.
M

any countries’ health systems are being completely overwhelmed during the COVID-19 pandemic. The only thing surprising about this is the when, not the what.

Some countries prepared studies years ago that forecast this situation almost perfectly. For example, Germany published a publicly available report in collaboration with the Robert Koch-Institute already in 2012 that described a coronavirus spread originating from China. The initial reaction from all Western countries was lack of preparation, ignorance, or unwillingness to consider the report.  Whatever the reasons, the effect was the same: Proven measures such as wearing face masks or social distancing—which should be termed physical distancing—are ignored or only belatedly implemented! Furthermore, fake news and uninformed opinions are proliferating, obfuscating and ridiculing those who are to better the overall situation.

A truly global problem demands the widespread understanding that a collaboration between all people and institutions is required for its resolution. It seems a global crisis is necessary to motivate more solidarity.

How We Can Become More Pandemic Ready

Some Asian countries—South Korea, Taiwan, and Singapore—have previous exposure to this kind of virus threat. They were able to successfully combine measures (i.e. thorough testing, masks, digital tracking), successfully building on previous pandemic experience.

We should similarly seek to learn from our collective experience to be better prepared for the next pandemic. It could be similar or of another kind, but the lessons we can learn are quite similar. If we follow the following set of principles and mix of methods (e.g. preparedness, supplies that are available or can be reactivated & training infrastructure) the impact and cost of the next pandemic will be much lower—therefore more cost efficient, socially friendly, and will be disruptive for a shorter period.

The following set of principles—taken from a body of early works on neurology and management cybernetics—can help manage situations we face from a risk and opportunity perspective:

1. Transparent: Facts, responsibilities, shared rules and values, competencies

2. Fast decision making between all stakeholders & communication

3. Trustworthy change of modus operandi: normal <> crisis based on active capabilities

4. Resilient: limited redundancy to be able to act in terms of capabilities, infrastructure and supplies

5. Recursive: structures and principles applicable on multiple levels from cities to the world

6. Relative autonomy: keep tasks, decision areas and competence in small but connected units with whole

7. Security: no data loss, no unauthorized reuse and no patient data privacy breaches

In addition to pragmatic ways toward a faster exit path for the Western world, there should be parallel work done on a new governance framework to tackle the unique challenges posed by a global catastrophe. Such a framework would embrace the need for global collaboration and the use of the technical infrastructure that facilitate the required transparency, security, resilience and ability to make fast decisions. For reasons of effectiveness this should be supported by interoperable technical platform approaches supporting the 3Cs:

• Collaboration

• Coordination—corresponding solutions must support interoperability and shared standards

• Communication

Healthcare Systems Require Reform to Cope with Crises

Healthcare systems in general are very siloed and therefore structurally slow to react to epidemic outbreaks. They consume ever higher percentages of national GDP (between 9% (AU) and 17% (U.S.) in 2017) in developed countries. These systems are perceived as administrative at best with regard to digital innovation, and “old-school” in how the actors interact through many committees and issue teams in non-pandemic times.

Figure 1 highlights some of the silos established (for good reasons) in the total system. The areas where a lack of coordinated digital transformation lets costs explode and total service quality plummet despite a lot of good will and money invested are depicted with red arrows in the infographic below.

Figure 1 – Current Health System inflexibility

Some causes of the slow pace are 1) low use of real-time data, 2) lack of interoperability of IT systems, and 3) complex regulations that hinder innovation in hospitals and the whole ecosystem. The system is largely dysfunctional. We need to rethink and reinvent how we conceive and act regarding healthcare to reveal the real levers without ignoring key interdependencies and information flaws.

Solution: Think of healthcare as a business ecosystem (BE) that integrates all the stakeholders’ interests. Ecosystem redesign would aim at increasing efficiency, quality and patient outcomes in coordination with regulators. All stakeholders co-create and co-deliver a new networked value proposition to the patients. Making it happen requires thinking differently from a functioning ecosystem and business outcome point of view:

• Avoid “Proof-of-Concept hell”—no real progress, let alone scalability or business viability

Problem: Blockage of interoperability and collaboration by incumbents that want to install proprietary solutions. This type of silo thinking-based strategy forces suppliers and customers to stall innovation.  There is a paradox here that can be overcome by regulatory interventions: Demand interoperability standards to increase innovation within and across silo boundaries.

• Increase security by reusing existing platforms and standards to protect patient privacy and data rights in more secure ways (e.g. Threema Work, OPAL & ENIGMA from MIT)

• Platform approaches can lower costs and increase transparency simultaneously by leveraging network effects (see Supply Chain track & trace for international transports; B2B messaging platforms) if security and interoperability are guaranteed.

Some positive examples:

• Use of AI-based DSP-1181 from Exscientia & Sumitomo Dainippon Pharma for personalized medicine helped to shrink invention time from 4.5 years to one (for treatment of obsessive-compulsive disorder)

• Novartis’ “pre-release” of the medication “Zolgensma” might demand a change in the regulatory system—irrespective of the moral discussion around the lottery and other aspects—regulatory process time losses kill or shorten lives of patients

• Patient-focused strategies such as telemedicine and Remote Patient Monitoring can be designed to improve ALL outcomes (medical, personal, financial, organizational) if properly regulated and incentivized from a business ecosystem view

• Bring self-analysis to the patient instead of moving the patient to rare and centralized hospitals

Further development

If healthcare systems are to be transformed from this current downward vicious cycle to a positive virtuous cycle by 2030, new ways of interaction between all stakeholders and a new regulatory involvement must be established now. Some examples already exist: e.g. Kaiser Permanente, Veteran’s Administration, selective EU examples.

Getting there requires that we rethink tasks and mindsets:

• How can regulators and pharmaceutical companies better focus on tasks to drive down cost and simultaneously improve patient services and health improvements?

• What are the pre-requisites and next steps?

A business ecosystem approach allows us to perform large scale transformations beyond traditional industry boundaries within healthcare. It must encompass a total health system perspective—from active ingredients to patients. It demands a real change of purpose, delivering less costly, wasteful, and siloed health systems without Chinese walls. Judging from other approaches it requires more collaboration and transparency (see added layers in Figure 2).

The current pandemic crisis highlights the urgency of risk monitoring and responsive systems provided at low costs. Some insights from supply chain management offer ways to devise an interoperable system of contact tracking that combines mobile phones and low-cost intelligent devices for children and elderly. With complementary solutions to encompass people without smartphones like Excalibur, the gaps can be closed.

Figure 2 – Improved, collaborative Health Ecosystem

BE thinking requires champions and evangelists. Start with a small subset of stakeholders (Minimum Viable Ecosystem) that want to make a change and involve regulators early. Wisely designed virtuous circles can then involve and engage additional stakeholders. Digital means provide the motor for network effects and scalability. Of course, privacy and security must be well respected.

The healthcare system suffers from a margin-rich and complacent subsystem with many incentives that are not always focused on the patient’s well-being and prevention of healthcare incidents. Figure 3 proposes a future BE view with dynamic trade-offs between alternatives:

Figure 3 – Impact diagrams help to focus on the central outcome of cost-efficient and effective health services.

New technologies can help but they are not the starting point. Rethinking healthcare systems needs to start with curious and open mindsets of relevant stakeholders to rethink the health system simultaneously from a patient interaction, data, and technological viewpoint. A significant portion of the data gleaned could be shared for the benefit of the overall health system. The health ecosystem governance must change for the better. Stakeholders should consider such questions as whether the same clinical trial process is the best choice for all patients and diseases, and whether AI can help to speed up some of the trials based on fact-based reasoning.

Questions like these need to be asked and should be answered differently if minimal viable health BEs are to avoid silo thinking and incentive traps. Rethink the mental framework and systems of healthcare that worked well in the past and fail to fulfill its purpose for the future? Are regulators, pharmaceutical companies, hospitals, care workers, and physicians willing to rumble? If so, then bringing together the right set with the right methodologies and technologies is not so difficult—the starting point is the willingness and drive for major change! So why not start today with a mutually interdependent view to define a better future?

Management cybernetics, neurology, AI, technology and social sciences are some of the disciplines that can fruitfully revolutionize the healthcare industry. Our eyes need to open to a roadmap towards faster and improved collaboration to cope with future’s increasing challenges. Having infrastructures, stocks, crisis services and instants tests to fight pandemic waves is only one of those. This can be a good starting point that we should take advantage of before going back to a slightly changed new normal.

About
Roland Klüber
:
Dr. Roland Klüber is a serial entrepreneur and business ecosystem innovator in health care, pharma, aviation, trade, supply chain, and multi-modal mobility. Roland is a digital transformation and AI expert. He is the CEO Consilis, Partner at Theron Advisory Group, and Member of STINT Think Tank.
About
Daniel Hackmann
:
Dr. Daniel Hackmann is chief advisor on business strategy and development, partner ecosystems, and high-tech trends at DWH Consulting. He specializes in go-to-market and growth strategies for high tech and service providers. His industry and technology expertise are on the use of IoT and IIoT.
About
Roland Bennett
:
Roland Bennett is a Medical Informatics consultant focused on extending clinical care into the patient's environment. Roland's focus has been on developing highly effective therapies, using low cost solutions like embedded systems and medical IoT.
The views presented in this article are the author’s own and do not necessarily represent the views of any other organization.

a global affairs media network

www.diplomaticourier.com

How the Health Business Ecosystem Should Reinvent Itself

May 25, 2020

M

any countries’ health systems are being completely overwhelmed during the COVID-19 pandemic. The only thing surprising about this is the when, not the what.

Some countries prepared studies years ago that forecast this situation almost perfectly. For example, Germany published a publicly available report in collaboration with the Robert Koch-Institute already in 2012 that described a coronavirus spread originating from China. The initial reaction from all Western countries was lack of preparation, ignorance, or unwillingness to consider the report.  Whatever the reasons, the effect was the same: Proven measures such as wearing face masks or social distancing—which should be termed physical distancing—are ignored or only belatedly implemented! Furthermore, fake news and uninformed opinions are proliferating, obfuscating and ridiculing those who are to better the overall situation.

A truly global problem demands the widespread understanding that a collaboration between all people and institutions is required for its resolution. It seems a global crisis is necessary to motivate more solidarity.

How We Can Become More Pandemic Ready

Some Asian countries—South Korea, Taiwan, and Singapore—have previous exposure to this kind of virus threat. They were able to successfully combine measures (i.e. thorough testing, masks, digital tracking), successfully building on previous pandemic experience.

We should similarly seek to learn from our collective experience to be better prepared for the next pandemic. It could be similar or of another kind, but the lessons we can learn are quite similar. If we follow the following set of principles and mix of methods (e.g. preparedness, supplies that are available or can be reactivated & training infrastructure) the impact and cost of the next pandemic will be much lower—therefore more cost efficient, socially friendly, and will be disruptive for a shorter period.

The following set of principles—taken from a body of early works on neurology and management cybernetics—can help manage situations we face from a risk and opportunity perspective:

1. Transparent: Facts, responsibilities, shared rules and values, competencies

2. Fast decision making between all stakeholders & communication

3. Trustworthy change of modus operandi: normal <> crisis based on active capabilities

4. Resilient: limited redundancy to be able to act in terms of capabilities, infrastructure and supplies

5. Recursive: structures and principles applicable on multiple levels from cities to the world

6. Relative autonomy: keep tasks, decision areas and competence in small but connected units with whole

7. Security: no data loss, no unauthorized reuse and no patient data privacy breaches

In addition to pragmatic ways toward a faster exit path for the Western world, there should be parallel work done on a new governance framework to tackle the unique challenges posed by a global catastrophe. Such a framework would embrace the need for global collaboration and the use of the technical infrastructure that facilitate the required transparency, security, resilience and ability to make fast decisions. For reasons of effectiveness this should be supported by interoperable technical platform approaches supporting the 3Cs:

• Collaboration

• Coordination—corresponding solutions must support interoperability and shared standards

• Communication

Healthcare Systems Require Reform to Cope with Crises

Healthcare systems in general are very siloed and therefore structurally slow to react to epidemic outbreaks. They consume ever higher percentages of national GDP (between 9% (AU) and 17% (U.S.) in 2017) in developed countries. These systems are perceived as administrative at best with regard to digital innovation, and “old-school” in how the actors interact through many committees and issue teams in non-pandemic times.

Figure 1 highlights some of the silos established (for good reasons) in the total system. The areas where a lack of coordinated digital transformation lets costs explode and total service quality plummet despite a lot of good will and money invested are depicted with red arrows in the infographic below.

Figure 1 – Current Health System inflexibility

Some causes of the slow pace are 1) low use of real-time data, 2) lack of interoperability of IT systems, and 3) complex regulations that hinder innovation in hospitals and the whole ecosystem. The system is largely dysfunctional. We need to rethink and reinvent how we conceive and act regarding healthcare to reveal the real levers without ignoring key interdependencies and information flaws.

Solution: Think of healthcare as a business ecosystem (BE) that integrates all the stakeholders’ interests. Ecosystem redesign would aim at increasing efficiency, quality and patient outcomes in coordination with regulators. All stakeholders co-create and co-deliver a new networked value proposition to the patients. Making it happen requires thinking differently from a functioning ecosystem and business outcome point of view:

• Avoid “Proof-of-Concept hell”—no real progress, let alone scalability or business viability

Problem: Blockage of interoperability and collaboration by incumbents that want to install proprietary solutions. This type of silo thinking-based strategy forces suppliers and customers to stall innovation.  There is a paradox here that can be overcome by regulatory interventions: Demand interoperability standards to increase innovation within and across silo boundaries.

• Increase security by reusing existing platforms and standards to protect patient privacy and data rights in more secure ways (e.g. Threema Work, OPAL & ENIGMA from MIT)

• Platform approaches can lower costs and increase transparency simultaneously by leveraging network effects (see Supply Chain track & trace for international transports; B2B messaging platforms) if security and interoperability are guaranteed.

Some positive examples:

• Use of AI-based DSP-1181 from Exscientia & Sumitomo Dainippon Pharma for personalized medicine helped to shrink invention time from 4.5 years to one (for treatment of obsessive-compulsive disorder)

• Novartis’ “pre-release” of the medication “Zolgensma” might demand a change in the regulatory system—irrespective of the moral discussion around the lottery and other aspects—regulatory process time losses kill or shorten lives of patients

• Patient-focused strategies such as telemedicine and Remote Patient Monitoring can be designed to improve ALL outcomes (medical, personal, financial, organizational) if properly regulated and incentivized from a business ecosystem view

• Bring self-analysis to the patient instead of moving the patient to rare and centralized hospitals

Further development

If healthcare systems are to be transformed from this current downward vicious cycle to a positive virtuous cycle by 2030, new ways of interaction between all stakeholders and a new regulatory involvement must be established now. Some examples already exist: e.g. Kaiser Permanente, Veteran’s Administration, selective EU examples.

Getting there requires that we rethink tasks and mindsets:

• How can regulators and pharmaceutical companies better focus on tasks to drive down cost and simultaneously improve patient services and health improvements?

• What are the pre-requisites and next steps?

A business ecosystem approach allows us to perform large scale transformations beyond traditional industry boundaries within healthcare. It must encompass a total health system perspective—from active ingredients to patients. It demands a real change of purpose, delivering less costly, wasteful, and siloed health systems without Chinese walls. Judging from other approaches it requires more collaboration and transparency (see added layers in Figure 2).

The current pandemic crisis highlights the urgency of risk monitoring and responsive systems provided at low costs. Some insights from supply chain management offer ways to devise an interoperable system of contact tracking that combines mobile phones and low-cost intelligent devices for children and elderly. With complementary solutions to encompass people without smartphones like Excalibur, the gaps can be closed.

Figure 2 – Improved, collaborative Health Ecosystem

BE thinking requires champions and evangelists. Start with a small subset of stakeholders (Minimum Viable Ecosystem) that want to make a change and involve regulators early. Wisely designed virtuous circles can then involve and engage additional stakeholders. Digital means provide the motor for network effects and scalability. Of course, privacy and security must be well respected.

The healthcare system suffers from a margin-rich and complacent subsystem with many incentives that are not always focused on the patient’s well-being and prevention of healthcare incidents. Figure 3 proposes a future BE view with dynamic trade-offs between alternatives:

Figure 3 – Impact diagrams help to focus on the central outcome of cost-efficient and effective health services.

New technologies can help but they are not the starting point. Rethinking healthcare systems needs to start with curious and open mindsets of relevant stakeholders to rethink the health system simultaneously from a patient interaction, data, and technological viewpoint. A significant portion of the data gleaned could be shared for the benefit of the overall health system. The health ecosystem governance must change for the better. Stakeholders should consider such questions as whether the same clinical trial process is the best choice for all patients and diseases, and whether AI can help to speed up some of the trials based on fact-based reasoning.

Questions like these need to be asked and should be answered differently if minimal viable health BEs are to avoid silo thinking and incentive traps. Rethink the mental framework and systems of healthcare that worked well in the past and fail to fulfill its purpose for the future? Are regulators, pharmaceutical companies, hospitals, care workers, and physicians willing to rumble? If so, then bringing together the right set with the right methodologies and technologies is not so difficult—the starting point is the willingness and drive for major change! So why not start today with a mutually interdependent view to define a better future?

Management cybernetics, neurology, AI, technology and social sciences are some of the disciplines that can fruitfully revolutionize the healthcare industry. Our eyes need to open to a roadmap towards faster and improved collaboration to cope with future’s increasing challenges. Having infrastructures, stocks, crisis services and instants tests to fight pandemic waves is only one of those. This can be a good starting point that we should take advantage of before going back to a slightly changed new normal.

About
Roland Klüber
:
Dr. Roland Klüber is a serial entrepreneur and business ecosystem innovator in health care, pharma, aviation, trade, supply chain, and multi-modal mobility. Roland is a digital transformation and AI expert. He is the CEO Consilis, Partner at Theron Advisory Group, and Member of STINT Think Tank.
About
Daniel Hackmann
:
Dr. Daniel Hackmann is chief advisor on business strategy and development, partner ecosystems, and high-tech trends at DWH Consulting. He specializes in go-to-market and growth strategies for high tech and service providers. His industry and technology expertise are on the use of IoT and IIoT.
About
Roland Bennett
:
Roland Bennett is a Medical Informatics consultant focused on extending clinical care into the patient's environment. Roland's focus has been on developing highly effective therapies, using low cost solutions like embedded systems and medical IoT.
The views presented in this article are the author’s own and do not necessarily represent the views of any other organization.