Category: Patient

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.

#5   ELECTROCEUTICALS

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.

In a previous article, we discussed the benefits of digitalisation in healthcare. In this article, we explore some of the digitisation of healthcare risks and concerns – both for healthcare professionals and for the patients themselves.

As in all revolutions, there is much positive potential, but there are also considerable risks. Knowledge is a powerful tool – the starting point to leverage the pros whilst minimising the cons. There are three major Digitisation of Healthcare risks:

• Cybersecurity (hacking)
• Electromagnetic interference
• Issues concerning data protection and security.

Let us first consider hacking. The depiction of the potential consequences of hacking a medical device, in this case, a pacemaker, came to many via the television series ‘Homeland’. In the award-winning series, an assassin hacked into the fictional US Vice President’s pacemaker to kill him. The subsequent revelation from the (actual) former US vice-president Dick Cheney, that when he had a device implanted to regulate his heartbeat in 2007, he had his doctors disable its wireless capabilities to prevent a possible assassination attempt, made headline news. “I was aware of the danger, if you will, that existed,“ he said in a report on ABC News. “I found [the depiction] credible because I knew from the experience that we had assessing the need for my own device that it was an accurate portrayal of what was possible.”

The potential for medical device hacking isn’t just a hypothetical scare story. With the progressive movement to digital health, medical devices are increasingly interconnected with hospital systems, hospital networks, the internet, smartphones…… so, the cyber security risk is a real one. Security researchers from all over the world have illustrated the relative ease with which devices can be hacked by someone with the know-how – from MRIs to anaesthesia machines, nuclear medical devices, pacemakers, and insulin pumps – all have vulnerabilities to attack. In short, anything that connects wirelessly to other equipment can be compromised, anything connected to the Internet is hackable.

According to Alpine Security, there are now 10 to 15 devices per hospital bed in the United States, many of which are vulnerable to attack. Whilst the connectivity of medical devices certainly increases the amount of data available to physicians and can lead to better outcomes for patients, unless stringent security measures are taken, hackers can compromise anything that connects wirelessly.

The main driving force behind cybercriminal activity is the theft of medical or personal data for financial or political gain. The cybercrime economy is one of theft, with cybercriminals acting as the internet’s burglars. This remains true in a medical context. Private medical data is among the most sensitive and valuable data that can be made public, and its use by cybercriminals for extortion purposes could be immense.

The biggest threat to medical security involves the shutting down of entire hospital networks. Instead of focusing on individual patients and their embedded devices or personalised healthcare apps, ransomware hackers are more likely to attack entire hospital systems. Any organization that is subjected to a ransomware attack will be subjected to similar outcomes: widespread panic, confusion, and significant impairment of operational capacity, not to mention the potential for loss of life. One such high-profile incident was the WannaCry ransomware attack on the UK’s National Health Service. This cyber-attack cost the NHS £92m after 19,000 appointments were cancelled.

IT’S NOT ALL BAD NEWS

Most manufacturers and healthcare providers are acutely aware of the risks posed by hackers and take rigorous steps to proactively identify, mitigate, and address security-related issues. Patient safety, the integrity of patient data and the secure functionality of medical devices are paramount considerations.

Cyber protection is big business too. Ethical hackers, also known as ‘white hat hackers’, are cybersecurity specialists who test systems’ security to expose vulnerabilities and find flaws so that the system’s owner can repair them. Hacker, programmer and computer security expert, the late Barnaby Jack, first demonstrated the wireless hacking of insulin pumps at the McAfee FOCUS 11 conference in October 2011 in Las Vegas. He was also instrumental in demonstrating the risk hacking posed to pacemakers and heart implants. In 2012 Jack’s testimony led the FDA to change regulations regarding wireless medical devices.

KNOWLEDGE IS KEY

Knowledge is the starting point for people being able to make considered, informed choices about their healthcare. Patients certainly need to be aware of potential risks. At the same time, they need to be reassured that healthcare professionals, worldwide, take these issues extremely seriously and are constantly working towards patient safety. The risk to individual patients certainly does not outweigh the benefit of treatment.

Patients should be encouraged to speak to their physicians, to ask questions like, ‘Is the software to my pacemaker up to date?’. Or ‘What measures have been taken to protect my insulin pump?’. Asking their doctors appropriate questions can help them cope and manage risks in advance.

There are other resources open to patients too such as patient advocacy forums, Medwatch (the FDA Safety Information and Adverse Event Reporting Programme) and the FDA Maude (Manufacturer and User Facility Device Experience) system.

Yes, there may be a risk from any cyber security perspective, and there is a possibility that an attacker could compromise a device, but the probability is relatively low and what needs to be considered is that the risk of not having a device far outweighs the risk of a potential cyber security attack.

ELECTROMAGNETIC INTERFERENCE (EMI)

Electromagnetic interference – or disturbance from radio frequency transmitters like RFID (radio-frequency identification) – is a relatively new area. EMI can affect several types of medical devices that have electrical or electronic systems such as pacemakers or defibrillators – implanted or external, implanted neurostimulators, programmable hydrocephalus shunts, cochlear implants, ECG monitors and infusion pumps.

There are many sources of EMI in hospitals and healthcare environments but the ones most likely to cause problems with certain medical devices include emergency vehicle/services radios, diathermy (electro-surgery), mobile phones, radiofrequency identification (RFID) devices and electromagnets.

EMI can also be caused by everyday objects like cell phones, Wi-Fi devices, microwaves, telecom networks, power grids, defence installations, even lightning strikes, solar flares, and magnetic storms. So, if, for example, a patient with an implanted device goes to their clinician to report things aren’t working out quite as expected, the clinician will need to work with the patient to narrow down where they have been, what environment they were in, and then try to work out if the device was affected by some sort of EMI.

Manufacturers of medical devices are required to minimise the risk that their device can cause, or be affected by, EMI. Where the risk is not eliminated, the manufacturer must include information about the residual risk in the instructions for use.

DATA PROTECTION & SECURITY: WHERE TRUST AND INTEGRITY ARE ESSENTIAL

Whilst the general population may not be aware of many of the practical challenges in managing the risks of digital healthcare, one area they are almost certainly aware of is data collection and storage. Trust and transparency are essential in creating a positive relationship between the ‘big three’ stakeholders in healthcare: patients, institutions, and manufacturers. Patients need to be able to ask questions and to believe that things are being done in an ethical, state-of-the-art manner.

Effective regulation plays a big part in maintaining public trust. So, in turn, institutions have the responsibility of setting regulations and standards to ensure that medical devices are safe and fit for purpose. We need clear rules and standards. However, whilst testing requirements must rightly be rigorous, they should also be proportionate and based upon scientific evidence. With the pace of new discoveries being made, and with so much innovation in digital medicine, it is not always an easy task keeping up with the rapid rate of progress. To be truly effective the regulators need to hire experts – data engineers, informaticians, genomics experts – just to keep up with science that progresses so quickly.

Imposing testing protocols that have not been adequately researched, or are fear or perception based (albeit with good intention), can hold up a product’s launch for years. This not only pushes up costs (potentially making a product either not commercially viable or else accessible only to a fortunate few), but by delaying market availability, patients are deprived of timely access to therapeutic benefits that could help them manage their conditions more comfortably and effectively.

Finally, manufacturers must play their part by diligently doing what is required of them and by increasing communication and transparency to patients. A positive circle of interaction between patients, institutions and manufacturers will continue to produce improved benefits for all: timely, cost-effective, and safe technology being more widely available to all patients.

CommuniD’s mission is to help patients remain up to date with current medical device solutions in an environment that is constantly evolving. The content of this article is for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the CommuniD website or articles.

If you want to learn more about Digitalisation in Healthcare, please

• Look around our website
• Contact us @ elvio.gramignano@communid.co.uk
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The digitisation of healthcare is moving inexorably, and excitingly, forwards. FDA’s definition of this trend is ‘digital health technologies use computing platforms, connectivity, software, and sensors for health care and related uses.

These technologies span a wide range of uses, from applications in general wellness to applications as a medical device.’ For the individual, digital health technologies can help us to better manage our own health and receive treatments that were impossible only a few years ago. It can also help professionals to collaborate with us to manage our condition with greater efficiency and less burden on both sides.

Since Covid 19 people have become more familiar users of certain aspects of the healthcare digitisation revolution: filling in online consultation forms to request a GP’s appointment, having telephone consultations, and using an online portal to request repeat prescriptions which they then collect directly from a specified pharmacy. Many already use digital technology to monitor things like sleep patterns, diet and weight or use internet-connected exercise equipment. In addition, some of us will have more intimate personal experience of healthcare medical devices and digitisation: pacemakers, insulin pumps, DBS implants or ingestibles.

Here’s an overview of how healthcare can benefit from digitisation:

Better Mapping

Technologies are getting smarter by the day with the dual meaning of being more connected but also more intelligent. From monitoring heart rate to counting steps, the small handheld gadgets of today can log pretty much everything about the body via smartwatches or smartphones but also via a wide range of wearable devices.
The connection of these devices to your smartphone, and your smartphone to the Internet, will allow all vital data about your health to be transmitted to the cloud and read and processed by doctors in real-time. Digitisation will enable easier monitoring and identifying of potentially alarming situations, proactively.

Better Coordination

Digitisation should make it easier for patients and healthcare professionals to remain on the same page. Luckily, the days when patients had to maintain a thick medical records file which they needed to bring with them to every medical appointment are gone. Digitisation has levelled this platform to keep both patients and their doctors well informed of every situation – every day, wherever they are.

Patients (as well as doctors) can create and maintain digital records of medical history, preferably uploaded to clouds or expert systems, where the patient decides who to grant access to. As with all traditional forms of record-keeping, it involves a little extra effort, but it pays off in the long run, offering a chronological history of medical visits, tests, and medications. This is particularly useful when a doctor not familiar with your medical history or patient profile is allocated your case, often in times of medical emergencies.

Both through traditional channels and through technology, doctors can now stay connected with their patients, offering medical support round the clock. This is particularly effective when the diagnosis of a medical condition depends on the way the patient’s body reacts to the suggested medications.

Higher Awareness

Google receives more than 1 billion health questions every day and Parade’s Cleveland Clinic reports that in the US 55% of women aged 25-49 admitted to taking health advice from social media.

This trend seems to be unstoppable and shows how much people care about their own healthcare situation, as well as how important it is to patients to have informed opinions about the prescriptions they receive, the treatments proposed and the solutions available. This new trend belongs to the concept of patient empowerment and it is proven that an empowered and informed patient will be more responsive to treatment; even the WHO defines empowerment as “a process through which people gain greater control over decisions and actions affecting their health” (WHO 1998). This shift is due in large part to the use of technology that facilitates increased patient access to information via the Internet, peer-to-peer sharing, consumer health devices, and mobile apps. The problem arises when a considerable proportion of the population would prefer to log on and consult the web for their symptoms rather than make a GP’s appointment, with all the inherent dangers of completely misdiagnosing a potentially dangerous condition.

Digitisation should enable medical practitioners and experts to reach out to this segment with authentic information. Communicating balanced, factual medical information through social media channels and enabling doctors to connect with their current and potential patients goes a long way towards re-establishing the appropriate level of communication, along with the added bonus of ultimately bringing healthcare costs down.

Patient Inclusion & Patient Compliance

We said it in the point above: there was a time when healthcare was a one-way conversation; the doctors would prescribe, and the patients would obediently follow their recommendations without question. We know for a fact that patient compliance, or the patient’s willingness to comply with the given protocol, influences recovery and well-being. Not only are they motivated to turn the tables in their favour but also are likely to go the extra mile for it, with immense potential in lowering the cost of healthcare.

The risk is when the new patient to doctor transition is turned into a retail-like business transaction. This places a greater emphasis on patient inclusion and patient compliance to ensure the overall patient experience is positive.

Use of shared data to improve treatment

Data can radically change healthcare. In fact, healthcare analytics have the potential to improve treatments while reducing costs, predict outbreaks of epidemics, avoid preventable diseases, and overall improve the quality of life. Health professionals will be able to collect massive amounts of data and with the extensive use of Artificial Intelligence search for correlations to transform the data into valuable and actionable insights.

Where do we go from here?

Digital healthcare seems to have progressed in leaps and bounds over the last 10 – 20 years. However, for some of the professionals involved, the last 10 – 20 years have not breached as many frontiers as they had hoped. Humans, and the human body, are incredibly complex, and designing a digitalised medical device adds further complication to the stand-alone device. In addition, we humans can take time to accept radical change and new innovations. And this plays also on the professional side; healthcare professionals at all levels also need to be trained to understand what new technologies are about. We cannot criticise them – there are new innovations and breakthroughs being made all the time, so they need to continually keep abreast of new developments and their applications.

However, we can expect to look forward to digital technology that allows people to interact with healthcare systems much more smoothly than is currently possible. Clinicians should be able to focus on care and not be worrying whether they can trust the technology or the AI algorithm.

There’ll be a shift to more home care, especially for long term conditions – we don’t want people in hospital if they can be managed at home – through the use of devices that monitor vital signs and treatment adherence, devices that can automatically collect health metrics like heart rate, blood pressure, temperature, and more, eliminating the need for patients to travel or for patients to collect it themselves.

The effects on the health service of improved analytics in areas like diagnosis, for example, would be really powerful. We should have a healthier population with improved outcomes as well as financial savings for our healthcare systems. And in drug development, we hope that many drugs will have been discovered through using AI and digital technologies. We also hope that clinical trials will move from being, say, 50% successful to maybe 80%. Doing that will have an enormous impact on patients’ lives, especially those with chronic diseases for which, currently, there is no real effective therapy. Healthcare professionals are committed to working towards people being able to enjoy at least five extra years of healthy, independent living – with an emphasis on enjoyment.

It’s an exciting time…… But at the heart of it we need to be sure that this digitisation of healthcare is equitable, and that no one is left behind. Vulnerable populations, people who may not have access to the internet, or whose educational attainment may not be as high as others, must also be able to access these services. How do we take everyone with us? One way is by education; to harness the power of knowledge and understanding and turn it into a tool that will allow inclusion.

CommuniD’s mission is to help patients to remain up to date with current medical device solutions in an environment that is constantly evolving. The content of this article is for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the CommuniD website or articles.

If you want to learn more about Digitalisation in Healthcare, please contact us today.

WILL MEDICAL DEVICES TRANSFORM THE THERAPEUTIC PROCESS TO MAKE IT PATIENT-CENTRIC?

For some years now, financial institutions, the press, regulatory process and large web corporations dealing with healthcare have increasingly focussed attention on medical devices. Whilst the general public may not yet fully understand, or possibly even be aware of the topic, many analysts are convinced that the growth in the relevance of medical devices, coupled with the management and subsequent processing through artificial intelligence algorithms of their data, will, when compared to ‘normal’ pharmacological treatment, enable a Copernican revolution in healthcare. Not only will this transition finally put the patient firmly at the centre of the process but potentially could also provide new solutions to manage the exponential growth of healthcare spending in developed countries’ budgets, generating significant savings.

Let’s see how, starting with a very interesting article published in May 2019 by McKinsey and written by Shubham Singhal and Stephanie Carlton, in which the two researchers tell us about nine new technologies that could have disruptive effects on the therapeutic path.

• Connected and cognitive devices: all those portable and wearable tools that provide us with data that when connected within an ecosystem can return information. We are talking about standard devices that measure heart rate, a number of steps, speed, sleep quality and other information, but we are also talking about new systems to monitor more medical parameters such as glucose level and blood pressure. Many of these devices are already available, others in the testing phase, others are in advanced design. Some of these devices will be worn (like normal watches), others will be implanted, still others “ingested” to give us information on the digestive system, for example.
• Electroceuticals: this will be a huge revolution. It has been discovered that the emission of electromagnetic waves inserted inside the brain can modify the electrical impulses emitted by the nervous system with the consequence of modifying the transmission codes between synapses to cure a large number of neurological diseases – diseases on which the classical pharmaceutical is today only marginally effective.
• Targeted and personalized medicine: the old dream of personalisation of treatment is back and today is truly becoming reality. Soon we will use patient-specific active ingredients with personalized dosages; treatments will be made with patient’s own cells or genetic material directed to specific cells. All these techniques are already under clinical trials and appear to work much more effectively than any form of traditional drug.
• Robotics: the next generation of robots will facilitate increasingly precise operations, making most surgeries more effective and less invasive as well as reducing the physical burden of surgery. In another field, a new class of robot could replace healthcare personnel for repetitive problems of low value or dangerous and dirty actions (3D: Dangerous, Dirty, Dull) and will therefore be ideal in the healthcare environment as it will leave operators free to carry out real added value activities. During the Covid-19 emergency in China we have already seen robots replacing healthcare workers in the disinfection of machinery, supply of drugs and delivery of food to infected patients in order to avoid contagion among nurses.
• 3D printing: this technology, already in use in various health sectors (with higher cost compared to traditional techniques), will facilitate the creation of a completely customized prosthetic, replacement of organs and the possibility of delivering customized precision dosing for a new way of delivering therapies.
• Big Data Management: dream or reality? Today it is still difficult to predict where this trend can lead us. One thing is certain: through connected devices and the enormous amount of information derived from modern diagnostics, we have more precise and personalised data that can be correlated through computers which are powered by higher than ever computing capabilities. It is estimated that once this trend becomes a daily reality, the amount of data that will enter the health system will increase by 48% per year.
• Artificial intelligence: the next step to Big Data. Bundling raw data provides us with information, but if we then process them with artificial intelligence algorithms, we can find new relationships between data and identify wider implications. We will be able to evaluate the outcome of our therapeutical pathway and therefore predict the patient’s final state at the beginning of the therapeutic path. The goal is to improve diagnostic solutions, anticipate therapeutic treatments according to scientific criteria and optimize clinical productivity. Many companies and institutions are starting to connect data to improve therapeutic protocols, pre and post-operative plans, rehabilitation, patient management. The goal is to transform data into “actionable insight” (deep knowledge that suggests action).
• Blockchain: this huge store of private data, considerations and forecasts will require the certainty of a level of confidentiality and privacy unthinkable today. It will therefore need to be managed by a system where information is completely decentralised and code breakers will never be able to access the patient’s information. The blockchain system used in the financial field becomes very useful for the ethical health revolution.

It is interesting to note that eight of these nine new technologies are medical devices or IT systems fed by data from medical devices. It is also important to consider that we are not talking about a futuristic vision but a reality that is already active today: in the last decade, the FDA has approved twice the amount of therapeutic processes it had approved in the previous decade and the majority of these are in some way linked to these technologies.
The reason many analysts believe this may be the new Copernican revolution is that the new devices will transform not only the way we treat patients but also the very concept of health management. It is estimated that in the next ten years, clinical care, an important focus for healthcare today, will affect only 15% of patient results; social factors, appropriate behaviour and genetics will affect the remaining 85%. And a large part of these elements can be measured, monitored, influenced, known, through medical devices.

The paradigm of health is shifting. My father lived his life going to the doctor when sick whereas my daughter will know in advance what her genetically weak areas are. She will have a personalised master plan to follow so that she can manage those vulnerable areas, regular and planned contact with medical staff (who may also include a personal trainer) to help her choose the most suitable regimen for her specific situation. Her data will be constantly monitored (not by Big Brother, but by herself) and she will be alerted of diagnostic investigations or pathologies at a very early stage. In a word, in the past we treated the disease, today we understand we must manage health. Tomorrow we will simply do it.

We are in the transition phase where we are beginning to understand the potential of these technologies, but we have not yet completely solved the problems related to their application. And, as always, a problem that seems technological is instead surprisingly human. This new paradigm cannot become reality without the active participation of the patient. Without data, correlations will not exist, and it will be impossible to build any predictive algorithms, provide advanced diagnostics or suggest empowering behaviours. Data will be the driving force behind this transformation that cannot happen if the patient does not understand the importance of collecting them, will not agree to transfer them, will not want to have them analysed, will not participate in the process to improve them.

The minimal experience we have makes us understand that there is still a lot to do. If the subject does not use the connected device and leaves it on the bedside table when they wake up, if they do not connect it, do not allow the use of personal data, do not participate by adapting behaviour to what is suggested by the “digital personal trainer”, if they are not actively interested and invested, the system does not work.

Co-participating in health management requires a strong commitment and active involvement by the subject and their family – an attitude that is not yet established because of lack of infrastructure, the complexity of making technology accessible to everyone, especially the elderly, but more importantly because of the mindset of patients.

The great scientific and technological healthcare revolutions of the previous century were largely elitist and confined the decision-making element solely to the physician. In contrast, this transformation must be “popular”, it must admit, encompass, and convince all the players but especially the patient.
Any of this transformation, even the more traditional (because fully managed by physicians) like robotics, 3D printing and electroceuticals will require a mindful and informed choice. Because in order to use these technologies a patient must decide to undergo a longer and more complex pre-operative path or choose to collaborate with clinical trials and sometimes accept a higher price to have a qualitatively better treatment.

The revolution will therefore have to be systematic. New processes will have to be invented, new metrics and a new nomenclature defined. The industry will have to start factoring in patients at the early design stages of new commercial projects and it will have to understand the problems and create a technology that can actually be used. I am convinced the very concept of the patient will disappear and will turn to “individual with a health project”.
Communication will be fundamental: ethical, objective, responsible, authoritative, all so that the subject can actually “see” the vision of this new project and the benefits available. A project that involves all of us; a project with great potential as well as risks to manage. In the last century, we conquered space – what if this was the century that we conquered health?

CommuniD’s mission is to help patients to remain up to date with current medical device solutions in an environment that is constantly evolving. The content of this article is for educational purposes only and should not be used a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the CommuniD website or articles.

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