Healthcare & The Fourth Industrial Revolution, (4IR)

The Convergence of Exponential Technologies - Innovating Digital Healthcare in An Era of Creativity & Ideas

In this segment, 'Navigating the Path to Future Care' we start to explore the challenges for Healthcare in embracing Fourth Industrial Revolution, (4IR), otherwise known as Industry 4.0 technologies.

The 21st Century is also going to start to see a shift in the role of the Health CIO, becoming more central to the organisation's executive function, especially the closer the Trust, or health organisation comes to achieving Digital Transformation.

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This is a Paradigm Advisory, namely a segment focused on providing Health CIO's with a good high level understanding of the nature of the issues around adoption and integration of 4IR technologies and practices into their Trusts, amidst some of their present day challenges, and provides guidance as to the sort of narratives and overtures they should ideally now already be either in the process, or be planning to make to their Boards as a matter of urgency. In a bid to put their Trusts on the front-foot of this migration.

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Perhaps one of the greatest future challenges for healthcare stems from the evolution of the times themselves. Knowledge is converging and increasing in an exponential, and some might even say a limitless way. Consequently it's anticipated that we are due to witness, a repeat of all the innovation, from the beginnings of time, to date in the next 13 - 14 years. In the previous ThoughtCast for our Blog, the Digital Paradigm which was entitled, Revolutionising Hospitalisation - Trends & Key Enablers, we touched on the point that Healthcare now finds itself in the unique position, especially as compared to other sectors of the economy, in not having yet fully attained transformation (digitally), yet due to the 4IR being now upon us, needing to speedily adapt to also now operate in this new technological era.

The Convergence of Paradigms & The Power of Ideas

However, these transitions are never easy, and just to add to the complexity, we are also now witnessing the convergence of paradigms or technological eras also, because

the inception of the 4IR, which is otherwise known as Industry 4.0, an era broadly defined by 'the convergence of exponential technologies,' was followed almost immediately by the onset of the Fifth Industrial Revolution, (5IR), which was believed to have actually started back in 2022.

The Fifth Industrial Revolution is essentially a refinement of the Fourth, so namely 'the convergence of exponential technologies', but now also with the admittance of attributes like values, and sustainability to the remit of digital innovation, so that what we are now seeing is the emergence of a new technological paradigm, fuelled by creativity and ideas, which have now become the new economic drivers for innovation and technological change.

The 4IR - The Challenges for Healthcare

This new technological era, presents a challenge for Healthcare on several fronts. The adoption of such monumental change would be a challenge for even the most experienced digitally-native corporations in any sector of the economy. However, the NHS now finds itself in the position of needing to negotiate this migration to the 4IR with some critical gaps in their preliminary digital knowledge, experience, skills and maturity, due in part to some of the challenges encountered, and their lateness in fully engaging with digital/ Industry 3.0. We're going to examine in highlight some basic implications of this, commencing with some recent published findings, not from the remit of Healthcare, but Human Capital, that can perhaps contribute to our understanding of some of the issues we typically see in relation to innovation in healthcare; and while we are on the subject of Human Capital also address. The issue of the role of Health-IT professionals and professionalism in Healthcare, as Healthcare finds itself in the unique position of no longer really having a mature, trusted, 'tribe' of skilled, specialist, 'in-house' Health-IT innovators and experts. We'll come on to look at why this is important, examining some of the reasons for this, and the effect this is currently having on innovation within the sector as a whole.

The Health CIO's Perspectives

Furthermore, in terms of the challenges certainly, as far as the Health CIO is concerned, of which they should now be aware and ideally be working actively towards remediating in managing their approach to the 4IR, arise from both the 'experimental' nature of some of the technologies themselves, and the fact that governments are still very much in the position of catching-up, as regards providing comprehensive legislative guidance and direction around use of a number of them. This leaves Trusts potentially open to risk, and importantly also has implications for patient safety, privacy and Trust, including for things like informed consent. We're going to evaluate these issues and provide pointers to others that the Health CIO should now ideally have thought about, or be in the process of thinking about, and provide some suggestions and/ outline guidance for the Health CIO, to think about, in constructing their own narratives to their Boards and organisational Execs especially, around the adoption of 4IR technologies by their hospitals.

The Brewing Ethical Debate

The absence of debate about the ethical considerations around the development and use of 4IR technologies particularly is increasingly becoming an issue. From the wider societal and even global context, the whole debate around the ethics of these technologies, on account of the 'experimental' nature of many of them, really does need to be addressed. While governments take the stance of not wanting to intervene too early, so as not to stanch innovation, and also in part because in many cases they are largely still in the process of trying to figure out, what exactly the 4IR is, and will become. This leaves Trust's, and those wanting to embrace and innovate in these technologies in the immediate-term in the position of needing to understand how they proceed, and work with these technologies in the meantime, as there is the risk, that once governments become clearer, they could subsequently intervene with laws, and restrictions that could have the effect of making a Trust or health organisation, if not directly legally, then even morally culpable in retrospect, including in the eyes of public opinion.

Negotiating the Ethics of the 4IR

How Trusts, and those wanting to deploy these technologies proceed in this gap, is something that certainly needs to be thought about, and planned for, as the position of Trusts wanting to hold back, and do nothing, either to wait for governments to lead, (by mandating policies and laws); or to learn from other 'early adopters', or those who've gone on before, will not be sufficient or an effective way to manage the gap. Learning lessons from other prior adopters of technology though important, in reality is a comparatively small factor in the attainment of good digital/ technological adoption, that is as compared to actually doing. Delay in active participation (in the 4IR) will mean that the Trust and indeed sector, will ultimately miss a vital component in its own self-development, necessary to evolve its digital capability, build digital resilience, and ultimately attain transformation.

Trusting the Process

There is no short-cut to the journey, Trusts just need to engage, and in order to do that, they must be brave in mastering the mindset of the previous digital era, industry 3.0, which they are still largely in the process of doing, of deploying these new technologies via the small iterative experiments, that are characteristic of digital (deployments), refining as they go, and 'trust the process'. The alternative, namely to wait, is to repeat the mistakes made by the industry with the adoption of digital in the previous era, (Third Industrial Revolution, 3IR), miss the wave of opportunity to onboard the technologies, together with developing the resilience needed to sustain it organisationally, including into the long term. This breaks the process or the model for digital adoption, as is slowly coming to be understood now in retrospect, and means that ultimately without this knowledge or experience, not only will the Trust, or sector not transform, but if another wave of opportunity is lost, the sector could find itself permanently hindered from full participation in the technological economy of the future.

Some of the Ethical Concerns.

Along the lines of ethics, what are some of the issues that we are saying are causes for ethical concern and why? Let's look at some of the technologies in highlight, so for instance: Genomics, Advanced Robotics, Internet of Medical Things, (IoMT), blockchain, nanotechnology to name just a few random examples of industry 4.0 technologies, not only is each complex, and potentially ground-breaking in its own individual right. However, we're now speaking of deploying these individually complex technologies in convergence or converged scenarios, just to further add to the complexity. This is what we mean when we allude to the 'experimental,' -for want of a better way to describe it,- nature of these technologies. It can be quite difficult to assess and manage the long-term implications of any one of them individually, making it near impossible to predict the long-term ramifications, and effects of their uses in convergence.

'The Convergence of Exponential Technologies'

The convergence of these technologies are then anticipated to produce what's being described as an 'exponential technology'.

An exponential technology is an innovation that, either in terms of its performance or capabilities follows a trajectory of exponential growth over time, for instance, either doubling in its effectiveness or efficiency within a short period, while bringing down, or halving its costs of ownership and or operation,

For example. Ultimately this convergence has the feature of making the resulting technology a 'black box', whose outcomes can become extremely difficult to understand, much less clearly predict. Furthermore, its important to remember that convergence of these new technologies, will culminate in a fusion of physical, digital and biological paradigms, which in themselves will fundamentally create, or represent a new paradigm in clinical medicine, that could potentially challenge, and in time come to completely redefine our understanding of what it even means to be human. We'll come on to talk in a bit more detail about this.

Other factors as well, around the fact that work in areas such as the mapping of the human genome for instance, now potentially makes humans 'hackable'. Could the human, or certain categories or even nations of peoples become the new targets for new forms of biological terrorism? Could a health service, or even health services globally be unwittingly swept up in these agendas?, due to what we were saying about the 'black box' nature of these 'exponential technologies'. These are just some of the examples of the discussions that society as a whole is yet to have, around the whole subject of the 4IR, and seems in danger of completely overlooking, but in view of the nature of some of the risks associated with the introduction of these technologies, is society right to do so?, and embrace these new paradigms and mindsets so unquestioningly? And if so, then what does that mean for healthcare? How should the industry now proceed in the 'gap', or in the absence of clear legislative direction around the use of these technologies? When doing nothing is not an option.

Moreover, is the health sector truly justified in not engaging in a debate around the ethics, and or use of these technologies, in view also of both, their commitments under the social contract they have with patients, including implied; and their trusted 'role' in providing 'patient-centred' care? Perhaps it is a debate above the remit of what's supposed to be a practical lab looking at digital Transformation in future Healthcare. However, if the expectation is to keep patients onboard and take them with us on 'the journey that is digital', to evolve future care, then it should probably be addressed at some level.

The Challenges for the Workforce in Adopting 4IR Technologies.

In this module we're going to review some guidance from a 2024 report on Human Capital Trends, which looks at what they are calling the impact of ‘the imagination deficit’, to understand its potential impact on technological advancement within the healthcare industry, to understand how this could be further exacerbating the crisis of the lateness of the health sector to digitally transform; and provide some guidance to the Health CIO as to some of things they might want to consider, and or do to address this challenge.

Furthermore, no discussion about the Workforce challenges from perspectives of technology would be complete without a discussion on the subject of Health-IT professionals, and professionalism within the industry, because healthcare as a sector may perhaps be unique in finding itself attempting to negotiate a very complex technological landscape without support of a mature, raft of technically and clinically strong Health-IT 'savvy' leaders and implementers, (that is apart from the Health CIO role). The issue is slightly more complex than that, as Health-IT professionals do currently exist within the sector, however, their present status and maturity is an issue, that both is and will in future come to have a significant impact on the availability of the clinical workforce over time, as staff, in many cases with no prior IT experience are increasingly being drawn especially from clinical areas to fill the void, which will only further intensify staffing issues already being faced by a very currently 'stretched' workforce.

The Challenges for Patient-centred Care of Adopting 4IR Technologies

Another important challenge for the Health sector in negotiating the 'migration' to 4IR technologies arises from our commitment to patients, and our needing to ensure not only that we don't leave patients behind in the journey that is digital, but that we evolve a future state, fit-for-purpose health service that they can really subscribe to, get behind, and be happy to continue to wholeheartedly support. This ties in with the points made in our previous segment, the introduction to Transforming the Culture of Care about our need to innovate intelligently, to ensure we deliver value, in evolving a future, fit-for-purpose compassionate and efficient health service, and one way in which we can assure that we achieve that is by involving, and even consulting patients, to ensure we understand and align the future service with the sorts of outcomes that are the most important to them. Ultimately,

Their (patient's) adoption of our ultimate efforts to evolve future care, will be key to the success of our endeavours

To assure we keep patients onboard we'll need to be very intentional as to how we engage them in the process, or along the way.

The 4IR Engagement Conundrum - A Paradox

Ultimately, the cumulation of all of these factors confront the health sector with a paradox, on the one hand we are saying, the implications of many of these technologies, especially when deployed in complex 'converged' scenarios, whereby they then become 'exponential technologies' is potentially a serious risk, and represents such a paradigmatic shift to everything that has gone before, that proceeding to engage with them, especially in the current absence of legislative guidance and direction around the use of them, would seem to be counter-intuitive. Yet on the other hand we are also saying, that for healthcare any further delay, could potentially spell an even greater disaster, as to miss another technological wave, and opportunity to engage, to seize the future, as it were, and work out how they can safely take on and embed the next new technology, could not only leave the sector unable to ever really catch-up or recover technologically, but could also potentially hamper the evolution of good future clinical medicine also. Faced with this conundrum, what should the health sector now do in moving forwards?, and what should the Health CIO advise? Many Health CIO's are already receiving requests to deploy some of these technologies? So how should they respond? to steer their Trusts through navigation of the 4IR in what we're calling the 'gap'? Which is roughly the period from the onset of the 4IR ,until the point of governments starting to understand and provide direction around. We're going to come on to discuss some of these issues further in some additional published guidance looking at some of these issues, which will be available soon.

A WEF Video: What is the Fourth Industrial Revolution?

- YouTube Video

(All Rights to video only to World Economic Forum, (WEF))

Suggestions, guidance and advice for the Health CIO to navigate the Fourth Industrial Revolution. Among the topics covered:

In Summary

Negotiating The Ethical Challenge
Digital Maturity & The IT Challenges of the Healthcare Workforce
The Complexity & Challenges of Health-IT Professionalism in the NHS
The Challenges for Patients - The implications of 4IR Technologies for Patient Safety, Privacy & Consent
Legal & Governance