Global Health Innovation and the Paradox of Choice in Healthcare (Hassan Chaudhury)

Which innovations are reasonable to implement in healthcare today? And which technologies are currently not ready for prime time just yet?

Hassan Chaudhury is a global healthcare expert, he worked in several countries across the world. He currently works at Healthcare UK; a joint initiative of the Department of Health and Social Care, NHS England, and the Department for International Trade (DIT). His global role includes advising commercial teams in over 100 UK embassies. In this discussion, we chatted about the digital transformation of healthcare and social care in the UK and Hassan’s experience with countries across the world. In his view, we still haven’t found a valuable application for blockchain in healthcare, he believes we have many low-hanging fruits to tackle before voice technology will see its prime time. As for markets, there’s plenty opportunities in China, he says.

Here are a few questions with time stamps from the discussion. Tune in to the full episode in iTunes or Spotify.

[00:04:33] Tjasa: Your current role is with Healthcare UK - a joint initiative of the Department of Health and Social Care, NHS England, and the Department for International Trade (DIT). However, you're a social worker by background. What do you observe in the UK or elsewhere, related to bridging the tech gap between social care and health care to create a holistic approach towards care?

[00:05:36] Hassan:  Historically, social care has been the poor in relation to healthcare. To date, we've only really focused on health when someone's gotten ill. We've been reactive. We're not doing healthcare, we're doing sick care. So the challenge for us is how do we look after people when they get ill? And that's the wrong challenge.

The real challenge is how do we support people to live well? We shouldn't wait until they get ill. We should be supporting them. That's why care and health need to be connected and integrated. Unfortunately, that's not something that we've done well. Often we discharge a patient from the hospital. They go back to their care home. The information doesn't follow them properly. It doesn't go into an electronic care record, a health record. There's no personal records for them that they can maintain. And therefore all the data gets lost. We can't be predictive. And if you can't be predictive, you can't be prescriptive.

[00:07:02] Tjasa: How might we integrate the data from community and healthcare in the hospital setting or the primary setting? What kinds of trends are you observing there in terms of a comprehensive electronic healthcare record that would be shareable, patients would have access to, and control over? From the sociological perspective, it's really difficult to expect that different organizations are all going to come together under one roof and in one network. During the short boom of blockchain startups the ideas about a comprehensive health record started shifting toward the patient, in the sense that maybe you could have a healthcare record on your phone, but you would just be the one adding the data in it. How do you see that, and the infrastructure challenges related to personal health records (PHRs)?

[00:08:30] Hassan: The data has to follow the person. Imagine someone goes to the hospital and they have an appointment for dermatology, but they also have a separate illness. So maybe they're going to see somebody about HIV, two completely different areas. But the patient also has depression and they're dealing with it in primary care. That means the primary care has one record. The hospital department for dermatology has a record. They're also on the HIV record in the community.

Until you gather around the citizen, around the person, they're always going to remain silent. And because of the current concerns about data security and privacy, we don't want the data to move. So what we need is a record that follows the person and has windows into it. And each window is related to what you're looking at.

[00:12:21] Tjasa: You visited HIMSS that was taking place in March in Orlando. What kind of trends caught your attention?

[00:12:29] Hassan: Three things come to mind. There's much more fear around cybersecurity. Lots of fear, not just because of what's happening with Russia and the Ukraine, but not long ago, Ireland’s health services were hacked by a ransomware attack. And that's the kind of thing that scares everybody.

When Wannacry happened a few years ago to the NHS, I remember the NHS digital team went to GCHQ, which is the government agency for cyber [00:13:00] and GCHQ said to them sure, we'll help you. We have one and a half people available. GCHQ didn't have people with healthcare background or enough of them to support. We've had to go to private agencies and companies and temporary execs were the ones that helped NHS digital. And that's what we need now.

Every single country in the world needs to make sure that they're protected and they've got the reserves. Another topic on the minds of people at HIMSS was interoperability. Health inequalities as well. Those are the three things that I saw that was very different from previous years.

[00:14:46] Tjasa: You're working with several organizations across the world. What are the decision-makers and those that are implementing these solutions struggling with most when deciding what to implement in healthcare? If we look at investments, according to StartUp Health, digital health startups raised a 22 billion USD in 2020, twice as much in 2021. CB Insights even recorded higher amounts. In one of the sessions at HIMSS STAT reporter Casey Ross mentioned that there are over 80 unicorns in digital health space in the US. How can we make choices?

[00:15:40] Hassan: First there's too much noise. Many companies are saying they're good. And they're saying, look at how much we've raised. And I think CIOs are becoming wise to this and saying, I can't take all of this noise. Can you solve my problem? They are looking at solutions that fit in their broader strategy.

[00:28:08] Tjasa: You either worked with or visited over 100 countries. Based on the experiences that you had so far, can you name any interesting examples of how you perceive other healthcare systems?

[00:28:34] Hassan: Most digital health companies would eventually go for the US or China. That's where the money is. In the US they're very good at taking something and commercially packaging it. So if you get acquired or invested in by an American company, you're going to do a fantastic job of becoming [00:29:00] a world-leading product, other countries aspire to. In the middle level I would put France, I would put Germany. And then you've got the smaller countries Israel, Estonia, Finland, South Korea. Singapore wants to be in that zone too, then underneath it, the countries that need more help. So weirdly I would put Austria ahead of Germany, right? I think Germany is big, but Austria is more advanced. When are we going to see countries from the GCC? So Dubai Abu Dhabi are starting to export out. We've got lots of companies going into the Gulf countries and their systems are becoming quite cool. But when are we going to [00:30:00] see them developing? So some countries are really about pushing their tech out because they are so good. And those are the ones that are the most interesting.

[00:30:46] Tjasa: I find it interesting that you mentioned that digital health companies would eventually want to land in China. The objective for the US is clear, but China is much trickier. They're very competitive. They're very hungry for innovation and success. The culture, the language is specific. There's just so many barriers that I see that I find it hard to imagine how you would even start considering that market and how long would even take you to enter it?

[00:31:24] Hassan: China wants you to come in so they can work out what you do, destroy you and defeat you and be better than you. The goal is we might not be as good as you now, but give us three years, we're going to be better than you. China very much has that feeling. So the opportunity for good technology really clever technology to get into China and make lots of money is available. But the goal for China is we're going to learn and we're going to beat you. We're going to have more AI papers than anyone in the world, and they are now more publications in AI than the US. More money available. The size of the market is huge. So the opportunity for companies is: Do I avoid the Chinese market knowing that they're going to try and accelerate or do I just enjoy the ride? How do you take China? Even Coca-Cola had to go regionally in China because it's that big of a market. You have to go slowly. The challenge culturally is that China doesn't traditionally have primary care. Their goal has always been, I'm going to see a doctor and if you're not a doctor, you're not good enough. I want to get to the hospital. But they've done something interesting where they've got everyone on the mobile phones. So Ping An Good Doctor. And now everyone is able to access health care on their phones. So they've jumped an evolutionary step into the modern world, but they've missed out their primary care bit, which is where Israel, Finland and Britain would argue that we have strength.