“We’re at the beginning of the digital revolution” wrote Bill Gates in his foreword to Satya Nadella’s book “Hit Refresh”, published not, as you might initially guess, twenty years ago, but in 2017.
This explicitly recognises that, while we have already seen remarkable changes to our lives, our societies and our cultures as a result of software, and the microprocessors on which they rely, we are actually only at the beginning of our journey.
“Software is eating the World” said Marc Andreessen, referring to the fact that in every aspect of our lives, software has disrupted the status quo and has revolutionised industries, sometimes quietly, and sometimes by storm. Commercially, we have seen businesses that have put software at the heart of their business overtaking incumbents slower to adopt technology and slower to realise the role of technology as an intrinsic foundation of all they do.
I work as a full-time consultant neurologist caring for patients with a range of neurological illnesses. Like most senior clinical staff, have a range of academic and leadership roles in addition to my clinical practice; in all of these roles, I see, first-hand, how the right technology could help my work and, most importantly, help the patients I directly care as well as the populations I serve.
But what do we mean by nebulous terms such as ‘digital’ and ‘technology’ and are we right to think about a digital ‘revolution’, particularly in my own field, healthcare? After all, the technologies at our disposal continuously change improve and we have ever more computing power at our fingertips. The word ‘revolution’ suggests a fundamental and relatively sudden change and while it is true, the maturity of our digital tools sometimes advances quickly, such as near ubiquity of smart phones in the developed world, would we not be better to talk about the “digital era”?
But whether we talk about a “digital revolution” or the start of a journey into a new “digital era”, what do we actually mean by “digital”?
I would argue that the starting point in trying to understand the implications of true digital thinking, in any industry, is our ability to:
transfer and process information to make it accessible and useful
Rapid and sophisticated processing = faster learning
But weren’t we were able to transfer and process information before we had digital tools?
For example, most of us in healthcare still rely on paper notes but that doesn’t stop our teams collecting piles of them to audit an important quality measure of our work. So perhaps we need to refine our understanding of the “digital revolution”, to explicitly recognise the importance of speed, accuracy and sophistication of our processing enabling us to make our information ever more useful.
The transition from film to digital cameras is a useful example of how digital technology has impacted our lives. The digital camera speeds up processing; you no longer wait weeks to see the pictures you have taken but instead see your pictures immediately, but digital tools do more than simply improve the speed of feedback, I can now also crop my images and share with friends and family.
So when we talk about “accessible and useful”, aren’t we actually talking about creating value and improving outcomes?
The outcomes in photography that are important to me are recording a cherished memory and sharing with those closest to me, and digital tools support these outcomes in a way that was not as easy with traditional film.
And the benefit of digital technologies over paper-based processes is that the feedback loops between our decision, in this case to take a photograph, and the outcome, can be made so much more quickly. With the right digital tools, my understanding of the best aperture and shutter speed to use in those conditions and in that situation improves; I learn.
Getting the right information at the right time, synthesised appropriately to make it useful, informs our learning and therefore our ability to make decisions.
And digital is, quite simply, the best way to enable a learning culture.
A continuous learning system
And that is why we are at the cusp of a true transformational change, because so many of our procedures and policies, our structures and services and even our budgets and planning, in so many industries, are rooted in the pre-digital era. That means our purchasing or budgeting decisions for solutions to problems are made on a cycle involving years. We plan projects because the pre-digital era required us to meticulous plan our work, deliver what was needed and then evaluate what we did.
Instead, digital is an important enabler of changing our mindset in all areas of our work, in healthcare and in other industries, mainly as a result of the speed and acuity of the feedback we can create by the right use of technology.
Lean methodologies teach us to defer decisions to the last responsible moment, understanding that there is always uncertainty and delaying decisions permits time to gain more information and reduce that uncertainty. Agile methodologies teach us that we should be iterative in our work, breaking it up into small chunks and gaining constant feedback to guide continuous improvement. We should be adopting these principles not only in our work to develop healthcare software, but to manage and improve our services. Digital is a vital ingredient to support those methodologies.
As a result, digital, and being data-driven, means our planning cycles should become shorter and shorter, because we’re using small focused interventions and data to constantly evaluate our hypotheses and build a continuously learning healthcare system.
That means changing the way we think about budgets and financing our work. Similarly, our real-life prospectively recorded outcome data should be used to inform our clinical practice; we have small examples of how this can already be done but the potential of the digital era is to make such an approach ubiquitous by understanding the importance of routinely collected meaningful data and how it can be used to support decision making by patients and professionals.
True digital transformation isn’t simply digitising our existing processes and replacing paper with a digital equivalent but instead, it is a complete change in mindset. We need to re-imagine our healthcare services with the benefit of the digital tools we have available to us and realise the value and improved outcomes that we can build on this data-driven foundation.
Software is like magic
Software is like magic, automating and systematising even complex tasks. My mission is to make the most effective use of software in healthcare, and I think we’ve barely even started that journey yet.
We have a new and vast array of technologies available to us, from enormous quantities of data to real-time analytics, machine learning and applied artificial intelligence, with computing power and different sources of data all growing exponentially. None of us know what the future holds, and none of us have all of the answers, so whether we are talking about ambient sensors or interacting with software using our voice, the essence of our digital work is not just the technology, but instead our ability to make use of data to learn and to inform our decision making. And that means learning how to build software that supports that goal.
When we bring digital technologies into play, we speed up feedback on our actions and can perform complex processing tasks to make sense of burgeoning quantities of information and so “digital”, to me, is inextricably linked to becoming data-driven, because digital tools are the best way to combine and process information. That means understanding the best, evidence-based ways of creating and delivering safe, secure and valuable software code to end-users. And the best ways to deliver software like that is to use those same data-driven methodologies and build our software incrementally in small chunks with constant feedback to guide continuous improvement.
So what next?
In my view, our biggest risk is to think that we have all of the answers. Instead, we can set the broad principles to which we must work but build trusted teams to deliver against the outcomes we set, whether that be our healthcare services or the software that supports and enables transformation of those services.
The true digital revolution will come when we focus on generating meaningful data and use appropriate tools to make sense of that data, to drive our decision making, to use those data to reduce our uncertainty about our decisions, so that, we, in whatever role we have, are supported to make the right judgments at the right time.
We need to learn, and digital technology is an essential part of building a continuously learning culture, in whatever industry you work. And that is the essence of digital transformation.