It wasn’t too long ago when hospitals were operating on paper and manually sending documents to providers and/or patients. But as technology advances, so does healthcare. From consumer-driven healthcare to blockchain, the lines between technology companies/products and healthcare are becoming blurrier. Let’s take a look at the top 5 digital health trends that will spearhead the future of the healthcare industry.
Consumer-driven healthcare (CDHC) is a broadly defined term. Many use it to reference insurance plans, such as Flexible Spending Accounts or Health Savings Accounts. But CDHC is much more than just health insurance. It is any type of product or service that empowers the consumer to take control of their own health. Such products allow consumers to be proactive about their health, rather than reactive.
One of the most popular categories of CDHC products is wearable health devices (WHDs). Wearables can monitor vital signs, cardiovascular disease and pulmonary obstruction, insulin levels, sleep conditions, activity levels, and much more. The clear advantage is that WHDs minimize discomfort and interference with regular daily activities. This market is continuing to grow with the saturation of the health apps market, and with the development of medical-grade wearables. In fact, the WHD market is expected to reach almost $34 billion in 2019.
The healthcare industry is in dire need of some disruption via technological advances. The giant tech companies seem to be interested in doing so through CDHC. Here are some notable examples:
- Apple Watch: Apple CEO, Tim Cook, once said that the healthcare market makes the smartphone market seem small. As such, Apple has made its intentions clear: they will become a major player in the healthcare industry. This is showcased by the release of the ECG feature and the roll-out of Health Records, where consumers have access to their personal health records right on their phones and watches. Apple is effectively turning its consumer products into medical devices, with personal health records as the central focus.
- Verily: Recently in the news for it's $1 billion funding round, Verily is Google's life sciences subsidiary that is involved in wearables, chronic disease management, robotics, etc. They are currently working on developing shoes that can track your weight, which is an indicator for falling and certain health conditions (i.e. congestive heart failure).
- PillPack: Another important news story was Amazon's acquisition of PillPack, the full-service online pharmacy, in 2018. The company's value proposition is straightforward: convenient and simple medication management. Amazon's supply chain and distribution network are important assets for PillPack's delivery service. The acquisition marked another step in Amazon's 2018 move into healthcare.
CDHC is one of the easiest ways for digital health adoption because it's the most consumer-facing category. With more people taking control of their health through these products, care delivery is seeing a shift towards a "consumer market focused in the home."
Telemedicine is the practice of delivering health-related services via telecommunications and virtual technology. The most common types of delivery of care are secure video conferencing and instant messaging. Telemedicine—often used interchangeably with telehealth and virtual care—makes it easier for patients to connect with providers, and receive appropriate and timely care. There are several types of telemedicine, including video conferencing, store-and-forward, remote patient monitoring (RPM), and mhealth.
- Video conferencing is the most straightforward type of telemedicine. It refers to a real-time video call where providers and patients can interact with each other, recreating the experience of an appointment at a doctor's office.
- Store-and-forward gives healthcare professionals (HCPs) the capability to share medical information, such as lab results and X-rays, with other HCPs. It is an efficient way for patients and their coordinated care team to collaborate despite conflicting schedules and/or geographical concerns.
- RPM is the monitoring of patients outside of conventional healthcare settings, and it's especially important in chronic disease management. For example, diabetics can greatly benefit from having their HCPs monitor their insulin levels, weight fluctuations, and sleeping patterns. The goal is for care to become proactive, rather than reactive. RPM is often tied to medical-grade wearables.
- mHealth, an abbreviation of mobile health, is defined by the WHO as the "medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices." Health apps, which also fall into the CDHC category, are the biggest component of this.
The list of use cases with virtual care is extensive. Outside of most primary care services, telemedicine has the capability to offer inexpensive but effective alternatives to the traditional delivery of care for mental health, rehabilitation, plastic surgery, home-based care, disability management, corporate wellness, medical cannabis clinics, and much more. Additionally, telemedicine is being offered to patients in different settings. On one hand, providers can equip themselves with a virtual care platform to offer video conferencing or instant messaging to their current roster of patients. On the other hand, consumers can join a subscription plan to access any provider that is available for medical advice. A subscription plan offers convenience for patients who are looking for a quick tip from an HCP. However, being able to interact with the same medical professional and create a longstanding relationship with them is correlated to improved quality of care and patient satisfaction.
The demand for telemedicine and virtual alternatives is increasing, so much so that health systems are beginning to open their own virtual clinics. Back in 2015, Mercy Health—one of the largest Catholic non-profit health systems in the US—spent $54 million on a digital-only hospital with no beds, known as Mercy Virtual. With a growing number of people using the Internet and digital devices, it's inevitable for certain healthcare services to be offered virtually. HCPs should begin integrating virtual care into their toolkits.
Artificial intelligence (AI) refers to any technique which allows for computers to mimic human behaviours. More general functions of AI include speech recognition, learning, planning, and problem-solving. AI shouldn't be confused with machine learning (ML) and deep learning (DL), which are more advanced subsets of AI with limited clinical applications.
Over the last two decades, multiple healthcare use cases have been developed for AI. It is especially useful for pharmaceutical R&D, population health management (PHM), and practice management.
- With a reported $650 million in funding (2011-2017) towards AI-powered pharmaceutical R&D solutions, AI is being used primarily as an efficient cost-saving measure for drug development. It can help with aggregating and organizing research data and can use predictive analytics for faster diagnoses, among other things.
- Social determinants of health (i.e. income, education, environment) have become an important topic of conversation in population health management. They're used as markers to identify patient types based on different characteristics. AI is currently being used in PHM to predict which groups of people are most likely to require medical intervention and tailor those interventions to as many individuals as possible.
- With regards to practice management, AI can transform practices by automating administrative tasks. These tasks include patient support (i.e. chatbots), billing, medical data organization, etc. It's important to note that AI is meant to augment, not replace, human activities.
By 2021, the healthcare-related AI market is expected to touch $6.8 billion with a CAGR of 40% and will save the healthcare industry $18 billion/year. Activities that have nothing to do with patient care consume over 51% of a nurse’s workload and nearly 16% of physician activities. AI is especially useful for writing chart notes, filling prescriptions, and ordering tests. Despite its benefits, there is still some hesitation to hand off tasks to an AI-enabled computer.
Gloria Lau, CEO of Alpha Medical, has an interesting take on AI, which serves as a great concluding thought for this section. "The concept of the ‘AI doctor’ is overhyped. We’re not replacing physicians anytime soon. Instead, we’ll be assisting and improving the efficiency of providers. Replacing a holistic diagnosis, treatment, and management care pathway with machines is far out—I’m not sure we’ll see that in the next ten years.”
Personalized medicine (PM) refers to tailored prevention and treatment based on environment, lifestyle and genetics. Its benefits are clear: “by enabling each patient to receive earlier diagnoses, risk assessments, and optimal treatments, personalized medicine holds promise for improving healthcare while also lowering costs.” PM is often confused with precision medicine. The former is a practice, whereas the latter is a science. Precision medicine refers to targeted therapies based on molecular diagnostics and is considered to be a part of PM.
The most popular use case with PM is CRISPR, or Clustered Regularly Interspaced Short Palindromic Repeat, which allows researchers to edit genomes. The infographic to the right offers a simple summary of how CRISPR is performed.
In late 2018, He Jiankui, a Chinese biophysics researcher, claimed to be the first person to ever create genetically-modified "designer babies". This created a conversation around the ethics of gene editing, and whether we should be enthusiastic or skeptical about the technology. Jiankui says his team used CRISPR on embryos from HIV-positive parents to inhibit the virus from affecting the children.
PM can be implemented for other use cases as well, such as:
- Drug dosage based on pharmacogenetics. For example, GeneSight can evaluate a person's genetic variations and assess which antidepressants are best suited for them.
- Personalized diets. Similar to pharmaceuticals, what we eat is processed differently based on our genetic code. Dieticians and nutritionists can utilize PM to offer well-balanced nutrition plans that fit their patients' goals (i.e. lose weight, control insulin levels, etc.) and their genetic variations.
PM is starting to become accessible through consumer-driven healthcare. Direct-to-consumer kits, like 23andMe and Ancestry, have become a popular way for people to analyze their genome and provide insight into health and ancestry factors. While some HCPs are skeptical of home DNA testing, most are in favor of this trend and see it as a way for their patients to gather valuable information. “Direct-to-consumer genetics companies are leading the way toward democratizing genetics and making it available to more and more people to learn about their risks and intervene in ways to keep themselves healthy,'' says Robert Green, a medical geneticist at Harvard University.
You might have first heard of blockchain when the price of one Bitcoin peaked at over $19,000 at the end of 2017. In the context of healthcare, however, cryptocurrency is less of a focus. Instead, HCPs are interested in the secure blockchain network, which could serve as the catalyst for a single health record database across the nation—if not the world. As big data becomes more prolific in healthcare, blockchain networks could provide a means to manage these vast pools of information to potentially combat the excessive amounts of information created by digitization. So what is blockchain exactly? It’s a complicated answer, but here’s the simplest definition: blockchain is an open source platform that allows all users to make transactions without a third-party administrator.
Blockchain has certain characteristics that are extremely favourable for its use in healthcare:
- Consistent: Since there is only one single record, problems regarding access, duplicate records, or tampered data is reduced, and the record can remain the same across multiple organizations.
- Ownable: Patients will own their data, which means they can control where their data goes, instead of letting organizations share it with a third party.
- Clear rules: There is only one version of the blockchain database, and the rules about it are known, unlike the current fragmentation of data standards and health records.
- Decentralized: The blockchain database has multiple copies stored in different places, with no need for a third-party administrator, which greatly reduces the risk of a security breach.
As of today, the exact use cases for blockchain are still being determined and no patient data is being handled. As a result, numerous healthcare consortia are being created to test these use cases. For example, Hashed Health is working to "develop proof of concepts where blockchain protocols can improve healthcare" alongside Accenture and Martin Ventures. There are different use cases currently being developed for short-, medium- and long-term applications.
- Short-term. In June of 2019, the FDA announced that it will be launching a pilot project for the US Drug Supply Chain Security Act with IBM, KPMG, Merck and Walmart. As per Forbes, the project will be "developing the technology that will identify and trace certain prescription drugs." It is also meant to "evaluate the most efficient processes to comply with supply chain security requirements." The pilot will be conducted on IBM's blockchain network.
- Medium-term. Health Information Exchange (HIE) lets patients and providers share health records amongst themselves. As simple as it sounds, HIE offers many benefits, such as reducing readmission rates and improving diagnoses. Blockchain is beneficial to HIE by working as a secure leger for the exchange.
- Long-term. Interoperability, despite becoming a buzzword in the industry, is very important to patient safety and treatment efficacy. By establishing universal identities through blockchain, health records remain the same throughout the course a patient's lifetime and HCPs are less at risk of medical errors.
The burning question about blockchain applications in healthcare is... are we ready? Most, if not all, HCPs and health organizations can see the potential benefits of blockchain. However, we are still far from the realization of all the potential use cases. While we wait for these consortia to showcase their proof of concepts, it's worth acknowledging blockchain's role in healthcare through data access, security, and privacy.