“The fundamental conditions and resources for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity.”
– The Ottawa Charter for Health Promotion, 1986

Digital technologies can facilitate the attainment of economic and human development through more efficient, effective, and equitable provision of healthcare services. In the last decade, the exponential growth in information and communications technologies (ICTs) provided the opportunity for health interventions to be increasingly supported by new digital technologies – collectively termed in this article as digital health innovations. Given the ubiquity of ICTs, health interventions are now increasingly able to reach people, allowing access to those constrained by geographical and financial barriers, through product and service innovations.

Digitalisation is considered key to meeting the challenges that face the healthcare sector; and there is a proliferation of material on the use of ICTs to reform health systems. For instance, mobile technologies have been integrated across a wide range of processes and in various layers of health systems in both developed and developing countries. In a 2009 survey¹ of the World Health Organization’s 112 member countries, at least 92 countries globally have been using mobile and wireless technology-enabled health interventions for diverse purposes, attesting to its predominance and adaptability, especially in low- and middle-income countries (LMICs). Coupled with trends such as declining costs of devices and data services, and increased uptake by developing countries, the integration of digital technologies into LMICs’ health systems has the potential to close the disparity in wealth and health and ultimately contribute to economic and social development.

Roxanne Llamzon, PhD student, UNSW & DELH

The good news is that there’s no shortage of innovators and collaborations in this space, all endeavouring to solve the barriers to access to quality healthcare globally. However, globally 70% of digital-enabled initiatives for good health and well-being – or digital health – fail to deliver their intended outcomes in terms of quality and scale². Despite its promising benefits, the attempts at digitalization of healthcare services are, more often than we like, marred with slipped deadlines, budget blowouts, unmet user needs, discontinuity, and abandonment. Service innovation in the healthcare sector is notoriously difficult³. One explanation is that public and private organisations are simultaneously cooperating and competing to provide essential services, making collaboration a major hurdle in this space. Yet, especially for public service innovation, success is hinged on the collective action of these interdependent actors.

As such, one of the major hurdles for the successful provision of mass-market digital healthcare is alignment. Alignment means connecting the necessary actors for the value proposition together and getting them to work together effectively. While these alignment antecedents seem rudimentary, it must be taken into account that these actors do not normally have to work together; and are unlikely to participate in voluntary coopetition4. One explanation is healthcare is essentially a “public good or service”, is neither owned nor fully captured by any one of the participating actors. Hence, organizations including the World Health Organization, view digitalisation as a vehicle towards achieving the “health for all” imperative. And that the way forward is to build an appropriate and sustainable ecosystem where digital healthcare services can thrive.

Since its reintroduction in the early 1990s, the concept of “ecosystems” has been applied extensively in various disciplines and sectors. In theory, we now know that’s exactly what ecosystems are for. An innovation ecosystem, following Ron Adner’s definition, is a network of autonomous but interdependent actors working toward a common value proposition. It is a complex web of actors – producers and consumers – that work cooperatively and competitively to support new products and services, satisfy customer needs, and generate inputs for continuous innovation. Adner underscores that partner alignment is the precondition for coordination and collaboration, which in turn, influence the outcomes of innovation ecosystems. Following this logic, we can then say that the high failure rate of digital health initiatives can be linked back to weak or lack of alignment in various levels of the innovation ecosystem, leading to fragmented solutions and information silos.

As ICTs become more sophisticated, the diversity of use cases in the health system likewise expands – we can only expect more novelty, and more complexity. Mobile and wireless technologies provide the capability to cut across layers of the health system, modifying (possibly simplifying in some ways) the relationships and interactions of patients, doctors, service providers, suppliers, and policymakers. In a study published in 2013 , over 15,000 mobile health applications were already available “off the shelf” for consumers within just five years after the introduction of the iPhone. Today, as self-tracking sensors and cloud computing becomes more pervasive, new capabilities, new products, new processes, and new behaviours inevitably emerge. Thus, across the board, the focal firm or the “hub” has consistently been outlined to play a critical role in ensuring the alignment of innovation ecosystems toward desired objectives. Hubs essentially curate and establish the key partnerships and orchestrate collective action among various actors; ultimately, to create the necessary conditions for collaborative innovation.

Within these ecosystems, organizations or actors are increasingly co-dependent in their business and innovation activities and that in order to succeed with innovation, hubs must manage the triple risk of initiation, interdependence, and integration. The “ecosystem” approach considers the digital innovation, actors, and the broader environment altogether. While globally, digital health innovations are not few and far between, the universal challenge is taking these digital-enabled interventions from proof of concept to commercialisation. Considering the growing evidence that digital health interventions can potentially contribute to addressing the perennial challenge of health inequities, this is of primary interest to practitioners, providers, and policymakers worldwide.

The highly complex entanglement of social, political, economic and ecological problems and the long history of failed attempts to solve the “health for all” conundrum demand an “all for health” approach. While having a leading “hub” firm is crucial, equally, we should recognise that it will take an ecosystem of actors for innovation to thrive – and we each have a part to play. Healthcare innovation requires from us a structure for continuous, collaborative, and coordinated digital transformation.

1. mHealth: New horizons for health through mobile technologies, published in 2011
2. HIT Or Miss: Lessons Learned from Health Information Technology Projects, by Jonathan Leviss
3. Herzlinger, R. E. (2006, May). Why Innovation in Health Care Is So Hard, Harvard Business Review.
4. Coopetition – collaboration between business competitors, in the hope of mutually beneficial results.

Written by:
Roxanne Llamzon
ARC Industrial Transformation Research Hub for Digital Enhanced Living PhD scholarship recipient
School of Information Systems and Technology Management, University of New South Wales
NB: The author reserves the right to showcase/publish this blog piece elsewhere and/or in a different medium.

Editorial review by:
Dr Scott Barnett, Chief Investigator
Kevin Hoon, Hub Manager