Trust: the foundation of our digital health care transition

Digital health care innovation offers big opportunities, from disease prevention and better diagnoses to helping alleviate staffing shortages magnified by COVID-19. As this revolution unfolds, a recent conversation at Swiss Re with leaders who are shaping the future of health care delivery reminded me that building old-fashioned trust during a period of rapid change will be critical.

In 1999, a tragedy altered modern medicine's trajectory: In an experimental gene therapy trial that scientists hoped would pave the way to treating rare diseases, a young man died. Suddenly, a promising technology was hit by a crisis of trust that set back efforts to harness DNA-carrying viruses to treat or even cure congenital conditions. It took years for gene therapy to regain its footing.

This terrible event illustrates how trust is an essential component in advancing innovation, in medicine and elsewhere in the human experience. Absent trust, innovations with real potential run the risk of withering on the vine, or as happened with gene therapy, face long delays in fulfilling their promise of helping people live longer, healthier lives.

The issue of trust, and the importance of nurturing it during periods of sweeping technological change, surfaced at a recent discussion that Swiss Re hosted with two health care leaders, Maulik Majmudar and Claudia Witt, about "The promises and challenges of digital health care." Both are medical doctors thinking deeply about the future of health care delivery: Dr. Majmudar is a Swiss Re Strategic Council member who co-founded the US health technology firm Biofourmis, while Dr. Witt is co-director of the Digital Society Initiative at the University of Zurich.

In our conversation, each emphasised how effective, efficient digital health care delivery hinges on stakeholders – patients, doctors, nurses and other health industry professionals, and insurers – retaining faith that new technologies deliver benefits that outweigh the costs of change. As Dr. Witt put it, "Trust is a main predictor for the adoption of digital health."

One big reason digital health care requires trust is it demands people share their personal information, often with impersonal systems. Take an employer that wants to initiate a digital health programme via its employees' mobile phones to reduce stress, help prevent chronic disease and, consequently, boost productivity. For this to work,  participants must have confidence that fairness is built into the system.

Transparency is key, so people know why their information is needed, how it will be used and the benefits they stand to gain. Only when these elements are in place can such a programme succeed

The vast array of technologies under the umbrella "digital health care" is astonishing. Software now underpins a majority of our health care interactions. There are hundreds of thousands of digital health apps available to consumers, with the figure growing steadily.

While many are wellness-focused, there are also sophisticated mobile applications where rigorous clinical trials have demonstrated their effectiveness, in particular in addressing mental health or diabetes. Swiss Re is active in these areas, too; a big reason we've chosen to dive in here is the apps we're developing with partners are backed up by data.

But digital health care goes far beyond apps. Electronic health records have potential to improve care quality, reduce physician (and patient) errors, and make for coordinated treatment. E-records can help to tame the deluge of data from our bodies, making information available in the right format for experts to turn it into valuable health insights.

Artificial intelligence and machine learning, concepts that are now the focus of heated debate as we work to leverage their advantages while mitigating their potential risks, are playing increasing roles in health care, too. AI-driven diagnostics for eye diseases or breast cancer may be superior to humans, helping reduce false positives or catch warning signals missed by a radiologist.

These demonstrate digitalisation's promise, including in contributing to longevity gains that my Swiss Re Institute teammates just wrote about in their report "The future of life expectancy".

But digital health care creates challenges, too.

Here's one example: With telemedicine, an area that saw massive COVID-19 -driven increases, researchers are interested in how this shift influences antibiotic prescription rates compared to physical visits. Some pre-pandemic studies suggest higher rates with telemedicine. With antimicrobial resistance concerns, you can see why tracking prescription patterns is important to ensure best practices, regardless of where patients get their health care.

Managing challenges arising from the digital health care shift is essential, because our ultimate aim is to ensure better quality, more efficient health care. Simple convenience should not trump quality in patient care.

As I spoke with Dr. Witt and Dr. Majmudar I could see a vision of future health care emerging. It sounds a little far out, but not that far out: One day soon, Dr. Witt predicted, we'll be able to create "digital twins" of our bodies, with the resulting data guiding everything from our eating habits to the best cancer treatments.

To make sure trust is embedded in this transformation, however, we've got an inevitable "to-do list." Regulatory bodies must become more agile, to better manage the flood of emerging technologies. We'll also need more randomised clinical trials, to build confidence among physicians and patients that digital health interventions really work.

We need to build more digital competency into our educational systems. And we need stronger partnerships between all actors in the health care system to understand the broader impacts of these technologies, including on areas like reimbursement where value created by digital health tools must be properly aligned with where it's captured.

This won't happen overnight. As Dr. Majmudar pointed out, "slow and steady" usually wins the race in health care because practitioners charged with protecting people's lives are skeptical of rapid change – for good reason. Like he said, the last thing we want is for an adverse event like the one that stalled gene therapy two decades ago to halt the digital health transformation.

From an insurer's perspective, approaches that advance digital health care ethically, safely and systematically make sense. They shore up trust that health care systems of the future are designed with the needs of people and a changing society at their core.