By R. vd Meer
9.30 am in a primary school in a small town not far away from Aligarh (Uttar Pradesh – India), and math class has just begun. The teacher, Mr. Akela is writing equations on the blackboard, but 11-year old schoolgirl Advika is frustrated, because she does not grasp the solution. Advika is a very bright student and received good grades in the past years at school, but she just can’t make out the numbers this time. At the end of the day, Mr. Akela asks Advika to see him and shares his worries about her recent performance. While discussing the situation Advika admits that she recently developed difficulties reading the blackboard. Mr. Akela thinks it has to do with her eyesight and he quickly conducts a visual acuity test using his smartphone-based portable eye examination kit. Luckily for Advika she only needs a pair of spectacles to correct the shortsightedness identified by the app.
A smartphone app called PEEK (Portable Eye Examination Kit) turns your smartphone into a practical and multipurpose eye examination tool. It produces high-quality images of the retina and can identify all sorts of cataracts and other eye conditions. As 80% of blindness is avoidable, in many poorer parts of the world access to eye care tools are not available. PEEK is just one of many examples of self-diagnosis tools and illustrates the digital revolution in healthcare.
Digital revolution in the less developed world
In this example, the digital revolution is making affordable healthcare available in less developed parts of the world. It is directly targeting one of the 17 sustainable development goals; good health. Subsequently, one could argue that by improving eye care, keeping people from blindness and therefore allowing them to participate fully in their communities is indirectly contributing to other goals too: no poverty, no hunger and reduced inequalities. Along making a technology like PEEK available to people in rural India, multiple challenges still exist. While using PEEK is a way cheaper solution than having trained doctors and expensive diagnosis equipment, the penetration of smartphones in these areas is not as high as in the Europe. Secondly, if a smartphone is available, the user should be educated about how to use the device and how to interpret the results of the tests. Lastly, once the test is performed the actual work starts. As the app can perform basic diagnosis, there might be cases where more advanced and follow-up examinations are needed. Furthermore, knowing what the problem is, does not necessarily mean that an affordable option is available to solve the problem.
Digital revolution in the developed world
This example does not only benefit less developed parts of the world, it has the potential to create good health in developed areas too. After a considerable increase in health care spending in many high-income nations over the past 15 years, the urge for strategies to control those costs are on the political agenda of all these nations. Moreover, controlling costs often has to go together with the improved quality of healthcare and greater efficiency; “better and more for less”. Three different approaches for health care cost containment strategies, based on a study of Canada, England, France, and Germany, are outlined: budget shifting, budget setting and direct and indirect controls of health care supply. In order to reduce health care spending, but simultaneously improve the quality of the delivered care, several options are discussed in two “New Yorker” articles: “Letting Go” & “Big Med” and technology-driven is one of them. Peek is just one of many examples that belongs to this category of technology-driven solutions. The challenges I see in the developed world are about the adoption of these new technologies. Firstly, this requires physicians and care providers to change their behavior; they have to start using the technology (in the right way) and abandon the old way of working. Often you see that new technologies are used in parallel to more traditional solutions, and so increasing costs instead of decreasing because something is added to the traditional solutions instead of replacing it. In addition, there is the challenge of budget and budget allocation. Whereas new technologies don’t have a proven track record yet, payers are reluctant of adopting new technologies and pay for them. Moreover, the attitude of big insurance companies seems conservative and risk-adverse. None of the insurance companies wants to be the guinea pig, experimenting with innovative solutions.
Future outlook
The digital health market is expected to grow from $79 bn in 2015 to $206 bn in 2020. This will offer opportunities for new players (start-ups) and non-traditional players (tech-companies) to bring in their expertise and innovative power and be(come) part of one of the largest and growing industries. New technical solutions are going to disrupt the way healthcare is organized today; traditional players like Philips are going to experience fierce completion and have to keep up, physicians need to change the way they work and integrate innovative solutions in their routines, payers, and governments get a solution to make healthcare more accessible and affordable but have to understand the opportunities and adopt.
PEEK is just an example of how mobile technology can contribute to one of the 17 sustainable development goals; good health. Technology solutions like PEEK, increase the availability of care in an affordable way in the less developed world. Simultaneously, it provides cheaper alternatives in the Western world, helping to solve a main issue in healthcare: “how to do more and better for less”.
Is the teacher Murali? Poor children :/
Jokes aside…this is a very interesting post. Do you have any more details about the quality of smart phone needed to do eye examinations? Cell phones are ubiquitous across emerging and frontier markets, but many high-end smart phones are still out of reach for many. Would be interesting to see how they can make PEEK as functional/available to as many people as possible.
Have there been discussions of vertical integration with glasses manufacturers? This could be huge if, para ejemplo, Warby Parker got all up in this bizness. WP loves a good publicity stunt, and they could definitely tap into this data to provide needed lenses to the developing markets with demonstrated need of spectacles.
Good post, R. vd Meer.
Really interesting technology! It’s great that people can utilise their own smartphones (if they have one) to self-diagnose. However, I see that one of the unresolved major issues of healthcare in developing and rural areas is the lack of access to medical practitioners (due to distances and low ratios of patients to specialists). It would really a huge shame to see the patient journey end at self-diagnosis 🙁