Bulls n Bears Entrepreneurship Zone :: The transformation of healthcare through technology

[Bulls n Bears]

Around the world, healthcare systems are struggling in the face of rising
demand and spiraling costs. And the reasons are complex and varied.

Partly, it’s because healthcare providers have so much more to do. The
populations of rich countries are aging inexorably. That means millions of
older patients, who tend to have more frequent and more complex healthcare
needs. Partly, it’s because providers can do so much more. The life sciences
sector continues to make strides in its ability to treat and manage a broad
range of diseases and conditions, but many of those new treatments are
extremely expensive to deliver. Partly, it’s because people expect much more
from their healthcare providers. In emerging economies, millions of people
are demanding better access to healthcare provision. And as people from the
wealthy baby boom generation enter old age, they aren’t willing to sacrifice
the convenience and high levels of service they have come to expect in other
parts of their lives.

These pressures are raising difficult economic and ethical questions for
the sector, and for society as a whole. How should healthcare resources be
allocated? Who is going to pay the bills? They are also forcing the sector
to explore entirely new approaches to healthcare delivery.

And when it comes to problems that combine scale, complexity and tight cost
constraints, there’s one obvious place to look for solutions. Digitalisation
has already shown that it can disrupt industries and define new service
paradigms, offering people cheaper, more compelling and more personalised
services in sectors from transportation to entertainment.

“The potential for digital technologies to help reduce the cost of
healthcare services, while also improving outcomes for patients, is
phenomenal,” says Scott Allison, the president of life sciences and
healthcare at DHL. In particular, he highlights four major trends that show
how digital or digitally enabled processes have the potential to transform
healthcare delivery.


The Internet of Things


First, there’s the Internet of Things (IoT). Robust, accurate, low-cost
sensors and secure communication technologies allow people to collect and
store unprecedented amounts of health-related data.

These technologies are already common in consumer products. Accelerometers
in smartphones track activity throughout the day. Watches measure heart
rate, body temperature and sleep patterns. More specialised devices can
measure and record a host of other attributes, from glucose to blood oxygen
levels.

The availability of this data, collected non-invasively and in real time,
is transforming the management of long-term medical conditions. It is also
rewriting the traditional contract between doctor and patient. IoT
technologies can reduce the need for patients to visit their doctors for
tests, while also providing new insights into symptoms that vary over time.
Continual monitoring can help to pick up potentially dangerous changes in
the patient’s condition faster, allowing timely intervention. And perhaps
most significantly, monitoring helps patients to help themselves, giving
them the data they need to manage their own health more easily and more
effectively.

In November 2017, the US Food and Drug Administration granted approval for
the first drug that uses an ingestible tracking system. Abilify MyCite
tablets, a treatment for schizophrenia and bipolar disorder, each contain a
tiny sensor that is activated by contact with digestive juices in the
stomach. A patch on the patient’s skin picks up signals from the sensor and
communicates with a smartphone app. The system helps patients track their
own use of the medication, and they can also allow care providers to monitor
their use through a web-based portal.

“This sort of technology could eventually have a big impact on treatment
outcomes,” says Allison. “Even the best drugs only work if patients use
them, and non-compliance with treatment plans, especially for long-term
conditions, can be a major contributor to poor outcomes.”


Big data and AI


The second major area of digital opportunity is big data. Modern medicine
has always been data-driven. Doctors make clinical decisions informed by the
results of large-scale studies and trials. And recent advances in the study
of the human genome are revealing how genetic differences affect both an
individual’s susceptibility to particular diseases and their response to
different treatments.

When it comes to picking the right treatment options for each patient,
however, medical professionals need to know they are basing their decisions
on the most relevant research. As medical databases contain millions of
separate references, that can be a formidable task.

This is where artificial intelligence (AI) can help. Advanced AI
technologies are accelerating the process of searching medical literature
and matching the symptoms and attributes of individuals with previously
documented cases, treatments and outcomes.

In a 2015 proof-of-concept study, researchers at the New York Genome Centre
sequenced the DNA of a tumor in one patient, along with the DNA of normal
healthy cells. Then they used a beta version of IBM’s Watson for Genomics AI
system to search for information on the specific mutations identified in the
tumor, while their own team of experienced oncologists did the same thing
manually.

The machine won the race with ease. After searching its database of more
than 27 million citations, the IBM system produced a report of “potential
clinically actionable insights” in less than 10 minutes. The human
researchers took 160 hours to reach a similar set of conclusions.

Elsewhere, drug manufacturers and researchers are using an array of new
data sources, from climate models to internet search results, to improve
their ability to predict disease outbreaks and spikes in demand. As these
approaches become more sophisticated, and their results more accurate, they
are helping companies and healthcare providers to take a more proactive
approach, for example by ramping up production of specific products or
shifting inventories to affected regions.


Digitally enabled manufacturing


Digital technologies are reshaping the drug manufacturing process too. In
2016, US-based Aprecia Pharmaceuticals was the first company to gain
regulator approval for tablets manufactured using 3D printing technology.
The company’s ZipDose system uses a proprietary printing technique to create
pills with a porous structure that dissolve rapidly in the mouth. The
technology is designed to allow the safe delivery of precisely controlled
doses of medicine to patients who have difficulty swallowing a normal
solid-dose tablet.

Research teams across the world have other ambitions for 3D printing
technologies, however. They hope such technologies will allow the creation
of highly personalised medicines, with doses and release characteristics
tuned to the needs of individual patients or multiple products combined into
a single pill. And 3D printing technologies that allow drug ingredients to
be transported separately and combined only when the final tablet is
manufactured may help to simplify the distribution of sensitive
pharmaceutical products. FabRX, a spinoff from University College London,
for example, is using a range of 3D printing technologies, including fused
deposition modeling, selective laser sintering and stereolithography, to
create “Printlets”: pills or chewable formulations containing various drugs.
Other researchers are exploring the use of 3D printing techniques to create
custom medical devices, tissue for transplantation and even complete
replacement organs. According to a recent report by Grand View Research, the
global 3D bioprinting market will reach $2.6 billion by 2024.

“Combining 3D printing with smart monitoring, advanced analytics and AI
could create an entirely new paradigm,” says Andrew Mitchell, vice president
of life sciences and healthcare EMEA at DHL. “Today, getting the medication
right for somebody with a long-term health condition is often a matter of
trial and error. “That involves significant time, effort and expense, not to
mention the impact on the patient’s quality of life. In the future, we will
be able to use data from the patient’s genome to identify the combination of
drugs that is going to work for them, and then we will be able to
manufacture a personalised medication that contains the right products in
precisely the right dosages.”


Going directly to the patient


The fourth big opportunity is in the supply chain. In the retail world,
e-commerce technology has driven a large-scale switch to self-service,
direct-to-consumer delivery. The healthcare sector, by contrast, remains
largely a bricks-and-mortar operation. It’s an unusually labour-intensive
one too. Even for straightforward conditions, patients may have to visit
their doctor to pick up a prescription, then go to a pharmacy, which could
be several miles away, hand over the script and wait in line for their
medication to be prepared.

The disadvantages of this approach are obvious, especially for patients for
whom travel is difficult or expensive, such as the elderly and people in
remote rural areas. It’s no wonder that interest in internet-enabled
ordering and direct fulfilment of drugs and other healthcare products is
rising rapidly.

The UK’s National Health Service (NHS) introduced its Electronic
Prescription Service in 2013. The system is designed to streamline a number
of stages in the prescription supply chain, allowing doctors to send
prescription information to pharmacies electronically, and patients to
manage repeat prescriptions for long-term conditions online. The system also
allows patients to order their medicines online from approved pharmacies and
have them delivered directly to their home.

The NHS says the new approach has cut the costs associated with
prescription management and fulfilment by £130m (US$176m) a year since its
introduction, and that the reduction in paperwork saves pharmacies around an
hour and a half every day. In March this year, the NHS announced that it was
extending the use of electronic prescriptions to urgent care settings, such
as hospital minor injuries units and out-of-hours medical services.
Healthcare providers are embracing other forms of internet-enabled service
delivery too, allowing patients to consult their doctor via video link, for
example.


Scaling up the digital transformation


These digital innovations clearly have the potential to transform the
individual patient’s experience. It is now possible to envisage healthcare
systems where every doctor has access to artificial intelligence systems to
aid diagnoses and recommend treatment options. The chosen treatment might be
completely personalised, manufactured using 3D printing technologies and
delivered direct to the patient in their home. And once treatment begins,
its effectiveness will be monitored by internet-connected devices, with
doses and drug combinations continually adjusted depending on the patient’s
response.

The transition to such a world will have implications for the entire
healthcare value chain, however. The manufacture of pharmaceutical products
may become a much more decentralised, distributed activity, for example,
with pharmacies taking on new roles as miniature drug factories. Other
services may be more distributed too, with patients receiving consultation,
diagnostic tests and treatment at their homes and workplaces.

That shift will challenge the industry. Regulatory barriers to the direct
distribution of drugs and other medical products will have to come down. The
industry will need to find new ways to ensure product quality, safety and
data security. Supply chains and logistics processes will need new
structures, new processes and new management approaches.

“The life sciences and healthcare sector has always been bold in its
application of cutting-edge science to meet the needs of its patients,”
concludes Allison. “But now the sector needs to be bold in other ways too.
Digitalisation is going to transform the way healthcare products and
services are designed and delivered. The successful application of these
approaches at scale will depend on the availability of the right
infrastructure to support them. Companies need to start experimenting now
with new technologies and new approaches in their supply chains and
logistics processes, as well as in their products.”--Howwemadeitinafrica



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