Digital in Health E-Book

Hanno Wolfram

• Herausgeber: Books on Demand
• Kategorie: Wissenschaft und neue Technologien
• Sprache: Englisch

Veröffentlichungsjahr: 2019

Beschreibung

Indicating ways to improve patient-outcome was the main driver writing this book. Two years of research, structuring, collecting, and writing around the central subject of our days: digital. Similar to other spheres of our lives, digital has the power to change many aspects of healthcare and improve patient's lives. Not only tells the book about the obvious, but also points to many use-cases and innovative examples of digital in health. By definition, digital interconnects and integrates people and things. Maybe some of the players in healthcare find the idea of working across sectors harmful to their own business model? Digital in health in any case means leaving traditional comfort zones. Besides telling about the digital past and present, the book Digital in Health defines, conveys ideas, triggers concepts, and indicates digital business models and cases already existing. In contrast to what we encounter every day, digital concepts in healthcare are lagging far behind. The rest of the world has already advanced a lot further. After technology is available, the most important prerequisite for the development of digital in health evidently is the mindset of protagonists. Digital today is far more than a buzzword, after every one of us is regularly confronted with it. Today many are already depending on digital, reaching into every corner of our life. None of our today's lives could continue to function as it is, without leveraging and using all these digital tools and applications. Digital in Health wants to help pave the way for digital ideas, supporting the constant ambition to improve patient-outcome. Joining forces for the common goal of better care, the coauthors added most relevant and important views. Each from his own professional background. Many thanks to Salil Kallianpur, Gerd Luippold, Christian Milaster, and Anup Soans who contributed so greatly to the book, while living in India, Germany, and the United States of America.

Leseprobe

LIST OF CONTENT

D

IGITAL

:

THE HOT TOPIC

Every‐Day Digital

D

IGITAL

: I

T

’

S DENOTATION

Interconnection and integration

Definition of d

igital

D

IGITAL AND PLAYERS

Digital for patients

T

HE

I

NTERNET

Internet‐usage

world wide web

D

IGITAL DEVICES

Devices to

produce

content

Device’s form factors

Devices to

consume

content

Devices to

create

content

Smartphones and health

D

IGITAL CHANGES

Mobile communication

From Cell‐ to Smartphone

TV ‐ any time

Smartphone money

Smartphone banking

Smartphone banking without a bank

Shopping habits

Shopping medication

Digital and “big data”

Dr. Google et al.

Curiosity lost

Habits changed

G

REEN DIGITAL

Green electricity

Home office

Paperless office

Industry 4.0

Carbon footprint

Social media

D

IGITAL AND

M

ANAGEMENT

D

IGITAL IN

R

ESEARCH

Drug Discovery Process

Big data in biological research

With the help of bioinformatics

Text and data mining tools

Big data and digitization in chemistry

Digital in clinical research

Digital initiatives

A glimpse ahead

Intelligent drugs

Analyzing big data and virtual testing

Regulatory changes and requirements

D

IGITAL

H

EALTH

T

ERMS

A Telehealth Taxonomy

Telemedicine includes:

The Benefits of Telehealth

Connected health

Personal wellness

Digital health

Health‐IT and eHealth

Precision medicine

A digital health taxonomy

P

HARMA DEPARTMENTS

Market access

Medical department

KOL‐management

Brand management

Sales‐ / Field‐Forces

Sales controlling

Patients

A

DVANCES IN TECHNOLOGY

The current state

The state of marketing

Successful pharma / devices companies

An Indian pharma industry perspective

New product launches

Channel partners

Flexible prices

The 4 Ps of healthcare

S

LAYING THE DIGITAL BEAST

What exactly is digital?

How can digital

Digital adoption by Indian Pharma

Need for education

D

IGITAL

D

ARWINISM

Digital Illiteracy

Digital Preparedness

Digital Expertise

Digital Transformation

1.

Use existing structure to begin digital activities

2.

Encourage digital experimentation

3.

Create digital innovation team in parallel

4.

Gradually embed innovation

P

HARMA

’

S DIGITAL DISCONNECT

Corporate brands

Concerns about Adverse Event Reporting

Uni‐directional engagement

Real time communication and engagement

Discontinuous engagement

Uncontrollable online activism

Unclear regulatory framework

The Digital World – Be there or Be Square!

Digital is simply about leveraging technology

Shifting the mindset

Misplaced obsession with sales

Marketing in a digital world

Selling in a Digital Era

D

IGITAL

F

UTURE

Customer engagement, not products or services

Data, not money

Customer experience trumps all else

The ‘Amazonization’ of Healthcare

India looks to Artificial Intelligence

The rise of non‐traditional competitors

New players in healthcare

“Uberization” of healthcare

D

IGITAL IN

P

HARMA

M

ARKETING

The reality‐profile

A. Push marketing

B. Pull marketing

Conclusion

D

IGITAL MEETS

A

NALOGUE

D

IGITAL IN

C

ARE

Six P‐Approach

1. Patient

Digital and Patients

2. Physician

Digital and Physicians

3. Pharmacist

Digital and Pharmacists

4. Pharmaceutical industry

Digital and Pharma‐Industry

5. Payers

Digital and Payers

6. Politics

Digital and Politics

Digital Outlook

The Care‐Process

Care in three steps

Remote assessment

Remote assistance of diagnosis

Therapy follow‐up

Trendsetters

Telehealth

Remote healthcare access

Wearables in healthcare

D

IGITAL

T

HERAPEUTICS

Akili®

Tinnitracks®

MindMaze®

Moodgym®

Reset®

Sleepio®

TheraxIum®

Future digipeutics

Huggable®, the robo‐bear

Conclusion

C

HAT

‐

AND OTHER BOTS

Standard chatbots

Intelligent chatbots

V

IRTUAL REALITY

Microsoft’s Hololens

T

HE

D

IGITAL

I

MPERATIVE

Business transformation

O

VERVIEW

: D

IGITAL IN

H

EALTH

Patient’s global access to knowledge

Global connection of patients

Global search for therapy

Interconnecting caregivers

Integrating patients

D

IGITAL FOR BUSINESS

Primary care

Secondary care

Pharma and pharmacies

The new world

Disruption

Who can be disruptive?

Digital medicine

Therapy‐Bus

The patient‐journey

Patient‐journey’s starting point

Disruptive plans

Digital in pharma

Pharma’s Commercial units

A way out

Pharma’s Field Forces

Pharma’s business model of the past

A future‐proof business model

Therapy‐adherence, a burning issue

Business model for generic manufacturers

A

DIFFERENT FUTURE

People’s focus

Politician’s focus

Patient’s focus

Industry’s focus

Leveraging the Existing

More of the existing

Social media analysis

Blockchain and trust

Data privacy

E

PILOGUE

A

BOUT THE AUTHORS

Gerd Luippold

Salil Kallianpur

Anup Soans

Christian Milaster

Hanno Wolfram

A

CKNOWLEDGEMENTS

L

IST OF EXHIBITS

Foreword

Talking with friends about the plan writing this book, some clearly advised against doing so. Their major reason was, that a subject like digital is developing far too fast to be dealt with and covered in a non-dynamic place like a paperback.

Yet the reason to pursue my plan further appeared simple: in the majority of discussions and meetings attended I found that the word digital meant something different to almost everyone who used it. “Digitization or digital” triggered so many different things and concepts, that for a time I did not understand at all, what people were talking about. Other participants apparently did not understand either what colleagues, managers, or friends meant to say or contributed around digital.

To get at least myself on track, I established the habit to regularly ask: “What do you mean by “digital” or “digitization”?

This question regularly brought a bit more of clarity and at least some direction into discussions with friends, colleagues, or corporate meetings. Value was added, after all participants at least had a similar idea about the digital subject in question.

What else can be assumed is that ideas about currently existing digital options and the imagination about an even more digital future depends on something trivial like knowledge. The knowledge which technology shall be applied and leveraged now and, in the future, hardly can be assumed to be available. One may have the impression, that some digital options now and to come, lie beyond manager’s grasp.

Some protagonists evidently lack the necessary creativity to imagine the impact digital will have on their life and business. There still seems to be plenty of room for false prognosis. “The internet will catastrophically collapse in 1996.” said Robert Metcalfe. 1996 is not too long ago.

Published in 2017 a study sponsored by the German Ministry of Economy and Energy revealed that 42% of German healthcare enterprises believe that digital is unnecessary for the own entity. No comment.1

The attempt to identify and clarify the meanings of “digital or digitization” was one of the major drivers and motivation to finish this book.

It was about striving to convey and disseminate existing utilizations of digital, plus sharing ideas about a possible digital future derived from what exists, plus conceptual or innovative ideas about unprecedented values and benefits that digital will add to better outcome for many patients in the near future.

1 Monitoring-Report | Kompakt Wirtschaft DIGITAL 2017

The book’s target-group

Following my professional background and my previous books2, the working title and the storage folder’s name on my computer for this book was “Digital in Pharma”.

The idea for the book and its structure became a lot clearer, thinking about a wider range of readers than only those working in the pharmaceutical industry. Whenever researching, putting together and writing I thought about all those people familiar with the pharmaceutical industry, knowledgeable in healthcare matters in general and of course patients. This created a more challenging and complex target audience.

In principle every single one of us is regularly confronted with digital and digitization. The word digital already reaches into every corner of our daily life. None of our today’s lives could continue to function without leveraging and using all these digital tools and applications.

This means that this book cannot only be written for people working in the pharmaceutical industry but is dedicated to all those being inflicted, influenced, or affected by digital in health. The target group of readers ranges from those who have an idea, what digital does to their individual daily life, to others who are digitally naïve and only have a rough idea how they could cope with and leverage digital by themselves in the future. This book shall deliver value for your time invested: quite a challenge, but worthwhile to try. Time will show, and readers will tell me and share with others.

This is the managerial triple jump I applied to the book and referred to frequently, while putting all these bits and pieces together.

Exhibit 1: An important triple

The manifold appearance of the term digital itself was another inspiration, trigger, and driver of my effort trying to come to grips with the subject. Surpassing the term’s most diverse understanding by explaining meanings makes “digital” the probably hottest topic today. Both healthcare and digital are inherent and vital parts of our lives. To shed some light on the subject digital in health is the book’s and my core objective.

2 Pharma Key Account Management (German, 2011), Key Account Management in Pharma, (English, 2014), Pharma Bettlektüre (German, 2017)

DIGITAL: THE HOT TOPIC

If you enter the word digital into a Google search, several million search results indicate that this word is widely used, to say the least.

This vast amount of search results helped me to establish a central starting point for this book, probably one of the values for the reading time invested: it is about the attempt to clarify terms and find some definitions.

As in numerous other contexts the clarification what the word digital could mean, must be of vital interest for the start and only then details can be derived and properly described.

Exhibit 2: A digital watch

It was in 1973, when Seiko presented the world’s first digital watch3. This changed time being displayed by hands, to wristwatches displaying time in a digital manner. The first one showed stunning 6-digits. More complex displays included date and other details later on. Digitally displaying time was a breakthrough and it happened just about 44 years ago, remember?

Today the word digital is omnipresent. In every newspaper, any blog, in discussions, and in literally any meeting the word digital is used and plays a role. And whenever mentioned, something different is meant with digital.

"Any approach should begin by clearly defining what it is.”4is a sentence from a recent Harvard Business Review article. This sentence probably is key if you want to establish understanding of digital. Even more so, when you start lecturing, presenting, or even discussing “digital”. The meaning of the word digital today appears to be unbelievably diverse. To underpin this, a quote from Christian Milaster may perfectly fit: “Everyone agreed, until somebody defined it.”

As far as I understand what I read and hear, the word digital remains undefined. Therefore, digital often remains a hollow buzzword.

In general, one might see two major ideas behind going digital:

In such a novel scenario, digital means and tools are leveraged to optimally serve the patient’s needs and requirements, striving for better patient outcome.

Whenever the word digital pops-up, it is an important and worthwhile idea to ask: “What do you mean by digital?”

Listen and learn.

EVERY-DAY DIGITAL

Since about 20 years societies around the globe experienced a comprehensive societal transformation caused by digital.

The emergence of the internet changed the world we live in, as did the steam-engine more than a century ago. The degree of enforced or enabled change may be seen as revolutionary in many parts and facets of our every-day life.

No other technology affected so many people in such a short period of time as digital does. Penetration-speed and penetration-rate are mind-blowing. It only took 26 years to interconnect almost 60% of the world’s population using the internet.

Exhibit 3: Internet usage

A fascinating situation only 26 years after the internet was ready for global use, triggered by the roll-out of the first graphical browser called Mosaic6 in 1993.

The fact that almost every individual is affected in the same way is another interesting point, differing relevantly from past experience. Technology, accessibility, handling, and content are identical across the globe. No limits, no boundaries: all are interconnected.

The internet as a technical platform serves every user in the same way.

The Internet is used by everyone for the same purposes.

3https://museum.seiko.co.jp/en/collections/watch_latestage/collect021/

4 Managers Think They’re Good at Coaching. They’re Not. by Julia Milner and Trenton Milner, AUGUST 14, 2018, HBR

5 Salil Kallianpur, Digital Transformation Lab

6https://en.wikipedia.org/wiki/Mosaic_(web_browser)

DIGITAL: IT’S DENOTATION

Digital has become a buzzword, appearing in any context and with randomly arbitrary meanings or connotations. It therefore appears normal, that “everyone agrees to digital, until somebody defines it.”7

Hardly can the word digital be explained or even understood by one meaning, a singular concept, a common notion, or a globally valid perception. The wide array of connotations of the term “digital” may well be one of those key phenomena around digital.

Any attempt to display a comprehensive list of items and issues relevant to digital in our lives or “only” in healthcare, will remain incomplete. We have to accept that literally all spheres of our lives are digitally contaminated. No field is left out and there is no room for exemptions for more digital in the future.

INTERCONNECTION AND INTEGRATION

The term Internet is derived from linking these two terms: interconnected networks. In essence the idea of the Internet is and was to interconnect computers residing in independent networks.

7 Christian Milaster

DEFINITION OF DIGITAL

In an attempt to deliver clarification about the subject itself, a definition is worthwhile.

Digital / digitization means to interconnect and integrate people and things globally.

Interconnection and integration relate to any subject, missing boundaries and borders.

Once digital is adopted by healthcare stakeholders and patients own their electronic health record, all players and stakeholders will be interconnected universally.

In an analogue world, efforts in time and money to interconnect various instances or players have ever been and still are high. The integration of relevant players and stakeholders, to ensure broad and comprehensive healthcare, hardly is achievable as long as integration is tied to analogue means, like paper. Time lags, cost of labor, and selective comprehension stand against the integration of many in an analogue world. Science-, or evidence-based medicine can serve as example for the analogue past and the digital tomorrow.

Paper-based sources of wisdom stand for the analogue world. Paper, serving as a medium to convey findings and updates of diagnostic and therapeutic approaches, takes a long time and causes high cost to produce and distribute. Healthcare professionals and patients in the past only could learn about novel approaches or findings reading the respective journal or scientific paper. To get access to certified and curated knowledge physically visiting a library is a must. An alternative to some extent is the costly subscription of respected papers.

In a digital world, delivering medical knowledge and updates only take seconds to distribute across the globe. News can be shared by push or pull. Leveraging technology, senders could verify if an addressee has read, find out if the message was understood, and if the indicated novel and different approaches are on their way to be implemented. Dispatching relevant information can be achieved around the globe, without any boundary, almost without cost, at one single click.

Digital means to interconnect players. Separating walls are inexistent in a digital world. Limits, be it culture, country, money, or language are gone. This allows to integrate healthcare-players around the globe in an amazing flow of directed, current, evidence-, and science-based digitally delivered and omnipresent information.

Climbing the summit of healthcare’s “Mount Olympus” is achieved when electronic health records of patients are established and available. Using and leveraging digital / electronic health records of patients, will bring the interconnection of all involved to the next level. Imagine the wealth of interconnecting healthcare providers directly with all these medical data enriched and administered by patients themselves. Imagine the huge benefit integrating individual patients in the process of care for their own health.

Any information created by scales, tracking devices, blood glucose measuring, and other patient-devices, could be embedded into the individual’s Electronic Health Record. This would enrich and improve machine-supported diagnostics and treatment pathways and patterns. The UK NHS8 has just found out that patients are willing to share their own data with selected players. The drug industry is widely eluded from sharing due to missing trust.

Accessing these patient data will allow Artificial Intelligence to learn more and faster and further boost improvement of healthcare. AI then will develop to be a breathtaking and digital door to better healthcare.

Interconnecting and integrating all involved, from patient to payer, in a comprehensive effort to improve patient-outcome is the most appropriate goal towards digital in health.

It is worthwhile to remember what Roch Doliveux, ex-CEO from UCB said: “If you deliver superior value to patients, you deliver superior value to shareholders. You can’t set yourself a goal of “I’m going to deliver superior value to shareholders, and I do this patient thing as it is a good thing to get there. It is exactly the other way around!”

If we appropriately apply the digital means that we have available today, this will lay the foundation for quantum leaps in healthcare quality.

8https://www.digitalhealth.net/2018/06/patients-trust-nhs-data-survey/

DIGITAL AND PLAYERS

Below list indicates some of these widely different meanings of digital in the healthcare arena of the 21st century. No one will be taken wonder about the various ideas, people in the pharmaceutical industry, consultants, healthcare professionals and all these other stakeholders in healthcare associate with the magic word digital. A first glance may reveal these different connotations or assumed meanings of digital:

To

payers,

Pharmaceutical Benefit Managers (PBMs) or reimbursement stakeholders,

digital

can mean, that tools collecting and analyzing huge datasets allow novel payment-models like pay-for-performance and improved detection of patient-outcome as key indicator for quality of care.

It points towards the phantom of Big Data and delivers evidence needed to drive healthcare’s effectiveness and efficiency.

To governmental

authorities,

digital

means that quality of care can be assessed, measured, and compared between providers at the point of care. These assessments will serve as law maker’s inspirations.

Quality control needs rules and stringent parametrization. Again, the phantom of “Big Data” pops up. There are attempts to collect data in an effort to bring the light of quality into secondary care. Hospitals can then be appraised, rated, and paid on the quality delivered.

To

governments

digital

can mean paperless healthcare-systems in an attempt to crack existing walls between healthcare sectors, like primary and specialist care, hospitals, and rehabilitation. Allowing and fostering cross-sectoral cooperation and collaboration needs

digital

tools. This will drive better patient outcome at lower cost, which equals higher efficiency of care.

The working hypothesis must be seen as: “Digital will be the enabler to close the chasm of healthcare sectors.”

Primary-, secondary-, and dental care, and the pharmaceutical arena are only some of the sectors to be interconnected. In an analogue world the walls between these sectors have so far shown insurmountable.

Family doctors

need

digital

to help and assist their daily practice. If diagnosis is a physician’s art, therapy is a relatively trivial part. Artificial Intelligence will ensure a comprehensive overview of therapeutic guidelines respecting every aspect of a singular patient. Any drug or other therapy can then be 100% checked for suspected or probable interactions.

A therapy approved by Artificial Intelligence will make sure that the best possible treatment pattern is provided to the patient. Unbiased Artificial Intelligence will make patients trust and improve therapeutic adherence and persistence for better outcome.

To a visceral surgeon

digital

may mean a lot more than “only” being assisted by a surgical system like “da Vinci®”. Let us not forget that

digital

already allows a specialist being located in Montreal, consulting a surgical procedure conducted on a patient in Paris.

Consulting an international expert somewhere on the globe during an operational procedure already is the norm rather than an exemption.

To a hematological

oncologist,

digital

means that diagnostic procedures can be assisted and supported by artificial intelligence. From what we know today, an AI-supported therapeutic pathway evidently is more precise and offers additional benefits for patients.

Titled “Man against machine” the diagnostic performance of Artificial Intelligence against the diagnostic expertise of 58 dermatologists of all levels in detecting melanoma was tested. Winner was the “digital machine”. 9

To a pharma researcher,

digital

means to leverage digital tools to better engage patients in clinical trials, optimize workflow, improve communication, and speed-up data reporting. All of these are critical factors planning and executing clinical trials more effectively. The constant endeavor to grant access to better care to as many patients as possible, as early as possible will be widely supported.

Screening molecules, designing biological drugs, and allowing personalized medicine for maximum therapeutic value may be more examples for digital in pharma research.

To a

market access

professional in the pharmaceutical industry

digital

means faster and much more efficient dossier-writing and compilation. Submission of all these huge collections of results and underlying knowledge digitally, is easily possible. Authorities administering these data, provide synchronous access to all authorities and their officials.

All know-how and files can be shared between many, at the same instant. In addition, no longer does anyone spend time in paper-based libraries. Medline and other full-text searchable data-collections are at every-one’s fingertips. It allows to speed-up and provide fine-tuned cost-benefit data and evidence-based suggestions to the authorities of choice in the most efficient way.

Exhibit 4: Descriptive graph courtesy of ordinary-people.de

To a

Key-Opinion-Leader-Team

in the pharmaceutical industry

digital

means that the identification of KOL’s is supported by huge datasets. All relevant connecting points, authorships, poster-sessions, keynotes, co-author references and many other informational pieces from publications and high-end congress-participants are subject for evaluation.

Scientific findings are made available to everyone as well. Even individual links between research people and assumed key opinion leaders are displayed on screen. These graphical screens display a number of “qualities” and allow drill-down at a click.

Leveraging the power of digital, makes it kind of easy to identify the most important KOL’s across the globe.

To a pharma

brand-manager

digital

means to engage with physicians and healthcare professionals through digital means. The tool of the early days of pharma-promotion was the medical representative. After personal access to healthcare-professionals is more and more denied, the idea is either to replace or complement rep-contacts by

digital

means. So-called

Digital

communication is a tool to replace or supplement the old and analogue world. The problem is that requirements and demands of addressees are changing: Healthcare professionals today request answers to their questions, no longer do they appreciate promotional messages around a so called

USP

10

of a pharmaceutical product.

To pharma sales forces or better: field-forces,

digital

means to use online-tools to report activities and expenses.

Digital

may even replace sales-folders with personalized and adaptable messages, delivered with the help of a digital device.

Reporting, or policing medical rep’s actions in a digital world by using so-called CRM-systems is nothing less than immediate and all-embracing.

To field-force

“controlling & reporting

”

digital

means leveraging tools like Tableau® to connect real-time data from various sources and in different formats in an attempt to establish real-time reports.

The value these reports add, at least appears questionable, since the question: “What will this figure / data-set help to improve?” is rarely answered. More often than not, the current reporting concepts are designed only answering manager’s request sounding like: “I need this information.” Purpose and actionability often is left unclear.

To a

medical department

digital

means that they must follow all these social media in a never-ending endeavor to detect reports or hints of unexpected side-effects in the www. Patients often send wrong and harmful messages in their forums about suspected or experienced side-effects. These complaints have to be found, collected, and followed-up by medical people in the respective company. Pharmaco-vigilance begins to be supported by Artificial Intelligence, to better comply with rules and regulations.

11

On the other hand, people called “medical science liaison managers” (MSLs), have easy and digital access to address-databases of Key Account Managers and medical reps. They easily can find their counterparts, supporting efforts to establish partners for clinical trials and enroll an appropriate and sufficient number of patients.

9 Hannels, Annals of Oncology, https://doi.org/10.1093/annonc/mdy166, June 12, 2018

11https://pharmaphorum.com/top-stories/bayer-artificial-intelligence-pharmacovigilance/

DIGITAL FOR PATIENTS

There is one important point to be agreed beforehand:

The individual in the center of healthcare is the patient.

A patient is someone notably different from other stakeholders in any healthcare system: A patient carries a diagnose, is suffering from a disease, and receives healthcare.

Healthy individuals, insurance company’s customers, or people covered by a public insurance, family members and next of kin are not patients. They are different.

Disease-prevention or prophylaxis is a different subject as well and not related to care. Many details which are normal and inherent to healthcare vary considerably in the area of disease prevention.

To patients, digital means that they will be interconnected with all involved in their individual care. Patient’s relevant health-data are available to any healthcare professional involved. Once patients are interconnected with all relevant players, it will be possible for them to be integrated into their individual care. In an appropriate digital situation, patients will be the sole owners of their data. Each patient decides with whom which data shall be shared.

Deliberately establishing the interconnection of healthcare players consequently allows, if not enforces, integrated care for the patient. If and when digital technology is fully leveraged, the healthcare system will start to provide comprehensive solutions and answers to patient’s problems and questions.

First and foremost, digital only will be meaningful, if digital projects are executed with the clear and outspoken objective to improve patient care.

Whenever digital tools are entering the playground, the objective or goal, as in many other cases, make the difference.

Whenever implementing

digital

in care is meant to serve patients and grant better outcome, digital will be beneficial for all.

Whenever implementing

digital

in care is meant to serve as a revenue driver for any industry, it will be counterproductive to collaboration and reinforce old, sectoral segregation.

If anyone talks about patient-centricity and means “more revenue”, this shall therefore better be named “intellectual deceit”. Projects of such nature will fail to show any improvement. This predication is supported and highlighted by a quote from Cesar Concepcion, Managing Director, Novartis Spain: “If you use patient-centricity to generate more sales you will fail. If that’s your purpose, you will fail.”12

To patients, prerequisite to go digital is internet-access. Being part of the Societal Digital Transformation, this grants patients the opportunity to retrieve and assess any information at any time from any place. Reciprocally they as well provide content and additional information and access for healthcare professionals to their individual, health-related data. This will turn patients into active participants in their individual care.

The early dogma of the paternalistic physician knowing it all and knowing it all better, has been widely minimized already and will be wiped out by the growing degree of digital transformation in each society. This aspect may well be one of these barriers or obstacles, obstructing the comprehensive utilization of digital in care.

12https://social.eyeforpharma.com/commercial/patient-centricity-cracking-formula

THE INTERNET

The Internet as we know it today, started in the early / mid 1990s. The name is derived from the truncation of “Interconnected Networks”.

What we all use and leverage in our daily life should better be called the content rich World Wide Web. The World Wide Web’s benefits depend on and are directly connected to the invention of hyperlinks. They allow us to jump from one source directly to another one. All those www-resources are identified by their respective Uniform Resource Locator (URL), starting with http:// and ending with a top-level domain abbreviation, like .de, .com., .in, or .eu etc.

In our every-day life we call this a web address. It is the unique reference to a web resource and specifies its location on the computer-network spanning the world. It was Sir Tim Berners-Lee, who paved the way for the World Wide Web writing the code, which is referred to as the Hypertext Transfer Protocol.

The htm13-language was prerequisite to all those benefits of the world wide web which can be enjoyed, experienced, and leveraged today. Good or bad, the www is open and available for all. It is not the internet to be blamed for any wrongdoing, but its users. For billions of users the www establishes benefits. Others use it with criminal energy and bad intent. This bivalence applied and applies to anything which human beings get hold of. The closest comparable items are cars: great means for transportation, but it can intentionally be used as a lethal weapon.

Only 30 years after its invention, almost 60% of the world’s population is connected to the Internet.14 This shows a truly global development at a breathtaking speed.

The world-wide-web is the world’s most impacting digital tool. It triggered societal transformation.

13 HyperTextMarkup-language

14 https://www.internetworldstats.com/stats1.htm

INTERNET-USAGE

It may be a more general question, yet it is valid and important if you ever have to work with numbers indicating the “Internet users”. What does “Internet-usage” mean?

Is it correct to be counted as Internet-user when your smartphone automatically connects and therefore uses the Internet-infrastructure?

Does automatically receiving e-mails or chat messages make anyone being an Internet-user?

Answers to questions like these could be of great importance when interpreting and assessing available options to leverage digital technology in healthcare.

Which channel or digital tool can you use, to support patients in their attempt to better manage their own disease?

What will work with chronically ill patients 60- or 70-years of age?

It may be worth considering if the growing number of people being online, is a real improvement of conscious and informed usage of technology. Or it is a simple coincidence that people are counted and identified as internet-users by simply switching on a “self-connecting” device like their smartphone.

WORLD WIDE WEB

The speed of change driven by this digital societal transformation is accelerating since it was invented. Some people are scared, others are enthusiastic, and many are trying to grab as many opportunities as are offered by the world-wide-web to organizations and individuals.

Individuals who refuse or cannot follow these rapid, technology driven changes, risk being left behind in their societal participation. The number of (n)on-liners in many countries still is far too high and causes room for concerns.

Exhibit 5: Internet users per 100 inhabitants

Interpreting the numbers of Internet-users, one may assume a data-bias. The “contamination” or spread of smartphones in the population itself may be a major driver of being online, since smartphones or their users appear to be “always online”. This will not really qualify users for leveraging or deliberately using their Internet-connection. Nobody knows in how many cases being counted as online, shows a mere coincidence.