Can information technologies revolutionize health care?

New technologies have the potential to reduce costs, expand access, and improve health services, but require agile and efficient government action in regulation and infrastructure.

Fernanda De Negri

Presumably, the most visible benefits of advancing scientific knowledge are in health. A person born in the late eighteenth century would most likely die before he or she turned 40. Someone born in a developed country today is expected to live more than 80 years, and although inequality is high, even in the poorest countries of sub-Saharan African, life expectancy is now over 50 years.

Science and technology are the key factors in explaining the reduction in mortality from various diseases, such as infectious diseases, and the consequent increase in human longevity. Until the first quarter of the last century, diseases such as pneumonia, tuberculosis, and diarrhea were the leading causes of death, responsible for almost 30% of mortality in the United States. In the 1900s, infectious diseases killed between seven hundred and eight hundred people per 100,000 inhabitants every year. It was the discovery of penicillin that was primarily responsible for the drop in mortality from this type of disease, which now kills less than fifty people per 100,000 inhabitants.

Main health challenges that need to be addressed by countries, according to decision makers (In % of respondents)

figure 1Font: Economist Intelligence Unit.

Nowadays, increased longevity has brought other problems, such as chronic and more complex health conditions. As the population ages and the demand for better living conditions continues to rise, health care costs are rising substantially. Between 2000 and 2015, global health spending went from 8.6% to nearly 10% of the world's gross domestic product (GDP). In developed countries, this figure is even higher: in the United States, for example, health spending reaches 17% of GDP.

In fact, decision makers interviewed by The Economist magazine's Intelligence Unit in several countries have revealed that the health-related issue that concerns them the most is the cost of health care. Inequality of access to health services and care for the elderly appear in second and third places, worrying 29% and 23% of respondents, respectively.

Information technologies represent a promising alternative for reducing costs, expanding access, and improving health services. The promises are numerous, to the point that The Economist magazine published, in February 2018, an article declaring that a health revolution is coming. Using cell phones and other devices to monitor chronic health conditions, such as diabetes, and alerting patients of the need for action before the situation becomes an emergency are some of the simplest examples of how these technologies can be impactful.

More and more patients will have greater control and knowledge about their own health, which tends to help prevent acute incidents. Mobile apps can also stimulate healthier attitudes towards eating and exercise, preventing diseases and chronic health conditions. Mobile apps are even being used as a contraceptive method. Recently, European regulatory agencies approved an app to be used for that very purpose, with a level of confidence similar to that of traditional contraceptive methods.

Far more promising, however, are the technologies that can be developed from the large and growing availability of disease and patient information. The use and sharing of patients' medical records are key in this process. A patient's complete access to these records and the ability to share them with trusted professionals can be a great tool in reducing healthcare costs. Many health expenditures are inefficient, stemming from the lack of information and the repetition of unnecessary tests. Accessing and sharing medical records has enormous potential to reduce these costs.

In the long term, the use of millions of peoples' health records for research purposes can revolutionize our understanding of diseases and the ways we diagnose a range of health problems. It is estimated that around 250,000 deaths per year, in the United States, are due to medical errors. Using artificial intelligence tools can help establish more consistent and reliable service protocols. In the future, artificial intelligence may, for example, provide automatic diagnoses based on reported symptoms, or measured by real-time health monitoring devices.

An example of how the vast amount of available data is being used for disease diagnosis is a company called Guardant Health, a startup that is analyzing a large amount of medical data in the hopes of developing a way to diagnose cancer from blood tests. If successful, the company can reduce the costs of diagnosing the disease by requiring less use of imaging equipment, which is quite costly to use.

Precision medicine, tailored to each patient based on their genetic profile, lifestyle, and health indicators, is another branch of technological advancement that is made possible by the large availability of patient and disease data. All of these technological routes are disruptive and have enormous potential for cost savings and increased efficiency in health care, which is of interest to all of society.

It is not difficult to see, however, that the competitive advantage to innovate in this market is access to information. Patients' medical records, as well as technologies for data processing through algorithms or statistical models, will be the great competitive differential for companies that want to innovate in this area. It is no coincidence that the information technology giants, Apple and Google, are entering the market strongly.

Apple, for example, is developing an app called Health Records, which aims to facilitate patient access to medical records coming from various service providers, such as blood tests, images, vaccines etc. Google owns several health-focused startups, such as Alphabet, and a British company, called DeepMind. The latter, specializing in machine learning, has developed, for example, algorithms aimed at early detection of vision problems that can lead to blindness. In addition, in partnership with a large British hospital, which shares its patients' medical records, it has developed a method to identify patients at high risk of kidney failure.

The potential and promises of these new technologies are enormous and can be extremely beneficial to society as a whole. Given this, how can countries stimulate the emergence and accelerate the diffusion of these technologies? How can we do this while still safeguarding patient privacy and preventing the concentration of information and knowledge in the hands of a few companies?

The health sector is extremely regulated. So, the first big challenge is precisely that: regulation. New devices that monitor vital signs and patient health, for example, need to be approved by regulatory agencies. Similarly, new medications or personalized treatments need to go through a similar process. Making these regulatory agencies agile and efficient to cope with the rapid progress of new technologies is a challenge worldwide.

Another crucial issue is the relationship between access to information and privacy, derived from the massive use of patient medical records, whether for research or for prescribing treatment and procedures. How can we enable the advancement of knowledge provided by the use of this data while at the same time ensuring the privacy and confidentiality of individual information? Most importantly, it is necessary to think about how we can ensure that information is not concentrated in the hands of a few companies, which would reduce innovation in the future.

An additional challenge, especially for developing countries, is the infrastructure for collecting and storing information. Brazil's Unified Health System (SUS), for example, is the largest public health system in the world, and therefore, a gigantic source of health information. However, the implementation of electronic medical records runs into simple problems, such as the availability of basic infrastructure: computers, systems, and broadband access.

These are all critical aspects in which agile and efficient government action can mean the difference in whether or not a country is a relevant player in the area of health, and whether or not it is possible for the country to reap the benefits of new technologies.