift Left
To align and accelerate progress we propose that countries adopt a Stay Left, Shift Left paradigm, policy and platform for adopting digital health solutions. The HSE’s digital innovation strategy is called Stay Left, Shift Left (SL2) and extends the concept of “Shift Left” which was first introduced by Intel Corporation’s Doug Busch and Andy Grove and is an approach to using solutions to make people’s health better. SL2 helps implement the Irish Government Health policy Slaintecare.
Stay Left: is about keeping well people well or if you happen to have a chronic condition you can be managed best of all at home
Shift Left: is about moving patients as quickly as possible from an acute to community to a home setting

Each time we seek a disruptive technology outcome we look for four linked outcomes, the so called quadruple aim, improvement in quality of care, quality of life, clinician experience and reduction in cost of care. 2 For such a complex transition we need take a new approach, choosing platforms not products for building next generation healthcare systems. By using interoperable platforms with open programmable interfaces (APIs) we create a platform for both significantly improved healthcare and
further innovation. The use of digital and other technologies can achieve 10X impacts in cost or quality of care and life.

Leap Frog Strategy

With the confluence of different digital technologies there is the possibility for both developing and developed countries to agree and execute a Leapfrog strategy. Instead of concentrating on deploying monolithic electronic healthcare record systems in acute hospitals, countries should focus on deploying home and community based solutions and shared care records that are mobile and cloud based. Advances in the Medical Internet of Things mean that low cost but effective remote monitoring and consultation tools can be deployed. Health system wide efficiency and effectiveness can be significantly improved as well as individual outcomes being be significantly better.

We propose that countries move their healthcare systems from paper and presence based systems to digital, virtual and cloud based systems where healthcare takes place primarily in the home and community. In this new model the focus shift to proactive, preventative and predictive health. Data is more joined, linked and used to better specify and target interventions. The use of closed loop digital systems which enable precision real-time care to be provided. Digiceuticals and digital theraputics will become common place with physicians or real-time AI systems suggesting and actioning new or modified titrations of medicine. Already Germany has moved to put in place a registry and approval progress for so called DIGAs.3

Many countries lack of a roadmap for digital health progression. Together with the Innovation Value Institute and other stakeholders we have set a collective goal of building a Digital Health Capability Maturity Framework which will allow countries assess their current level of digital health maturity and determine next actions to improve outcomes. Having a simple common model will streamline how all actors in the digital health ecosystem can innovate and work together to provide best outcomes for all.

The capability maturity framework consist of four macro capabilities and maturity paths how much and how we spend our digital health budget, how we develop and orchestrate collective digital health capability, how we measure and manage digital health value and finally the business model we deploy and use for digital health. We expect that in the future all health will become digital health but for now it is useful to discuss and measure digital health maturity.
Determinants of Health

Most healthcare spending is focussed on Healthcare Delivery but paradoxically healthcare outcomes are only 10% determined by Healthcare delivery. Other factors such as behaviour, genetics and public health are far more impactful as shown in the attached figure. The emergence of digital technologies such as the internet of things and artificial intelligence can significantly influence and change behaviours and create precision medicines for people with certain genetic dispositions. The digital transition thus can also enable a shift in policy, budget and emphasis on proactive/preventative healthcare.

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•   SDG10