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THE BUSINESS OF E-HEALTHGLOBAL & REGIONAL CONSIDERATIONS
CLAUDIA PAGLIARI, PHD FRCPEDIRECTOR, GLOBAL EHEALTH PROGRAMME, UNIVERSITY OF EDINBURGH, UK
9th Nigerian Conference on Telemedicine & eHealth, Nov 2015
GLOBAL E-HEALTH ECONOMY
Global E-Health market expected to
reach USD 308.0 billion by 2022, according to recent reports (Grand View Research Inc.)
WESTERN PRIORITIES Disease • Chronic conditions & aging
Business • Telehealth & supported self-care• Mobile web, wearables, insidables• Smart homes• Augmented and virtual reality• Assistive robots • Big Data analytics• Genomics & personalised medicine• Machine Learning & Artificial
Intelligence• Open data
Diagram: Paul Sonnier. LinkedIn Digital Health Group
NEW PLAYERS
http://www.rolandberger.fr/media/pdf/Roland_Berger_EHealthAndNewCommercialModel_20140924.pdf
Pharmaeutical industry investing in data analytics,direct-to-consumer
compliance techGlobal IT businesses investing in Smart Homes, Internet of Things
etc
http://www.slideshare.net/Tracxn/tracxn-smart-homes-startup-landscape-feb-2015
ICTs investing in mobile trial recruitment & real
time evaluation
AFRICAN PRIORITIESHealth priorities• Maternal & child mortality• HIV/AIDS. Malaria• Malnutrition. Security.• Access to meds & immunisation
Business opportunities• Mobile money & micro insurance• Data collection & analytics• Stock management• SMS/smartphone interventions• Crowdsourcing• Accountability interventions• Cloud solutions
From: Techcabal.com
From: phn.ng
Whose job –Government,
Global Donors,Non-Profits,Companies, Individuals?
UNDERSTANDING CONTEXT: NIGERIA
• Informal economy (c. 75% small businesses)• ‘Islands’ of wealth (oil) & technology, but majority poor (90%)• State responsible for public health but invests little in it • c. 70% of health expenditure is private, more so amongst the poorest• Emerging eHeath strategy & innovation but systemic problems of governance • Business caught in the gap – Innovate without gov support or crawl with it?• Potential markets –
• Citizens without adequate provision• Private health service providers • Government/Public Health agencies
Where to target – Luxury market?Average citizen?
Instutitions?
Glocalisation or home-grown
innovation?
“Healthcare has been all about government and treated like social welfare but the private sector needs to be involved” PHN Blog
http://www.phn.ng
http://nigeria.gsmamhealthfeasibility.com
Source: UN Foundation draft eHealth strategy 2015-20
“of 45 mHealth services in Nigeria 18 target maternal and child health and nutrition, 12 of which include demand generation, registration and data surveillance. Commercial aggregators and mobile operators have signed up to common short codes and discounted pricing as a means of improving access”http://nigeria.gsmamhealthfeasibility.com/GSMA_Country_Feasibility_Report_Nigeria_2014.pdf
Source: www.slideshare.net/eddodds/e-health-strategiespdf
National Information Technology Development Agency-NITDA 2011
Source: Personal communication
Key themes: Capacity Building; Governance; Leadership; Strategy & Investment; Legisation & Policy Compliance; Architecture, Standards & Interoperability; Infrastructure, Solutions
ALIGNING E-GOVERNMENT & E-HEALTH
GOVERNMENTS REACHING OUT• E-Government• “…can provide savings for governments
and businesses, increased transparency, and greater participation of citizens in political life” https://ec.europa.eu/digital-agenda/en/public-services
• “ …can be a tool for sustainable development and a lever for new employment, better health and education” http://nuviun.com/content/3-global-lessons-for-ehealth-providers
OPEN DATA 4 BUSINESS• “governments should focus more on
starting, growing and sustaining open data initiatives” UN e-Government Survey 2014
http://unpan3.un.org/egovkb/en-us/Reports/UN-E-Government-Survey-2014
• “...Open data [can] enable public health services, private sector innovation, and prosperity in developing countries. The …annual potential economic value of open data may be as high as $3-5 trillion”http://www.acquia.com/gb/blog/government/open-data-global-health-data-imperative/22/06/2015/3285076
• Mobile apps • On-top data services• Visualisation platforms etc.
• “companies are combining different open datasets, or public and private datasets to build new businesses. We're seeing companies starting to use sophisticated data analytics"
http://www.informationweek.com/government/open-government/open-government-data-companies-cash-in/d/d-id/1113143
OPEN TECHNOLOGY• Massive infrastructural investments can be too costly with commercial
tech• Open Source Software Platforms useful for scaling at low cost
• Some issues with paid-for customisation when consultants leave• Organisations like OpenMRS are prioritising local health informatics capacity
to fill the gap• Open APIs support the evolution of a
local businesses around big tech
THE ‘BIG DATA’ BUSINESS• Data as a Commodity• Linked health records for pharma R&D• Social media and mobile device data for market segmentation
research & public health surveillance
• Analytics as a Service• Data-driven insights for business, government or citizens• Prediction of health risks & resources
• Ethics as a Necessity• Risk of exploitation and privacy breaches. Need to ensure reciprocal
benefit and government trustworthiness• Business opportunities in privacy-as a service, consent software etc.
• Security as a Priority -> Privacy-as-a-service?• Hacking, Identity Theft• Market governance & enforced penalties
ADDITIONAL CHALLENGES AND OPPORTUNITIES
OPTIMISTIC BIAS
• Companies want to sell• Politicians want to be elected• Governments want to ‘spend to save’• Investors want the ‘next big thing’• Consultants want to get paid• Lawyers and bankers want a slice in the middle …and so do some public servants
-> Financial front-loading-> Failure to anticipate or budget for complexity -> High failure rate-> Lack of organisational learning -> Repetition & failure to penetrate/scale
www.nao.org.uk
http://www.slideshare.net/assocpm/where-did-it-go-wrong-handout
->
HYPE
ETHICS & GOVERNANCE
Holeman, Cookson & Pagliari. ICT for increasing transparency, accountability & public participation in lower income country health systems. MSH/USAID
Poor security is expensive for governments &
businesses
FRUGAL & REVERSE INNOVATION
“In low-income countries…the need for solutions is often felt more urgently, driving entrepreneurs to challenge assumptions on the ground and find new, immediate ways of delivering healthcare that connect vulnerable populations with the care they need” UK Health Foundation, 2011 http://www.health.org.uk/publications/what-can-the-uk-learn-from-healthcare-innovation-in-india/
www.who.int/goe/publications/baseline/en/
FOSTERING LOCAL INNOVATION
http://ubi-global.com/wp-content/uploads/2015/07/UBI-Global-GBR1415-Preview.pdf
Supporting Business Start-Ups & Technology Hubs:
http://venturesafrica.com/five-innovative-startups-in-nigeria-for-2015/
WHY WE NEED ‘R’ AS WELL AS ‘D’
Ensure valid productsImprove usability & ‘fit’
Unpick complexity to inform investment & implementation
Evidence-based business case
Avoid costly failures Promote sustainability
Developers, designers (Suppliers)
Researchers & evaluators
(Scientists)
Users, Purchasers,
Commissioners (Payers)
Integrated approaches work best
http://www.jogh.org/pdfviewer.aspx?pdf=documents/forthcoming/jogh-06-010401.pdf
“Most studies are of poor quality and few have evaluated impacts. Ambiguous descriptions of interventions and their mechanisms of impact present difficulties for interpretation and replication”
20 reasons start-ups fail https://www.cbinsights.com/blog/startup-failure-
reasons-top/
CAPACITY BUILDING
Focus: Generic health system leadership Partnering with Univ LagosFocus – Overall Health Information Workforce
(applied) Nigerian HIM representation Focus: Global e-Health Innovations, Research & Strategy (Leadership). Includes Nigerian students & tutors
INSIGHTS CAN BE EXPENSIVE!
Enrolling Now
The Business of eHealthApril-June 2016
Executive-level online study (credit is transferrable to the full MSc)
@mscehealth@EeHRN
