"It actually is quite easy to be a futurist with regards to where are we going with health," says Dr Ron Grenfell, director of health and biosecurity at CSIRO.
"It takes 15+ years to get evidence into practice," he told the Commonwealth Bank's Future of Health conference in Sydney last week. The "inertia of the system" will hold back the adoption of a lot of technology that's being pitched as the future of health.
That, in your writer's view, is one of the two big conceptual challenges at the heart of so many discussions of the digital transformation of healthcare. Vendors are pitching technologies like AI and chatbots to reduce the workload of humans, yet the healthcare sector is way behind the pace.
Dr Kevin Cheng is founder of Australian healthcare provider Osana. They use cloud communications provider 8x8 for their own needs, and use cloud-based medical records, but they run into the usual problems when communicating with other providers.
"I tried really hard not to buy a fax machine for our startup, but we failed," Cheng said during a roundtable in Sydney last week, to much knowing laughter.
"When I talk to allied health and specialists, we're often crossing IT barriers. It's hard to get people on the phone to talk, so we're very transactional ... the other clinician could be sitting in a room next door, but we're literally writing letters to each other and not talking," he said.
Cheng believes Australia is lagging behind other high-tech nations. GPs in the US are now doing many of their consultations virtually, he said, whereas in Australian that generally only happens in remote locations.
"We're having to create our own scorecards and dashboards in our own datasets, because there's no reporting analytics that is on the market that fits our workflows," Cheng said.
Phil Kernick, co-founder and chief technology officer of information security firm CQR Consulting, confirmed that belief.
"Nowadays doctors use computers for everything, and it doesn't matter which industry you're in, these are run badly. They're run inefficiently. They're run insecurely," he said.
When it was "just" data, that didn't matter so much. But software is now integrated into diagnostic and therapeutic devices, and if vendors are to be believed, AI will soon be taking control.
"I have a real concern that as everything moves to technology, and when we get into AI and machine learning something, we stop understanding how the technology works," Kernick said.
We're building systems that have a "very shaky foundation, and there are no regulations around this," he said.
"If you look at the Therapeutic Goods Act, you look at how we regulate medical equipment, there are no software security standards. The information page actually says we take a risk-based approach, and use the same risk-based and safety-first approach to all systems, whether they include software or not. I mean, that's just waffle. It doesn't mean anything."
Making patients the actual focus of healthcare
Cheng says that Osana's strategy is to put the patient's health at the centre of their business, focusing on prevention and outcomes, rather than the transactional fee-for-service treatment model.
"Patients are going to be consumers, so they're our customers, and that means that we need to practice in a different way. We want to be partners with patients in their health and well-being," he said, and data and apps will be part of that.
Dr Bertalan Mesko, director of The Medical Futurist Institute, says that the healthcare sector could and should go much further.
"By 2050 the most important change will be that patients will become the point of care," he told the CommBank conference from Budapest. Not just becoming more engaged, or "empowered", but the actual point of care and service delivery, using their own apps and devices to gather data, rather than travelling to medical facilities for diagnostic tests.
This isn't so much a technological revolution, according to Mesko, but a cultural revolution. In your writer's view, that's the second big conceptual challenge.
"Since Hippocrates, for 2000 years, medicine has been quite straightforward. Medical professionals know everything, and they let patients come to them for help, they tell them what to do, and patients go home, and either they comply with what they were told or not. Usually half of them do, and half them don't. That's quite a bad success rate," Mesko said.
Medical knowledge, and even the patient's own data, were held in the medical professionals' "ivory tower," he said. But that's changing.
"With crowdsourcing and crowdfunding, with Amazon and social media, with open access to medical papers, and all of these online communities out there, now patients can get access to the same resources," Mesko said.
"The hierarchy of the doctor-patient relationship is transforming into an equal partnership."
And sometimes patients race way ahead of their doctors. Diabetes patients, for example, have combined a continuous glucose monitor, an insulin pump, and a small computer such as a Raspberry Pi, to create what is in effect a do-it-yourself pancreas.
"Many of us have no medical or engineering training and we work on improvements in the evening or at the weekend, for free," Dana Lewis, founder of the Open Artificial Pancreas System project, told the The Guardian in July.
"Commercial devices similar to ours are now being trialled and gradually coming on to the market: we're happy to be helping companies to speed up development. The most important thing is that people don't have to wait," she said.
Governments and regulators "seem to be pretty terrified about these developments and technologies", Mesko said.
"When patients find out that there's a solution technologically for their health problem, they will not wait for regulators to come up with a solution. They will make those solutions themselves," he said.
"It's possible for a government to come up with a digital health policy -- not just a healthcare policy or a health IT policy, those are different things -- a digital health policy that focuses on the cultural aspects of the changes technologies initiate."
It's the Terminator scenario forever
This is not to say that the technology isn't important. AI-powered chatbots can take care of routing patient interactions, for example, leaving the clinicians more time for managing and patient's health.
According to Murray Brozinsky, chief strategy officer of Conversa Health, the company's chatbots have saved Northwell Health some $3,400 per patient when they've been used to help manage patients after a hip or knee replacement surgery.
Rather than having a clinician call a patient every week to see how they're doing, a chatbot can check in daily, or whenever the patient has a question. Using what Brozinsky prefers to call "augmented intelligence" any problems can be escalated more quickly.
Mesko, like many other medtech boosters, thinks AI will be the key technological change between now and 2050, but he says it's important to be clear about what than means.
Artificial narrow intelligence is what we have now, in everything from a car's braking system or Amazon's recommendation engine.