The Digital Transformation of Healthcare

Health 4.0

Marek Ćwiklicki, Mariusz Duplaga, Jacek Klich, Marek Ćwiklicki, Mariusz Duplaga, Jacek Klich

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000514964
• Edition: 1
• Topic: Betriebswirtschaft
• Subtopic: Pharma-, Biotechnologie- & Gesundheitsindustrie

Health 4.0 is a term that has derived from the Fourth Industrial Revolution (Industry 4.0), as it pertains to the healthcare industry. This book offers a novel, concise, but at the same time, broad picture of the challenges that the technological revolution has created for the healthcare system.

It offers a comprehensive view of health sector actors' interaction with the emerging new technology, which is disrupting the status quo in health service delivery. It explains how these technological developments impact both society and healthcare governance. Further, the book addresses issues related to key healthcare system stakeholders: the state, patients, medical professionals, and non-governmental organizations. It also examines areas of healthcare system adaptiveness and draws its conclusions by analysing recent health policy changes in different countries across the Americas, Europe, and Asia. The authors offer an innovative approach to the subject by identifying the critical determinants of successful implementation of the Fourth Industrial Revolution's outcomes in practice, on both a macro- and microlevel. The macrolevel analysis is focused on essential factors of healthcare system adaptiveness for Health 4.0, while the microlevel relates to patients' expectations with a particular emphasis on senior citizens.

The book will appeal to academics, researchers, and students, across a wide range of disciplines, such as health economics, health sciences, public policy, public administration, political science, public governance, and sociology. It will also find an audience among healthcare professionals and health and social policymakers due to its recommendations for implementing Industry 4.0 into a healthcare system.

1The Fourth Industrial Revolution and the healthcare system

Jacek Klich

DOI: 10.4324/9781003144403-1

Introduction

The Fourth Industrial Revolution (4IR) profoundly affects not only service production and provision but also business, governments, people, and the entire social sphere (Schwab, 2016a). The aim of this chapter is to explore the phenomenon and nature of the 4IR (the first part of the chapter) in the context of the challenges it poses (and will pose) to the health system (the second part). The concept of Health 4.0 is then used to interpret these challenges (the third part). The author sets out to demonstrate that the 4IR has initiated a new stage in human development, which will require far-reaching changes in the organisation and financing of the healthcare system.

The Fourth Industrial Revolution and its dimensions

The concept of the Fourth Industrial Revolution

The 4IR is understood here as an economic and social phenomenon driven, among others, by the development of artificial intelligence (AI; Dahl, 2019), robotics, the Internet of Things (IoT), autonomous vehicles, 3D printers, nanotechnology, additive manufacturing, neurotechnology, biotechnology, materials engineering, energy storage, quantum computers, etc. Although the 4IR is in statu nascendi, it is rapidly developing and is subject to intensive research. Research findings show that it is having an increasing impact on all the dimensions and aspects of human life, including the healthcare system (Nadella, 2018, p. 9). As Karl Schwab puts it, we will have to “understand and shape the new technology revolution, which entails nothing less than a transformation of humankind” (Schwab, 2016a, p. 7). The phrase “transformation of humankind” is by no means an exaggeration in this context.

The 4IR entails far-reaching and system-wide changes due to its three essential characteristics: (a) high pace; (b) breadth and depth; and (c) a sweeping impact on all the spheres of human life. These changes result in, among other things, “a fusion of technologies that is blurring the lines between the physical, digital, and biological spheres” (Schwab, 2016b). The interpenetration of these three worlds with sophisticated technologies can be considered as the specific difference between the 4IR and the previous three industrial revolutions. In such a context, of key importance are the consequences of these processes, including, in particular, the gradual disappearance of the boundary between man and machine. This is a two-way process, which involves, on the one hand, equipping machines with functions and characteristics inherent to humans (using AI) and, on the other, equipping humans with a range of devices (including implants) and/or applications that expand their physical and cognitive capabilities to an unprecedented degree, known in the literature as human enhancement (HE).

The impact of the Fourth Industrial Revolution on the environment and human life

The 4IR leads to profound changes in the environment and human life.¹ Its impact on industry and industrial relations (Badri et al., 2018; Martinez et al., 2019; Schwab, 2016a; Schwab, Davis, 2018), trade (Kaur, Kaur, 2018), and education (Gleason, 2018) has been intensively studied, and its scope as an object of research is constantly expanding.

The World Economic Forum identifies eight areas through which the 4IR affects economies and societies: ethics and identity, agile technology management, inequality, business disruption, labour market disruption (including worker skills), security and conflict, innovation and productivity, and technology connectivity/interpenetration. Each of these areas is subsequently associated with more narrowly defined fields and phenomena (based on functional relationships and dependencies). Their list is quite long (currently, it consists of 31 items and is growing as our knowledge develops) and is comprised of, among others, values, biotechnology, global governance, justice and judicial infrastructure, cybersecurity, drones, circular economy, the future of economic growth, mental health, advanced materials, 3D printing, information technology, entrepreneurship, international security, public finance and social protection, and geopolitics (World Economic Forum, 2019).

It is noteworthy that relatively little attention (as emphasised by e.g. Schwab, 2016a; WHO, 2011) is devoted to tracking and analysing the current and expected future impacts of the 4IR on health or, more broadly, on the healthcare system. This book aims to contribute to filling this research gap.

The impact of the Fourth Industrial Revolution on health

The recently published research findings on the impact of the 4IR on health have made it possible to identify its five key aspects, namely “the impact on healthcare efficiency and effectiveness, the impact on government action, the impact on human resources, the impact on health system organisation, and the financial impact on the health sector” (Castro e Melo and Faria Araújo, 2020). Given the current status of the 4IR as an emerging phenomenon, research on how it affects public health and the healthcare system is only gaining momentum. In Figure 1.1, the author identifies the directions of the 4IR's impact on health as part of the still modest current of cross-sectional studies²aimed to classify and categorise these issues. The following have been singled out as direct effects of the 4IR: new products, technologies and procedures, new services and information technologies, and virtual reality. These effects can then be associated with the supply and demand side of the healthcare system, and then in each of these areas, we can try to identify sample categories which stem from the highlighted direct impacts of the 4IR, as shown in Figure 1.1.³

Figure 1.1Directions of impact of the Fourth Industrial Revolution on healthcare system.

Source: Own study based on Klich (2021).

The supply side comprises new medicines, medical devices and technologies, new medical devices and technologies, nanotechnology and genetic engineering, implants, telemedicine, big data, and AI.

The demand side includes a range of categories, such as obesity (which in this context is associated with media and electronic gadget addiction and the consumption of highly processed foods), lifestyle diseases, and stress and depression (broadly defined, including stress and depression resulting from job loss as a result of people being replaced by machines and/or computer applications in the workplace), which, in the context of the 4IR, shall be treated as the derivatives of Internet addiction.

This book focuses exclusively on the supply side of the impact of the 4IR on health, and only selected elements shall be discussed in more detail: new medicines and medical technologies, new devices, nanotechnologies, genetic engineering, implants, telemedicine and e-health, AI, and HE.

At this point, it is worth commenting on the exponential growth of health information available on the Internet as it has a dual nature and cannot be clearly attributed to either the supply or the demand side of the healthcare system. In view of the fact that this topic will be discussed in more detail in subsequent chapters, it is only briefly remarked upon below.

Easy and rapid access to large amounts of information available on the Internet encourages patients at all stages of illness (diagnosis, treatment, rehabilitation, recovery) to use it, which decreases the information asymmetry between them and their physicians. Research on the use of the Internet has shown that it has become an influential mass media source of health information in Northern Europe (Kummervold, Wynn, 2012). Although, admittedly, access to health-related sites is not difficult, it is by no means unproblematic. Advice sourced from the Internet may have both positive and negative (i.e. outright dangerous) consequences for the patient (Tan, Goonawardene, 2017). The former includes a greater awareness of disease processes, health promotion, and preventive healthcare. However, it may easily become harmful when patients acquire information that is unproven, incomplete, or even contradicts medical science and may go on to use it to self-diagnose themselves and/or challenge their physician's findings/recommendations, which may have a negative effect on therapeutic relationship and outcomes (see Chapter 13).

Challenges posed by the 4IR to the healthcare sector

The phenomena illustrated in Figure 1.1 can be interpreted in terms of challenges posed by the 4IR to the healthcare sector⁴. They are only briefly remark on here since they are discussed in more detail in subsequent chapters of the book.

The challenges that the 4IR poses to the health sector should be analysed in the context of the most pressing issues facing global health policy. In 2019, before the outbreak of the SARS-CoV-2 pandemic,⁵ they included problems arising from malnutrition and living in areas of armed conflict and natural disasters (including the endemic presence of the Ebola virus), the spread of HIV, antibiotic-resistant microorganisms (e.g. gonorrhoea strains), family planning methods (including modern contraceptives), provision of nursing care at present and in the near future, and more broadly defined issues affecting health, such as the relationship between health and AI, dynamic changes in the natural world and their impact on humans, and problems of using big data (Nathe, 2019). Francesca Scassellati-Sforzolini (2018), when drawing up her list of the five most significan...