During the dark and difficult times of 2021 – a year dominated by the Covid-19 pandemic, as we all know only too well – healthcare providers and patients faced novel challenges that somehow facilitated the deployment of new solutions. In many instances, these solutions were already technologically ready to be deployed, but the extraordinary circumstances of the pandemic provided the catalyst to their rollout, ushering in an environment that smoothed the path to new ways of doing things, widespread acceptance of change, and the adoption of new technologies.
As we move from 2021 to 2022 – and to hopefully happier times – rapid innovation continues apace. Given that huge advances and transformations are already occurring in the area of digitalisation, what can we expect in this new year, and what issues will be trending?
In this article, we will evaluate five digital healthcare trends for 2022 as predicted by the medicalfuturist and we will add what we believe could also become a trend in the digitalisation of healthcare.
# 1 VOCAL BIOMARKERS
Identifying conditions from a voice sample: “Do I sound sick to you?”
Vocal biomarker technology is pushing the boundaries of smart healthcare. Voice tech start-ups are booming, leveraging machine learning-based voice recognition technology, such as that developed for Amazon’s Alexa, to potentially revolutionise the diagnosis of health issues by offering fast, accurate and cost-effective check-ups, remotely. As research money starts to pour into the field, an accurate, non-invasive, diagnosis for some conditions could soon be as easy as the patient speaking into a smartphone.
How do vocal biomarkers work? With artificial intelligence (AI) based techniques, symptom checker software can detect so-called “vocal biomarkers”. Vocal patterns such as pitch, tone, rhythm, and rate as well as breathing and coughing can be processed to develop vocal biomarkers of disease. AI-powered vocal biomarkers are being developed to diagnose a multitude of disorders including Parkinson’s disease, cardiovascular disease, post-traumatic stress disorder and Covid.
An interesting and relevant example highlighting the potential to use vocal biomarkers to identify a condition comes from researchers at the Massachusetts Institute of Technology (MIT) who used artificial intelligence to detect asymptomatic Covid-19 infections through cell phone-recorded coughs. They found that people who are asymptomatic for Covid-19 may differ from healthy individuals in the way that they cough. These differences are not decipherable to the human ear. But it turns out that they can be picked up by artificial intelligence.
The team is working on incorporating the model into a user-friendly app, which if approved by international regulatory bodies and adopted on a large scale, could potentially be a free, convenient, non-invasive pre-screening tool to identify people who are likely to be asymptomatic for Covid-19. A user could log in daily, cough into their phone, and instantly get information on whether they might be infected and therefore should confirm with a formal test.
Whilst there is still some way to go until we can fully realise the potential for vocal biomarkers in the early detection of disease, it is a healthcare topic we are sure to be talking about in 2022. Stay tuned for more information about this.
#2 AI IN DIAGNOSTICS
The physician’s assistant
Correctly diagnosing diseases takes years of medical training. Even then, diagnostics is often an arduous, time-consuming process. In many fields, the demand for experts far exceeds the available supply – the shortage of laboratory staff and technicians being just one such example. A KPMG study, ‘Who cares, Wins’ predicted that by 2030 the world would be short 80 million physicians and nurses which means that healthcare systems must innovate to ensure that they can work effectively.
AI is the integration of deep learning, data insights, and algorithms, and it has the capacity to deal with large data and imaging. It has enormous potential to help address these shortages as well as to relieve some of the growing concerns about work pressure on the medical staff. It can also support clinical decisions in time-critical situations, or when there is a lack of expert knowledge available such as in remote or poorly funded medical facilities.
Medical imaging is one of the most promising areas for the application and innovative use of AI. Machine learning – particularly deep learning algorithms – have recently made huge advances in automatically diagnosing diseases, making diagnostics cheaper and more accessible. Machine learning is particularly helpful in areas where the diagnostic information a doctor examines is already digitised, such as detecting lung cancer or strokes based on CT scans, assessing the risk of sudden cardiac death or other heart diseases based on electrocardiograms and cardiac MRI images, classifying skin lesions in skin images, or finding indicators of diabetic retinopathy in eye images.
However, whilst the application of AI in diagnostics has already demonstrated a great deal of potential and opportunity, humans are still needed to manage the process. There are real concerns related to risks of bias and lack of clarity for some AI algorithms, and it is possible for mistakes to be made. There is also the risk that the use of AI can introduce new potential errors. AI systems are not as equipped as humans to recognise when there is a relevant change in context or data that can impact the validity of learned predictive assumptions. In addition, ethical concerns directly related to patient safety also need to be addressed as the use of AI becomes more pervasive and plays a greater role in patient diagnosis.
Balanced against the risks, the use of AI in diagnostics will lessen the burden on healthcare systems and professionals both physically and economically. AI will complement rather than replace traditional approaches used by radiologists; it is a tool to help doctors, it won’t replace doctors. AI systems will be used to highlight, say, potentially malignant lesions or dangerous cardiac patterns – allowing the doctor to focus on the interpretation of those signals. This innovation is providing such a great deal of efficiency to systems that it is likely to be well-received by all stakeholders involved in the process and therefore we should expect to see it in use relatively soon.
#3 AT-HOME TESTING KITS
Lab tests in the privacy and comfort of your own home
One of the most readily available and accessible healthcare developments is at-home testing – the global home diagnostics market size is predicted to surpass USD 8.15 billion by 2030. With a personal testing kit, you can measure a range of health parameters that used to be only available in laboratories. You can monitor your blood pressure, test for HIV, colon cancer, hepatitis C, deteriorating vision, urinary tract infections, track ovulation and check your blood sugar too – all in the privacy of your own home.
Having relatively easy access to currently available at-home tests (like lateral flow tests, for example) we can forget how revolutionary at-home testing was when it was first introduced. When home testing pregnancy tests became available in the 1970s it was truly ground-breaking, whilst the possibility to monitor blood sugar levels using finger-prick tests transformed life for diabetics.
The progression of this revolutionary trend continues with exciting developments in at-home testing. We now have access to previously unimaginable areas like whole genome sequencing and microbiome analyses – tests that can help us take better control of our health and healthcare management plans – as well as innovations like new intelligent toothbrushes that will monitor our glucose levels, COVID detection or progression of Parkinson’s disease without interfering with our daily standard morning routine. Empowering patients is key for the future of healthcare and testing kits can be great tools to help people take control of their own health data and to shift the paradigm from reactive to proactive care. In addition, at-home testing can remove a time consuming and costly burden from the shoulders of medical professionals.
#4 DIGITAL HEALTH INSURANCE
A growing trend in Europe
Access to effective and affordable healthcare is already one of society’s great dilemmas. The issues and challenges are well-established and increasingly urgent; especially the aspect of ever-escalating costs.
Issues surrounding healthcare insurance may seem irrelevant to European patients as the vast majority of European citizens are fully covered by their national healthcare system, even in cases of extreme poverty or unemployment. However, against a backdrop of declining services and increasing waiting lists, a clear trend is evident: year-on-year an increasing number of European patients take out medical insurance to cover shortfalls and limitations within their national ‘free at the point of use’ service. With Covid accelerating these complexities, European patients should carefully monitor these healthcare trends.
The inexorable digitisation of healthcare, in all its forms, generates a plethora of data. For better or worse, health insurance companies are now able to gather vast amounts of information about us, their customers, and, with increasing access to personal health metrics (often garnered through the use of wearables and healthcare apps) it’s not a question of if or when health insurers will use this data, but how. Digital tools can create a detailed picture of each user’s overall health, leading to the possibility of insurers using a data-driven approach to personalise premiums through a “pay-as-you-live” system. This is not necessarily bad news. Insurers will be able to partner with their customers to help them manage their health and make better lifestyle choices. We already have examples of this: US health insurance firm Oscar Health incentivised a healthy lifestyle by rewarding its customers with Amazon gift cards for achieving their daily goals as measured by Fitbit wearables, for instance.
The flip side
Whilst it’s true that the more health data insurers hold on you the more effectively they can tailor your plan (like if someone’s genome test indicated a high risk for breast cancer they could build in a subsidy for more regular mammograms), the flip side of the equation is that in a dystopian scenario, companies could mandate that patients provide access to all of their health data, including those from their personal devices. This could lead to patients’ premiums being based upon “private” lifestyle choices, or even in extreme circumstances (such as a patient assessed to be potentially too costly and therefore unprofitable) being denied access to healthcare cover at all.
So, above all, the principle of universal coverage, of ‘best care’, must be maintained, and quality, compassionate care must be guaranteed to be available to everyone, regardless of circumstance. Patients with life-threatening conditions should not have their treatment stopped through lack of insurance coverage, even in systems (like the model that is becoming predominant in Europe) where health insurance is an add-on to the national system. Effective regulation is a crucial safeguard, enabling the positive effect of innovation whilst managing the cons. Regulators and institutions need to play their part in ensuring that no one gets left behind; they have the responsibility of setting appropriate regulations and standards to ensure an acceptable balance between enabling patients access to quality, personalised care whilst still maintaining a level of privacy.
Keep an ear to the stethoscope on this one!
We believe that one area that will see significantly increased usage in 2022 is in the medical device field of Electroceuticals.
First of all, what are electroceuticals? Deriving from the word combination of ELECTROnic and pharmaCEUTICAL, electroceuticals are bioelectronic devices – some smaller than a grain of rice – that alter electrical impulses along nerves, in order to treat medical conditions. Electroceuticals have, in fact, a long history in medicine: think pacemakers for the heart, cochlear implants for the ears and deep-brain stimulation for Parkinson’s disease.
Electroceutical devices can be invasive and minimally invasive depending on the complexity of the surgery to implant and the patient perception after implantation. Pacemakers are an example of the first category. The invasive category has been around for several decades and continues to grow at a steady pace. The minimally invasive device segment has been growing at a higher rate and is expected to explode with the improvement in electronics, data analytics and artificial intelligence. The degree of invasion can have differing impacts on patients’ lives; some patients may experience a profound level of discomfort or restriction whilst others will be able to forget they even have an implant. The one thing they will have in common is a significant improvement in their medical conditions.
The hope with electroceuticals is that by miniaturising electrode devices and attaching them to strategic nerves, the body can be fed alternate messaging in order to heal itself or to inhibit a vast range of complicated chronic diseases and afflictions and degenerative disorders.
Unlike pharmaceutical drugs, electroceuticals have the potential to provide targeted, personalised, medicine. Traditional drugs can take a scattergun approach to care. They suffuse the body, often in places they aren’t wanted, solving one issue but potentially creating more in the form of difficult to predict and potentially fatal side effects. Electroceuticals, on the other hand, provide clinical benefits with marginal to no side effects. The ability to ‘set and forget as the technology becomes smarter and more robust has obvious advantages over an inconvenient daily regimen of drugs that can be forgotten, dangerous in the wrong combination, or misprescribed. This ability to target only the problem being treated offers a personalised health solution to a patient – one that could be further customised to meet a particular person’s needs, responsiveness, and anatomy – a solution that is undeniably attractive.
New Devices, New Applications
There are so many developments in the world of electroceuticals – from ‘bionic eye implants’ to directional Deep Brain Stimulation – that we can barely scratch the surface of the subject in this piece, but we will be publishing more in-depth articles in the future. It is no exaggeration nor hyperbole to state that advances in electroceuticals are ushering in truly remarkable and absolutely life-changing technologies.
Take spinal and nervous system damage, for example. Traumatic injuries, especially those involving the brain and spinal cord, can be particularly difficult to treat. Electrical stimulation therapies have been proposed for promoting neural repair and regeneration after injury and for modulating neural plasticity mechanisms that may assist to recover lost functions.
In cases in which disease or injury has led to complete paralysis, such as in spinal cord injury (SCI), stroke, and motor neuron disease, brain-computer interface (BCI) technology has been of particular interest. BCI technology allows signals in the brain to be recorded and decoded to determine the user’s thoughts, which can allow a paralysed or locked-in patient to communicate, control devices, and, when combined with neuromuscular stimulation technology, regain volitional movement. Recently Elon Musk’s brain chip firm, Neuralink, announced that they were lining up clinical trials in humans for his technology with the hope it would “… restore full-body functionality to someone who has a spinal cord injury”.
Where are we now, and where do we go?
As our knowledge in the field of bioelectronic medicine increases, we can expect devices to become more readily available, easier to apply, and smaller. The combination of molecular biology, neuroscience, and engineering – as a core foundation of bioelectronic medicine – will continue to pave the way to a new future, allowing doctors to target a long list of diseases and conditions that currently have no cures.
Of course, there are still many questions to answer and technical challenges to be addressed along the way, and both industry and university research teams are actively working in several of these areas with studies that should increase usage and indications of Electroceutical solutions. The health opportunity is immense and we believe it is wise to keep an ear to the stethoscope in this area.
AND IN CONCLUSION…….
What is the overall prognosis, Doctor?
COVID has taught us many things but probably the most important is that we (patients, healthcare structures, politicians, healthcare stakeholders) can innovate. For instance, no one could have predicted the sheer volume and usage of new apps that the pandemic would give rise to; apps like track and trace, e-consults and the covid pass, being used by millions of people every single day. It made the unpredictable happen.
Continuing in the same vein, some of the trends we have written about may gain traction, some may not – certainly not all of them will be ready to roll out in 2022. In our article, we are talking about trends, predictions, potential – the digital zeitgeist of 2022 – ideas and innovations that will fire imaginations, drive creativity, and ultimately result in new treatments and processes that will benefit us all – whoever we are, and wherever we may be.