December 1, 2020
About 15 years ago, the eHealth Behavior Management Model started applying time-tested, behaviorally focused theories to health education in a way that would prove to become the primary platform for the world’s economic and societal development: the Internet. Harnessing the network of educational information available, the eHealth Behavior Management Model sought to connect individuals to the most appropriate, personally tailored resources facilitating self-management of health behavior.
Today, the Internet is a means for interconnecting more and more devices we have come to depend on. “iPhone” and “iPad” are household words. Social networking has taken on a whole new meaning with Facebook and Instagram motivating and cultivating the collection of personal history for most individuals in the developed world. More and more of us are using sensors to collect personal telemetry using smart watches and activity tracking devices like FitBit.
How we will use the Internet long term appears to be driven by whether it successfully enables personal empowerment. This started with connecting users to information. It is transforming into a means of interconnecting our personal history and behaviors, valuable information leveraged mostly by information brokers like Google, Facebook, and Amazon. However, recent events like the use of personal data by Cambridge Analytica for the 2016 presidential campaign suggest that the time is right for individuals to take ownership of their own data. Not only to protect it, but manage and benefit from its value. Individuals should leverage data about themselves for daily decision making and at their own discretion, share with health care providers, other professionals or “intelligent” applications that offer services to improve quality of life. The tide is turning and individuals are realizing the value of their own data and will seek solutions for helping them manage and use it effectively.
The recent success of cryptocurrencies exemplifies the trend toward individual empowerment and decentralization of control. These digital currencies are still widely misunderstood, but will eventually change the way most individuals think about the security and value of everyday consumer and business transactions. For example, rather than trusting a bank to manage a transfer of funds, the transaction is governed by a set of rules coded to be executed by a network of computers. A public digital ledger of all transactions is updated based on consensus of the network.
The drive to build deeply connected platforms that leverage autonomous execution of decisions to deliver high value is shared across many industries and applications. The buzz for “digital transformation” can be heard from the largest corporations to local schools and health care providers.
We are in the midst of a rapidly expanding, digitally mediated interconnectedness that could increase efficiency and better distribute available resources. Security and privacy are just two examples of the many challenges that must be addressed. However, the potential value is worth the risk with respect to enhanced solutions from healthcare financing to managing personal health behavior.
The current system for financing healthcare is inefficient, bloated with administrative cost and burdened with bureaucracy. How healthcare is delivered and reimbursed is nearing a tipping point for disruption. The recent acquisitions of Aetna by CVS, Express Scripts by Cigna and possibly now Humana by Walmart, I believe, are attempts to maintain stronger centralization of services among a few, with profits the primary objective.
Rather than relying on for-profit orchestration of healthcare benefits and payments between consumers, doctors, retail pharmacies, health insurers, drug wholesalers, pharmacy benefit managers (PBMs) and drug manufacturers; technologies like blockchain could make this middleman-based system obsolete. Blockchain can provide a means for smart contracts to be executed directly between consumers and service providers.
Okay, let us step back and think about this. Does having your every move tracked, measured, evaluated and stored on a public, distributed ledger sound like a good idea? Despite the “Big Brother” implications, the key is decentralization. The lack of a central authority means that no one organization is in control. In reality, data is treated like a valuable commodity owned by a relatively few number of large organizations. As consumers begin to realize the value of their own data, more and more technologies will emerge for enabling individuals to wield ultimate decision-making power with respect to how their data gets accessed and used.
The opportunity for digital transformation in how we pay for healthcare is promising. Likewise, the potential for impact in how we manage personal health behavior is significant. The eHealth Behavior Management Model has demonstrated the power of using the internet to provide the right information to an individual to meet their specific needs, most evident with the increasing adoption of online behavior management tools like wichealth.org.
Expanding the scope of an individual from engaging with, for example, wichealth.org lessons at only a few contact points throughout the year, the eHealth Behavior Management Model of the future would always be at work. This means potentially interconnecting all daily transactions, not just about what we buy, but what we eat, what we do, how we exercise, what we commit to, basically anything measurable about our lives. This valuable information can not only help us make better personal health decisions, but it can be curated and made securely available to those from whom we seek healthcare services to ensure preventive and therapeutic recommendations are precisely tailored to our personal needs.
As an epidemiologist, I immediately see the potential that digital innovations have to increase access and availability of education and health management resources at a low cost. However, getting individuals to really use them, commit to curating their own data and engage in self-management and monitoring is a challenge. The development of digital innovations that are able to add immediate value to the consumer will be those that can be easily integrated and used with little effort or even automatically. Immediate value that digital innovations can have on individuals include facilitation of appointment setting, prescription fulfillment, behavior management, and medical compliance. Further sophistication could enable better coordination of health demands and medical resources to reduce barriers to routine services such as check-ups, health screenings, vaccinations, and education.
The ability of digital innovations to integrate seamlessly into one’s environment will definitely be a factor in widespread adoption. Wearable technologies are emerging as key enablers of personalized healthcare through digital transformation; connecting applications to a distributed information sharing model while keeping individuals at the center of control. Furthermore, research has already shown that such devices foster the creation of new health knowledge and more effective prevention and treatment techniques that will increase the likelihood that engaged consumers will stay healthier and live longer.
Scalability is another concern that digital innovations, such as wearable devices, will be able to address. By 2020, the need for chronic disease and self-health monitoring will increase significantly due to the rise of the elderly population. Digital technologies will be able to reduce overall costs for disseminating resources for monitoring and prevention.
The eHealth Behavior Management Model serves as a strong foundation for how we can leverage the right information at the right time to educate and motivate individuals. Likewise, personal health management must be about empowerment. The value of a fully connected, decentralized and autonomous personal health management network may just be the answer needed to help eliminate healthcare resource issues.