Healthcare today is reactive meaning that it delivers emergency care to conditions that it already knew existed. Exacerbations (worsening of symptoms) of chronic diseases is expected and if the patient was involved in his, or hers, own healthcare, those exacerbations could in most instances be predicted saving money and avoiding unnecessary suffering. The patient is after all the only one who knows the exact symptoms and how the symptoms affect daily living.
8 of 10 Swedish Krona in healthcare is spent treating the chronically ill. As comparison, 0.3 out of the same 10 Swedish Krona is spent on preventing those exacerbations.
According to a report from Swedish Statistics, back in 2010, each person working provided for 0.71 person not working. In 2020 the same number is up to 0.78, an increase of 10 per cent. The population pyramid is starting to look more and more like a population tower.
Predictions from OECD says that in 2030, the number of employees in healthcare will decrease with 30%.
We, the society, is setting up an equation that can’t be solved with prevailing paradigm within healthcare.
The upcoming challenge in healthcare is that fewer people needs to deliver an enhanced care to a population spending their life in quality management organizations and hence expect it in their healthcare?
The statistics above is for Sweden but it is similar in most parts of the western world and in a decade or two, it will become a global challenge.
What needs to be changed?
Politicians in Sweden are still supporting the reactive paradigm in healthcare. There have been efforts made in reducing time of care, earlier discharge from hospitals without a satisfying follow up. This has led to more readmissions, higher costs and increased suffering for patients.
For the chronically ill patient it means that they get less time when visiting their primary care unit. Primary Care Units reimbursements are based on how many people they have medical responsibilities towards and how many visits they can squeeze in in a day. For the chronically ill this is devastating. It is easier, quicker and more profitable to take a few blood samples rather than listening to the patient. If the blood samples are negative the chronically ill patient can go back home. The major problem here is that often this means that the patient develops an exacerbation that most likely means admission to a hospital. Once again, increased costs and unnecessary suffering for the patient. Several surveys among chronically ill shows that this group often feels neglected and unsafe in their daily activities. Wonder why?
So, the change needed is that healthcare professionals take their time and listen to patients, read up on their medical history and not only provides the urgent healthcare but also take the time to start a rehabilitation plan? Well, it would be a great solution in a perfect world but the facts are clear, we have less healthcare professionals that need to produce more with a higher quality to a more demanding population.
No, the change needs to be more profound, changing focus of our healthcare from a reactive stance to a proactive stance where prevention and prediction is in focus.
Healthcare today invests billions of Swedish Krona into cutting edge technology in areas like imaging, surgical robots and so on. Thus, we know that healthcare professionals aren’t technophobic.
A thought: What if we invested some of that money in low technology and make that technology available to all citizens?
Having a healthcare where the individual is in focus, taking a supported responsibility for their own health? The support from the healthcare system is delivered when you need it and it ranges from complete rehabilitation programs to a simple motivation when needed the most.
Investing 1500 Swedish Krona into every household would mean that we, in ’folkhemmet’* could do a simple test checking our blood pressure, heart rate, activity and other basic parameters, answering a short questionnaire and have all the data added to our medical records. How many people would we find with high blood pressure? Depression? In risk of myocardial infarction?
Today we have the technology needed and it is affordable. Spending 1500 Swedish Krona gives an individual the tools needed for assessing several vital parameters.
A majority of the mobile phones in Sweden are smartphones and they could act like a hub for the devices and also for easy communication with healthcare professionals. The smartphone would also have a questionnaire that is ‘smart’ asking the right questions at the right times.
A proactive healthcare would generate massive amounts of data**, too much for any human to handle. This is where emerging technologies in artificial intelligence will play a big part. Today we meet artificial intelligence everywhere, in our phones, cars, computers, and virtual assistants and so on.
Once our data is processed it will be put in context with all of our previous reported data, showing patterns, changes and information that predict a change in our health status. The AI also takes other contextual information into account, what time of year it is, reported numbers of influenza cases in the patients proximity and so on and so on.
When the artificial intelligence has processed the data it is shown to a healthcare professional emphasizing which patient should be contacted first. If the patient receives medical advice or treatment this is also added to the medical record letting the AI follow up on the patient, reminding him or her to do certain assessments at home, and deliver the right motivational messages when they are needed.
This means that we, both as patients and as healthcare professionals don’t have to spend our time trying to come up with a logistical plan to make ends meet. Instead as a patient, we get instant advice and, in the near future, instant treatment and in the data driven care, healthcare professionals gets augmented capabilities and expertise when treating ill individuals.
*Folkhemmet - political concept from the 1920’s meaning ’a home for all, characterized by mutual understanding and equality.’
**Swedish population approx. 10 000 000. Extremely guesstimated amount of data per individual = 10 Gb/year. That’s an annual collection of 10 Petabytes of data.
A study from University of Cornell showed that continuous collection of ECG, 3 axis accelerometer, 3 axis gyroscope, oxygen saturation and breath rate was about 30 kb of unprocessed data per second.
Image from Stockphoto.cc