Through the Looking Glass

Author: Rohit Khanna

Source: PMLive

For the past decade, the topic of innovation in healthcare has dominated our collective conversation. Instead of focusing on traditional innovation, let’s look at where we stand in regard to non-traditional innovation. Let’s look at where it’s happening, why we should be hopeful about it and why we should still be staying awake at night.

In part, our current view of traditional healthcare innovation is captured in Figure 1 and this shapes much of our thinking. It’s centred on scientists working with test tubes and microscopes trying to come up with cures for really serious diseases. And this is still an image we should all hold in our minds. This is still a significant part of innovation in healthcare. Traditional innovation.

What about this notion of non- traditional innovation? Where is it happening? Well, where everything is happening, of course: social media. Let’s take Facebook as an example. Today, Facebook is changing the way we track adverse events and side effects. A concept known as pharmacovigilance. What does that mean? It means that when someone gets on their Facebook account and reports that they are feeling ‘sick’ after taking their medicine or that they have ‘redness on their skin’, we can code that as nausea or an injection site reaction. Facebook is taking unstructured data generated by users and attempting to codify it into meaningful information that can inform our decision-making.

Are there challenges? Of course. When is ‘sick’ just ‘sick’ and when is ‘red’ just ‘red’ versus being an adverse event. And how do we separate association from causation from just plain old meaningless noise. In other words, how do we know the drug caused the nausea or the skin redness?

What about Google? How are they innovating in healthcare? We know that people go online to search for health information more than ever before. And we know that these searches drive health literacy. Google’s core search engine continues to evolve, and its algorithm continues to bring richness in terms of search query contextualisation and relevancy to users. And from an innovation standpoint, this matters. Research shows that people who are better informed about their health status are more likely to have better outcomes. In fact, lower levels of health literacy have been consistently associated with increased hospitalisations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to take medications appropriately, poorer ability to interpret labels and health messages and, among seniors, poorer overall health status and higher mortality.

So, why do we stay awake at night? Well, some estimates suggest that upwards of 60% of online health information is incorrect, incomplete or purposefully deceptive. And, we also know that paid search results that vault to the top of a page can have a profound effect on what the average patient sees and believes (see Figure 2). So, when your neighbour’s kid invents a psoriasis cream in his basement and, through the magic of search engine optimisation, his product is now seen on page 1 for any search query that includes the search term ‘psoriasis treatment’, we have a problem. Given that well over 80% of health seekers never get past page 1 of a search query, we need to find ways to better ensure that search results are organic and not paid.

Lastly, what about Yelp? What’s so innovative about rating your doctor? Well, in a world where you believe that quality drives demand and demand impacts access to healthcare and allocation of scarce resources, this is really meaningful. Yelp and other such sites have the ability to fundamentally change the way patients select and ultimately access their care.

But, what keeps me awake at night? We know that patients are not great at distinguishing between high value and low value healthcare. In other words, we don’t know a bad doctor from a good doctor most of the time. And because of this, we are unable to risk adjust a doctor’s practice. Maybe this doctor is seeing the sickest patients. The patients that no one else wants to see. And because of this, maybe this doctor is always running late and has a disorganised practice. And because of this, maybe you are impacted and you rate this doctor negatively. It is difficult to make an apples-to-apples comparison between two doctors if we don’t understand these nuances.

In the end, I remain hopeful about healthcare innovation despite the challenges. And I am reminded of the saying by British author Douglas Adams who said of innovation: “I may not have gone where I intended to go, but I think I have ended up where I intended to be.”