The Evolution of Healthcare in the Digital Transformation Era

Will doctors, described in Ancient Greece as "the hand of God," lose this title to the robots in Silicon Valley?

According to United Nations records, while in 1960 the average life expectancy was 52.5 years, today it has risen to 72.9 years. As life expectancy has increased by nearly 20 years over the past 50 years, it is not unreasonable to think that the exponentially accelerating pace of technological developments will increase life expectancy even more over the next 50 years. As important as average life expectancy, which is a key indicator of health, is the number of healthy life years spent during one's lifespan without any health problems or physical activity limitations. In this regard, the OECD's Health at a Glance: Europe 2018 report states that 80 percent of the average life expectancy in European Union countries will be spent as healthy life years. We can say that the increasing life expectancy will also significantly raise the disease burden. According to the World Health Organization's Disease Burden Projections report, the share of non-communicable diseases such as cancer, diabetes, and cardiovascular diseases among causes of mortality will increase globally in 2030 compared to 2015. In the European region, including Turkey, the prevalence of chronic diseases and their share among causes of mortality will rise in parallel with the rest of the world.

Based on these statistics, it is not wrong to say that changing demographics and people's evolving health needs are transforming healthcare. While the incidence of chronic diseases or conditions such as cancer will rise, we can say that thanks to the opportunities technology offers and will offer, access to healthcare will improve, and the quality, speed and impact of healthcare services will change with the digital transformation of healthcare. 

The increase in average life expectancy will directly drive population growth. This population growth shows that we need to change our perspective on many fronts, from how we define health to how we can deliver healthcare services to patients and healthy individuals. It is clear that today's healthcare system and medicine cannot be sustained with the mindset of 25 years ago. We believe that the healthcare system, by embracing digital transformation, will accelerate and ease this change. By designing this paradigm shift through digital transformation, we can build the future more effectively.

The Hospital of the Future
Today's hospitals must make certain changes to keep up with the transformation of demographics and patients, and these changes should not be physical but digital. There is a clear gap between today's hospitals and our level of technological advancement. While digital solutions are being deployed in every aspect of life, we observe that hospitals are lagging behind in providing digital solutions to patients' demands and needs, apart from designs that are not patient-centered. The foundation of the healthcare services we provide in the 21st century should be a technology-empowered patient. Several steps to take in this direction include:

The hospital and healthcare personnel must complete the digitalization process. To give a very simple example, in most hospitals, radiology images and results are still delivered to patients via unsustainable means such as paper and CDs. Not sharing data that is already digital with the patient in a digital environment also lowers the patient's level of technological satisfaction. We should instead deliver, in a digital environment accessible even from mobile devices, the patient's need to be able to access their radiology images at any time and from anywhere to obtain a second opinion. In the future, what will differentiate hospitals is the completion of the digitalization process for both the hospital and the healthcare staff.

The services provided should be tailored to patient needs. The aging population and chronic diseases will require us to treat and monitor patients outside the hospital. Today we are preparing so that, in the future, we can monitor half of the patients currently treated in hospitals at home. We foresee that large central hospitals will open peripheral 8 to 10-bed centers focused on outpatient care and short-term recovery, where most patients will be stabilized for one day at the central hospital before being digitally monitored at home post-procedure. Especially what we call tertiary care hospitals such as university hospitals, training and research hospitals, and specialty hospitals will need to make room for more complex cases. To be able to provide more services to patients requiring critical care such as intensive care, systems will need to be set up so that they can monitor patients with chronic conditions outside the hospital. Wearable health technologies and telemedicine will step in at exactly this point and, through home monitoring of patients and mobile health teams, enable hospitals to provide faster service to patients whose conditions are more critical.

A more effective experience should be delivered for both patients and employees. In the hospital of the future there is no room for wasted time. Patients can already book an appointment with a single click via mobile apps and websites, and conduct video consultations with their doctors via their mobile devices. In the next stage, patients will be able to enter the hospital and complete registration by scanning their fingerprints, just like the mobile boarding passes we use at airports. The patient's identity will be verified using the fingerprint, and all of their personal and medical information will be in front of the doctor and healthcare staff. The easier sharing of information will, in turn, enable customized care for the patient and personalization of patient rooms. Patient rooms are planned to be equipped with wide screens, applications compatible with the patient's own mobile device, and smart assistants that recognize voice commands like the ones we use at home. Hospitals will be able to deliver personalized care to the patient by knowing the patient's preferences, genetic codes, lifestyle, region of residence and financial situation and by making the patient a partner in the process. To provide a more effective experience for both patients and staff, we will need to integrate not just the patient's health data such as vital signs but their entire life data.

Digital Transformation in Healthcare
Today we see that people are reaching information about their health much faster, and as a result they are much more conscious about their health conditions. David Schlanger, former CEO of WebMD, which provides medical information and news, stated that in 2015 the site reached 212 million unique visitors and 4.12 billion page views per month. This awareness has made it imperative for the healthcare system to change so that people can receive care and treatment in the most ideal way. As digitalization rapidly takes hold in every aspect of our lives, the digital transformation of the healthcare sector has also started to accelerate.

With Apple's new device the Apple Watch, irregular heart rhythms can now be detected. As a result of analyzing the heart rhythms of the 400,000 participants in the research conducted jointly with Stanford University, an irregular heart rhythm was detected in 5 in 1,000 participants (approximately 2,000 people). For most of those in whom an irregular heart rhythm was detected, doctors arrived at the same diagnosis. As this example shows, wearable health technologies will continue to play a significant and important role in the early diagnosis of diseases.

In the near future, in which artificial intelligence software that makes doctors' lives easier in areas such as radiology imaging, pathology diagnoses, and intervention with stroke patients will be in routine use, we can say that doctors will process their clinical decisions with transparent data, machine learning will improve with every operation, and systems based solely on doctor's decisions and the doctor at the center will diminish.

Human-Centered Care
Digitalization alone cannot deliver a miraculous prescription for offering experience-driven, patient-centered care. At this point, supporting patients' maximum and effective participation in their treatment processes and including them in decision-making about hospital operations is critical. Therefore, people must always remain at the center. For digital transformation to be embraced, all doctors, nurses, allied healthcare staff and patients need to be involved in the process. 

In this regard, we have launched various applications within the Digital Transformation Office at the Vehbi Koc Foundation Healthcare Institutions and continue to develop new solutions. For example, we are working on a new platform that allows patients to access their health records in real time and via a digital environment so they can be more knowledgeable about and participatory in their healthcare processes. We know how important patient feedback is for improving and raising the quality of healthcare systems. Because conducting face-to-face conversations with each patient requires significant cost and time, we have shifted the feedback collection process largely to a digital environment. Being able to connect with our patients through digital platforms became the first phase of digital transformation. The digitalization of in-hospital processes helped us improve the hospital's hospitality services and, in turn, raise patient satisfaction. We have created a system in which the criteria affecting patient experience apart from healthcare needs, such as food, cleaning and IT services, can be tracked digitally and continuously. We have placed the patient as the decision-maker in their own journey at the hospital.

Participatory Health
Patients now want more control and more choice in their healthcare journeys. Unfortunately, the time doctors can spend physically with their patients within a year is very limited. Patients live through most of their illness with limited or no access to their healthcare providers. If we cannot increase the time doctors spend with patients, we must make the time they do spend more effective. One of the biggest gains of the digital transformation of healthcare emerges right here: the participation of patients, their families and healthcare providers in the process increases. The patient's ability to share their data in a digital environment will enable the doctor or healthcare professional to share the necessary information with the patient in a timely manner and more quickly and easily, based on this data. It will deliver patients access to healthcare services faster and more easily, improve the quality of care, and enable hospitals and therefore doctors to shift to a more effective working model. As patients' participation in the process increases, they will also be able to make more informed decisions about their own health. At the same time, patients will be able to take quick action with early alerts received through mobile applications and wearable devices. These technological advances in medicine will support the development of preventive medicine that will make it easier to diagnose diseases in developing countries.  

Case Study: Koc Healthcare
In light of these developments, we have launched the Koc Healthcare mobile application. With this application, our patients can access their radiology, pathology and laboratory results and medical archives at any time, can be notified of their results in real time, and can also access all of their surgical reports, message healthcare staff, and reach our call center with a single tap. With our electronic health records application used by both our patients and our doctors, we aim to give patients a more participatory role in their own journey. Through this mobile application, our patients can access their results in real time at the same moment as our doctors. In line with our value-based care approach, we want our patients to be empowered and informed through their own health data and records. 

Personalized Medicine 
Whereas the old drug-development technology focused on the disease itself, the new technologies focus on the patient. The disease-based approach holds to the principle that a treatment method or a drug treats all patients who have received that diagnosis. However, this is fundamentally wrong for two reasons: 

1) Whereas in 2007 you could have your DNA gene sequence, which provides in-depth information about a person's genetic makeup, decoded for an average of 10 million dollars, by 2014 this price had dropped to 999 dollars. This analysis, which became 10,000 times cheaper in 7 years, makes it possible to deliver personalized treatment options to people. Being able to learn about diseases linked to genetic predisposition through this analysis also strengthens doctors' hands when it comes to early diagnosis and treatment. The technology is becoming more accessible to everyone day by day.

2) According to a report by Dell EMC, since 2016, health data has grown by 876 percent. The collection, storage and analysis of personal health data continues to grow. This big data flow shows that we will be able to advance healthcare services faster and offer personalized treatment.

Artificial organ and tissue production, which will enter our lives with personalized medicine, will enable us to treat diseases that were once considered impossible to treat or very risky in medicine. At the same time, it will be possible to develop medical devices that are freed from the limiting functionality of the human factor. Today, we are closer than ever before to moving from producing a single drug for all patients receiving the same diagnosis to producing personalized drugs based on patients' genomes.

The Changing Healthcare Stakeholders
Patients' needs around protecting and improving their health are changing, and the players in the healthcare sector also need to change. The fact that the NHS has begun reimbursing for "Sleepio", a mobile application that aims to improve patients' sleep quality using cognitive behavioral therapy as an alternative treatment method alongside conventional treatments for insomnia, the disorder of being unable to fall asleep or sleep through the night, is a fundamental indicator of this. Trying digital therapies alongside standard, expensive treatment methods will be a decision that affects every stakeholder in the healthcare economy.

The acquisition of the startup "PillPack" by Amazon, one of the world's largest companies, for personalized digital pharmacy is one of the most prominent examples of the changing healthcare stakeholders. Thanks to online pharmacies that can automatically supply us with new medications when a drug is about to run out, the healthcare and pharmacy sector, which has long enjoyed immunity to the disruptive effects of digital transformation, does not seem able to escape Amazon's impact this time.
So what can hospitals learn from the new stakeholders that have joined them? Thanks to the analysis of patient data collected over the years, all processes for the patient can be made easier, and options can be prepared in advance. This will help foster patient loyalty to the hospital. In the future, when patients come to the hospital, they will be able to be informed in advance and in more detail about issues such as clinical decision mechanisms, procedures, and health insurance processes.

Alternative and Complementary Medicine
Diseases are caused not only by vectors such as bacteria, viruses and fungi but also by our genetics and environmental factors such as stress, unhealthy nutrition and radiation. According to the World Health Organization, "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Why do we not focus more on this definition?  We believe that healthy nutrition and reducing the stress in our lives are as important as not taking medication. To this end, in 2017 we launched the Code Lotus project under the motto "Heal Yourself," which embraces holistic approaches that contribute to the physical, mental and spiritual health of our patients as well as our employees. With complementary medicine, we offer programs that support medical recovery through alternative dietary habits, mindfulness, and medical yoga and pilates classes designed for different disease groups for both our employees under intense stress and our patients. In addition to the Code Lotus center, we are also planning to invest in keeping records of our patients' well-being and correlating it with the treatments they receive. In this context, we are working on a software that will evaluate our patients' parameters such as sleep, mood, appetite and physical activity on a daily basis in a digital environment and analyze how these parameters change based on the medications they take. We plan to ensure our patients' complete well-being in this way. With our mobile acute care teams, we plan to quickly address patients' post-discharge needs such as care, diet, mindfulness, rehabilitation and exercise at home according to the parameters we will monitor digitally. We believe that digitalization will open new doors not only in modern medicine but also in alternative medicine.

The Importance of the Human Factor
Will doctors, described in Ancient Greece as "the hand of God," lose this title to the robots in Silicon Valley? We can answer this critical question very simply by virtue of human nature: no, the importance of the human touch will prevent this.

To achieve efficiency, many hospitals around the world are moving to a model in which monotonous processes such as drug or food service performed by healthcare staff are handled by robots. It will not be easy for a robot to build the trust relationship and communication that a doctor establishes with the patient. Similarly, it is frequently said that, in the future, artificial intelligence will replace doctors working in image-based, pattern-recognition fields such as radiology, pathology and dermatology. The Stanford University School of Medicine's 2017 Health Trends Report shows that the deep learning algorithm is as successful as dermatologists at the same hospital in diagnosing skin cancer. We can say that, rather than leaving doctors out of work, artificial intelligence will mean that doctors who use AI technology will outperform those who do not. We believe that this order of automation and standardization will dull the human side of medicine. As Professor Abraham Verghese of the Stanford University School of Medicine put it, "The most important discovery in medicine over the next 10 years will be the power of the human hand."  

In Summary
The Problem
Today's healthcare system cannot be sustained with the technology and mindset of 25 years ago. Patients now want more control and more choice in their healthcare journeys.

Why It Is Happening
The healthcare system needs to be reimagined because of the rising population and disease burden and the changing health needs of people. There is a gap between hospitals and our level of technological advancement.

The Solution
Hospitals and healthcare workers can keep up with the change in the healthcare system by embracing digital transformation. The foundation of the healthcare services provided in the 21st century should be a technology-empowered patient. With the digital transformation of healthcare, the quality, speed and impact of healthcare services will change.

HBR Turkiye