Trust Me I’m a Computer

On 6th October 2017 by good2us

If someone goes into cardiac arrest, survival depends on just how quickly the heart can be restarted. Amazon’s Echo, a voice-driven computer answering to the name of Alexa, can recite life-saving instructions about cardiopulmonary resuscitation, as to it by the American Heart Association.

Alexa is just one example of a drive to disrupt an industry that has not embraced the potential of digital information.

medicHealth care is, by necessity, very regulated and expensive to innovate in with a history of failing to deliver ambitious IT projects. But that may be changing as the momentum towards a digital future speeds up. Investment into digital health care has soared (see chart).

The potential for cost-savings is significant. In 2016 Americans spent the equivalent to about 18% of GDP on health care. That is far more than most but other countries face rising cost pressures from health spending as populations age.

Much of this expenditure is inefficient. Spending on administration varies enormously between rich countries with huge differences in the cost of medical procedures. Wrong or unnecessary treatments in developed economies waste about one-fifth of health spending, There seems to a growing acceptance of such digital products. The field includes mobile apps, telemedicine where health care is provided using electronic communications, predictive analytics (using statistical methods to sift data on outcomes for patients) and automated diagnoses along with wearable sensors to measure things like blood pressure.

Whenever there is disruption in an industry there are winners and losers. There are, basically, three groups in the health-care value chain. The first is the “traditional innovators” such as pharmaceutical firms, hospitals and medical-technology companies such as GE Healthcare, Siemens, Medtronic and Philips.

The second is made up of “incumbent players”, which include health insurers,, pharmacy-benefit managers that buy drugs in bulk and single-payer health-care systems such as the UK’s NHS.

The third group are the technology “insurgents”, including Google, Apple, Amazon and a host of hungry entrepreneurs that are creating apps, predictive-diagnostics systems and new devices. These are the most likely winners from the shift to digital.

Drug companies face specific problems. More data will identify those drugs that do not work and digital health care may give rise to new services that might involve taking no drugs at all.

Diabetes is a prime example of this. There is evidence that exercise gives diabetics better control of their condition and prevents the condition in the first case.. UnitedHealthcare, a big American insurer, has a prevention programme that connects those at risk of diabetes with special coaches at gyms.

An app or a wearable device that persuades people to walk a certain distance every day would be far cheaper for insurers and governments to provide than years of medical attention. Players of Pokémon Go have collectively walked nearly 9bn kilometres between the release of the smartphone game in 2016 and 2017.

Google’s health-care venture, Verily Life Sciences, and Sanofi, a French drug firm, set up a firm last year, Onduo. This will start by developing ways to help diabetics make better decisions about using drugs and their lifestyle choices. Eventually, the plan is that Onduo will help those who are at risk of diabetes from developing it. The startup is a good hedge for Sanofi, which faces a slowdown in sales of its blockbuster insulin medication, Lantus, which lost patent protection in 2015.

Such thinking is counter-intuitive for drug firms. Digital innovation will mean selling products based on patient outcomes and if pharma firms do not design solutions that put the patient, rather than drug sales, at the centre of their strategy, they risk losing relevance.

Telemedicine, predictive analytics and earlier diagnoses of illnesses are expected to reduce admissions, particularly emergencies. The sickest patients can be targeted by specialist services, such as Evolution Health, a firm in Texas that cares for 2m of the most-ill patients across 15 states. It claims to be able to reduce emergencies by a fifth, and inpatient stays in hospitals by two-fifths.

Guardant Health, a startup that is analysing large quantities of medical data in order to develop a way of diagnosing cancer from blood tests Such data-based diagnostics are an example of the power to change business models is. If the firm can devise an early test for breast cancer, demand for mammograms and the machines that take them would fall, along with the need for expensive drugs and spells in hospital.

Increasingly, machine-learning programs are able to make diagnoses from scans and from test results. An intriguing recent project has been to stream and analyse live health data and deliver alerts on an app that is carried around by doctors and nurses at the Royal Free Hospital in London. The app, the work of DeepMind, a British artificial-intelligence (AI) research firm owned by Google, identifies the patients at greatest risk of a sudden and fatal loss of kidney function. The Royal Free says that the app is already saving nurses’ time.

Health-care entrepreneurs have some bold visions. They foresee the point of care moving into the home, they say. People will monitor their own health conditions. In 2016 the US Food and Drug Administration (FDA) approved 36 connected health apps and devices. An app, called Natural Cycles, was recently approved in Europe for use as a contraceptive. Its failure rate for typical use was equivalent to that of popular contraceptive pills.

The most likely applications in the short term are those that give consumers direct access to qualified GPs on their mobile phones. Britain’s NHS is testing a medical AI from a London-based startup called Babylon which can field patients’ questions about their health. Push Doctor offers an online appointment almost immediately for £20 ($24). The firm maximises the efficiency of its doctors by reducing the time they spend on administrative duties. Meaning they spend 93% of their time with patients compared with only 61% in Britain’s public sector. Babylon reckons that 85% of consultations do not need to be in person.

Longer term, the biggest upheaval will likely come from the large technology firms. Amazon and Google are not the only giants to be stalking health care. Apple has expressed a strong interest in it, though it is taking time to decide exactly what it wants to do. For several years it has provided a way of bringing together health data on its iPhone, and tools for health researchers to build apps. As personal-health records accumulate on its platform, from sensors such as Fitbits to medical-grade devices, it will encourage more app development..

None of this will materialise quickly. Regulated health-care systems will take time to deal with concerns over accuracy, security and privacy. In Britain the Royal Free is already under scrutiny over how it shared its patients’ data. A broader worry is that technology companies are too cavalier with their users’ data. Such firms typically use long agreements on data rights that are hard for individuals to understand. The medical world places importance on informed consent, so a clash of cultures seems unavoidable.

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