The Seven Obstacles: Success factors for digital transformation in international health tourism and global health

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Mohammed Yassin Blal

Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontier.“

With these words, the United Nations (UN) spells out a fundamental human right to information in Article 19 of the Universal Declaration of Human Rights.

In our globalized macroeconomic environment, new innovations are emerging almost daily from the earth, but few are truly milestones – like digitalization (ICTs). With Information and Communication Technologies (ICTs) and the associated digitalization processes that are the engine of our globalization, the technical implementation of the digital computing principle “Universal Machine” (cf. Turing 1936), the Internet and the World Wide Web, new prerequisites have been created for digitalization in the field of international health care. In the course of these processes, global sociality is adapted into applications by transforming cultural techniques into locally specific cultural practices.

But it is precisely at the international level, where different people with individual cultural conceptions meet, that frictions arise that have not yet been able to keep up with the pace of digital glocalization.1 The solution for keeping the most important good in a service society alive, namely trust, is barrier-free communication, and, above all, mutual understanding, which is crucial for success. This applies not only to the health sector, but also in any form to companies with international customers.

Unfortunately, the international healthcare market is less digitised than almost any other industry despite its huge potential for care and profitability; the reasons why international digital solutions are being thwarted are yet to be tackled.

Research shows over 100,000 health apps and undefined number of health travel agencies (concierge/assistance) worldwide: possibilities for treatment abroad and technical monitoring of one’s own health at home and abroad are hitting a nerve among more and more people. If they are sound and culturally friendly, digital services create better informed and more self-determined patients who are not afraid of treatment or a doctor appointment on the other side of the planet.

This is not the only reason why the international healthcare market is predestined for a digital update: in most countries, file management and data transfer systems are outdated, and economically inefficient, and legal regulations lag far behind technological possibilities. In many areas, the intercontinental healthcare market is still scarcely digitalised and efficiently used.


1  The translation of Information and Communication Technologies into German is >>Information and Communication Technologies<<. In our idea paper we keep the English word and its abbreviation, because the actors and discourses to which I refer use this form. ICTs are binary digital devices such as computer hardware, the Internet and the World Wide Web, including software applications.

2  Glocalization is a neologism and a suitcase word formed from the terms globalization and localization, whereby these two terms are to be understood as a spectrum of orders of magnitude, i.e. not as opposites, but as connected levels. (Globalisation at local level)

3 One reason for the innovation bottleneck is the framework of conditions in the highly regulated national healthcare market are extremely complex, and the regulations in the international market even more so. This suggests that the international digital healthcare market needs to be picked up. Hospitals or governments cannot handle this task alone. While in other industries disruptive business models literally sweep away established companies, digital innovators have a much harder time unfolding here. Mohammed Yassin Blal, CEO of Caresocius.org explains the most important brakes on innovation, initial success stories, and why the international digital healthcare market will still come through.

1.Stakeholders in a fragmented market block innovation

What a complex construct the international healthcare market already is can be seen in everyday services such as financing a preventive check-up for your disabled uncle in Morocco or arranging an appointment for him and bearing the costs. A surprising number of actors are involved in carrying out this task, which appears relatively simple from the outside: clinic, health insurance, doctor, agent, family members, transport, and accommodation. In Switzerland alone, about 2000 medical supply and device-technology companies with an average of 10 to 15 employees compete in the provision of medical aids. In a global and connected economy such small structures cannot compete. Consolidation will certainly be slower than in less regulated markets, but the pressure to consolidate will undoubtedly change the landscape in the healthcare sector as well. For the market entry opportunities of digitally-based business models, less fragmentation can only be advantageous.

2. Business blindness: the successful “core business” clouds the view for innovation potentials

The healthcare service providers established today (classic SMEs) are optimally networked regionally (in countries with compulsory health insurance) and, as long as the reimbursements flow through private and statutory health insurance, are quite profitable. But they have a hard time with innovation and digitalisation. Their processes and structures tend to be more conservative and thus are more concerned with defending their position, rather than constructively questioning and changing it. This phenomenon specifically exists in hospitals, clinics and medical travel agencies.
In a sluggish market, however, the risk of oversleeping necessary developments increases.

In addition, industry companies lack a functioning, international, centralised and politically neutral ecosystem of initiators and innovative partners to develop digital services. For most people, the maintenance of their own homepage already becomes an annoying “problem” and a potential point of attack. The establishment of a professional and modern marketing system isn’t even in the scope of discussion.

Here, cooperation in the form of partnerships can make decisive steps forward. In Bahrain, the economic development initiative “Tamkeen” took the young Swiss-German software company caresocius.org off the ground with a regional head office for the Gulf Cooperation Council (GCC) region. Initial attempts to use Caresocius’ novel patient procedure on the international market show a promising potential for both partners. This is the basis from which stories will be written for the international healthcare system.

3. National regulations and approval procedures strangle innovations, but not really at the international level

Hospitals, doctors, agencies, insurance companies need to be tenacious and have a proven organisational structure when it comes to foreign patients. The way forward for the international healthcare market leads through complicated regulations but has never been so economically important for all the stakeholders. There is a constant danger of being overtaken by current IT possibilities, including new frameworks and new API’s.

It is important to understand that at an international level, it does not depend on your own internal IT infrastructure, but on a same level of digital solution for all stakeholders and the integration of already existing structures.

4. Rigid data protection regulations: patient law vs. patient interest?

Patient data is carefully protected in many countries. This is often criticised as an obstacle to innovation, but often enough also serves as an excuse for a moderately widespread desire to innovate. It’s true: the requirements for data security and data protection are high. But this can also lead to more acceptance.

Legislation and effective regulation give the information security professionals the leverage to do their job. Although the recent introduction of the General Data Protection Regulation (GDPR) has regional, EU jurisdiction, it has also launched a new privacy and security standard with international consequences on countries trading with the EU. Unlike the US HIPAA standard, that needed the High-Tech Act of 2009 before it had any effect, the GDPR has the legal power to effect global organisations. It also raises the bar and shifts data ownership back to the data subject, with consequences in the medical data brokerage market.

In the US, it is estimated that there are 880,000 health data brokers and marketing companies using medical data that they have purchased without the data subject’s awareness (Bruce Schneier, 2017). These are not medical centres and so are not normally the focus of theHealth Insurance Portability and Accountability Act (HIPAA) regulators. Although GDPR is a EU regulation, it changes the goal posts and introduces a new example of protection to the data subject that the medical profession can use regionally.

Historically, the medical professional handled patient data with the privacy and integrity that the Hippocratic Oathdemanded. Now that medical data is handled by so many different, non-medical professionals, in different organisations with different objectives, the Oathno-longer applies, and new standards have to be incorporated into the data management architecture. This places the burden on the information security professional to commit to the cause at corporate level and provide the confidence and security that patients need.

Caresocius recognises this need and using the SABSA approach to enterprise security architecture, they are focusing on a platform that returns control and ownership of patient data back to the hands of the patient. It allows the patient the opportunity to choose what, when, how, and who is reviewing their medical data and who will eventually provide the service.

It is no-longer a concept of tourism. A holiday tour doesn’t usually have life-long consequences, but a medical treatment does.

The vision is shifting the focus away from the casual term of “Medical Tourism” back to Medical/Health Provider Selection: where the client can select the playing field, regionally and internationally.

The Swiss-German company Caresocius intends to soon cover the reimbursement process worldwide, with the market for add-ons divided among a few top dogs. The international department in a hospital is networked via a module in the form of an application. The hospital and the patient agency software provide communication with the Caresocius Server and ensures end-to-end encrypted communication with the patient. Maintenance and support are ideally offered in each country. Even if Caresocius would like to be further in spreading the marketon the basis of trust in digital solutions through a democratic way, perhaps the most important step for the breakthrough has been taken.

5. Security in the international health system through sustainable processes

The legacy architectures of medical IT have made it difficult to build a platform connecting medical stakeholders internationally. Various organisations have been fighting the battle and have presented reliable, secure and efficient packages, but the lack of international medical data transfer standards muddies the waters.

The variety and scope offered by different organisations to establish trusted patient data transfer, has given the medical profession a valuable range of options, but it also creates a maze of options their IT staff have to struggle through.

Looking at the work of organisations such as GlobalMed, PulseSecure, and GlobalScape, the industry has the tools and the will to change the situation, yet it requires the introduction of regulation that has international impact before the business vision changes to include a trans-corporate standard, into the medical data economy. Only when the strategic, corporate assets are challenged does legislation come into effect, and usually to protect the corporate asset rather than the data subject.

6. The fairy tale of target groups far removed from technology

A classic problem, which digital health companies are repeatedly thrown against by skeptics is that the important target groups of older people,multi-morbid in particular, are far too remote from technology and the Internet for such “gimmicks”.

Those who still think like that today should think about their understanding of customers. Media usage behaviour is now a fairly impressive indicator that the time is improving for broad-based digital business models in the healthcare market. The “Silver Surfer” is no longer a marginal phenomenon. More and more senior citizens are partaking in the digital world, especially through tablets, for entertainment, to maintain contacts or to inform themselves. They train their physical and mental mobility with fitness apps and brain jogging programs. We won’t have to wait another generation until the “elderly” are ready for digital health.

7.The international stakeholders who do not dare

Stakeholders are usually reluctant to take risks, as it is normal to concentrate on the functioning operative business. Despite the demographic development, this market is considered to be one of the largest markets of the future. Nevertheless, only a few stakeholders (hospitals, clinics, agencies, insurance companies) are really massively involved in expanding their customer acquisition digitally. There’s a reason for that: the majority of B2C sales are tied to reimbursements from international health insurers, with the exception of private patients. These are, of course, still subject to political changes, albeit less so in the GCC-Region. Those who go with its offers into a smaller, although growing self-pay market and accept the challenge to improve by offering better quality, are often “rewarded” with more patients. The attitude learned over decades is that all digital services for the patient must be free of charge, or covered completely by hospitals or health insurances, allowing minimal potentials to be increased through digitalisation.

The lesson is clear

The hurdles that need to be overcome in order to gain a foothold in the international healthcare market with new, innovative or even disruptive approaches are still high and are likely to rob some stakeholders of their nerves.

The greatest challenge, creating regulations at the international level, will remain for the foreseeable future, at least in part, with such sensitive issues as health and data protection.

However, new software solutions, rising life expectancy, and demographic changes are causing healthcare costs to rise further. And since the funding pools cannot increase to the same extent, legislators, health insurers and patients will sooner or later have to seek their salvation in productivity gains and efficiency increases. This calls for digitalisation, and digitalisation will come. Also, in international healthcare and health tourism.