“The end of the beginning”
About the Book
What is happening in (digital) Health(care) ?
Please find the prologue of the book for you to read below.
“Omnia mutantur nos et mutamur in illis”: Everything changes, and we change with it.
The world is changing, society is changing, technology is changing, and so health(care) is. And it does so at ever increasing speeds. Platforms like Facebook, Youtube, Spotify, and Amazon have entered our life and are here to stay. Many of these platforms did not exist 15 years ago, and some of them will no longer exist in 10 years from now.
Healthcare apps for smartphones, portals and big corporate electronic health record (EHR) systems struggle to adapt to a new reality where algorithms and platform thinking emerges. Where patients are in control of their own personal data, everything is INTERconnected and traditional healthcare systems (still) are just INTRAconnected. They will enter the ‘End of Life’ phase of their current product cycle.
While many digital health critics at present address privacy and security issues – next to the looming market domination by modern tech-titans – I expect these new global corporates will be compliant to the European GDPR sooner than many of our healthcare institutions. And although
I share the worries on the risk of monopolization by tech corporations; I trust the current and future governance systems to handle this. Even though we will see hiccups on the way like recently with the ‘Cambridge Analytica files’ – officially not a ‘data breach’ but a flagrant crossing of ethical borders – I believe that law will follow the practice.
New players like Apple, Amazon, and Google (Verily) first explored the healthcare scene and now aggressively fight for (the data of) patients, offering a consumer-friendly user interface and removing the friction that the traditional silo-structured healthcare industry has been reluctant to address.
Meanwhile these tech-titans create interconnectivity ‘by design’ and on a global scale. Together with their ambition to enter the health(care) domain at an increasingly speed as you can see in this graph below. In it I have pictured the announcements of these non-traditional players into the healthcare arena over the past year, starting May 7th, 2017. I think this picture needs no further explanation.
We have entered the fourth industrial revolution where everything will connect with everything. In this book, I elucidate onthe four pillars of change that I sense healthcare is facing: Delocalisation, Democratisation, Digital, and Dollars, hence my 4D’s.
Why are we at the “End of the beginning”?
I think this current digital transformation is at the “End of the beginning”. In an era where data will be continuously and easily gathered, analyzed for new patterns and used for machine learning at meticulous speed, technology will ‘augment’ the way we deliver health(care). Not only in industrializedcountries: due to the proliferation of network coverage, Augmented Health(care)™ will become accessible to all people worldwide, enabling citizens to stay healthy and professionals to help people with a condition even better than today.
Some people try to change healthcare by focusing on the quality of care and service. Others focus on safety or healthcare economics. I choose to focus my work and research on the impact and opportunities digital technology can bring, transforming health(care).
Healthcare has been subject to waves of change in the past centuries when developments came together. We are on the brink of a new wave right now. Although we all want to progress and we need more sustainable health(care) to cope with societal challenges such as aging populations, we also face a daily struggle with the implementation of new tools.
In this daily struggle important issues like workload, reimbursement, policies, culture, knowledge, and information are all roadblocks in the way to a gentle transition. We need to remove these impediments and change the way we educate and train health(care) professionals, change the way we pay for health services, and change how we measure and research digital health(care).
It requires continuous awareness of the ever-changing technological horizons. It requires a thorough implementation of those innovations and the incorporation of digital tools and a digital mindset in daily workflow, becoming “the new normal”. It is almost like building a plane while it is already in mid-air. Maybe we should call this an ‘adaptive digital transformation’.
This book is neither a step-by-step guide nor a plan. Health(care) organizations, their contexts, and their cultures are different. These external and internal influences vary in each and every organization, which implies there is no blueprint for innovation. Hopefully, this book will offer some actionable guidance on the next steps, to take on the challenges that lie ahead of us.
I stepped into this arena almost seven years ago, and it all began with a shared ambition to address change. But back then, there was no detailed, worked out plan at REshape, the Center for Innovation in the Radboud University Medical Center. In these early days, we’ve experienced that a shared vision and awareness are powerful motivations for change.
Adjusting over time to the level of awareness, we are now facing a bigger overhaul, because our organization is ready for the next steps. Merely building awareness, weaving concepts, presenting a compelling vision, and inspiring people does not suffice anymore. The need of the hour is to address the “how-to”-question. How to create meaningful digital tools for professionals and patient, how to organize and align stakeholders, how to scale digital health solutions?
This “how-to” has not been addressed adequately yet. To me, it appears that a whole network of healthcare innovators across the globe is struggling with the same issues. Some individuals and organizations have a plan; some have partial success, while some fail. It looks like we are all ‘writing the book’ as we speak; yet, we need to create tempo and build capacity.
Back then when we started REshape, I would have loved to have a book to learn about thatfirst phase. A tour d’horizon of what is next when you start working on health(care) innovation. While some people think their organization can bypass that first discovery phase, or simply hire someone to do this – or even stop exploring and testing at one point in time – however, I would urge you that this exploration is nothing short of vital.
You really have to ‘live’ through this phase with your own people. You have to “feel the joy and the pain”, as my friend Chris McCarthy – who ran the innovation center at Kaiser Permanente for twenty years – likes to say. What I am saying is this: you can’t learn how to bike from a book. To innovate in healthcare, you have to experience it.
Although the current increase of demand for scaling is valid, there is also the risk of losing sight on the constant change that will be permanent if we myopically focus on scaling. The world will not pause to change. There should be a fair balance in creativity and room for exploration, as well as implementation and scaling.
In the journey towards this publication, I have interviewed some great friends that we have partnered with over the past years. Some of them have written a brief perspective on the changing healthcare landscape. They have enriched the broader picture with their ‘vignettes’ throughout this book.
This book is merely a reflection on the seven-year innovation-journey at Radboud University Medical Center (Nijmegen, The Netherlands), my work as a faculty member at Exponential Medicine (Singularity University, Silicon Valley) and as CEO of my small company Transform.Health. At all these positions, I have always been aiming to create sustainable health(care) change by collaborating with great professionals, with patients, and with the latest useable technology.
This book titled Augmented Health(care)™ encompasses all my personal and professional learnings, the joy and pain, the lessons from others and my observations over all these years. I wish it was available as a direct ‘download’ from my brain, but since we’re not in that exponential era yet and since there still is no USB plug in my brain, we had to write it down ourselves ?
The way this book came about is a journey in itself, through the integration of modern and classical tools and means. You can learn more about it in the chapter, “how this book was made”.
The combined mission of my work at REshape and my other endeavors was and continues to remain is to prepare healthcare for a soft landing into the future. I do hope that sharing these reflections and assumptions with you can help and inspire you to (re)think and encourage you to come across the opportunities in this current era, to change health(care) for the better.
I’m grateful for the past and current executive board to have the courage, the boldness, the vision and trust in sending me out there to be their scout, ambassador, and rebel for change. Everybody thinks they’re innovative, but it takes more than throwing some money against the wall and putting up a shield “innovation center’. The majority of the things they allowed me to do have a long lead-time, before having any impact.
Sadly, health(care) innovation is not impervious to tokenism; some claim that you can change or even fix health(care) overnight. It is neither about technology nor about the process; it is about bringing about a systemic change in the culture of an organization. As we know, culture eats strategy for breakfast. Having remained stuck in there with me for over seven years, the ‘seven years itch’ is definitely to their credit.
And last but not least – my stellar team – what can I say: you are my fuel, my northstar and my passion. Being able to guide you is an honor in itself.
All of this takes time, dialogue, and understanding from those surrounding us. There is no quick fix, no silver bullet, and our world will never stop changing. So let’s get on with it!
With embedded contributions, interviews and perspectives from Simon Sinek, Daniel Kraft, AnneMiek Vroom, Hal Wolff III, Bart Brouwers, Bart Timmers, Peter Bennemeer, Anya Kravets, Jules Lancee, Marco Derksen, Marie Johnson, Martijn de Groot, Chris McCarthy, Michiel Muller, Bert Vrijhoef, Rene Bleeker, Tom vd Belt, Claudia Rijcken, Maarten van Rixtel, Jörn-Ole Stellmann, Shawna Butler and Maarten Steinbuch amongst others.
ePatientDave, Dave de Bronkart, patiënt-activist:
“Entrepreneur Lucien Engelen has an extraordinary vision about the future of health and care. He was the first to conceive a TEDx focused mainly on patients, the first to declare that health conferences MUST bring patients, the first to innovate a medical school curriculum with patients’ advice. A man of insane energy, broad experience, unstoppable passion and clear vision, he has worked tirelessly to inject “patient DNA” into the future of medicine. Work hard to see what he sees. Help make it real. :
Daniel Kraft MD, Stanford & Harvard trained MD-Scientist, Aspen Institute Innovation Fellow. Medicine Chair Singularity University and Founder Exponential Medicine. :
“He is too harsh on himself. The message of this book is not about the latest technology, but about broader themes. His first-row observations on the nature of digital innovation, organizational resistance and the still often-neglected effects of consumerization may (yet) lack scientific rigor, but more than makeup for that by their candor, hands-on learnings, and valuable insights.” :
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