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2024: a sneak peek into the biggest challenges and main opportunities

As we step into 2024, the landscape of healthcare technology appears poised for groundbreaking transformations. The past years have seen an accelerated pace of innovation, and the coming year promises to be no different. However, there's more to it: physicians are taking on new roles, a renewed drive for mergers and acquisitions is reshaping the sector, and evolving patient expectations ask for increased attention to data portability.

Eduardo Freire Rodrigues

January 5, 2024 · 10 min read

Despite centuries of seeming imperviousness, the healthcare field is now embracing advancement and the start of a significant metamorphosis.
As we bid farewell to 2023, it's impossible to overlook ChatGPT, the artificial intelligence (AI) large language model that has been developed by San Francisco based OpenAI using natural language processing and trained on conversational data (reinforcement learning from human feedback) obtained from the internet. One year after exploded onto the scene, ChatGPT has over 180 million users, including healthcare professionals and is already upending health care — an industry not exactly known for its speedy adoption of tech — while accelerating questions about Artificial Intelligence promises and limitations.
In this article, I explore industry trends, anticipate the themes that will define 2024 and raise some questions for consideration.

1. Health worker shortages calling for new strategies and solutions.

One of the most urgent challenges confronting healthcare is the ongoing scarcity of proficient professionals. The World Health Organization's Regional Director for Europe emphasized that Europe's healthcare worker crisis, once a "looming concern", has manifested as a "stark reality", leaving the sector in dire need of reinforcement. This declaration1 followed a report highlighting a concerning trend: over 40% of doctors are close to retirement age in one third of countries in Europe and Central Asia,2 posing a substantial threat to the workforce's sustainability.
An ageing healthcare workforce was a serious problem before the COVID-19 pandemic, but is even more concerning now, with severe burnout and demographic factors contributing to an ever-shrinking labor force. Another key finding of the report is the poor mental health of this workforce in the Region.
In Medscape’s Physician and Burnout Report 2023, a whopping 79% of physicians stated that the pandemic had affected their work-life happiness at least somewhat in the past year. For physicians, the top contributor to burnout is “too many bureaucratic tasks”, followed by “Lack of respect from coworkers” and “Too many hours at work”.
In response to such challenges, technology is stepping in to bridge this gap. Virtual assistants, clinical decision support systems, medical record keeping or translation, medical writing and documentation are some of the most developed areas. Beyond task substitution, we're witnessing a paradigm shift concerning the role of healthcare professionals, as detailed later in this article.

2. Artificial intelligence and Language Learning models bridging the gap.

Automated patient journeys, powered by cutting-edge algorithms and AI-driven systems, are enabling streamlined and efficient care delivery. These advancements free up healthcare workers' time, allowing them to focus on critical tasks while ensuring patients receive timely and personalized care.
Much have been done (and published) in 2023, from a machine learning model foreseeing weight-loss patterns post-bariatric surgeries3 to an algorithm gauging ICU necessity.4 Additionally, a natural language processing tool pinpointed social determinants of health for Alzheimer's and related dementia patients using complex medical records,5 while a user-friendly 'smart' stethoscope achieved a 90% accuracy rate in identifying heart failure cases,6 offering early detection prospects.
Two recent studies7,8 have highlighted the potential of AI in distinguishing whether lung nodules, abnormal growths spotted on a CT scan, are cancerous. Each compared their technique to the standard Brock score recommended by the British Thoracic Society and both types of AI predicted cancer more accurately than the Brock score. These findings suggest that AI could assist clinicians in making more timely decisions, potentially enhancing patient care and outcomes.
While numerous other examples could have been listed here, let’s look into two clinical trials, identified by the experts consulted by Nature9 as among the most promising in their field. The first one, a randomized control trial, tests if artificial intelligence applied to chest X-rays as soon as they are taken shortens the time to a CT scan and time to diagnosis. Researchers demonstrated that prompt reporting of chest X-rays by radiographers significantly reduced the time to diagnosis, nearly cutting it in half from 63 days to 32 days and have a new hypothesis: AI may identify lung cancer earlier and reduce time to diagnosis as much as 50%.
The second one is a prospective multi-center, randomized, open-label, non-inferiority pilot clinical trial of risk-score assistance to clinicians in the emergency department. It aims to evaluate the use of an AI model in assisting clinicians in the emergency department by predicting the 31-day mortality risk for patients seeking treatment.

3. New roles for healthcare professionals

At the rapid pace of evolution, both within and beyond hospital settings, thought-provoking questions have emerged regarding the role of AI in medicine: "Can AI replace doctors?" and "Will doctors utilizing AI supersede those who do not?"
To shed light on this debate, a recent article10 focuses on emphasizing the augmentative role of AI in healthcare. It emphasizes that AI is designed to enhance rather than substitute doctors and healthcare providers. The core solution lies in the collaboration between humans and AI, merging the cognitive strengths of healthcare providers with the analytical capabilities of AI. Adopting a human-in-the-loop (HITL) approach ensures that AI systems are directed, communicated with, and overseen by human expertise, thereby upholding safety and quality standards in healthcare services.
To put it simply, there are routine and less impactful tasks assigned to highly skilled yet often overburdened professionals. Therefore, contemplating the potential of technology for a healthier, more effective, and specialized future is only worthwhile if the fundamental approach to providing care is also revolutionized. This would involve freeing up doctors, nurses, and other healthcare professionals from routine duties, allowing them to concentrate on tasks that hold greater significance and yield higher impact. And I’m thrilled to shout out that UpHill solutions are playing their role to make it happen.
Previously on this blog, I’ve drawn attention to the significance of care journeys in reshaping the roles of healthcare professionals, particularly doctors and nurses. Their involvement in designing and overseeing these journeys not only enables them to pinpoint where technology can be optimally employed but also allows them to delegate tasks effectively, ensuring a more efficient allocation of responsibilities and greater control over the care process.
Lastly, research firm McKinsey & Co. estimates that globally, jobs in healthcare could grow by 50 million to 85 million by 2030.11 Without a doubt, tech will influence a great deal of these, by creating new types of employment such as the virtual hospital manager, 3D printing surgeon, health data analysts, algorithm trainer or lifestyle strategists.12,13

4. Integrating preventive apps to meet new expectations on health and wellness

Lifestyle strategists? It appears to be precisely that.
In recent years, there has been a significant shift in healthcare towards a proactive approach focused on prevention rather than reactive treatment. This change has been influenced not only by evolving consumer expectations and behaviors, where individuals prioritize their well-being and seek proactive health maintenance, but also by a heightened public awareness regarding the impact of lifestyles.  
  • In Europe, chronic diseases consume 80% of overall expenditure.14
  • Worldwide, preventable sources cause 80% of heart disease, stroke and type 2 diabetes and 40% of cancers.14
  • The sickest 5% of the US population consume 50% of total health care costs whereas the healthiest 50% only 3%.14
  • Traditional medical care accounts for only 10-20% of overall health outcomes. Genetics and social and behavioural drivers account for the rest.14
Apps play a pivotal role in meeting these expectations, serving as tools that offer tailored guidance, track wellness metrics, deliver timely reminders for health screenings or activities, and provide educational resources to foster informed decision-making. Consumers are embracing these apps as proactive companions in their daily lives: currently there are over 400.000 health apps available on app stores worldwide.15 Chinese and Indians are the most eager users of healthcare apps worldwide, followed by Australians and Americans. So far, the European Union has the lowest number of healthcare app usage, with only 22 to 40% reporting using one.16
Moreover, the rise of preventive health apps isn't just meeting consumer demands but also fostering a cultural shift towards wellness and self-care. The ease of access to health information, coupled with personalized recommendations, motivates individuals to adopt proactive measures, whether it's maintaining fitness, monitoring dietary habits, managing stress, or scheduling routine check-ups.
But what about data portability? The issue of fragmentation persists among health apps, hindering seamless communication and data exchange between different platforms, impeding a cohesive and comprehensive approach to personalized healthcare management.

5. Merge & Acquisition on the rise (again)

“Improving cost of capital, increased management team confidence in the ability to forecast, and narrowing price gaps between acquirers and targets support a more active healthcare services M&A environment in 2024”.17 This forecast stems from Lazard Frères & Co. and has been validated by the latest reports. The second quarter of 2023 experienced a considerable surge in hospital mergers and acquisitions, reaching the highest count since the beginning of 2020.18, 19 Significantly, this closely resembles statistics from the pre-pandemic era.
This trend signifies a significant shift and revival in the consolidation and restructuring of healthcare entities, illustrating a transformative shift within the industry's landscape, as organizations seek to integrate care across the continuum, increase patient/resident access to providers, form stronger partnerships among practices and facilities, and enhance market share through consolidation.
Although healthcare integration creates larger and more financially liquid organizations, these transactions do not necessarily translate into better patient care.20 Failure to do so may lead to a wide range of clinical, operational and liability problems, including:20 - 24
  • Low staff morale and turnover stemming from cultural differences post-merger.
  • Inconsistencies in policies and procedures concerning clinical care and operations.
  • Elevated risk of patient harm due to potential staff-related quality of care issues
  • Quality of care problems leading to patient complaints and possible legal action.
  • Inefficacies in risk management and quality improvement initiatives.
  • Insufficient documentation and communication gaps.

Uncharted territories: questions that still to be addressed.

  1. Does AI genuinely possess the capacity to integrate into healthcare institutions and attain the required reliability?

    The limitations highlighted in artificial intelligence are multifaceted. Algorithms are notoriously bad at context and nuance – two things critical for safe and effective patient care, which requires the implementation of medical knowledge, concepts, and principles in real-world settings.25 Healthcare professionals acknowledge the potential of incorporating ChatGPT into their practice, benefiting decision-making, patient and family support and medical research.26 However, concerns linger regarding information credibility and sources, hindering its full integration. Additionally, AI's sensitivity to varied question phrasings and struggles with ambiguous prompts pose challenges. Inaccuracies, biases, and transparency issues further compound these limitations.27

    Last but not least, a recent study28 points out that existing AI benchmarks lack direct clinical relevance and fail to cover essential clinician-associated tasks, such as routine documentation and patient data administration. As a result, the current benchmarks inadequately align with the desired targets for AI automation in clinical settings, emphasizing the urgent need to develop novel benchmarks that address these substantial gaps.
  2. What regulatory constraints exist?

    The primary regulatory challenges in healthcare revolve around the application of AI in medicine. While healthcare workers adhere to stringent assessments and codes of conduct, there's a lack of globally standardized laws or regulations governing AI's use. Determining responsibility in AI-related issues—whether it lies with the manufacturer, user, or maintainer—is a significant hurdle. The delineation of each stakeholder's responsibility remains ambiguous, especially in complex cases, raising questions about the fair distribution of responsibility instead of placing the entirety of AI medical treatment risks on doctors alone.29
  3. Are healthcare professionals adequately skilled for their evolving roles?

    In the ever-evolving technological landscape of healthcare, professionals face a paradigm shift necessitating a broad spectrum of new skills. Beyond clinical expertise, proficiency in navigating digital tools and data analysis has become imperative. Healthcare professionals now require a solid foundation in understanding and utilizing innovative technologies, such as artificial intelligence, telemedicine platforms, and data-driven decision-making systems. Adaptability and continuous learning are key, as the rapid evolution of technology demands agility in embracing new advancements. Additionally, effective communication in the digital realm and the ability to interpret and apply insights gleaned from vast datasets are essential skills in this technological era, empowering healthcare professionals to deliver optimal care while leveraging the potential of cutting-edge innovations.
  4. How much long will digital health apps perpetuate care fragmentation?

    According to the latest study conducted by the National Coordinator for Health Information Technology, a mere 22% of apps integrated with Electronic Health Records (EHR) support Fast Healthcare Interoperability Resources (FHIR), the standard for data exchange.30 This limitation leads to healthcare facilities utilizing disparate systems, resulting in the segregation of patient data within isolated silos. As many hospitals are now achieving top levels of digital maturity, apps are not. This fragmentation hampers healthcare providers and administrators' abilities to access and share both individual patient records and broader health information. The lack of effective data sharing contributes to fragmented care, potential treatment errors, operational inefficiencies in healthcare delivery, and challenges in devising comprehensive health initiatives for communities.
  5. Which payment models will facilitate hospital transition to value based models?

    Ensuring precise care at appropriate locations within a multi-site care delivery structure remains pivotal in a value-based healthcare system. To achieve effective care integration, providers must redefine the services offered at each facility, rationalizing each site's contribution to the organization as a whole. This strategy may require the implementation of a new payment model. In contrast, on a volume-based scenario, individual providers tend to prioritize maximizing their billing volumes.

    Bundled payments for complete care cycles present an optimal method for aligning providers' incentives towards delivering utmost value to their patients. Bundled reimbursement encompasses all treatments and interventions throughout an entire care cycle for acute medical conditions, benefiting key stakeholders. Patients receive well-established and efficient care for their medical conditions, providers gain positive margins by efficiently treating patients and achieving favorable outcomes, while payers curtail expenses on medical treatment and enhance primary and preventive care for distinct population segments.

References

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  2. Ticking timebomb: Without immediate action, health and care workforce gaps in the European Region could spell disaster. (2022, September 14). Www.who.int. https://www.who.int/europe/news/item/14-09-2022-ticking-timebomb--without-immediate-action--health-and-care-workforce-gaps-in-the-european-region-could-spell-disaster
  3. Saux, P., Bauvin, P., Raverdy, V., Teigny, J., Verkindt, H., Soumphonphakdy, T., Debert, M., Jacobs, A., Jacobs, D., Monpellier, V., Lee, P. C., Lim, C. H., Andersson-Assarsson, J. C., Carlsson, L., Svensson, P. A., Galtier, F., Dezfoulian, G., Moldovanu, M., Andrieux, S., Couster, J., … Pattou, F. (2023). Development and validation of an interpretable machine learning-based calculator for predicting 5-year weight trajectories after bariatric surgery: a multinational retrospective cohort SOPHIA study. The Lancet. Digital health, 5(10), e692–e702. https://doi.org/10.1016/S2589-7500(23)00135-8
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  5. Wu W, Holkeboer KJ, Kolawole TO, Carbone L, Mahmoudi E. Natural language processing to identify social determinants of health in Alzheimer's disease and related dementia from electronic health records. Health Serv Res. 2023; 58(6): 1292-1302. doi:10.1111/1475-6773.14210
  6. Bachtiger, P., Petri, C. F., Scott, F. E., Ri Park, S., Kelshiker, M. A., Sahemey, H. K., Dumea, B., Alquero, R., Padam, P. S., Hatrick, I. R., Ali, A., Ribeiro, M., Cheung, W. S., Bual, N., Rana, B., Shun-Shin, M., Kramer, D. B., Fragoyannis, A., Keene, D., Plymen, C. M., … Peters, N. S. (2022). Point-of-care screening for heart failure with reduced ejection fraction using artificial intelligence during ECG-enabled stethoscope examination in London, UK: a prospective, observational, multicentre study. The Lancet. Digital health, 4(2), e117–e125. https://doi.org/10.1016/S2589-7500(21)00256-9
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  9. Arnold, C., & Webster, P. (2023, December 7). 11 clinical trials that will shape medicine in 2024 - Nature Medicine. Nature. https://doi.org/10.1038/s41591-023-02699-5
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Eduardo Freire Rodrigues

CEO & Co-founder

Eduardo is a Public Health specialist, CEO and co-founder of UpHill. He has a master's degree in medicine from NOVA University of Lisbon and a postgraduate degree in clinical research from Harvard University. He is also a visiting assistant in Digital Health at ISCTE and NOVA Medical School. Early on, he learned how to code at the age of 14 and became passionate about it since then.

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