Digital transformation is at the core of the fundamental change all branches of trade and industry are undergoing. Capgemini recognizes digitization as the key opportunity. Arguably it is an essential cornerstone to adapt to future challenges.
A digital approach promises significant potential, especially within the medical and health insurance sector. The processes underpinning the buzzword “digital health” are focusing on tracking and managing the personal health and health details of close relatives and family members. The aim is to improve health management for both patients and service providers. Digital health provides the chance to facilitate personalized medicine at lower cost. Furthermore, digital applications allow cross-disciplinary work and easier access to international expertise regardless of location.
The health sector cannot currently be considered a leading sector in terms of digital progress. Nonetheless, the political agenda as well as the sector’s circumstances afford a high priority to driving the digitization of the health sector in 2019.
According to the German e-government act passed in 2013, all medical information should be held in digital format by 2021 in a so-called electronic patient file (ePa). While the concept of the ePa is not new, the approach did not previously garner widespread recognition for several reasons, especially because of concerns regarding data privacy and security. Customers don’t feel that technology can provide the required levels thereof yet. This reticence towards the electronic sharing of details was fueled by several high-profile privacy breaches and by the misappropriation of data, resulting in the uncontrolled use and distribution of personal data. An additional factor is the age structure within the general population. Germany is still dominated by older generations that had not grown up with digital technology. Another crucial issue is created by the sector itself since the lack of standardization across medical services and health care providers has created plenty of applications based on numerous, varying, standards.
Increases in life expectancy have led to a disproportional increase in demands on the healthcare sector. The limited answers that have been developed so far tackle the challenges insufficiently. Digitalization provides a key opportunity. The past years have shown significant development in the digital health sector paired with a distinctively amended political framework. The General Data Protection Regulation (GDPR) has significantly improved data privacy. The ability to streamline processes within the healthcare sector and improve the way in which patient data is handled in terms of both speed and consent can be realized thanks to the GDPR. In order to overcome reluctance towards the ePa, both within the sector and among the general population, it is necessary to take full advantage of its multidimensional potential. The health sector is complex, with numerous and varied stakeholders. While the patient is at its center, medical professionals, hospitals, pharmacies, insurance companies, and health authorities form essential components. In addition to these, pharmaceutical companies and medical research centers/organizations are creating a second focal point as they revise their business models, which are based upon research, development and the production of new drugs and medical devices.
The phrase “beyond the pill” already encapsulates the core thrust of the pharmaceutical industry towards broadening their portfolios beyond drug research and production. This is also the segment that has drawn the interest of startups developing health-focused apps or driving further technological developments. The health sector as such is increasingly attracting attention from companies that are branching out and are not traditionally seen as part of the sector. One example is pulse-measuring smart watches or fitness tracking watches, some of which are officially registered as health applications. This emerging market, known as “wearables” enables each one to become a ground-truthed data source itself. Wearables are anticipated to log data points, such as heart rate or blood sugar levels. Under ideal circumstances, these data points would be directly logged with a Mobile ePa app. Regulatory requirements and technical skills would be covered to collect and manage individual’s personal health related data.
Within such a Mobile ePa App, all data points would be accessible via various visual and data options. The patient would then be able to provide or revoke access to institutions for whatever reason. Medical professionals would be able to base their examinations on a patient’s health data and adapt their diagnosis and treatment suggestions accordingly. Furthermore, a health care app would also allow for a virtual consultation, providing relief to crowded waiting rooms. It would also allow access to health care in low-coverage areas. This wouldn’t meant that patients would never have to set foot in a doctor’s office again. It would simply mean that checkups could occur less frequently.
GP hospitals would also be able to assess a patient’s current health status, previous or current medication, and any previous health-related information. Furthermore, billing and linking health insurance is not only feasible but already applicable. Individual, tailormade offerings as well as changes to their premium structure would provide a source of additional potential for insurance providers. Pattern recognition and the identification of high-risk groups would also become significantly easier.
The crucial point is that any release of any part of a patient’s personal medical data is managed by the patient themselves, whether this release be to the GP or for anonymous clinical trials. In the latter case, the regulated environment is largely organized by the clinical research organization (CRO), but it also demands that neither the test subject nor the sponsor/pharma company are known to each other. The direct link of test subject and test subject ID can only be done by the research organization. Each study requires dedicated consent from the test subject. This informed consent (IC) is only ever valid for the particular study for which it had been sought, meaning that the pharma companies that hold data from previous studies are not allowed to use it for a new study without additional approval. This entails significant communication efforts which must go via CRO. With Mobile ePa App, patients could decide quickly and easily whether they want to participate in a certain study and provide the IC via, for example, digital fingerprinting.
If the Mobile ePa App includes a “clinical trials” subsection, the management of trial participation, data release, etc. would meet regulatory requirements. Pharmaceutical companies would be able to publish actively and more prominent their need for test study participants which would be made available to patients/potential candidates in an anonymized form via mobile app. Additionally, related topics, such as information on, advice and questions about IC, could be placed with specially selected practitioners. Incentives for participation could also be provided both by the pharmaceutical and insurance companies. Options such as discounts on expensive medications would provide incentives even though this would raise significant moral questions. Test subject recruitment and retainment would be supported, reducing expenses incurred in the long run. The key requirement for all these scenarios is the adequate encoding of data which makes anonymized communications possible. All of this would be covered by the use of the Mobile ePa App through privacy-enhancing technology, which is focus of the German tech startup MADANA. It is essential that the Mobile ePa App supports easy user handling ensuring automatically the highest level of data privacy security.
A further component of the Mobile ePa App is real-time data sharing. This could support further research and enhance existing medication. Real-world evidence (RWE) could potentially be used as credit for insurance premiums, medications, or other discounts, for example at a health store. Moreover, prescriptions could be more easily handled, and refills handled automatically at the patient’s preferred pharmacy.
Currently, communication and information management are cumbersome and time intensive. This is due to the limited harmonization within the healthcare sector and the IT solutions used. The ability to reduce friction and to streamline processes once all actors use the same platform or standards for their day-to-day business is important. While this may be interpreted as blue-sky thinking, technology is already able to map the requirements today. While providing a GDPR-compliant solution, the exchange of data and documents could be simplified as well as sped up.
The Digital Health Platform, which is currently being developed by Capgemini and MADANA, fills the outline requirements. Combining the characteristics of a platform solution with blockchain technology provides a unique setup. Members of such a platform can both share their data with other users and access the data shared by others. As is standard within blockchain technology, the data owner owns the privacy key for their own data and can allow or retract access. However, this access does not extend to copying or transferring data as this would lead to an uncontrolled perpetuation of data. Data is always held on the respective home servers. This method allows for a high degree of data security and data sovereignty. Additionally, any data transfers are logged via distributed ledger technology. The user can individually decide to release their data, to whom, and in what format (open, anonymized, etc.).
In addition to the patient, all other stakeholders, such as pharmaceutical companies, health insurance companies, and regulatory authorities can take advantage of the simplified and expedited processes. The assessment of large-scale anonymized data under these new processes could make it possible to identify new patterns or high-risk groups. This would be a significant improvement, especially for insurance companies and hospitals. Personalized service offerings would both support high-quality health care and reduce costs in the long term.
In summary, considerably more stakeholders have a dedicated interest in valuable health data than previously assumed. Capgemini and MADANA have recognized this and created the Digital Health Platform as a future-orientated concept to support all stakeholders within the healthcare sector on this journey.
By using a patented blockchain technology, the Digital Health Platform bridges the gap between idea, regulation, and digital innovation.
‘Fabian Rusch is part of Business & Technology Solutions Life Sciences & Chemicals in Capgemini. As Life Sciences Subject Matter Expert he supports clients during their Digital Transformation Journey especially in the area of Research & Development (R&D). You can contact him at firstname.lastname@example.org or +49 151 4025 1120.’