07 Apr 2011 eHealth project

What is “eHealth”?

As to that second ques­tion… It turns out that de­fin­ing “eHealth” is very, very dif­fi­cult. In some sense, the way that we cre­ate our defin­i­tion is ef­fect­ively the an­swer to “what are we, No­vartis, go­ing to do about it?”

When we talk about eHealth, we refer to a HUGE range of sub­jects and catch-all phrases: elec­tron­ic health re­cords, pa­tient con­nectiv­ity, mar­ket ac­cess, pa­tient re­cruit­ment, telemedi­cine, health data man­age­ment, per­son­al health re­cords, med­ic­al so­cial net­work­ing, pa­tient strat­i­fic­a­tion, next-gen­er­a­tion se­quen­cing, new com­mer­cial mod­els, pa­tient-defined com­munit­ies, treat­ment paradigm in­nov­a­tion, re­mote mon­it­or­ing, mo­bile devices, glob­al­iz­a­tion, ge­n­om­ics re­volu­tion.

Augh!

Let’s turn to the au­thor­it­at­ive source of all hu­man know­ledge: Wiki­pe­dia.

Wiki­pe­dia’s defin­i­tion of eHealth is one of those “everything” pages. It ba­sic­ally says, “this com­prises many top­ics, in­clud­ing: elec­tron­ic health re­cords, telemedi­cine, con­sumer health in­form­at­ics, health know­ledge man­age­ment, vir­tu­al health­care teams, mHealth, Grid-based med­ic­al re­search, health­care in­form­a­tion sys­tems”.

And then in the next sec­tion of that page, the au­thor(s) point out that this defin­i­tion is con­tested.

So, the Wiki­pe­dia defin­i­tion is not par­tic­u­larly help­ful… but it does un­der­score my point - eHealth means many things to many people, and is very, very broad.

Hav­ing struggled with this ques­tion for sev­er­al weeks, here is my at­tempt at an an­swer:

eHealth refers to any as­pect of health-re­lated activ­ity that is
be­ing changed by ad­vances in in­form­a­tion tech­no­logy.

Un­der this defin­i­tion, eHealth is BIG. Really, really big. Broad­er than the tra­di­tion­al do­main of phar­ma­ceut­ic­al in­dustry, which is ba­sic­ally about cre­at­ing and selling ther­apies? Broad­er than caring for sick pa­tients (gen­er­ally the top fo­cus of the med­ic­al in­dustry), – be­cause eHealth is also about pre­vent­at­ive medi­cine and care, so touches people who are healthy and are try­ing to stay that way. Moreover, one could ar­gue that ad­vances in in­form­a­tion tech­no­logy are them­selves im­pact­ing more or less EVERYTHING. So… eHealth is a very broad top­ic.

Hmm. This defin­i­tion­al ap­proach to try­ing to un­der­stand why eHealth mat­ters to us is turn­ing out to com­plic­ate things, not provide sim­pler an­swers.

So let’s turn to ana­lo­gies.

eChanges in The Music Industry

Let’s look at an in­dustry that has been rad­ic­ally trans­formed by in­form­a­tion tech­no­logy: mu­sic. What happened? Who won, who lost?

The very first iPod was re­leased in Oc­to­ber of 2001. That was less than ten years ago. (Yes, I have one of those iPods.) What was go­ing on be­fore that, and what has happened since?

While the iPod is the sym­bol of the “e-if­fic­a­tion” of mu­sic, I would ar­gue that the in­tro­duc­tion of the com­pact disc in 1979 was more found­a­tion­al. That was the first real demon­stra­tion of the abil­ity to en­code and re­pro­duce mu­sic fully di­git­ally.

Mu­sic en­cod­ing is what ul­ti­mately has en­abled the en­tire world of mu­sic to move what is fun­da­ment­ally an ana­log activ­ity (singing or play­ing an in­stru­ment) to what is now ef­fect­ively 100% a stream of di­git­al bits, used in thou­sands of ways that could not have been ima­gined be­fore.

The world spent the next twenty years after the in­tro­duc­tion of the CD ar­guing about di­git­al mu­sic. Did it lose au­dio qual­ity? Did it mat­ter? Hey, what about my big al­bum art? Do CDs melt if you leave them on your dash­board? Etc… And then the trans­form­at­ive things happened: we got bet­ter at di­git­al en­cod­ing (mp3 files) and the In­ter­net es­caped from the labor­at­ory, which en­abled the Web to come in­to ex­ist­ence, chan­ging how hu­man be­ings in­ter­act with each oth­er.

The full di­git­iz­a­tion of mu­sic and the mass-con­sumer­iz­a­tion of the In­ter­net were the core con­di­tions that en­abled Apple to cre­ate iPods and iTunes, shak­ing up and trans­form­ing the mu­sic in­dustry. Apple didn’t do any­thing ma­gic at all, they just made di­git­al mu­sic much more ac­cess­ible to the com­mon masses than oth­ers had. Dur­ing this era, fights about in­tel­lec­tu­al prop­erty and pir­acy ex­ploded… the mu­sic in­dustry star­ted go­ing after col­lege stu­dents for file shar­ing, and for­tunes were made and lost on steal-my-mu­sic busi­ness mod­els. (Re­mem­ber Nap­ster?)

Sim­ul­tan­eously, the web be­came more in­ter­act­ive - Face­book, MySpace, Twit­ter and home-grown sales ven­ues ex­ploded, al­low­ing mu­si­cians to reach out more dir­ectly to their audi­ences. Mu­sic mar­ket­ing and pack­aging has fun­da­ment­ally changed. Now di­git­al mu­sic play­ers are the norm, sales of CDs con­tin­ue to drop, and Apple dom­in­ates the re­cor­ded mu­sic dis­tri­bu­tion busi­ness so much that they are be­ing in­vest­ig­ated for mono­pol­ist­ic prac­tices. Di­git­al mu­sic has com­pletely a part of the world we live in – no one even thinks of the al­tern­at­ive.

We’re not done… it will all con­tin­ue to change. iPods are less trendy and fad­ing in­to whatever-land. Au­di­o­philes and hip­sters are mov­ing back to vinyl. Someone else will fig­ure out how to ex­ploit the next tech­no­logy shift, or some­thing will hap­pen on the glob­al stage, and some day Apple will be fight­ing to re­tain dom­in­ance, be­cause, let’s face it, iTunes can­not pos­sibly be the best thing out there.

Sim­il­ar things are hap­pen­ing in re­lated in­dus­tries. Ra­dio is mov­ing to satel­lite and the In­ter­net. Movies and TVs are fol­low­ing sim­il­ar pat­terns to mu­sic, just a bit later. The book in­dustry is in tur­moil. The smal­ler world of the dic­tion­ary and thesaur­us have been ut­terly changed by un­be­liev­able changes - I would give any­thing to have a re­cord­ing of an En­cyc­lo­pe­dia Brit­an­nica board meet­ing in 2004… back when the bizarre user-con­trib­uted world of Wiki­pe­dia had been in­ven­ted, was pick­ing up steam, but had not yet com­pletely crushed all oth­er forms of en­cyc­lo­pe­dia.

Ok… there’s the mu­sic ana­logy. It’s my simplist­ic ana­lys­is of a fas­cin­at­ing change. What does this mean for eHealth, and what does this mean for us?

Relating Digitized Music to eHealth

Here are a few of my ob­ser­va­tions from the world of the di­git­iz­a­tion of mu­sic that re­late to our situ­ation.

1. No one refers to “eMusic”. The en­tire mu­sic in­dustry has been im­pacted by changes in IT, from re­cord­ing to pro­duc­tion to dis­tri­bu­tion to listen­ing to per­form­ance. It’s not some­thing dif­fer­ent from the mu­sic in­dustry; it is the con­text that the mu­sic in­dustry is in. I be­lieve the same thing is go­ing to hap­pen to the med­ic­al field: it won’t have some com­pon­ent that is elec­tron­ic; it will simply be­come more di­git­al in ag­greg­ate.

   Every as­pect of medi­cine is be­ing im­pacted. The ques­tion is prob­ably not how No­vartis should have an “eHealth” busi­ness. This is about how all of No­vartis can shift in­to the con­text of a di­git­ally-fa­cil­it­ated and rap­idly-chan­ging mar­ket.

2. Those changes, while ob­vi­ous in hind­sight, were NOT easy to pre­dict. Every­one knew that di­git­al en­cod­ing of mu­sic was pos­sible. Every­one knew you could listen to mp3s on com­puters. Mu­sic shar­ing was pre­val­ent. People had been chat­ting on­line about mu­sic since the 70s. Wi­kis were around for a long time be­fore Wiki­pe­dia.

   And yet in each of these areas, someone took a ba­sic tech­nic­al cap­ab­il­ity, one that may not have been ob­vi­ous in any kind of stra­tegic plan, and cre­ated a com­pletely new dis­tri­bu­tion plat­form around it that changed the in­dustry.

3. Re­la­tion­ships of en­tit­ies in the mu­sic sup­pli­er/cus­tom­er world changed fun­da­ment­ally. Good grief. A com­puter com­pany is now shap­ing the mu­sic in­dustry. What is up with that? Bands are talk­ing dir­ectly to their fans, without the re­cord com­pany telling them what they can do. People are dir­ectly shar­ing enorm­ous amounts of in­form­a­tion about what they like and don’t like. But the mu­sic that I hear - that’s ba­sic­ally the same.
4. Most of the early movers did not “win”. But a few of them - those who got the devices, plat­forms, and re­la­tion­ships right at the right time - cer­tainly did.

5. Changes have been driv­en, in es­sence, by what con­sumers fig­ure out they want. (But not com­pletely.) Car­ry­ing around my en­tire mu­sic lib­rary in my pock­et, plug­ging it in­to my car ste­reo, shar­ing mu­sic with my friends, buy­ing mu­sic eas­ily, find­ing mu­sic eas­ily? Cool.

   That said, if you go back to the 90s, would I have told you that’s what I wanted? No, prob­ably not. But when someone showed it to me.. yeah, that made sense.

   On the oth­er hand, elec­tron­ic books still drive me nuts. Too hard to share.

6. The fun­da­ment­al change for mu­sic, movies, and pub­lic­a­tions is not the same fun­da­ment­al change for medi­cines. In those areas, the product it­self - the mu­sic, the movie, the book - lost its phys­ic­al form and be­come a stream of bits. This seems much less likely in the pharma world be­cause our products - medi­cines - are much harder to di­git­ize.

   (I must throw a word of cau­tion out: the abil­ity to make phys­ic­al things is it­self be­com­ing much more di­git­al. We have 3d print­ers, open-source hard­ware, and re­mote-con­trolled factor­ies. It is en­tire feas­ible that, in the near fu­ture, it will be pos­sible to send the in­form­a­tion for the cre­ation of a medi­cine to some type of fa­cil­ity, and it will then pro­duce that com­pound. It sounds in­sane now, but then, so did Wiki­pe­dia. In any case, this is farther out than oth­er as­pects of eHealth.)

7. From a con­sumer stand­point, the ac­tu­al product of the health mar­ket is the en­tire in­ter­ac­tion. For sick pa­tients, this is the as­sess­ment by the doc­tor and the pro­gram that may fol­low: con­sulta­tions, dia­gnostics, sur­gery, ther­apies, care, etc. That treat­ment is as much about re­la­tion­ships as it is about the products. For healthy pa­tients, this is about on­go­ing in­form­a­tion about a myri­ad of top­ics: ex­er­cise, diet, symp­toms, ex­perts.

   In­form­a­tion tech­no­logy does fun­da­ment­ally change the nature of com­mu­nic­a­tions - and thus re­la­tion­ships. The de­liv­ery of this en­tire health product is what is chan­ging - ele­ment by ele­ment. We have to think about the in­ter­ac­tion and the en­tire con­text, not just the ther­apy.

8. The in­form­a­tion about the products is as im­port­ant as the product it­self. The iTunes plat­form sells di­git­al mu­sic files, but the power of the plat­form comes from the in­form­a­tion about the mu­sic. Where it came from, who it was sold to, who listens to what, what mu­sic is re­lated to what, who to ad­vert­ise to, who to con­nect to what, what songs are part of what al­bum. The power of Wiki­pe­dia is the art­icle, yes… but it’s also the search­ing, the re­la­tions, the ref­er­ences, the ex­tens­ib­il­ity.

   This mat­ters to us im­mensely. Our product is not just medi­cines - it’s also the in­form­a­tion about the medi­cine. Which pa­tients does it work best for? How does it in­ter­act with oth­er medi­cines? How of­ten, and in what dosage, should I take it for it to work for me? Why would my doc­tor pre­scribe this product in­stead of that one? What does my buddy down the hall in the can­cer ward or on pa­tients­likeme.com think of his treat­ment plan?

9. The pro­cess of cre­at­ing the mu­sic has changed thanks to bet­ter soft­ware and hard­ware, but that was not really a factor in the change in the mar­ket. In our world, we’re us­ing phrases I men­tioned above: elec­tron­ic health re­cords; pa­tient re­cruit­ment; telemedi­cine; per­son­al­ized medi­cine; know­ledge man­age­ment; bioin­form­at­ics.

   In the equi­val­ent in the mu­sic busi­ness in the 90s they might have been say­ing: full di­git­al cap­ture, pro­duc­tion, and re­pro­duc­tion; file shar­ing; di­git­iz­a­tion formats; in­tel­lec­tu­al prop­erty pro­tec­tion; Walk­man killer; dir­ect-to-fan ac­cess… and so on.

   It turns out that none of these were the game changer: you had to be good at all of them simply to stay com­pet­it­ive. The game change, and the shifts that cre­ated op­por­tun­ity and put oth­ers out of busi­ness, came from in­sight­ful use of these to change the nature of the re­la­tions between con­sumer and pro­vider.

   Be­ing very good at IT and its chan­ging use in the busi­ness was ne­ces­sary, but not suf­fi­cient.

10. The mu­sic in­dustry is SO MUCH SIM­PLER.

Winding Up…

So, there’s my defin­i­tion of eHealth (“everything”) and a first few thoughts of “why does it mat­ter to us” - both as hu­man be­ings and as No­vartis as­so­ci­ates.

It mat­ters be­cause everything will change, in some un­pre­dict­able way, that ul­ti­mately will be bet­ter for all of us. We will have the op­por­tun­ity to thrive, and to im­prove care for pa­tients. I hope we will do that by cre­at­ing and driv­ing a vis­ion, by be­ing a core part of the changes across the in­dustry, by de­vel­op­ing ex­pert­ise in key areas, and by seiz­ing the right op­por­tun­it­ies.

We will even­tu­ally get to the deep­er ques­tion of “so, what are we do­ing to do about that in the near term?”.

Craig and I will also up­date you on what our cur­rent plans are to be­gin to pull to­geth­er in­form­a­tion and in­sights.

In the mean­time:

• What is YOUR defin­i­tion of eHealth?
• What are YOU do­ing about it here at No­vartis?
• What do YOU think we should be do­ing as a com­pany?

Jump in with com­ments or send me email.

eCheers,

-r’m