While it’s been said that the 2020 Corona pandemic has propelled us 5 years forward in the adoption of digital in 8 weeks, or “decade in a few weeks”, real transformation will not come from the mere introduction of new (digital) technologies. It will come from human insight and creativity in the form of engagement design, change management, empathy,… transforming the current model where one makes money from (chemical & biological) drugs aiming to treat disease, into a stronger model where one will make more money by anticipating disease and keeping a larger population healthy. It will come when re-active sickcare switches to pro-active healthcare & personalised wellness. When preventive care becomes a real business model and the urge to tackle one Coronavirus is adopted to tackle the real reason why people die: the raise of chronic diseases linked to human behaviour.
Healthcare organizations, technologists, and government agencies proved for the first time that speed, innovation, and safety were indeed possible in healthcare. It should be seen whether they last, also when the forces of corporate silo’s, red tape and academic rivalries will try to reassert themselves once the crisis is over.
A good example was the grand-scale behind-the-scenes effort by the pharmaceutical companies is under way to expedite the creation of therapies and vaccines to treat COVID-19. Or the COVID-19 Host Genetics Initiative, which called on researchers working at biobanks around the world, repositories of DNA collected from millions of people, to radically join forces. Over 700 researchers at 140-plus biobanks tore down barriers of institutional and academic independence and bureaucracy to share data, resources, and insights, in order to study the genetics behind why some people react with severe cases of COVID-19, while most do not. It now could turn its focus on ‘collecting’ vaccine responses to different virus variants; more ambitious, it could start to collect also real world patient data, collected from wearables or ambient computing, environmental data and social determinants of health, to allow for complete personal health profiles (see further).
This way, I believe the most sophisticated information, from treatment protocols to CT scans or genomic information, is going to be as easily accessible as your bank balance. As an entrepreneur, realize what this means. Imagine if you were the first to think about the implications of online banking? That is where we are today. And that is what a number of banks are contemplating as well – getting involved in preventive care. So here is an idea. What if emerging fintech App Cake, would reward not just the use of financial data?
So here is my 7 cents.
1. Very fast, high-performance, low-cost COVID diagnostic tests will be available over the counter, at the pharmacy, the post office, your retailer, … because people will want to test all the time. As we emerge from social distancing, we might not know long term efficacy of vaccines, or, more importantly, whether they present from spreading the virus. Think Lucira Health.
The first CRISPR based Covid19 diagnostics where your smartphone provides the readout, promise to be able to identify the exact virus strain you’re infected with.
2. I believe a smartphone app that provides globally accepted certification of SARS Cov-2 vaccination status would become available, either from the likes of Google & Apple (ApplePay) – similar to their joint work on contact tracing software – or Ant Financial (AliPay) or from a novel startup. A tool as recently announced by Healthvana comes close already. Obviously, one needs to support those who don’t use smartphones when society starts to creak back to life. But even aside from those issues, the platform could provide a much-needed tool to help keep the vaccination process itself organized.
3. Following the COVID-catalyzed shift toward rudimentary virtual healthcare services, aka Telemonitoring, we will start to see the ability to use text messaging for all sorts of healthcare transactions, services, and communications. You will be able to use WhatsApp alike services, chatbots, to order a COVID test, make an appointment, ask a question to any of your doctors, get mental health care support, and to talk to the people taking care of your aging parents. Healthcare providers will also use texting to check in on patients more often and to track or collect clinical data points, which will help them respond more quickly when help is needed. It will lead the way to remote care where on-body sensors are bringing medical grade monitoring and management to the home for scalable remote care.
4. Hospitals and other healthcare organisations will invest in a digital front door, a new kind of portal, which includes the organization’s website and mobile apps that host the online patient portal, scheduling, telehealth visits and educational resources. While adoption levels and satisfaction levels with telehealth have been promising, healthcare leaders charged with improving digital engagement, the challenge will be not just to overcome technical challenges such as interoperability but also to make these experiences friction-less while accounting for the needs of all different segments in the patient population. A typical patient journey (Figure from a Microsoft Dynamics folder) may have over a hundred digital engagement touchpoints, while a typical digital front door program today addresses a third or less of these opportunities. That opens plenty of changes to create patient delight.
I expect more collaborations alike the recent deal between Cerner Corporation, one of the leading EHR providers, and Xealth to offer health systems new centralized digital ordering and monitoring for clients. These capabilities are designed to help health systems choose, manage and deploy digital tools and applications while offering clinicians access to remote monitoring and more direct engagement with patients. With the new capabilities, health systems can prescribe digital therapeutics (see point 6.), smart phone and internet applications to address areas such as chronic disease management (behavioural health), maternity care and surgery prep but also badly needed mental health. This access to a more holistic view of the organization’s digital health solutions supports the clinical decisions doctors make every day and provides real opportunities to improve medical outcomes and enhance efficiency. It promises 24/7 care, a digital twin doctor, always present thus able to predict disease before striking.
5. COVID-19 has led to the rise of AI in conversational interfaces such as chatbots that have emerged as an essential tool in building online self-help capabilities for patients. The growth and approval of AI in clinical applications has been mainly limited to imaging / radiology applications, partly due to more rigorous evidence requirements. An additional challenge has been the highly fragmented data sources and the lack of standardization and interoperability. Several tech firms are rising to the challenge. Amazon recently launched its HIPAA-enabled data management service, HealthLake, to aggregate information into a centralized, searchable repository and normalize it using machine learning and FHIR. Google has launched an API for NLP as part of its cloud healthcare API effort that could unlock insights from unstructured data estimated to comprise 80% of patient medical information in EHR systems. The reliance on technologies that collect our data only increased during the pandemic, as we did more and more things online, like grocery shopping and doctor visits, that we used to do offline. As the pandemic recedes, and to deal with the power imbalances of this model, we’ll likely see new data governance models become more popular in 2021 and beyond – like data trusts combining for instance combining genetics and insurance data – which operate as trusted intermediaries between consumers and big tech platforms.
6. Digital therapeutics galore.
Following first 10 approvals for App reimbursement in Germany, and a waiting list of 17 more, 2021 will see a flood of first generation digital therapeutics entering the market. This is part of a growing trend of using online devices instead of drugs to treat and diagnose maladies, with poster child companies like Akili, which was granted approval by the FDA for EndeavorRx, its neuro-gaming platform to treat attention deficit hyperactivity disorder (ADHD) in children; and Pear Therapeutics, which uses apps to help treat substance abuse, insomnia, and other diseases. Our database currently contains over 50 emerging digital therapeutic plays, with certainly more to arise this year. I look forward to help steer this novel domain as member of the Digital Therapeutics Alliance. In a next level Digital Therapeutics will pave the way to real human Digital twins, the ultimate digital health providers. Together with my co-chair from Dell, I look forward to lead the Healthcare & Life sciences vertical from the Digital Twin Consortium to draft a framework therefore and to spearhead a number of inspiring use cases. Stay tuned for that.
7. Lastly one bet. A fitness play like Peloton or SoulCycle, companies which sell wellness, will acquire Garmin or another consumer wearable. Or maybe they acquire a number of medical grade devices (like AliveCor) to become a leading health company, as large as the company which was born last year from the merger between Teladoc and Livongo.
Finally, I suspect that when the public believes that they were saved from COVID-19 by science, roaring out of the pandemic is poised for a surge in funding, innovation, and initiatives in all the fields mentioned above. My biggest hope is that the concept of prevention will stand to be used now to tackle chronic diseases, with every company posed to become a healthcare company. Where soap, the biggest invention ever as it helped us deal with infectious disease and increased our lifespan with roughly 100% in less than 200 years, will get digitised to now tackle behaviour change (including dealing with genetic predisposition) aka chronic disease.