COVID-19: The tipping point for rapid tech adoption
Every care provider and life sciences business says the same thing: the global pandemic emergency is acting as an unprecedented accelerant that is profoundly changing the way healthcare is delivered and R&D is conducted.
Above all, the experiences of 2020 have expanded our sense of the possibilities for technology to transform our health.
We are in a new technological era. “COVID has disrupted our industry,” says Bertrand Bodson, Chief Digital Officer at Novartis. “It has highlighted our strengths and areas we now need to dial up. Healthcare’s digital moment has arrived.”
Widespread telehealth adoption has been the standout feature of this warp-speed advance into a digital-first future. HCPs have deployed tools including video consulting, e-messaging, and remote monitoring at high speed. HCPs and patients alike have both discovered how much they like the convenience and safety of remote consultations and how much time and hassle this saves.
Let this statistic sink in: In November 2019, less than 5% of GP practices in England offered video consultations. By mid-2020 this was over 99%. It is a statistic that will be mirrored in much of the developed world.
Embracing the possibilities
Or take ophthalmology as an example. Dr Pete Thomas, director of Digital Innovation and consultant paediatric ophthalmologist at Moorfields Eye Hospital and his team challenged the accepted wisdom that ‘video consults don’t work in ophthalmology’.
They provided a digital waiting room for emergency eye care that successfully reduced footfall at their physical facility whilst improving access and response times. They have now delivered over 10,000 ophthalmology video consults and are expanding it to other ophthalmology services such as oculoplastics.
Everyone is now open to the potential for a broader and deeper embrace of technology. What were vague future possibilities are now near-term inevitabilities.
For example, the restrictions imposed on clinical trials by the pandemic have focused minds in the life sciences on the potential to use technology to streamline them. A 2020 survey of life sciences leaders by Reuters Events Pharma revealed that 71% expect to see a significant increase in the number of wearables or other remote capture devices for data collection used in trials in the next 18 months.
This use of such digital devices in trials is expected by almost two thirds (62%) of respondents to result in the discovery of reliable novel endpoints in the near future.
There is vast opportunity for digitally capable life sciences companies, says Bodson. “When it can take 12 years and $2.5b to get a new drug to market, we need to explore how we can better use data and digital to speed this up.”
Cutting the time to discovery
Combining clinical imaging and genomic data, is just one cutting edge example of how the digital revolution is yielding new insights. The successes achieved by companies such as Recursion Pharma here demonstrate the extent of the possibilities, potentially cutting the time to discover new medicines by a factor of 10.
Data is the fuel that will speed such discoveries and researchers have broken new ground here in 2020. Collaboration between researchers, pharma and healthcare providers to find the best ways to treat COVID-19 by mining large and disparate data sets demonstrates the power of smart analytics and AI to drive new insights into disease and how to treat it, says Babylon Healthcare’s Clinical Innovation director, Dr Keith Grimes.
Grimes cites one of the world’s largest observational studies published by Ben Goldacre and his team, based on the OpenSAFELY secure analytics platform. This allowed researchers to use the pooled medical records of over 17.5 million patients in UK general practice to identify the factors that increased risk of death for those with COVID19. “What is even more impressive is that the platform has been built with open collaboration and security from the ground up,” says Grimes, “allowing others to participate in this work.”
There is now an appetite to apply the lessons learned to new consortia. These will be large-scale partnerships in which members share masses of data from electronic health records to population-level data. The goals include better therapeutic approaches, better ways to target patients most in need of intensive help from specialists or finding ways to better treat and reach neglected populations.
The confluence of a range of technologies - including AI, remote sensing, cloud computing and augmented or virtual reality (AR/VR) is another powerful trend. We are just starting to see some of the possibilities when they converge.
Wearable devices can gather diagnostic data in the home, often passively and without conscious patient involvement. This data can be sent to the cloud where AI searches for anomalies or makes a diagnosis and a specialist then calls the patient in for a timely intervention.
The applications are vast across a range of chronic diseases. Networked continuous glucose monitors, thermometers, at home ‘stethoscopes’ or ultrasound devices, or wearables gathering constant heart or blood oxygen data are all examples of what’s possible. AI can then take data from such devices to start triaging patients to take some of the load from overworked clinicians.
Suraj Kapa, a cardiologist and Director of Augmented and Virtual Reality Innovation at the Mayo Clinic, cites advanced, AI-enabled chat bot information gathering tools as an obvious and relatively straight forward application.
Historically the patient has had to come into the physician’s office to gather quite basic information and decide which diagnostic tests to do, he says. “Now I can quickly gather the same level of data in the home and I can start reducing cost in the healthcare system.”
Remote interactions can conceivably go beyond information gathering tools to remote examinations and rehab with the help of virtual reality (AR and VR) tools, adds Kapa. “A physiotherapist could instruct someone recovering from surgery and walk them through different exercises and advise them on what they are doing wrong or you could carry out orthopaedic examinations of patients at home.”
Such capabilities are not possibilities of the far future but are in fact enabled by the latest generation of AR and VR hardware and software incorporating the potential for haptic feedback or projecting other data into a physical environment. “For example the clinician could sit with a patient and show them anatomical models by projecting that to them in a seamless interface,” says Kapa.
AI: healthcare’s multi-skilled digital assistant
AI will be the key for many of these applications. It will become an essential healthcare assistant tasked with processing the firehose of data clinicians will soon be dealing with in the technological revolution that is already underway.
“One month of continuous data from a wearable is not a practical use of anyone’s time given the costs of a human scouring that data,” says Kapa. “But it is valuable data. The patient can’t tell you when they felt something, in a day you have 100,000 heart beats, but automation can find the abnormalities in that data.”
Harnessing AI to rapidly and accurately interpret data from a range of sources in such ways could enable clinicians to increase the number of patients they take care of by an order of magnitude from 100 to 1000 people a week, he adds.
The small but growing digital therapeutics (DTx) market, where prescription therapies for conditions ranging from tinnitus, back pain and mental health are already being served, usually via smartphones, offers yet more promise for technology-led healthcare advances. The possibilities for using DTx to manage and treat a range of conditions and chronic diseases is vast.
The ultimate destination of this data, device and AI-driven future should ultimately be a focus on wellness rather than sickness. Sensors will analyse our wellbeing in the background and alert us and those tasked with maintaining our good health when our indicators show risks and anomalies.
Indeed the great opportunity of cheap, ubiquitous and theoretically highly scalable remote health powered by smart technology is that it changes utterly the ‘sick care’ paradigm. It could afford everyone the chance of optimising their health by pre-empting, slowing, ameliorating and even preventing ill health.
What are the barriers to such a utopia?
1. Regulation and regulators, not technology, are a limiting factor
In the US, telehealth only accelerated after regulators eased restrictions on it, not least the restrictions on healthcare crossing state borders. “The shift in telehealth is not attributable to technology, it is attributable to a policy shift,” says Kapa.
But the relaxation on the rules may only be temporary and if so, the US could suffer a reversal, he adds. “If I can’t cross state lines, what is the point of cheap kit that allows patients to do a test at home? What’s the point if the physician is not allowed to use the data?”
It would seem incredible to throw away the advances witnessed and wrung at cost from a catastrophic pandemic but such a possibility remains.
Regulatory barriers are not the only impediment to more rapid adoption of technology-led healthcare. Frail human egos are another stumbling block to the wider adoption of technology, says Kapa. “Many type A personality experts don’t like idea of computer telling them what to do.”
And there is also the question of the extent to which humans and regulators will accept errors from a machine, he adds. “We don’t accept errors or mistakes in judgement from a machine or AI like we do from humans.”
2. Human appetite for screen time is limited
Digital fatigue may seem a trivial impediment but it is emerging as a significant factor for HCPs. “Increased remote working has led to greater digital fatigue thanks to remote working and extended hours at home, which necessitates greater management care for remote workers and improved workplace practices,” says Grimes. “I've also heard of some workers experiencing distress as the traumas they help at their work (especially in mental health) are now entering their own homes.”
3. IT Silos and a lack of data standards
Data interoperability, or the lack of it, is yet another barrier to the use of technology to drive new insights and get the innovation wheel spinning ever faster. It is both an internal and an external, healthcare sector-wide challenge. Internally, many pharma companies are still wrangling disparate data systems which cannot easily share data. In the wider healthcare system, the lack of universal data standards and inconsistent data quality prevents disparate sources of data from being synthesized and value extracted from them.
The way ahead
Despite all the challenges outlined above, 2020 has proven such a rupture from established ways of working that there is no way back.
When the pandemic fades into the rearview mirror, the healthcare sector can focus on applying the technology revolution for the great healthcare challenges of our time, not least among them driving down the WHO’s feared 52 million annual deaths from non-communicable diseases by 2030.
There may be glitches and bugs to work out but the future is digital first now.
A new pandemic-driven technological revolution is reshaping the entire healthcare system in 2020 and everyone’s sense of what is possible beyond it