The urgency for transformation 

The first big question we ask is why a digital transformation is needed. So, before we get to the transformation and the selection of methodologies themselves and plan the transformation, first, we need to understand why we (urgently) need the transformation and what drives this transformation.

In all the rapid advancements and increasingly overwhelming scientific and technological progress, we tend to forget that, at end of the day, it’s all about humans. So, what is in it for you personally, whatever your role is? That is the question we asked ourselves when we started writing this book. From our professional roles in healthcare technology, as a patient or the next of kin of a patient, and as members of society, it’s the human factor that really counts. Therefore, this book will be 100 percent person- or people-centric, meaning that we will look at healthcare from the patient’s and caregiver’s perspectives the entire time. This is our perspective for the following assessments and quest for understanding.

On one hand, we see many great opportunities in things such as big data, machine learning, and artificial intelligence in combination with bioengineering. However, we also see the potential undesired effect on people and society. We, as people and as a society, need time to digest the new possibilities before taking well-founded decisions. The consequences can be profound.

With that in mind, first, we must put a stake in the ground and understand what drives the urgency for changing healthcare. This urgency is mainly caused by demographic drivers and disruptive economic drivers.

Understanding demographic drivers

Although certainly not complete, we will give some examples in which to understand demographic drivers:

• One obvious driver is aging: we are getting older. That fact alone is already driving demand for care, in both emerging and developed economies. Figures from the United Nations show an increase in the global population by 1 billion people in 2025. That’s only 3 years from when this book was written. Of that 1 billion extra people, around 300 million will have reached the age of 65 or more.
• But there are more demographic factors that we need to consider. For instance, there will significant growth of the so-called middle class due to developments within countries. So, how’s that a driver for healthcare? The middle class will have greater and better access to a more luxurious lifestyle, which might lead to the occurrence of more obesity and other health problems that will burden the healthcare system.
• Growth is not equally divided across the planet. It’s expected that the population on the African continent will double by 2050, while the population in Europe will shrink.
• There’s a downside to the preceding point. With the growth of developing countries, there’s another trend that is becoming visible: the World Health Organization (WHO) calculated that, in 1990, breast cancer, diabetes, stroke, and other noncommunicable diseases (NCDs) formed 25 percent of the total amount of death and chronic illnesses in these countries. That number will rise to 80 percent by 2040 in some of the economically rising countries.
• Where people would likely die a century ago because of a certain disease that could not be treated, we are now able to cure a lot of these diseases due to immense scientific progress. Cancer is probably the best example here. Although it’s still life-threatening, a good number of cancers can now be treated with the prospect of good outcomes for the patient. Again, the issue is that access to cures and treatments is not evenly divided across the globe.
• Finally, a very important driver is the scarcity of staff in care. This is a global issue. In some countries, it has been calculated that, over the coming years, one-third of all jobs will be in healthcare, something that has been accelerated by the COVID-19 pandemic. This is not a sustainable model. To make it slightly worse, in some countries, care institutions are recruiting staff in other countries that need skilled personnel just as urgently as anywhere else, causing a “brain drain” in some parts of the world and enlarging the inequality of access to care.

The net result of all of this is that people will need complex, coordinated care for a longer period. There will be more people to take care of, and these people will live longer because we also have the capabilities to cure more diseases. On the other hand, there’s a huge risk that we can’t deliver that care because we don’t have the skilled staff to do so. This is causing the urgency to transform healthcare into a more sustainable model – a model that also allows us to scale it across the globe.

Understanding disruption in healthcare

Healthcare is already transforming, as we will discover in this section. Disruption is happening, as in almost any other industry, by highly innovative newcomers on the market. Global initiatives have been launched, disrupting traditional healthcare. We see non-healthcare industries expanding into this new market. This includes retail, wellness, and even telecom companies. They all have good business reasons for expanding into this market: healthcare is growing in the global market with tremendous opportunities. From a commercial perspective, healthcare is becoming a more and more attractive space to be in as a business.

On the other hand, we have no choice because of the increasing demand that traditional players can’t address sufficiently anymore. New entrants are leaping into the gap. It’s inevitable: a collaboration between the traditional stakeholders and new, private, commercial initiatives is required to meet the expectations of patients and clients. These patients and clients are getting used to on-demand and fast service, with the continuous improvement of products and services alongside comfort and convenience experienced with the likes of Uber, Booking.com, and other platforms. Healthcare is like any consumer market, acting with the same principles as, for instance, retail. The consumer sets the pace of innovation: on demand, ease of access, ease of use, reliability, always on, anytime, anywhere, and anyplace. This comes with a huge shift in the way healthcare must reshape its delivery model and become more agile.

At the same time, we need to control costs, so solutions need to be cost-effective. A shift to more prevention, on one hand, and more at-home care, on the other hand, are the North Stars here. Promoting wellness, a healthy lifestyle, and preventing diseases should, in the first place, benefit people and, at the same time, drive costs down – a very attractive perspective for payers and governments. Plus, the solutions are cost-effective when they are scalable. These solutions are developed once and deployed many times, preferably on a global scale.

Understanding the business context

The big change is the shift to prevention through lifestyle and behavior rather than cure. The WHO and many national government institutions have highlighted this more and more on their agenda. The COVID-19 measures on social distancing are a good example.

Therefore, a lot of new companies in healthcare are focusing on prevention by stimulating a healthy lifestyle. This is a global trend where we start to acknowledge that healthcare doesn’t start in the office of a doctor but in our personal lives and the way we take care of ourselves, for instance, with our lifestyle choices.

A well-known example is the various wearables that track movements – they monitor basic parameters such as your heart rate, sleep score, and activity points, and based on that data, provide advice for exercising. Some of these devices – think of the Apple Watch – already go the extra mile and make it possible to produce electrocardiograms (ECGs). Other apps measure an individual’s body fat percentage by using the camera on their smartphone – one of the features of the Halo View by Amazon.

Devices such as wearables and apps simply help people to maintain a healthy lifestyle. We probably all know what’s good for us and what’s not. Health is impacted by lifestyle:

• Inactivity
• Unhealthy diets
• Too much alcohol
• Smoking
• Not enough sleep
• Too much stress

We know all of this, but apparently, it helps if someone or something helps keep us to stay alert to these factors. The biggest alert that a person could get is a serious health issue that results from an unhealthy lifestyle. Therefore, lifestyle is a very important driver in overall healthcare architecture and the transformation to more sustainable healthcare.

A sense of urgency is about pace – the pace of change. Many industries already adopted this new paradigm some time ago and started changing their business models for mainly one reason: they were forced to because of disrupting models that had been introduced into their markets.

Famous examples include Uber, which disrupted the market for taxis, and Airbnb, which did the same with traditional leisure. Are we seeing this in healthcare, too? The short answer is yes. There’s a shift happening already. In this book, we will look at some of these disrupting initiatives, for example, Amazon Care and a famous Dutch initiative called Buurtzorg that has gone international. The message of Buurtzorg is to simplify the systems and start again from the patient perspective.

Tip

Although Buurtzorg started as a Dutch initiative, the model is marketed internationally. We will refer to Buurtzorg a few times in this book, but more information can also be found at https://www.buurtzorg.com/about-us/.

Healthcare made easy, says the website of Amazon Care, promising care when the patient wants it, in the way they want it, and at the time they want it, fully focusing on the health experience. It should not be a surprise that Amazon brought this to the market. It’s derived from the guiding principle on which Jeff Bezos started Amazon: the company and its employees are obsessed with the customers of Amazon. Amazon calls this customer obsessed. In the case of Amazon Care, this becomes patient obsessed, including quality time with your team of doctors and nurse practitioners – on demand.

One other factor that makes Amazon Care and Buurtzorg great examples for this book to study is that both concepts are fully scalable and work according to agile principles. In Chapter 8, Learning How Interaction Works in Technology-Enabled Care Teams, we will learn more about these principles.

Note

A number of books have been written explaining the development and management philosophy of Amazon. Recent books include comprehensive descriptions of the working backward methodology that Amazon uses to create new services and products. This method was also used in creating Amazon Care: starting with the patient or the client, and their need, and then working backward to solutions that would address this. It’s a fundamentally different methodology of doing architecture. Although we will use Amazon Care as an example in this book, we will not go into detail about working backward.

The question is how to determine what must be done for health, when, and where. This is where diagnostics come in. Let’s get some insights into that in the next section.