The panic to secure medical advice and treatment during the COVID-19 pandemic has accelerated the integration of technology into healthcare. That development continues in 2023 and beyond. “Health care is entering a period of profound and accelerated change,” said the World Bank’s Digital-in-Health report in August.
The document noted those changes go “beyond the notion of new technology or digital solution[s] to digitize an existing process … The change brewing in the health sector is existential in nature — person-centered health care, embracing new medical and health discoveries.” Those new healthcare solutions will require “the integration of previously separate disciplines.”
Keeping up with those trends is essential for improving the quality, reach and variety of healthcare services. “Governments that have made progress in enhancing the health of the populations have applied digital technology” to strengthen their health systems, secure financing for the sector, and ensure healthcare is accessible and effective, the World Bank report stressed.
Changing landscape
The coming era of medical and healthcare services will equate to a revolution. The World Bank calls it Health-in-Digital. “It is the antithesis of using ICT to support the healthcare system or of digitizing health data, or creating digital solutions for existing (inefficient) health services without changing those processes.”
Health-in-Digital ensures “value and [lower] risks while embracing transparency and interoperability” among service providers. It would lead to a “democratization of health care and a cultural transformation in how health is delivered and perceived.”
The technologies that fuel that transition would be “disruptive, yet provide accessible, digital and factual data to both … patients and caregivers.” The result would be an “equitable relationship between doctors and patients, [giving rise to] mutual decision-making.”
That increasingly digital landscape will expedite demand for more advanced technologies in the coming years. “It will be … characterized by rapid technological advances not previously seen in a generation.” According to the World Bank report, generative artificial intelligence “will be one of the main areas for rapid advancement.”
Digitizing the system
“Stage 1” in creating a Digital-in-Health system “focuses on data, reporting and process efficiency.” The first step is to create a health information database, followed by connecting medical facilities nationwide via a unified system. Next, the government has to develop a strategy and tools to collect and store patients’ medical data and have robust mechanisms to process such data.
“The focus [would be] on data and digitization of existing workflows and administrative processes,” said the World Bank report.
That transformation mandates a significant shift in how decision-makers perceive investments for digitizing medical systems. “At this stage, both the demand and supply of digital health are rudimentary, and ministries of health tend not to pay much attention,” the report said. “ICT is mostly thought of as a cost in the health system.”
The next “stage” would see the “focus expand from digitizing data and supporting administrative processes to integration and [testing] the effectiveness of clinical and administrative processes.” The report says it would see “data and technology becoming part of daily operations. [That] sets the stage for [transforming] healthcare service delivery, financing, and behavioral and regulatory models in public and private sectors.”
That stage requires substantial upfront investment because “digitization transforms processes and workflows.” Meanwhile, administrators focus on increasing service quality, scope and scale.
The successful implementation of those digital systems, even on a small scale, should change the mentality of the sector’s medical and administrative staff. “Digital technology and data are recognized as factors in the success of operations and reaching healthcare systems’ goals,” the World Bank report said. That would lead to more demand for advanced solutions and tools.
At the end of that stage, “business processes become technology dependent because they are typically re-engineered around technology. And the optimization of ICT infrastructure [would result in] cost reductions.”
The final stage is “Digital-in-Heath, [where] technology and data become indistinguishably embedded and assimilated in … health systems and healthcare.”
That level of integration would open the door to new ways to deliver health services and add new ones that weren’t previously possible. Meanwhile, patients will demand increasingly innovative and convenient services, increasing the sector’s dependence on technology.
That transformation will make the system more adaptable and resilient to emergencies. “At this stage, Digital-in-Health [becomes] a cultural and structural evolution in [how] health is achieved,” the World Bank report said.
High cost
The primary challenge to developing a Digital-in-Health system is financial. It is most evident in “lower-middle-income countries [which] typically struggle with chronic failures in … mobilization of financial resources to develop and operate a health system.”
Those nations also struggle with managing “prepaid resources, such as … insurance contributions and premiums, … spreading the financial risks of illness and medical expenses and increasing access to needed services” for eligible individuals.
Those governments also fail to “pay for the required service inputs [and] providers [of] the delivery of service,” the World Bank report said. “Purchasing decisions determine what services are available, where and to whom, at what quality, delivered with what mix of inputs at what costs.”
The lack of funds makes expanding the health service delivery network challenging. The report noted, “Many people in low-and middle-income countries do not receive even basic health care. Health facilities are often located in urban areas, far from rural areas, and difficult to access by public transportation.”
The other fallout of limited funding is a country’s inability to develop tools for digital diagnostics and drug development. That ultimately translates to expensive health care services, as equipment and medicine are imported. Additionally, those services are likely confined to high-end geographic locations close to patients who can afford them. Alternatively, the state would need to subsidize them for low-income citizens.
On the ground, that means accessing quality health products can be difficult. It also results in more falsified medical products, higher medicine prices, shortages of essential medications and poor logistics.
Another significant challenge to creating a Digital-in-Health system is awareness. That is evident in education systems. “Challenges [include] outdated curricula, insufficient funding, slow [inclusion] of new research in curricula, and lackluster quality control and accreditation systems.” The other awareness challenge is poor “public health, [which] tries to prevent people getting sick … in the first place.” That is evident in resistance to using digital tools, let alone visiting a clinic or hospital if unusual symptoms appear.
There is no one-size-fits-all path to achieving Digital-in-Health. That is because “countries are at different stages of maturity in terms of digital health infrastructure, systems and governance.” That is why the World Bank report stressed the importance of partnerships. “This includes new types of working arrangements and partnerships with and among private sector partners, as well as stakeholders supporting wider digital transformation efforts outside the health sector”
