Digital technologies are constantly evolving and finding new applications in healthcare, even while the industry is struggling with adoption and ‘digital transformation’. Each year new applications emerge, but the underlying technologies driving them remain the same. For 2019, we asked companies around the world one basic question: “Please indicate the key technology which you believe will have the most profound impact on the healthcare industry during 2019?” The results are not very surprising:
Figure 1: Key Technology to Impact Healthcare in 2019 (Survey Results).
Of course, these respondents are distributed across widely different sectors – pharmaceuticals and biotechnology, medical devices, medical imaging equipment, in-vitro diagnostics, remote patient monitoring, healthcare IT and digital health solution providers – but excluding care delivery settings such as hospitals and other facilities. This means that these technologies are being viewed through a different lens, depending on which sector the respondent belongs to. This also means that the applications of these technologies would be different in each sector.
To build further on this data, we analyzed some of the key challenges faced by each sector, and ranked them to understand the most important ones for 2019. We then mapped the technologies identified in the survey to the challenges prioritized for this year, in order to understand what applications would emerge at the top for every sector. Here we present some of the most interesting insights that emerged from this analysis. Each application below represents a single sector as one of the top five applications of technology in the arena. Between them, they cover several of the key technologies identified above.
1) Artificial Intelligence Will Help Radiologists to Create Their Future – Not Replace them!
The Radiologist’s Workload
Today, imaging diagnosticians such as radiologists and other imaging subspecialists often spend long hours carrying out intensive manual tasks as part of the process of image analysis. Heavy workloads also mean that radiologists barely get enough time to read images, leading to errors and misdiagnoses. For radiologists, ten to twelve-hour working shifts are common, with some even working 60 hours a week. The increasing number of patients being referred to radiology, and ongoing developments in imaging technology, will only make the amount of data to analyze larger and the data analysis more intensive.
The Artificial Intelligence Solution
Acceleration and automation (or semi-automation) using AI algorithms for image analysis tasks can act as key time-saving and productivity-gaining contributors. AI that seeks to streamline image analysis processes by reducing the number of clicks to perform a task and guessing the next steps based on context, that learns user preferences and so on will help accelerate the process of image analysis. Another category aims at automating image analysis tasks that are otherwise carried out manually, where AI has been shown to perform equally or better than current human-based standards.
The Startup Tsunami
Over a hundred startups are active in the space of artificial intelligence for radiology, apart from the incumbents who are developing solutions across different conditions. Some representative examples include iCAD (breast cancer), HeartFlow (cardiology), Vida Diagnostics (lung imaging), icometrix (neurology), Tencent (oncology), Google and Amazon (ophthalmology), Enlitic (orthopedics) and Vuno (pediatrics). This breadth of solutions was well-represented at the Radiological Society of North America (RSNA) 2018 conference in November last year, where a dedicated machine learning showcase area allowed several companies to exhibit their solutions, while some leveraged the opportunity to present at the Machine Learning Theatre to showcase their solutions to packed audiences through the four-day event.
Assuming a $400,000 average annual salary for a radiologist in the United States, every minute of their working time is worth $3.33, and therefore any time savings result in cost savings. Any automation that alleviates redundant tasks also helps reduce radiologist fatigue (estimated to result in a 4% drop in diagnostic accuracy). Ultimately, this would help improve diagnostic accuracy and avoid missing opportunities for the earlier detection of disease conditions, therefore resulting in improved patient outcomes in the long run.
Where We Are Headed and Impact
Frost & Sullivan believes that overall, AI in the medical imaging space will be a $1+ billion market by 2022 – the potential is enormous. It also provides an avenue to enable precision imaging approaches, allowing medical imaging to play a larger role in the wider precision medicine paradigm.
2) Augmented Reality Revolutionizing the Efficiency and Cost Optimization of Surgeries
The Surgeon’s Challenge
The past decade’s advances in diagnostic imaging, real-time data streaming and data processing technologies have revolutionized how doctors utilize images and scans to plan for surgical procedures, but have done little to save their valuable time and effort while performing the surgery itself. Surgeons and their teams have to continuously winnow through a clutter of images, vital signs data, and other patient indicators on a number of displays and 2D flat screens scattered across the operating room (OR). This often forces them to look away from the patient and even from their own hands while operating. If we add to this the pin-point accuracy required for aspects like depth of incision, the placement of a screw or implant as well as perfectly locating a deep-seated organ within the patient’s body, the focus suddenly shifts from surgical efficiency to error prevention.
The Augmented Reality Promise
Augmented Reality (AR) based headsets and solutions, which leverage 2D images and other patient data, create and superimpose a 3D model of patient anatomy on the patient’s body, are currently one of the most feasible answers to this issue. AR is a technology capable of revolutionizing the efficiency and cost optimization aspects of surgery, while improving the error rates owing to the high degree of precision offered in terms of surgical navigation and locating targets within the patient’s body. Along with this come the parallel benefits of enhanced surgeon comfort, reduced effort, a less cluttered OR and potentially lower costs due to AR’s capability to replace OR display systems.
The AR Innovators
2018 already saw a few companies such as Leica Systems and Novarad getting FDA clearance for their AR based surgical planning and navigation solutions. The field is expected to further evolve this year and beyond, with several other companies such as Augmedics, Truevision, Scopis Medical, Insight Medical Systems and Onkos Surgical lining up their respective solutions. These leverage a combination of AR/VR, AI, 3D modelling and other relevant technologies to improve efficiencies and reduce surgical error rates in key areas such as hip, knee and shoulder arthroplasty, spine surgery and osteotomies.
Where We Are Headed and Impact
We believe this technology will be fully commercialized in 2019 and will become a very useful futuristic tool for surgical planning, integration and collaboration that could improve patient safety, enable modular OR designs and ensure value-based care delivery.
3) The Data-driven Advantage for Health Insurance
Quantified Self and Consumerism
One of the most transformative shifts emerging in healthcare is the rise of the ‘quantified self’, which probably needs no new explanation. The digitization of products, services, and payment models is democratizing current healthcare systems and also represents a new era of healthcare consumerism. This entails an evolving ecosystem of connected health technologies such as wearables, telehealth, artificial intelligence, virtual reality, and others that support targeted, personalized health and well-being services.
Technology Adoption Laggards and Need for Change
The adoption of digital solutions by the health insurance sector has been limited over the past decade. There can be no denial that the health insurance policies available today are dated and often fail to meet the personalized needs of individuals. As a result, global health insurance market growth rates have been declining, from 9% in 2014-2015 to 6-7% in subsequent years. The industry needs consumer-centric insurance programs that incentivize individuals for adhering to healthy habits and lifestyles.
A Changing Paradigm: The Health Insurance Pioneers for Tech Adoption
Globally, progressive private insurance companies have already started to leverage the convergence of digital health solutions, such as wearables and health apps, to rejuvenate the health insurance market. Technology adoption is driving them towards data-driven, incentive-based health policies that promise to provide a personalized experience for policy holders, while reducing costs from potential claims. During 2018 alone, some of the leading private health insurance companies globally have launched new programs or expanded existing ones in order to remain at the forefront of this digital transformation journey. Examples from across the world include Prudential in Asia (with Babylon Health), Discovery Group in Africa (the Vitality program), Manulife (with Vitality) and Sun Life (BestLifeRewarded) in Canada, and UnitedHealth Group (Motion Program with Qualcomm Life and Apple Smartwatch) and Cigna (Healthy Babies program) in the United States.
Where We Are Headed and Impact
Frost & Sullivan’s research suggests that lifestyle and health data-driven interactive health insurance plans will continue to gain popularity globally, as they enable insurance companies to personalize premiums by stratifying health risk and reward programs. This would open up business opportunities for wearables, OEMs, mobile apps, and health data aggregators to collaborate with progressive private insurance participants and employer health programs in order to promote consumer-centric insurance programs that incentivize individuals for adhering to healthy habits and lifestyles. Furthermore, policy changes toward reimbursement for digital health and wellness technologies are set to provide more flexibility for emerging digitally-led insurance models, especially in healthcare markets with a high spending level on lifestyle-driven chronic health conditions and relatively mature digital health initiatives (such as the United States, Western Europe, Japan, Australia, and South Korea).
4) Is Blockchain the Game Changer for EHR Interoperability?
The Inaccessible Medical History
Remember the time you visited a different in-network doctor to your regular doctor, and they didn’t know your entire history, despite your being with the same health system for decades? This is a major challenge for doctors, resulting in regulatory non-compliance, poor referral management to specialists, longer in-patient stays when hospitalized, and preventable hospital readmissions – all because the care team did not have access to your entire medical history (items such as allergies to specific medications, for instance). Add to this the fact that patients would also like to have access to their treatment recommendations, in case they forget all of the instructions (which almost always happens). Almost 50% of all patients fail to understand treatment plans and do not adhere to care management guidelines, which are complex to interpret and not easily accessible. Contrast this with the fact that almost 70% of next-generation healthcare consumers prefer to have access on-the-go to the latest clinical information. This has required payers, providers and pharma to team up and offer personalized medical insight via omni-channel media platforms including EHRs and patient portals. Yet this has not been enough to work across all health systems for the entire patient population in a given region.
The Solution: Improving Access to Medical Records
The Centers for Medicare and Medicaid Services (CMS) have decided to replace the existing EHR incentive program with the ‘Promoting Interoperability’ program. This incentivizes meaningful effort from hospitals to enable clinical and financial data interoperability for their patient population. CMS also has launched specific provisions to sponsor Chronic Condition Management (Non Face to Face). This mandates seamless data accessibility between native and third-party health IT workflows, powered by advanced technologies such as AI and blockchain. This essentially means that active incentives and policies are pushing hospitals to develop solutions that allow for patient records to be accessible across different hospitals, and not just within a single hospital or health system.
InterSystems, a healthcare information systems vendor, recently enabled Northwell Health to integrate its entire provider network comprising 23 hospitals, 655 outpatient facilities, and 18,500 affiliated physicians. Following this integration, Northwell was able to create a unified patient registry, offering a billion data points, and can practice centralized risk assessment, patient engagement and remote patient monitoring.
Where We Are Headed and Impact
Overall, in the US and other mature markets around the world, progressive providers are expected to launch central digital command centers, enabled with major healthcare interoperability standards, including the most advanced IHE and HL7 FHIR standards, and supported by a blockchain integrated, enterprise-wide master patient index. The overarching objective would be to create unified patient registries that prompt personalized and rule-base care coordination across multi-modal clinical systems. This will then allow for patients to visit any facility or affiliated physician in the health system and have their unified medical record accessible at the point-of-care, thereby enabling physicians to access entire medical histories and provide personalized clinical guidance, without having ever seen the patient before.
5) Virtual Clinical Trials: How are Wearables and mHealth Aiding Patient-centricity?
Pharma’s Clinical Trial Challenges
The pharmaceutical industry faces significant challenges and cost burdens around clinical trial patient recruitment, retention and adherence, the increasing complexities and cost of on-site monitoring, and increasing payer and regulatory pressure for proof of value. About 80% of pharmaceutical trials do not meet enrolment deadlines, resulting an average loss up to $1.3 million per day for a given drug candidate. Additionally, about 37% of research sites fail to meet their enrolment targets, and 10% fail to even recruit a single patient for the study. Based on industry estimates, the lack of patient-centric trial designs leads to 35% of patients dropping out of clinical trials. Another 35% do not adhere to study protocols, costing about $1 million per trial in lost productivity alone.
The Solution: Wearable Devices and mHealth Apps
A solution has emerged involving wearable devices and mHealth smartphone apps. If you or a loved one has been a participant of a client trial, you will be well aware of the challenges, including the frequent need to visit a hospital or a clinic, sometimes foregoing work or other leisure activities. But wearables and apps are beginning to change this, allowing for the concept of virtual clinical trials to emerge. These enable you to participate in clinical trials from your home or any other location you like. The advantage works both ways, as it allows the sponsors of the clinical trials to reduce costs while simultaneously helping streamline processes and demonstrating real-world efficacy. This is also because such apps and devices enable investigators to incorporate everyday data like diet and weather along with other health parameters as input for big data analytics programs, to derive a true, real-world picture of efficacy, something that companies like Evidation Health are assisting larger players with. Companies like Science 37, on the other hand, are working on engaging with and monitoring the patient throughout the virtual clinical trial.
Where We Are Headed and Impact
In 2019, the Clinical Trials IT solutions market-enabling patient recruitment and the remote monitoring required for virtual trials-is expected to reach $450 million, driven by such solutions. For example, the VERKKO phase IV diabetes clinical trial used a remote clinical trial platform integrated with a 3G-enabled wireless blood glucose meter, spent 66% less time in study coordination activities and achieved 18% higher compliance rates. Our analysis therefore points to cost savings, with these being the highest in central nervous system (CNS)-focused areas such as pain and anesthesia trials, with the potential to save up to $10 million per study.
Clinical trial sponsors will play a central role in validating new digital endpoints with their ongoing research work and will act as a central point for facilitating collaboration between wearable device OEMs, data aggregators, and mHealth platform providers. They, thus emerge as the largest force behind the scalability of mHealth solutions. With the advent of remote monitoring technologies, those vendors such as site management organizations (SMOs) and patient recruitment organization (PROs) which use traditional business models will witness maximum disruption and will need to explore collaboration opportunities with emerging virtual trial platform vendors, eRecruitment providers, and remote monitoring solution providers to expand their capability to support distributed/hybrid CT models.
This article was written with contributions from thought leaders Unmesh Lal (Pharmaceuticals & Diagnostics), Kamaljit Behera (Blockchain and other Innovative Technologies), Koustav Chatterjee (Digital Health and Health IT), Anuj Agarwal (Advanced Medical Devices and Technologies) and Siddharth Shah (AI and other Innovative Technologies). Please email email@example.com to get in touch with our team of analysts.
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