The world has changed.
According to Jennifer Erwitt, in her book The Human Face of Big Data, “…in the first day of a baby’s life today, the world creates 70 times the data contained in the entire Library of Congress.” Think about that.
IBM estimates that 90% of the world’s data was created in the last two years which means we generate more data every day than was generated in all of human history prior to 2012. Facebook alone has over 182 million members in the U.S. with over 1.1 billion worldwide making its population that of the third largest country in the world trending toward becoming first within the next four years. Streaming video from Netflix and YouTube make up just over half of all peak Internet traffic in the United States. Today, over 58% of the US population carry a mobile device that didn’t exist just seven short years ago, with half of them leveraging it as their primary Internet source. Leveraging this, wearable device connections are expected to jump more than 700% between 2013 and 2018 totaling over 64 million devices in the next four years.
Individually these numbers are staggering. Together they paint a picture of the digital world we exist in today and foretell the one will come to live in tomorrow. A world comprised of connectivity, data, social media, mobile, sensors and wearables, and location-based context. Where ubiquitous connectivity creates expectations of always on, always available, immediate gratification.
Healthcare has changed.
On the surface most Americans are familiar with the Patient Protection and Affordable Care Act (ACA). Besides increasing the quality and affordability of health insurance, ACA emphasizes the role of pharmacies, NPs, and PAs as more patients gain coverage and burden on the system is distributed and costs are lowered. Barriers to self-directed learning and patient-centric care are also being removed through mHealth, online health portals like WebMD, and access to records mandated through Meaningful Use.
Below the surface, however, there are three additional initiatives that have been catapulted forward that will change the face of healthcare as much or more than the ACA itself.
First, which predated and is considered by some as the enabling foundation of the ACA both because of its mandates on “meaningful use” of Electronic Medical Records (EMR) and its initial foray into payment reform which the ACA extends, is the Health Information Technology for Economic and Clinical Health Act (HITECH). This is the legislation and impetus for the technology that is responsible for the retirement of the physical healthcare record. Together with Health Information Exchange (HIE) technologies health data can now move fluidly across systems along with the patient, on demand and accessible, granting immediate access and more efficient, higher-quality care.
Separate from ACA and HITECH, but closely related in objective, is the Big Data Research and Development Initiative (BIGDATA, 2012) which funneled $200 million to agencies like the National Institute of Health (NIH) with the goal of identifying challenges and goals in extracting the most information and value from massive data sets. Additionally, the Big Data to Knowledge Center of Excellence (BD2K) specifically oriented toward advancing discoveries and improving health while reducing costs and redundancy.
Enabled by the ACA is The Patient-Centered Outcomes Research Institute (PCORI). PCORI’s mission is to help people make informed healthcare decisions and improve outcomes. The inception of PCORI marks a significant milestone in the transformation of healthcare from practice to patient centric care. This transformation ultimately defines outcomes as common goal between healthcare practitioner, payer, caregiver, and patient. PCORI goes a step further designating improved outcomes as contextual to the patient themselves.
Together these three initiatives – electronic medical records, outcomes based medicine, and big data research – have laid the groundwork for a connected healthcare system that changes the conversation from health to wellness.
From the patient perspective, as Internet based information abounds, and health information becomes more accessible, control is shifting. Where previously doctors were singularly trusted, today there are more perspectives to align and consider – specialists, payers, pharmacists, thought leaders, caregivers, and more. Combined with the changing world of fitness apps and quantified-self trackers, patients are more connected than ever and proactively owning their own health and wellness.
Collectively, each of these health trends are united in the singular pursuit of patient centered care measured primarily by outcomes and influenced largely by wellness.
Marketing has changed.
In response to jumps in technology evolutions coming ever faster and channels multiplying in number but decreasing in individual importance the advertising, marketing, and communications industries responded by removing digital as an independent vertical and distributing the responsibility to become digital at the core throughout all disciplines.
Traditional strategies emphasized the zero moment of truth – that singular instant when a consumer stands in the isle and must choose which product to pull off the shelf. But digital has evolved the model. Today we do not talk about a moment, we talk about the many moments along consumer journeys as they crisscross our brand forming opinions and making decisions.
Our commerce mentality – from that of a consumer who is first made aware so they could evaluate, consider, then act – has shortened to that of a perpetual considerer. Armed with tablets and phones we rarely find ourselves more than a pocket or purse from purchase. Sophisticated multi-channel delivery networks integrate tracking to automated segmentation delivering messages where and when they are needed along our journeys. Further, our one touch, five-star rated post-purchasing feedback has become the social contract between consumers granting them a voice louder than that of any marketing budget. As a result the power has shifted away from brands and in favor the consumers themselves.
This on demand, consumer-centric shift in mentality has further propagated beyond commerce into many other significant aspects of our lives. So how then does this one-click, overnight shipping paradigm of continuous commerce translate to the complex and physical world of something like healthcare?
The new language of healthcare communications.
The world has changed; it is evolving digital. Healthcare has changed; it has become outcomes and wellness. Marketing has changed; it is contextual. This is the world we now live in. One of ubiquitous connectivity, data, social, mobile, sensors, and location-based context.
We are the global healthcare communications and behavior change experts and we must combined these three pillars – digital + outcomes + contextual value – to drive healthcare and improve outcomes.
We are not passive observers.
The world is digital, and we must become digital with it. Our customers are patients, doctors, payer, specialists, caregivers, and more. But beyond that, they are people and they don’t care that Amazon 1-click doesn’t need FDA approval; they just want seamlessly curated and orchestrated content. We must provide it. We must be digital at the core.
Outcomes are about adherence. Adherence is no longer just taking a pill, but eating right, exercising, lifestyle, and following up. Outcomes are about changing behaviors. And that’s what we do best. We must influence outcomes.
Everything we do is content. Our content provides value. Value is contextual. And context is continually changing. If today technology can send a message to someone open to receiving it, when, where, and how they need it most it is our job to know what to say. That is the art and science of what we do.
Where do we go from here?
In his 2008 book, Outliers: The Story of Success, Malcolm Gladwell repeatedly claims the key to success in any field is 10,000 hours of practice. At forty hours of work per week, this would take approximately five years. We don’t have that kind of time.
Just as the advertising complexity gap widened in the late 90’s and we had to convert our thinking from print to digital another evolutionary jump occurred around 2003 and web became social web. This was about 5 years and many had Gladwell’s 10,000 hour expertise to make the leap, but some did not, and still have not.
The next leap came more quickly, but the gap was just as wide as social became mobile in 2007, just three short years later. And again a leap occurred in 2009 when mobile became wearable with the release of FitBit, and today wearables are now ushering in the age of context.
To keep up we can no longer rely on forty hours of work and five years of practice to reach our 10,000 hours. Change is coming too fast. We must become digital at the core. Not just as an agency, but as individuals.
We are not passive observers.
Today concepts like the Internet of Things (IoT) and Google Glass are the subject of active debate, much like smartphones and Bluetooth headsets were just a few years ago. And much like the Bluetooth headsets, where non-users protested the awkwardness of not knowing when someone was on the phone or simply talking to themselves, wearable computers like Google Glass will one day be accepted as normal within societal boundaries.
Or not; but we cannot be the naysayers. We cannot back down from complex issues like social or judge Goolge Glass to be too far off for consideration, or location-based contextualization to be “creepy”. The models we know – commerce, television, music, media, healthcare and even the way we hail a cab are evolving. It’s our job to figure them out – to use and to understand them, become one with them, and to push the boundaries of what’s possible.
Because today the standard best practice recommendation may be to redirect the social message, and that is fine, but we know it will not always be the case. Change isn’t coming, it’s here, and we need to be one step ahead – driving change, leading, not following, and ushering in the new age of digital healthcare communications.
But to get there we have to change. We have to shed our individual metrics and unite under the one thing that unites our industry: outcomes. We are not about the best message, or prettiest creative, niftiest technology, or highest utilization. Our metrics must be the same as our industry – one metric: outcomes. Was the project a success, or not? We win and lose as a team.
Digital + outcomes + contextual value means that we are saving lives and helping people live both longer and better. That is the core of what it means to be the healthcare behavior change experts in a digital world.
 Facebook, 2013
 Pingdom, 2013 – http://royal.pingdom.com/2013/02/05/facebook-2016/
 Sandvine’s Global Internet Phenomena Report
 Pew Research Center’s Internet Project, February 2014, Adults 18+
 eMarketer, Wearable Devices Shift from Accessories to Ad Platforms
 eMarketer, As Wearable Tech Sales Grow, So Do Privacy Concerns