Last week, I had the opportunity to participate in a workshop and one of the leading digital technology companies in healthcare. We had people from academia, people from the industry, thought leaders, doctors, and oncologists among others at this workshop. One of the things we discussed was, why is it not simple for disruptive technologies to come in and disrupt the industry. And that’s a problem everywhere, right? I’m not saying it’s just a healthcare problem. If you look at something like blockchain, right, my favorite topic, blockchain has huge potential. And I was just finishing up an article on blockchain and its implications on data privacy, in healthcare especially. And I look at blockchain and said, Why did not blockchain which is just such a fascinating value such a promising disruptive technology, why did it not disrupt healthcare?
To delve deeper into the question, I started looking at it from a different lens, right? So if you look at another technology or another tech technology framework, which is your telemedicine, how did it disrupt healthcare? Now telemedicine had three aspects to it. There was a technology aspect there was video conferencing IoT Cloud then there was a process and protocols that now telemedicine was acceptable. There was the Medical Council of India and Niti Ayog are your guidelines on it. Some key aspects that were covered include
What could be prescribed?
What cannot be prescribed?
What should the prescription look like?
What are the disease conditions you can’t discuss, for example, you can’t prescribe antidepressants, and you can’t do certain kinds of sleep medicines over telemedicine?
That is a good protocol. And there was also this requirement for the telemedicine discussion or the appointment to be recorded. And in certain cases that are inserted into the longitudinal record of the patient, right, which continues as a health record for the patient. So what’s your process and protocol coming in place? And the third thing they did was a lot of training for doctors and nurses on how to manage patients on telemedicine. How to talk to them over videoconferencing how to interact with them, what are the guidelines, what are the do’s and don’ts, etc. So that’s how telemedicine has been around for the last 20 years. In many ways it was illegal and suddenly became legal suddenly became part of our daily health care system. If you look at something like blockchain, now blockchain is, as you know, another word for distributed databases. It has cryptography. It has encryption. And there also it relies on certain basic technologies like solidity. And I think we in healthcare, at least missed it right from the word go. First of all, there was no use case for blockchain that was coming out. Cryptocurrency remains the biggest use case for blockchain. And a lot of healthcare organizations were hoping that we would move beyond cryptocurrency. And we look at things like financial services and fintech where the cryptocurrency boom is essentially centered. But nobody moved beyond it. No use cases came out specifically for healthcare. There were a few around the supply chain, especially around track and trace of drugs. You know, Bill of Materials and inter-country remittances when you import medical equipment
Some ideas did emerge especially on paper for putting patient records on the blockchain, which was which is an interesting idea. But all of these were never developed into use cases. They continue to remain as theories or at best in the sandbox. environment, no service provider worked with a hospital to look at a use case, build the use case and then take that use case to production. And it never happened. Because that did not happen. There were no protocols or processes even discussed. How do I make a blockchain transaction part of the medical record or the patient record? How do I put it as part of my debriefing? Or my daily stand-ups with clinical staff or nurses.
To take it further, how can I put the prescription on a blockchain? And one thing interesting is, you know, it took a long time for auditors and the government leaders to accept ERP, a similar impact to make blockchain admissible, or as part of their compliance report or a blockchain will be signed up by the auditor. Those things were never even discussed, they were never even started, we continue to discuss the technology piece of it, which is great.
And almost every CTO worth his salt had something on blockchain or at least had an opinion, which is fantastic. But we never move beyond that. And here the fault lies not with the technologies, not with the doctors, not with the hospitals, not with the healthcare industry, but with our understanding of how disruptive technologies work and how they become disruptive. So, if you look at the disruption caused by technology, first of all, technology by itself cannot cause disruption, there has to be adopted. And for that adoption, there are two key parameters right?
One is the use cases that you develop. And when I say use cases, I mean, how it will be used, what will be the protocols, what will be the process? How will it be integrated with the business flow, or the clinical flow of the organization, those are very important. And then in addition to that, you need to have the right kind of talent. So when you talk about blockchain talent, we never had any pure-play blockchain talent both on the technical side as well as on the functional side. So we had people who are good at Java who also did blockchain on the side, and we have people who are .Net full stack developers who also did blockchain on the side. Or we had cryptography experts who did encryption in cybersecurity, who also understood how it works in the beast.
If this was a scenario on the technology side, the function side was even worse. And whoever was up you’re playing blockchain developer, but picked up by all the cryptocurrency exchanges and developers. So we didn’t have any functional experts or technology experts. With no talent and no strategy for talent, no policy for talent, how is technology going to be disrupted? Somebody has to develop those. So I think when it comes to disruptive technologies, it’s good to talk about all of them. But until we have the use case, and people process protocols in place, it will let us be a reality.
Today everybody’s focused on AI. Well, good luck. We probably will see a lot of narrow-use AI. But when it comes to general-purpose AI, we will still struggle. We are still struggling with 5G and understanding what are the implications of 5G in healthcare, Blockchain remains an unfulfilled promise. And the difference between adoption and successful adoption remains the process protocols and people. And all you have to do is look for look, look, look at the cloud as technology was available for about 15 years, maybe longer. But Cloud’s successful adoption in the industry started only in the last seven to eight years and healthcare was because of the pandemic. So we need the protocols and people then use cases in place we need the right talent.
As always will be happy to hear your views on the topic. Also last week I had written about how the Global Hunger Index data on India was flawed more on that article here. Also, do read SA Aiyar’s commentary on the same topic.