The Key To Health Care’s Success Post-Pandemic? Decentralization

Sarah is the CTO of Sight Diagnostics, a company transforming healthcare through fast, accurate and less painful blood testing.

Technology experts have long known that decentralized systems, while sometimes more unwieldy and expensive to manage, are far more adaptable and resilient to disasters. The health care industry has historically lagged behind in such reform, but the Covid-19 pandemic has entirely changed the way patients interact with their health. It’s clear to me that post-pandemic, we will see a shift toward the decentralization of care. 

Transforming Traditional Care Delivery Models

A clinical model based around a centralized hospital that provides diagnosis, treatment and disease management may no longer make sense. The American Hospital Association reports that hospitals are losing more than $50 billion per month as a result of canceling procedures and redirecting focus to treat Covid-19 patients.

In order to survive these bleak financial projections, hospitals should adapt their care delivery models. They should rethink their mission and strategy by extending care outside the four walls of the hospital and into the home and community.

The pandemic has made people afraid to seek out in-person emergency care and has taken a heavy toll on non-Covid-19 patients. For the estimated 150 million Americans living with chronic conditions like diabetes, asthma and heart disease, routine care is important for health maintenance. However, when social distancing requirements were put in place, nearly half of Americans surveyed in May delayed care.

There is an increasing need to adapt how care is delivered and to invest in technologies that digitize health data and bring diagnostics and treatments into the home or community. For example, remote-based testing kits for Complete Blood Count (CBC) — a common blood test used to check overall health — offer a portable format to deliver rapid and accurate results outside of a laboratory setting. Several startups, such as Sandstone and Everlywell, are exploring portable blood collections where the patient collects their own sample or a nurse visits a patient to collect blood samples and process the diagnostics remotely, eliminating the need for a patient to leave their home. Also, new “hot labs” with rapid testing equipment are being created in hospitals in the U.K. as a way to improve test processing times. These sites can be run by primary care physicians, and testing focuses on time-critical, near-patient tests.

In a decentralized care delivery model, this patient data must be digitized in a format that can be easily analyzed by artificial intelligence (AI) and shared across systems. For example, uses computer vision to turn a cell phone into a testing lab to allow patients to conduct urine tests remotely. A patient self-tests at home using an FDA-cleared stick, then uses a smartphone to scan the results and sends the data to a physician to provide a diagnosis. Advanced sensor technology can also aid in at-home recovery and help move care outside the hospital — a trend that I believe is inevitable given the high cost of treating patients in hospitals. States are also ramping up community testing efforts. For example, in North Carolina, the local Department of Health and Human Services has “released a Partner Covid-19 Testing Toolkit designed for organizations looking to host community testing events.” The Toolkit “offers guidance to organizations on practical considerations such as selecting accessible locations, securing supplies and personal protective equipment, working with medical partners and local health departments, and connecting individuals with appropriate support.” 

The Rise Of Telehealth

Delivery of care has been further transformed with the rise of telehealth. Telehealth has become the new normal for health care delivery during the pandemic and, in the U.S., there is now bipartisan agreement pushing for a permanent expansion of telehealth services.

Telehealth can fill the gaps in the provision of care or even help meet the increased demand for care to treat Covid-19 and non-Covid-19 patients who delayed chronic disease management or preventative care during the pandemic. However, telehealth cannot entirely replace in-person visits during which a physician can check and confirm symptoms and potentially identify other health concerns that the patient may not have addressed. Medical care is complex and fragmented, so in order for telehealth to support a decentralized health care system, the care should be integrated into the overall care delivery model with a central platform to feed and connect the data. Advanced sensors for health monitoring and home-based diagnostic technology can supplement care, but there’s work to be done to bridge the gap between telehealth and in-person care to ensure the proper patient follow-up and care coordination.

Responsibly Investing In Data Infrastructure

In a decentralized health system, it’s also critical to build the appropriate data infrastructure so that patient data collected at the hospital level is supplemented by system data collected at the community level. This requires a coordinated system at the government level to view the health care system as a whole and extract meaningful trends about population health, such as the spread of infection. 

The spotlight is certainly shining on the digital health tech scene right now, but this new way of health care provisioning will require significant investment in the infrastructure of building operations and logistics. I live in Israel, where our health care system has been digital for 20 years with ongoing investments from the government to make anonymized health data available to researchers and private companies. This digitization has created a large body of de-identified medical data that opens new opportunities in the analysis and optimization of patient treatment. With all records in a common format, AI models can mine the data and extract more actionable insights to inform more personalized treatments.

Any benefits of AI-enabled digital technologies can only be realized with coordinated care. The insights gathered from sensors and patient input from virtual care chatbots, for example, should be fully integrated into the care modalities of the entire system. I believe decentralization is key to transforming the health care delivery model to improve patient care and reduce inefficiencies and costs, but it will require an enormous amount of integration and analysis that only AI models can handle.

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