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Why traditional cardiac support is a pain in the heart…and how to fix it!

  • Marie Johnson, Centre for Digital Business
  • Danny Tomsett, CEO, FaceMe

Have you ever walked the cardiac rehabilitation road? It’s confusing, frightening and often unnecessary. Heart disease is a ‘wicked’ problem; the tragedy is that it doesn’t need to be.

It’s 6:00am on a Monday morning and you’re about to leave for work, but you’ve just noticed that you have pain in your upper back, again. It’s happened a few times now since your heart surgery but it’s worse this time. Is it serious, you wonder? Could you have damaged it while lifting weights as part of your new get fit program? How heavy should the weights be to avoid this type of damage? Looks like you’ll have to call in sick to work (again) and try and get in to see a GP or worse, go to emergency area at the hospital – the stress of not knowing if it’s more serious than it looks has spoiled your day.

What if things could be done differently, more efficiently and in a way that results in less anxiety? What if you could use a smartphone app provided by your hospital to quickly access your personalised online ‘cardiac coach’ in the form of a digital human who could listen to your concerns, instantly provide you with information on this type of pain, assess your symptoms via a decision-tree model and schedule an appointment with a specialist close by who could see you that morning, if needed?

Is there another way?

In a recent Bain & Company survey, more than 60% of 172,000 private healthcare patients in 20 countries expressed interest in healthcare services other than more traditional models.

Digital disruption in the form of a digital human ‘Cardiac Coach’ could hold the key to solving many of the problems associated with preventing heart disease and providing rehabilitation from cardiac events and heart surgeries. The potential for investors is huge with global savings and additional revenue for private health insurers, major hospitals and government health budgets, possibly measured in the billions.

Firstly, it’s critical to understand what digitalisation in healthcare is not. It’s not about the replacement of trained medical specialists via chatbots. Rather, “It’s about digitally enhancing the customer experience so care is delivered more efficiently and more effectively.” (Forbes)

A wicked problem…

Whilst the knowledge of how to prevent and treat heart disease is well developed and proven, attempts to change the lifestyles of those at risk have plateaued. This is especially evident in the area of cardiac rehabilitation (CR) which is a programme used to modify the lifestyles of heart patients – those that have had a heart event or heart surgery.

Organisations such as the British Heart Foundation, American College of Cardiology, American Heart Association and so on, all report that participation in CR is at best 50% of the eligible population (in Britain) and below 30% in many countries. Worse, these percentages are much lower for various ethnicities and especially for women. There is also evidence that the health outcomes for women attending CR are not as good as those of men

The programmes are not accessible for the disabled, they do not reach those in remote areas who suffer socio-economic disadvantage, and even the middle class and wealthy close to outpatient facilities often don’t participate because they can’t fit the traditional group CR classes into busy working and family lives.

The model is broken!

What is frightening is that the incidence of heart disease will rapidly rise with the obesity epidemic and yet, even today, if every eligible patient suddenly tried to attend CR the programmes would crash; they don’t have the necessary budget or resources. A large chunk of health budgets is wasted. In most countries hundreds of CR programmes create their own education materials despite the global commonality of the requisite knowledge. These materials are often not even created to a standard within countries. They are difficult to update, and updates are not communicated to those patients who have already graduated from a CR programme.

At its core, the knowledge required by individuals to prevent or recover from heart disease is the same around the world. Medication, diet, exercise, stress management, smoking cessation and so on are common. What is unique is how individuals implement these. The knowledge might say ‘eat more vegetables and fish’ but many patients can’t meal plan and after several weeks of eating the same 3 dishes will give up in despair. Specialisation is necessary when delivering this knowledge but not in a staccato stop and start fashion; patients need to be coached on their journey.

Depression is often part of the aftermath of heart surgery and affected patients need additional support. Once graduated from CR programmes many heart patients ‘fall off a cliff’; there is no ‘lifetime learning’ to grow and support lifestyle changes and the result is further heart events and further surgeries.

Time for the disruption of one-size-fits-some

The introduction of intelligent digital humans as part of service delivery upends the traditional approaches to this ‘wicked’ problem – by bringing back empathetic conversations that people yearn for.

The British Heart Foundation, amongst others, advocates additional delivery models beyond the group-based outpatient scenario, including presenting CR information on the web. For example, the Australian National Heart Foundation and American College of Cardiology both offer excellent information, education and tools online. The problem though is that this web-based information is still the ‘one-size-fits-some’ offered in the group CR programmes, and lacks the essential component of an effective prevention or rehabilitation programme – persistent reinforcement and ongoing support. It is also seldom accessible by people with disabilities.

Democratising help

These problems are not unique to heart health. In 2015 a ‘digital human’ was used as part of an omni-channel strategy to provide information and services to people with disability in Australia. The project brought together companies with expertise in customer experience, AI, and digital communications to establish this capability. The highly capable co-design team consisted of people with disabilities, psychologists to provide advice on empathy, linguistic experts and specialist strategic architects. The result, in less than twelve months, was “Nadia” – the world’s first digital human for service delivery for people with disability. This was first and foremost a human rights endeavour.

FaceMe, one of the world’s leading Intelligent Digital Human Platform companies, played a significant role in “Nadia”. The company is now developing digital humans for the government and finance industries and has a range of digital humans ready for training in different fields, including healthcare. One of their most exciting digital human developments to date is FaceMe’s recent ‘digital cloning’ of a real person UBS Bank’s Chief Economist Switzerland, Daniel Kalt, to help empower private wealth clients with instant financial knowledge for better decisions.

So, what could a digital human ‘Cardiac Coach’ look like:

The common core information would be created, managed and updated in one place – the massive duplication across the world and its cost would be eliminated.

CR education would be available anytime and anywhere for all, through a multi-channel approach and patients would know that the information is current.

The AI engine would provide specialisation at delivery by learning about each patient’s particular circumstances and challenges. These lessons learned would provide improved outcomes for others in the same circumstances and facing the same challenges.

Patients would be coached with empathy throughout their journey; lifestyle changes would be reinforced and supported. CR is not a 6-week boot-camp – CR is ongoing throughout life.

The value proposition is enormous, with commensurate investment potential. Government health budgets, private health insurers and major hospitals could save billions in both heart health delivery costs and reduction of future cardiac events and surgeries with all of their associated costs.

The Cardiac Coach capability could be licensed or white labelled and sold to these organisations. Digital humans can present content including text, images, videos and maps. The content of these features could include the promotion of services and products relevant to heart patients; a further source of revenue. Once established, these revenue streams could support the expansion of the Cardiac Coach’s capabilities into other areas such as mental health support.

Marie Johnson will be talking in more depth about digital humans and the Cardiac Coach at the O’Reilly AI Conference in London on 11 October.