The power dynamics of healthcare are shifting. To date, healthcare providers have been the source and gatekeeper for all information about a patient’s health. Now, consumer technology is allowing individuals to measure their own health in greater detail, and therefore play more of an informed role in their own treatment. Technology driven investors see a big opportunity.
In 2015, almost $1.8 billion was invested in US start-ups focused on the consumerisation of healthcare, with investment in personal health tools up 223%. The most visible tools for patients on the market are wearables with health monitoring capabilities — for example, the more than 23 million Fitbits and iWatches that have been sold. These and other devices are providing medical information directly to the patient, with a focus on metrics that the patient can easily understand and act on — heart rate, calorie loss, sleep patterns, exercise, others.
An emerging generation of patient tools focuses on remote patient monitoring — patient-based monitors that generate a continuing data feed from the patient to the doctor and healthcare system. Sense4Baby, for example, provides expectant mothers with a wireless fetal and maternal heart rate monitor, which is continuously linked to doctors through a web portal. Instead of periodic or emergency – driven check-ups, doctors can monitor and even anticipate pediatric emergencies in real-time. Physician acceptance of these devices is not automatic.
“There are a lot of challenges involved in getting the physician to take that data seriously. For a physician, making clinical decisions based on that data is a challenge, potentially because of work flow and time constraints,” says Jesus Pindado, Vice President of engineering at MC10, a Cambridge, US-based company specialising in biometric devices.
However, remote monitoring technologies will only become more valuable as populations in developed countries age, and chronic conditions such as heart disease, diabetes, Alzheimer’s and hypertension increase in prevalence. These progressive diseases lend themselves to a daily monitoring approach — providing more predictive care for patients, and allowing them to receive care within their homes.
“One of the big underserved areas has been in the field of chronic disease management — conditions such as diabetes, cardiac ailments, COPD and so on,” says Chris Witt, President and co-founder of WAKE TSI, which provides IT services to healthcare organisations. “If a clinical team can manage long-term critical care on an ongoing basis, this will reduce the lines in the emergency rooms.”
The infusion of medical practice with new digital technology not only aids in the treatment of individual patients, but may also advance medical research. For example, a network of thousands of heart monitors can be used to detect aggregate patterns of cardiac anomalies across populations. Connecting these monitors to hospital databases would allow doctors and specialists to correlate arrhythmia with previous diagnoses and medication history.
This emerging vision of new healthcare delivery assumes that technology can meet a number of information-related challenges. The first is the variety of data that must be integrated to create a holistic view of a patient, or a community of patients. In the future, patient data will be generated from the full range of biosensors, smartphones and wearables, as well as technologies yet to come. Healthcare providers themselves will need to use data from test machines, doctors’ tablets, MRIs and nurses’ records. Third party institutions, service providers, ambulance operators, insurers, will contribute data from their own devices, standards and operating systems.
Bringing all this data together in such a way that allows a doctor to see all the relevant information about a particular patient is no mean feat.
The second challenge is the volume of data produced by these various sources. Every patient is potentially a source of Petabytes of medical information, all of which must be kept for future reference to provide ongoing personalised care. Added to this challenge is the fact that historical data may be contained in legacy and unstructured sources, such as scanned paper documents.
Witt believes the cloud will be the point of collection and integration for the mass of medical data that healthcare providers will soon need to contend with. “Eventually all the data from wearables, inserted monitors and the like has to come back to a central location. Clinicians will access that data and potentially some analytics programs will access that data too. The benefit coming from the cloud is performance. Hospitals can upgrade their performance in a pay-as-you-go model much more nimbly than they can with an in-house data center because there is less expenditure involved.”
Speed, server performance, storage and network operation are all enhanced, which ultimately serves patient needs more efficiently and effectively. So far, the healthcare industry has been a slow adopter of cloud computing. Only 43% of healthcare respondents say the technology has a significant or pervasive presence in their country’s healthcare industry today. This compares to 59% and 58% of finance and retail executives respectively who say the same of their sectors.
This relatively low adoption by healthcare providers is explained, in part at least, by the sensitivity of the data they handle. No information is more personal than details of one’s health, and healthcare providers have a moral and legal requirement to treat patient data with the utmost care. While the security and privacy implications of cloud computing can be debated, companies with more to lose should their data be compromised are typically, and understandably, more cautious about adopting new IT platforms.
However, the healthcare sector expects adoption to grow. Eight out of ten survey respondents 81% believe that cloud will be a moderate or major factor in their industry in three years’ time. Cloud is evidently an important dimension of a technological revolution that will have far reaching implications for the healthcare sector.
This revolution promises to empower patients to take greater control of their own health, and to allow providers to offer more integrated and personalised care. But it will also challenge healthcare providers to rethink their relationship with patients, including the way they store, process and analyse their information.
One key area in which the technology can help people stay healthy is electronic health records. Rather than having history isolated in a file folder in a doctor’s office, and possibly lost if a patient changes physicians, that data can be stored in the cloud, available to any health care professional who needs it. That alone can help eliminate situations in which patients receive conflicting advice and medications from physicians who are not aware of what colleagues have already prescribed.
Electronic records also expedite the detection of risk factors. For example, the US Centers for Disease Control and Prevention lets interested parties generate health profiles for any county in the United States. Each profile includes key indicators of health outcomes, which describe the population health status of a county, and factors that have the potential to influence health outcomes, such as healthcare access and quality, health behaviors, social factors, and the physical environment.
And in Ontario, Canada, the Institute for Clinical Evaluative Sciences maintains anonymised databases of patient records, available to researchers. These databases are used for everything from evaluating healthcare in different constituencies to early detection of trends that could indicate an outbreak of an ailment, or an issue with a treatment.
These analyses not only tell physicians and governments how they are doing, they also alert them to the need for preventive treatments, for example, updating measles vaccinations in a location where the disease has shown up, or isolating malnourished populations that need further education about diet. If ailments caused by environmental factors present, the appropriate agencies can be advised so they can investigate and take action to prevent further issues.
All this relies on centralised, accessible records, and people who know how to analyse them. But those records also can be used for less benign reasons, so those centralised records have to be properly secured, and access to them regulated, to protect patient privacy.
Another, as yet unmined, area for healthcare data is the information from individual wearable devices, which can provide invaluable hints to healthcare providers about a person’s day-to-day state. Device vendors also store data from these devices in the cloud, often a less robustly secured cloud than that of healthcare providers, which puts user privacy at risk.
As long as proper precautions are taken, though, those cloud-based records can help governments and medical personnel create a healthier society. Of course, the impact of the cloud is felt in industries other than healthcare.
When the Economist Intelligence Unit asked 72 survey respondents working in healthcare about the current usage of cloud computing in healthcare in their countries, they were split: 43% said there was a high, or very high, level of usage, and the remainder said that the level of usage was moderate to non-existent. The highest penetration was in the United States, the lowest in Europe, likely due to the challenges in navigating privacy laws and other regulations in the European Union.
However, all expressed optimism that any challenges will be overcome. 61% said that cloud will be a decisive factor five years from now, and a further 28% said it will be a major factor. By that time, even the EU respondents feel that the cloud will be a major factor in healthcare.
