| 4th September 2017
* This article first appeared in the July edition of Pharmaphorum's Deep Dive publication.
From the use of exoskeletons in paralysis patients to cybernetics to compensate for sensory loss, technological advances are impacting healthcare. However, the tangible progress over the last decade has come through the realisation of the promise of the information age.
Data capture, analytics and subsequent insights drive innovation in almost every field. And now healthcare has started to catch up. The Internet of Things (IoT) allows the collection and collation of a plethora of data, Mobile Health (mHealth) is enabling the role of the ‘patient expert’ and Artificial Intelligence (AI) is finding new and exciting applications.
With the patent cliff approaching for more than 150 big brands over the next 10 years (affecting $190 billion in brand name sales), how will pharma remain at the forefront, while investing wisely?1
The Gartner Hype Cycle for emerging technologies is an increasingly popular model to make sense of technology’s real-life applications and evaluates where each emerging technology sits in its adoption (Figure 1).
Breakthrough technologies often face hype at the ‘Peak of Inflated Expectations’, when everyone is focused on their foreseeable short-term strengths. After this peak, challenges to implementation are experienced, pushing them into the ‘Trough of Disillusionment’. This is often a make-or-break point, where adopters weigh challenges against strengths. Successful technologies move forward into the ‘Slope of Enlightenment’ and then, in the ‘Plateau of Productivity’, companies begin to deliver real productivity and value.
While the Gartner Hype Cycle spans industries, it is a useful lens through which to hypothesise on the adoption of new technologies in healthcare.
Figure 1. The Gartner Hype Cycle. Source: Gartner
Three main health technologies are making their way out of the ‘hype’ phase and may be intrinsically linked as they move into the Plateau of Productivity.
The World Health Organisation defines mHealth as, ‘the provision of health services and information via mobile technologies such as mobile phones and Personal Digital Assistants (PDAs)’.
In 2017, mHealth revenue is expected to reach about $23 billion. The market is driven primarily by the monitoring services and solutions that aid chronic disease management. These include cardiac monitoring, diabetes management devices, health and wellness apps (focusing on exercise, weight loss, women’s health, sleep, and meditation) and medical reference apps. With most of big pharma already engaged with, or entering, this space, and further growth expected, mHealth is in its Plateau of Productivity.
As we move beyond the pill to an electronically holistic system, the coming insights will give researchers a wealth of data to look for new disease and health insights as well as new therapeutic approaches
– Michelle Longmire, CEO of healthcare app and analytics platform Medable Inc.2
The healthcare Internet of Things (IoT) encompasses health trackers, wearables, medical devices, implants, electronic medical records (EMR) and even ingestible pills. Long-term data from these devices can be brought together to empower patients and provide a better picture of their treatment experience.
A new report by Allied Market Research says that the use of IoT will increase dramatically in the next few years and predicts that, by 2021, the IoT healthcare market will reach $136.8 billion worldwide.
While IoT is entering the health sector, it remains a challenge to integrate it into complex, cost-sensitive, widely varying health systems. Personal data sharing is also a sensitive topic. Integration of EMR across health systems is needed, and data sensitivities need to be addressed. However, with such unprecedented amounts of rich data, is it possible to gain actionable insights through traditional means? In addition, while volumes of deep data can be gleaned from so many devices, can actionable insights be taken? Integration of data sources is needed, and analytics need to be made easily accessible. Until then, IoT technology is, arguably, still on the Slope of Enlightenment.
By 2025, AI systems could be involved in everything from population health management, to digital avatars capable of answering specific patient queries – Harpreet Singh Buttar, analyst at Frost & Sullivan
Big names, such as IBM Watson and Google’s DeepMind, offer software that can interrogate huge volumes of big data. Their innovative deep learning and predictive analytics can spot trends and find insights.
Moreover, the insights themselves are becoming increasingly accessible. Through understanding conversation patterns, IBM Watson’s ‘chatbot’ technology allows insights to be drawn from lines of conversational questioning.
AI is now recognised as a key investment area in healthcare, with 106 start-ups in this space – 70 of which launched in 2016 alone. Applications for these start-up AI platforms range across patient and risk analysis, lifestyle management and monitoring, nutrition, in-patient and hospital care, medical imaging and diagnostics, mental health, drug discovery and, more recently, virtual assistants. However, all intend to address the ‘big data’ challenge.
It remains to be seen exactly how AI will be used in everyday clinical practice. Indeed new data unveiled by IBM Watson at the American Society of Clinical Oncologists’ (ASCO) meeting showed that, though the software agreed with doctors’ recommendations up to 96% of the time, the studies don’t suggest that the technology can actually improve decision making, suggesting that AI sits at the Peak of Inflated Expectations. However, given the challenges of being able to analyse and interpret big data, AI will be needed. The focus of ‘here-to-stay’ technologies.
mHealth, AI and IoT have been hyped, but what is their potential long-term value to healthcare?
In 2017, patient centricity is embedded in many organisational vision statements. Technology will make it easier than ever to put patients at the heart of all decision-making. mHealth and IoT will enable collection of rich, patient-specific data and AI uses deep learning, analytics, and predictive analytics to draw reliable, personalised insights from it.
Sanofi is an example of how seriously pharma is focusing technology on patient centricity. Its vision statement says it is a ‘global healthcare leader focused on patients’ needs’. Perhaps this is why it has partnered with Google’s Verily to support people with diabetes by injecting a total of $500 million into the startup Onduo.
Patient monitoring and personalised medicine are focal points, reflecting the need for long-term monitoring and personalised management of patients with chronic diseases.
A great example of what can be achieved in patient-centric monitoring is GlaxoSmithKline’s MyAsthma programme, which brings together mHealth and IoT to support patients in monitoring and managing their disease. The technology allows a user to track asthma flare-ups over time, set personal goals, and involve a healthcare professional (HCP) as needed, providing analytics to support the shared decision making between the two.
Personalised, or precision, medicine is another area for patient-centric technology. London’s Babylon offers a mobile app that provides an AI virtual doctor, remote access to real doctors, delivery of medication, connectivity with self-monitoring wearables/IoT, and even supplies self-test kits. It already has over 300,000 users, completing over 80,000 consultations. Customer centricity Health systems across the world are creaking under the pressure of increased populations, longer lifespans, and the complexity associated with more elderly co-morbid patients than ever.
A lot of time is spent collecting data in clinical practice. EMR and telemedicine are helping to amalgamate this data, making it more accessible and allowing physicians to stand at the centre of decision making. Flatiron Health, for example, is a healthcare technology and services company focused on accelerating cancer research and improving patient care. Its platform enables cancer researchers and care providers to learn from the experience of every patient.
The health technologies of the future will support faster diagnostics, enable tailored insights into patient needs and help HCPs to make better clinical decisions, thereby reducing pressure on healthcare systems.
For pharma to remain competitive and at the forefront of the industry in the future, investment must be put into innovating solutions in these spaces to support customers and patients.
While it may seem like the health technologies landscape is chaotic and uncertain, the trends in AI, IoT and mHealth point towards improving the patient experience and reducing the burden of diagnosis and monitoring on HCPs.
When choosing a technology in which to invest, it is worth considering which unmet need you are fulfilling, how that fits with what competitors are already doing, and how that generates value for your patients, your customers and you yourselves.
2.https://www.klick.com/health/wp-content/uploads/2017/01/ eMarketer_US_Healthcare_Beyond_the_Pill-Digital_Tech_and_New_Partnership....pdf? (Original source eMarketer. Victoria Petrock. Contributors: Annalise Clayton, Sean Creamer, Maria Minsker)
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