Digital health’s last mile problem

In my book, The Big Unlock, I describe the four major categories of technology providers as Custodians, Enablers, Arbitrageurs and Innovators. Each of these categories of providers has staked a claim to reimagining the digital future of healthcare.

First, the Custodians: These are the big electronic health record (EHR) vendors like Epic and Cerner who have the data and the workflow. As systems of record, they enjoy the long-term strategic commitment of the health systems they serve and are the first port-of-call whenever a health system decides to enable new functionality for enhancing the patient and caregiver experience. 

Systems of record have certain limitations and are arguably weak in several areas, such as advanced analytics, which is critical for a digitally reimagined healthcare experience. Along came the Enablers to address this problem. Big technology firms such as Google, GE Healthcare, Microsoft, Salesforce and IBM’s Watson Health business have built technology stacks that integrate multiple emerging and traditional data sources, including EHR systems, and have incorporated some proprietary data sources as well, such as images in the case of GE Healthcare.

These big technology stacks include inbuilt advanced analytics capabilities that can deliver insights to power digital health experiences. Google’s Deep Mind, for instance, recently analyzed eye scans from over 125,000 patients to build an algorithm that could detect diabetic retinopathy, the number one cause of blindness in some parts of the world, with over 90 percent accuracy. The company claimed the accuracy of the analysis was on par with board-certified ophthalmologists.

The Arbitrageurs are mostly technology agnostic consulting firms such as Accenture and Deloitte, as well as India-heritage firms such as Wipro and Infosys, that rely on information and labor-arbitrage models to build digital experiences from scratch using the preferred technology tools that exist in health systems.

The Last Mile problem

All three categories of technology providers described above have stopped short of building ready-to-deploy digital health experiences, which leads us to the Last Mile problem in healthcare. Despite the powerful computing and data analytics infrastructure that big technology firms have invested in, there is a shortage of viable, proven digital health experiences for health systems and their key stakeholders in healthcare delivery i.e. patients and caregivers. The challenge – and the opportunity – has fallen to the fourth category of technology providers, namely the Innovators.

By definition, the Innovators are typically startups that have come up with a whole new way of addressing an existing problem with technology-enabled healthcare experiences, or for filling a gap in the current healthcare experience with technology. Digital health startups raised an estimated 11.5 billion in 2017, and money continues to pour into the sector, despite the slow pace of exits. Despite the promise, a report by IQVIA indicates that while over 318,000 health apps and 340 consumer wearable devices are now available worldwide, 85 percent of the apps had fewer than 5000 installs. The few apps that did reach critical mass demonstrated strong clinical evidence, robust integration with the established workflow integration, and high user ratings – prerequisites for any digital health solution looking to break into the health systems marketplace.

Addressing the bottleneck

The need for last mile applications is enormous, and yet the innovation ecosystem has not built and implemented viable applications fast enough and at scale to meet the demand. Common challenges include:

• Extended cycles to hit prime time usage: most health systems follow a traditional approach that takes promising new solutions through the phases of a free pilot, paid pilot, and enterprise adoption. The process could take years, and many solutions remain in “pilot purgatory” for an extended period, often failing to break through to enterprise adoption. Health systems need a newer, more agile model, to assess and deploy promising solutions more quickly and efficiently
• Too many standalone solutions: the digital health landscape is littered with thousands of point solutions that stand in isolation, with no established connectivity to systems of record which is the price of entry for any new solution. Health systems are loath to sign up dozens of point solutions and take on the burden of integrating and managing these solutions. They prefer to default to the many solutions that EHR vendors have built or are actively building (or claim to be building) that effectively make stand-alone solutions redundant, despite the superior experience architectures that startups are known for. A potential approach for startups is to align with one of the big Enabler companies who, through established relationships with health systems, can create a pathway to adoption and growth.
• An absence of scale: No single platform addresses all the needs of a digital health enterprise today, unlike the mature enterprise resource planning (ERP) systems of the manufacturing and financial sectors. There is a significant opportunity for Enabler companies to build ready-to-deploy innovation ecosystems through partnerships with digital health startups. However, Enabler platforms too have increased and are at risk of becoming too fragmented to present a real alternative to health systems looking for scale and velocity in the digital transformation journeys.

The digital transformation of healthcare is in its early stages, and the gold rush is underway. Wanted: creative approaches to solving the Last Mile problem and unifying the fragmented ecosystem of point solutions and stand-alone technology enablement platforms.