The unbundling of healthcare is approaching, and it has the potential to change the way we receive and pay for medical care.
The process of releasing data and disintegrating services that is taking place in the banking world could also be set in motion in healthcare with the arrival of the European EHDS bill. The sharing and (re)use of healthcare data opens the door wide to competition and disruption by third parties. With all the benefits for the patient: it is often coined "the unbundling of healthcare."
Fifty percent discount on your health insurance in exchange for access to your medical data. Have your blood pressure measured at a drugstore like Etos instead of a cumbersome trip to a doctor or hospital. "The Kruidvat drugstore chain also employs 4,000 college-educated personnel, one at every retail location, so why shouldn't they do that?" Previously, these kinds of examples were mentioned as possible vistas. "But with the proposal for the European EHDS act, which should make it easier to share and (re)use healthcare data from 2025, these are now real scenarios."
See here the link with the PSD2 that opened up the banking system. It is exactly four years ago this month that this European law for payment services came into force in the Netherlands and that the banking market, until that time, exclusive territory of banks, was released. "An important goal was to promote competition and innovation in that market," says Bastiaan Walenkamp, Director of Center for the edge at Deloitte, who has worked in the financial market before. During a cup of coffee, we sat down, philosophizing about similarities between healthcare and banking. "Also, as a European response to the financial crisis of 2008. The intended effect was to wake up the financial conglomerates, with opaque products aimed at profit instead of serving the customer."
Psd2 opened up the banking system to third parties and thus to innovation. Walenkamp: "In short, it comes down to the fact that the information from you as a consumer at a bank is not from the bank, but from you. The law gives third parties, such as Google, permission to ask you if you are okay with using your payment information. The moment you give permission, a bank is obliged to share that data with Google as well."
Hand in hand with digitization, this law has accelerated the process that was already underway in the banking world, namely the disintegration of the traditional banking model into a number of sub-activities – the so-called 'unbundling of banks'. "The entry of big techs and the arrival of all kinds of fin startups has changed the playing field and the rules in the banking world enormously," says Walenkamp. "It has yielded innovations such as Apple Pay and Paypal. But also services such as Tikkie (sending a direct "pay-me" request) and digital household books. With welcome benefits for the consumer who has now embraced these services on a large scale in her daily lives."
Back to the EHDS act, which should facilitate the sharing and (re)use of healthcare data as of 2025: with the arrival of the European Healthcare Data Space, a similar process could be set in motion in healthcare as in the banking world. Take the various developments in the healthcare sector, says Engelen. "We all know that the accessibility of care can no longer be guaranteed if we continue on the current path. We can read and hear that every single day. The healthcare model has been under considerable, increasing pressure for some time. Both in terms of accessibility & cost, and quality. With a greater demand than supply and an already staff shortage of 80 thousand people that will grow to 175 thousand in the coming years."
The mantra 'work a little better, cheaper and faster' is not (anymore) sufficient in this case. According to Engelen, the solution lies in working from a different paradigm. "From the line of thought of digitization and, for example, what I coined healthcare meets retail: moving parts from healthcare to retail, with the help of new technology, in doing so opening up space for more complex patients and a doubling in demand."
From a patient perspective, healthcare is eighty percent a logistical process, I often argue. "Someone has to go from A to B. But why does someone have to go from A to B when you can do it in a different way with a technical solution."
He mentions the example of the 'self-measuring kiosk' in the Laurentius Ziekenhuis Hospital in Roermond (where he is also employed): a chair equipped with all kinds of technology that the patient can sit on and that measures things like his weight, blood pressure and oxygenation level of blood.
"That device is now at hospitals. But imagine that you put them at local drugstore branches in rural areas, so that people in those areas no longer have to go all the way to a hospital for this kind of thing, but go to the local drugstore in the village. Then you take parts out of the current healthcare system, that's where the 'unbundling' of healthcare is coming to life already."
The second aspect in this context is the great data power of and about the patient that is now at the healthcare institution. "As a patient, you can take a look at what the hospital knows about you in a portal," says Engelen. "But of course, there is a lot more information." The EHDS – the equivalent of PSD2 in the banking sector – ensures that the patient has access to all that data. "And so he will decide for himself what he does with that data and with which other doctors he shares this. This means that the free choice of doctors is expanded."
Here's the analogy with the broken open banking system that has fallen apart into parts. Engelen: "The big issue within healthcare is how this 'unbundling of healthcare' works out. What parts do we get out of the existing healthcare system and where are we going to invest them? Are retailers or tech parties opening up for that? And what benefits will this have for the consumer? This is an ongoing process we're exploring as we speak in malls, city centers, neighborhoods and mobile, as we speak in the Roermond region."
The unbundling of healthcare is something that is going to happen to healthcare too, says Engelen. "In healthcare, people say that people do not want this, that data belongs to the healthcare institution. There are even doctors who say that patient data is their intellectual property." The release of healthcare data will give an extra boost to innovation and research. With, as with the banks, potentially disruptive effects from outside parties. "This is a process that is now really going to happen to healthcare," says Engelen. "Winter is coming, I often mention."
The European Healthcare Data Space (EHDS) is a proposal for European legislation that will make it possible to share and (re)use healthcare data as of 2025. For healthcare, research and innovation in the Netherlands and the rest of the European Union. The creation of a common European health data space should facilitate the cross-border exchange of these data.
The impact of how this plays out could be seen in a recent example by my friend and patient-activist Dave deBronkart, AKA ePatientDave. Having access to his own data via opennotes being able to use that to switch to another provider, or get a second opinion, is just one example of what lies ahead. After the surgery, he accessed his records, including what the doctors have written in his file, and published it. Think of the possibilities for a joint effort and relationship between patient/professional. It truly enables consumer mobility, which will unleash beneficial market forces.
It is at the intersection of technology and patient empowerment, which is where Lucien Engelen (1962), director of the Radboud University Nijmegen Medical Centre REshape Center and advisor to the Board of Directors (since 2007) feels most at home. The two worlds combined into the Radboud University Nijmegen Medical Centre and Singularity University in Silicon Valley & the Netherlands and in the Nordics, his modus operandi is always challenging, sometimes provocative but always techno-realistic. Writing on a new book that will be titled "Augmented Health(care)™ : The end of the beginning" (May 2018, Barcelone Spain) as he thinks we're at the end of an era of creating awareness, pilots, proof of concepts etc in the digital transformation of health(care). More on that on, his Linkedin Page has over 750.000 followers. He is Faculty Global Health(care) & Medecine since 2011 at Singularity University's Exponential Medicine in the US and in the Netherlands.