What are the latest trends in digital healthcare? We take a look at the top ten digital trends — from AI-based machine learning systems to wearable technologies — that are driving the transformation of healthcare across the spectrum, from clinical research to healthcare delivery.
1. Silicon Valley Digital Giants Invade the Healthcare Sector
Adoption rates for digital healthcare tools have finally reached a critical mass in the US. In a Rock Health survey of 4,000 Americans, 80% looked to online tools for health information, while 28% reported using mobile tracking tools to monitor their health.
At the same time, nearly 90% of healthcare execs surveyed by Accenture report they are ‘experimenting’ with implementing digital tools, including distributed ledgers, AI, extended reality, and quantum computing (a category Accenture calls the “DARQ” technologies).
A similar percentage of hospital execs surveyed by KaufmanHall consider tech-savvy companies as a major threat to their organizations, with Optum (the UnitedHealth pharmacy benefit manager and care services group), CVS Health/Aetna, and Amazon causing particular concern.
These execs have good reason to be worried — investments in digital healthcare by Silicon Valley companies and venture capitalists (VCs) has skyrocketed. For example, Pitchbook reports that during 2018 alone, VCs invested over $1 billion into AI and machine-learning startups that were focused on drug discovery (with another $700 million invested so far in 2019).
Tech giants, including Apple (with its ResearchKit and CareKit data collection APIs); Microsoft (with its Microsoft Healthcare AI-based solutions); Google (with its DeepMind AI tools, now part of Google Health); and Amazon (with its $1 billion PillPack acquisition and the newly HIPAA-compliant Alexa voice assistant) are all on the move, as we’ll see in the sections below.
And, just as those traditional healthcare execs feared, consumer pharmacy companies are also making a big play in the digital healthcare space as well. Walgreens is investing $300 million in a partnership with Microsoft to create “digital health corners” in its stores, while CVS (which bought insurance giant Aetna for $67 billion) is investing up to $350 million to transform its stores into healthcare shopping and services facilities.
2. We’re in the Second Wave of Enterprise-Level EHR Integration
Spurred by rule changes written into the Affordable Care Act (more commonly known as the ACA, or Obamacare), nearly all healthcare organizations have implemented digital EHR (Electronic Healthcare Record) systems by now, according to Internet research guru Mary Meeker.
However, the overall usefulness of these first-generation EHR implementations is widely viewed as rather limited, for reasons ranging from lack of interoperability between competing vendor implementations, too clunky, time-consuming user interfaces, to the lack of a streamlined single-sign-on (SSO) password systems.
(Given the situation, it’s not surprising there is even a popular Twitter parody account, which mocks common EHR shortcomings.)
According to a few stock photos, doctors are happy with the EMR.
This shows our commitment to evidence-based medicine. pic.twitter.com/aADhB0YS8c
— EPICparodyEMR (@EPICEMRparody) July 22, 2019
Unfortunately, consumers may have started to sour on using healthcare portals, according to a study published in Health Affairs. Adoption rates are down overall, and the study cites these reasons:
- Patients prefer to speak directly with a physician—70%.
- Patients have no need to use the portal—57%.
- Patients don’t have an online medical record—32%.
- Patients lack internet access—25%.
- Patients have privacy concerns—22%.
In an effort to fix things, HHS (Health and Human Services) has just closed comments on its proposed new rules that would prevent unreasonable “information blocking” between systems.
Enterprise-level interoperability was also a major theme of this year’s HIMSS19 conference in EHR vendors, with lots of talk about implementing more data-sharing-friendly protocols, such as the FHIR (Fast Healthcare Interoperability Resources) specification.
Cerner and Epic (the two leaders in the HER segment) are stepping up with more robust “enterprise” level EHR system product announcements, while rumors persist that Google and Apple are themselves eying an entrance into the EHR marketplace in the near future.
Meanwhile, major healthcare systems keep rolling out new enterprise-level EHR implementations (55 in the first half of 2019, according to Becker’s Hospital Review, many of which cost more than $100 million a pop).
3. Telemedicine and Non-Traditional Healthcare Settings Gathering Steam
Do you always visit your primary care physician for most of your healthcare needs?
Maybe not for much longer if non-traditional healthcare providers have their way.
We’ve mentioned two of the main players earlier, CVS/Aetna and Walgreens, that are aggressively marketing their store clinics (derisively called “doc in a box” by critics) as a convenient alternative to physician visits for things like routine flu shots and diagnostic tests.
Other digital startups, such as Zocdoc and Solv, are trying to create an Uber-style online marketplace to aggregate available physician appointments so that users can get a same-day physician appointment.
Yet it may be telemedicine (also known as telehealth) that brings about the biggest change of all in the patient/physician relationship. While the adoption of telemedicine was thwarted in its early days by the lack of generally available HIPAA compliant video tools as well as restrictive state regulations (such as requiring an initial face-to-face visit with a physician), today, the adoption of telemedicine is growing quite rapidly (reaching 34% in 2018, up from just 7% in 2015).
Seniors may be the most enthusiastic users. A survey found that 52% of Americans over 65 are open to using telemedicine, due to these factors:
- Offers faster healthcare service: 73%.
- Saves time: 58%.
- Saves money: 54%.
- Helps increase provider access: 53%.
4. Meet Your New Digital Health Assistant Alexa (and Other Robots)
If telemedicine becomes the dominant setting for healthcare, will your physician be on the other end of the line?
Not necessarily.
In fact, you may not be interacting with a human at all.
Amazon* is leading the charge with a healthcare-oriented version of its popular voice-activated Alexa. The new digital health assistant version of Alexa (now fully HIPAA compliant) is currently undergoing real-world testing at Cedars Sinai Hospital in Los Angeles.
*Disclaimer: Amazon is a Formaspace customer.
And Amazon’s Alexa is making even greater inroads in the UK healthcare system, where it has teamed up with the NHS to provide the first line of home healthcare advice for patients who would otherwise call their local NHS staff.
The digital health assistant in your future may also take the form of a robot. (Amazon’s entry in this space is rumored to be called Vesta.)
But they won’t be the first to market. The Japanese anthropomorphic Pepper robot has already proved to be very popular among elderly Japanese requiring nursing care.
Closer here to home, Austin-based Diligent Robotics has been testing their new healthcare robot Moxi at the Texas Health Presbyterian Hospital in Dallas. Moxi’s role is envisaged as an indefatigable assistant, tasked with those time-consuming but necessary tasks including delivering prescription medicines, linens, lab specimens, etc., to give nurses on duty more time to interact with their patients and provide higher levels of care.
5. Wearables Moving into Diagnosis & Chronic Disease Management
Wearable devices first burst onto the scene in the guise of “connected wellness/fitness apps,” with FitBit’s line of wrist band step counters being a prime example. They cleverly avoided being categorized as medical devices (which would trigger a host of regulatory rules, including HIPAA compliance).
But surveys indicate that the wearable market is beginning to grow beyond the fitness market into the diagnostic and disease management arena: their use in healthcare has increased from 13% in 2015 to 33% in 2018.
The Apple watch (which famously failed to meet one of its original design objectives, e.g. to measure blood pressure*) now has the capability to detect potential cases of atrial fibrillation, providing users an early warning of a condition they might be unware of (when sleeping, for example).
* Arch competitor Samsung has introduced their new Galaxy Watch Active, which does include a blood pressure monitoring feature.
Crucially, Apple has engineered connections with major EHR vendors (via its ResearchKit and CareKit data collection APIs) to give patients the ability to upload the health data collected on their Apple devices as well as to download their personal EHR-based health records directly on their iPhone.
Other vendors, such as Medtronic*, are taking advantage of Apple’s APIs. Medtronics now offers an iPad-based app that allows doctors to monitor and control a patient’s embedded pacemaker.
*Disclaimer: Medtronic is a Formaspace customer.
6. Security Breaches Hit Smaller Organization Especially Hard
Connected medical devices are not without risk, however.
The FDA has issued security concerns about these devices that are connected to the Internet, including pacemakers and glucose pumps, for fear that they could be subject to hacking – with potentially mortal consequences.
This is just one aspect of a larger trend in digital healthcare: concerns over data security.
As anyone in the healthcare community knows, HIPAA violations that reveal the Protected Health Information (PHI) of patients are deadly serious, and the fines for these data breaches can be quite onerous – ranging from $100 to $50,000 (up to $1.5 million for the most egregious cases) for each compromised PHI record.*
*HHS is currently considering reducing the overall penalties somewhat.
Yet, it seems that more and more healthcare providers are finding their EHR systems are vulnerable to aggressive attacks by hackers. In 2018, HHS collected $28.7 million in fines. (Here is a list of 2018 violators.)
Smaller healthcare providers may be especially vulnerable to hacking, due to smaller IT budgets. In some cases, ransomware demands by hackers have left small hospital systems unable to access their EHR records entirely.
In one case, a small private medical practice in Michigan simply elected to shutdown entirely rather than pay a ransom to hackers who took control of their EHR system.
7. AI Targets Precision Health and Evidence-Based Medicine
Medical researchers are eager to take advantage of the massive amounts of personal health data collected each year by EHR systems. They want to sift through the data to identify the most promising treatment protocols (evidence-based medicine) and begin to develop clinical treatments that are targeted to an individual specific genetic makeup (precision health).
It’s a classic big data operation, but first, it’s necessary to remove any protected health information that can identify individual patients in the data. Amazon has announced an automated system for doing this kind of depersonalization work, using their machine-learning-based image analysis service Rekognition, followed by post-processing the data through Amazon Comprehend Medical, which mines (and cleans) the EHR data using natural language processing.
Meanwhile, machine learning and artificial intelligence-based clinical systems are making themselves felt across the board; here are some recent success stories:
AI-Based Drug Discovery
- Google’s Deep Mind system recently wowed pharmaceutical researchers during a recent demonstration in which it was able to successful predict the 3D shapes of proteins, a startling development that paved the way for AI-based systems becoming the dominant approach for designing new pharmaceuticals.
AI-Based Clinical Image Analysis
- A research paper published in Radiology indicates that AI-based systems can match the performance of human radiologists when analyzing thyroid nodule images and maybe provide more consistent results.
- A study found that machine-learning based classifiers were able to outperform human experts in the diagnosis of pigmented skin lesions.
- Several reports indicate that AI-based systems may be better (and faster) at detecting lung cancer than human radiologists, including systems from Google’s AI team and that of a crowd-sourced system developed via a world-wide competition.
- A deep learning algorithm is reported to be more accurate at detecting cervical cancer and pre-cancer from imagery than human evaluators.
Blood Specimen Clinical Analysis
- A system using machine learning and natural language processing has been shown capable of analyzing genomes from blood samples to detect childhood genetic disease markers in only 20 hours on average, making it much faster than traditional methods which take an average of 40 hours.
Auditory Data Clinical Analysis
- AI-solution provider Eko announced that in a recent clinical study, its heart murmur detection algorithm outperformed four out of five cardiologists in the detection of heart murmurs.
- Researchers at Emory University report that a machine-learning system they have developed can detect predict the future onset of psychosis disorders with 93% accuracy, by examining speech patterns of patients.
8. Don’t Overlook AI’s Impact on Backoffice Operations
While machine learning and AI-based algorithms used in clinical applications may grab most of the news headlines, the adoption of these systems to facilitate managing data in the office may prove to be more important to healthcare providers over the long-term – by automating patients appointments, managing provider resources and scheduling, handling burdensome CMS-mandated recordkeeping, taking care of insurance authorization and payment processes, as well as prescription management, tracking, and fulfillment.
Here are a few recent developments to consider:
- M*Modal, a division of 3M, has announced plans to deploy its conversational artificial intelligence (AI) platform at Community Health Network (CHNw). The system is designed to use real-time speech recognition to automate the time-consuming tasks of scribing and transcription, by inputting physician notes and data into EHR systems automatically.
- In the HR arena, IBM has created an AI-based system that can predict (with a claimed 95% accuracy) which employees are likely to resign in the near future.
- Microsoft Healthcare has announced a system to match up qualified patients with suitable clinical trials, using what Microsoft calls its Clinical Trials Bot to interact with prospective participants.
- Revenue cycle manager Waystar has acquired Digitize.AI, an artificial intelligence technology firm whose software is designed to streamline the time-consuming process of getting pre-authorization from medical insurance companies.
9. Meet Tomorrow’s Bionic Man and Bionic Woman, Elon Musk Edition
What are the long term trends in digital health?
Elon Musk recently presented his vision of the future: a brain-computer interface that aims to bridge the gap between humans and artificial intelligence.
Musk announced ambitious plans for his new venture, dubbed Neuralink, in what is hoped could provide new clinical methods for recuperating from brain and spinal cord injuries.
10. Risk of Unknown Unknowns: The Coming Global Pandemic?
It’s tough to make predictions, especially about the future.
— Proverb often attributed to Yogi Berra
When making predictions about the future of digital health, we can’t overlook the potentially dramatic impact of what Donald Rumsfeld famously called the Unknown Unknowns.
In other words, it’s very likely we will be surprised by a new invention, discovery, or insight that will change the future of digital health.
Yet some of these potential Unknown Unknowns (also called Black Swan events) may be staring us in the face, such as the potential for another destructive global disease pandemic — originating from either the current Ebola outbreak in the Congo or the ongoing African Swine Fever and Swine Flu outbreaks in China.
If these long-feared, yet long-predicted, pandemics rage across the planet, digital health technology may provide a welcome mechanism to assist in tracking disease vectors — if the appropriate steps are taken now to prepare.
Time will tell if we’ll be ready.
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