What is digital healthcare?
Roni Zeiger: Digital health is two things coming from different directions. Within the healthcare system, digital health is about doctors and hospitals and all the other workers and facilities using new digital tools to do their jobs better. Perhaps more interesting is what is coming from outside the healthcare system. We have solutions, entrepreneurs who never thought they would be in healthcare who are now realising that they have the ability to create something that would be really useful to people and improve their health. These things are colliding a little, they work against one another. But they are increasingly learning how to collaborate, and this is where the real magic will happen.
How can big data and healthcare fuel each other?
I’m not sure if there’s another area where we have the same combination of a tremendous amount of data and so much learning that we haven’t yet exploited. Healthcare is a very traditional field where we rely a lot on the experts and their opinions. And it’s actually quite new that we’re beginning to understand that experts don’t always know everything and that we need to combine our human expertise with the ability to learn from data, and not just traditional, slow, expensive randomised trials, but also the data we can now collect in massive, efficient ways. We’re really beginning to see a revolution in healthcare because of the presence of large sources of data and our technical and cultural ability to learn from them.
Will the Internet make healthcare more transparent?
My time at Google taught me many things. One is that we have to be willing to take risks and do things where failure is quite likely, because otherwise we’re not trying hard enough to discover or create the next big opportunity. The other is that there’s no such thing as a one-man show and that a multidisciplinary approach is really critical. Before my work at Google I’d really only worked inside the healthcare system. And combining the creativity and the knowledge, the problem-solving abilities, of people from different disciplines to – in my case – help solve healthcare problems taught me that I will never again be willing to work on a team that isn’t multidisciplinary. It’s short-sighted and doomed to failure.
What did you learn from your time as Chief Health Strategist at Google?
The Internet is beginning to help make healthcare more transparent. The problem, however, is that unlike restaurants where it’s pretty easy to not only put reviews, but also the menu with the prices online, in healthcare we can’t do that because we don’t even know the costs of the care we’re providing. As a practising physician, when I order a test or a medication or make a referral, I actually don’t know what the cost is. It is essentially hidden from me and is in the hands of only a few administrators or bureaucrats, who would charge more if they can do so. So we still live in a world that’s inside of itself, is not transparent, and we’re limited in our ability to make it more transparent. I think one thing the Internet is doing is pointing that reality out and making more of us realise that we need more transparency in healthcare, because we now have tools and a culture that demands it. But it’s going to take us another decade or so to get to the place where other industries are today.
Why is there no Tripadvisor in healthcare?
I’m not sure that we are anywhere close to seeing a TripAdvisor for healthcare, at least not a good one, because healthcare has some very important subjective and some very important objective components to it. If I’m going to have a procedure or another healthcare experience, I want to feel comfortable having that procedure done to me. I also want to make sure that the technical result is good. TripAdvisor works very well for purely subjective experiences, like what will be my experience in a hotel. But objectively speaking, it’s not important to know exactly how many hours of good quality sleep I will get in that bed. With healthcare, on the other hand, I not only care about my subjective experience, but I want to know objectively that I’m likely to survive and become healthier, depending on the nature of the procedure or the intervention. And that’s something we don’t actually have good data for yet.
Can digital health help to solve the problem of rising healthcare costs?
Digital health is beginning to and will dramatically change the way in which we practise medicine. I expect that in the next five years I will more often be prescribing a digital health intervention, for example, for depression, than a depression medication. And that’s not because we have such amazing digital health interventions coming, but we have some new ones, and antidepressants only work okay. The bar is therefore low in many cases, and many people would prefer to have, for example, digital counselling or a virtual reality intervention to help them reduce the anxiety they feel in certain situations rather than take a medicine that has side effects and an imperfect success record. I think digital health is going to explode as we begin to measure its impact and as the practice of medicine begins to embrace digital therapeutics as a legitimate kind of thing to prescribe.
How to avoid that healthcare data get into the wrong hands?
Unfortunately, I don’t think we can be assured that they won’t get into the wrong hands, just like every other kind of data. We have great security and we have great hackers, the bad kind of hackers. So instead of pretending that we can make any data set completely secure, we need to be really thoughtful about what kind of data we collect, how we make people aware of the way that we’re collecting data, and make sure that they agree to whatever we’re going to do with the data. Which means that we have to do something for them that is so valuable that they’re willing and comfortable taking the hopefully small risks associated with it. But it means that we have to have the conversation. We certainly need to get better at data security. I think we also have to acknowledge that we’re talking about a new paradigm where things aren't perfectly secure, because I’m afraid there’s no such thing. So instead we have to have a very conscious discussion about risks and benefits and make sure that we’re always providing more benefit than risk.