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Vision of 2020

What form will digitally driven healthcare take by the end of the decade?

Vision of 2020On a bitterly cold day in January 1921, a father carried his 14-year-old son into Toronto General Hospital. Leonard Thompson had developed type 1 diabetes and was facing the certainty of an early death.

Two doctors, Frederick Banting and Charles Best, had been taking an interest in type 1 patients, believing that the cause of their deaths was a failure of their bodies to produce insulin. They wanted to test their theory on a human being. It might work; it might not.

Leonard's father, facing the loss of his son in a ward surrounded by other children waiting to die, gave his permission for insulin to be injected. The first dose was a failure; it was not pure enough and made little difference. 

But they tried again and the result of that single second injection changed medical history and millions of lives. Leonard Thompson's blood sugar levels dropped to normal. He woke, got up, and went home. The doctors then went from bed to bed injecting other children. Diabetes, which had killed every human in history who had contracted it, had met its match.

Then, 87 years later, I rushed my own son Sam to hospital for him to be diagnosed with the same condition. In one sense, little had changed as type 1 diabetes has not been cured and insulin is still the treatment. The causes are still not known. 

But for Sam and all others with type 1 diabetes, and other diseases and conditions of all kinds and levels of seriousness, something has changed: technology. Its sophistication and its ubiquity in modern society has transformed the way type 1 patients approach the condition and their lives. Banting and Best would recognise the insulin used today, but not the delivery system; an insulin pump of extraordinary sensitivity, controlled wirelessly by a device that looks like a mobile phone, known as a personal diabetes manager (PDM).   

By 2020, a year just around the corner but not yet fully in sight, personal multifunctional devices (PMFDs) will be used to help keep everyone healthy. Hopefully, their role will not be to treat a chronic disease but to act as the gateway to knowledge about our own health and access to treatment. Our PMFDs will enable us to interact with our medical histories, to monitor our health in real time and, when something goes wrong, to allow doctors to 'visit' us online, eventually delivering drugs that themselves interact with the device and check in to register that they have been properly administered.

As between a third and a half of all patients do not comply with medical advice when it comes to taking medicines even when they tell the doctor that they do, knowledge of what is really going on will be invaluable to doctors in managing their patients and will help improve outcomes ultimately.  

This is not a fanciful fantastical vision of a distant future. Technology in healthcare is on the march. In fact, almost 70 per cent of physicians in Europe already use smartphones and belong to professional social networks. More than half use web video and recommend websites to their patients. A total of 90 per cent of adults across Europe rely on the internet to help manage their health and wellness and the majority of Europeans now use social media for health information. Therefore, by 2020, there is no doubt that healthcare will be digitally driven.

And the impact will be huge. The biological processes of our bodies will be added to the subjective judgments of our brains and then melded together to provide a fuller picture. Like home security systems, our bodies will use Radio Frequency Identification (RFID) technology to create instant medical alerts when something seems to be wrong. This information will be stored in our 'cloud-based' electronic health histories. 

Advanced genetic profiling will also become commonplace and will be held in the cloud. To a greater extent than ever before we are going to know what may be around the corner, as are those treating us. Screening and intervention will be part of life. Bad news, and good, will be known in advance. 

Even in terminal care we envisage the use of already invented 'mind-reading' technology to allow people to communicate their wishes and receive the care they want. Choice and knowledge will be delivered to a greater extent than most of us can imagine at the moment. 

But we will still be human. Under the cloud-based repositories of knowledge and clutching our wireless devices we will still live our lives with all the baggage of human existence, all the irrational fears and all the joyous hopes, all the passions and all the disappointments. It will still be us, with the same unwillingness to change.

Whether people choose to engage in preventative health activities is predicted by their age, sex, class, ethnicity and personality. They are influenced by the media and their friends. So, although people may know that sedentary lives are shorter or that fat is bad and self-examination is easy, they do not always make changes. Just an invitation to be screened can make some people worry, possibly because they fear that the invitation itself implies the presence of that illness. Others are anxious even when receiving good news. Perhaps they feel they are just putting off the inevitable.   

So someone, indeed many people, will need to be in the business of helping everyone live with, and prosper from, the technology that will improve healthcare. Simply handing us technology, unexplained and not moulded to our needs as humans, would be utterly disastrous. An entire generation of benefits could be lost to suspicion and resistance from the very people they are designed to help.  

If technology helps identify people who are not using their medication properly, but poor communication makes them feel persecuted or treated condescendingly, then the benefits of the 2020 world will not be fully realised. Human beings will find new ways to fail to comply. The same will be true of the wider messages about health that will flow from the greater knowledge available.

Like the SatNav in the car, the message needs to be personalised a little; male voices versus female, strict or friendly, but above all approachable and welcoming and using the language of inclusion and persuasion. The 2020 world must not be about bullying or hectoring. It has to be like the best broadcasting, focused on storytelling and empathy. The technology must sit in the background and that can only happen if the messages are crafted by humans, for humans. 

This is where communication takes centre stage in the medical world of 2020. The English comic writer Douglas Adams wrote once about how to recognise technology: 'A good clue is if it comes with a manual.' He was writing some years ago and in the modern age his words are no longer literally true. However, metaphorically, they are exactly right; when we use a complex tool we do not need to understand how it works, but we do need a sense of how we can get the best out of it, how it works for us, what it is telling us. We are still human.

So the level of sophistication of messaging will have to be increased hugely. General health prevention messages, or lifestyle advice, will be far more specific and tailored to the individual than at present. Risk will need to be explained in a way that does not frighten or patronise. This messaging will have to be delivered in the spaces where people engage as well.

For example, using gaming to communicate in ways that entertain and engage at moments when people want to be entertained and engaged. A clear path will be needed to communicate through storytelling and information visualisation (infographics). The provision of information will become an art and a science. 

The challenge is huge. Technology has already had a profound impact on healthcare and social media has greatly influenced the psychosocial context of health. Pharma will continue to invest in this technology at an accelerating pace and by 2020 all manner of benefits will be available that can only be dimly perceived today.

Some technology will surprise us with its usefulness or its failure to enhance lives, but it will be more important than ever to have the 2020 equivalent of Douglas Adams' manual. Investment must be made in guiding patients and healthcare professionals so that the focus remains the human being not the technology, the patient not the disease. Everyone in the healthcare world of 2020 must ensure that the true potential that technology can offer is realised.

Sarah GordonSarah Gordon is an associate director and member of the management team at OgilvyHealthPR (OHPR).

She has a degree in Biochemistry and Physiology from the University of London. She started out in medical publishing and worked in medical education before moving into PR at OHPR (then known as Shire Hall International) where she was a member of the founding team. In 1999, Sarah moved to Brussels to work in public affairs and then in 2002 to Washington DC, where she specialised in crisis management and reputation building. On her return to the UK in 2009, Sarah rejoined OHPR and recently collaborated on 202020 Vision, a report authored by David Davenport Firth examining where the trends in digital healthcare could lead by the year 2020

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26th May 2011


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