By Karen Taylor, Director, Centre for Health Solutions
As 2019 gets firmly underway I thought it would be interesting to revisit the six predictions in our November 2017 report, The future awakens: Life Sciences and health care predictions 2022, examine relevant developments in 2018 and consider what might happen in 2019. Over the past 14 months or so, the scale of change is escalating at such a pace that some of the predictions are closer to being realised that initially anticipated, while others may well be overtaken by events. While the predictions are relevant to all stakeholders across health care and life sciences, I have split them into two groups, the three more health care focussed ones are the subject of this week’s blog and next week will be the turn of our three more life sciences focused, ones.
Prediction. The quantified self is alive and well: the genome generation is more informed and engaged in managing their own health.
In 2018, there was an increase in the use of bio-sensing technology, including wearable non-invasive biosensors,1 and the first intelligent ingestible pill, enabling stricter monitoring and management of medication adherence, was approved by the FDA.2 By mid-2018 there were more than 75,000 genetic tests available, with over 10 new tests entering the market every day. According to Global Market Insights, the global genetic testing market is expected to surpass $22 billion by 2024 with the costs of these tests dropping significantly, typically ranging from under $100 to more than $2,000, depending on the kind of test and its complexity.3 These developments have enabled individuals to become better informed about their genetic make-up, have more knowledge about the diseases they have or might develop, and obtain a greater understanding of the effectiveness of health interventions. As a result, increasing numbers of people are more engaged in improving their own health, and have increased expectations of the health care they want for themselves and their loved ones. Moreover, patients are increasingly exercising choice about how they access care and demanding access to their health data.
The adoption of digital doctor apps, wearables, and the use of virtual assistants is enabling people to be more connected and enjoy convenience. For example, in 2018 the use of a chatbot as part of a mental health application, based on Cognitive Behavior Therapy (CBT), came into its own for those who need short, regularly scheduled check-ins with a mental health provider. During 2019, patient empowerment is likely to be increasingly important, with a noticeable increase in people acquiring their own health data and patient-generated data integrating with patient/consumer-owned health records, changing the way in which healthcare is viewed and delivered. However, there is also a real risk that there will be an increase in health inequalities, as those who might benefit most from increased patient engagement and empowerment are unable to afford, or unwilling to engage, in self-monitoring and other patient engagement initiatives.
Prediction. The culture in health care is transformed by digital technologies: smart health care is delivering more cost-effective patient-centred care
2018 saw an increase in the number of digital hospitals and digitally connected health care systems, whether measured by the Hospital Information HIMSS Analytics Electronic Medical Records Adoption Model (EMRAM) rating4 or, in the UK, by the NHS digital maturity index assessment.5 However, prioritising patient-centric delivery of care is being hindered by the varying levels of maturity of health care’s IT infrastructure. Electronic Health Record (EHR) implementation remains top of most health care providers’ agendas, however, once organisations reach a certain level of maturity, priorities shift towards patient empowerment. According to the HIMSS Analytics European eHealth 2018 survey, Denmark, Sweden, Estonia and the Netherlands are leading the pack when looking at the adoption of digital technology and innovation. Digitally advanced organisations and countries have also expanded the skill set of their digital transformation management teams by creating new roles, including more Chief Nursing Information Officers, Chief Digital Officers and Chief Innovation Officers. However, while the main eHealth hurdle remains IT security, a lack of funding is perceived as the ‘major challenge’ for providers, with 59 per cent of employees arguing that their institution’s IT budget for the next 12 months is ‘too low’. Lack of interoperability and being able to find and hire sufficiently skilled employees are the other two top four issues.6
Meanwhile, a growing number of hospitals, are using cognitive and AI technologies to deliver more seamless, integrated care, designed around patient needs, allowing clinicians and bed managers to better understand patient flows and patient acuity to inform workforce planning and clinical pathway re-design.
Prediction. New entrants are disrupting health care: the boundaries between stakeholders have become increasingly blurred
In 2018 non-traditional health care players had a major disruptive impact on health care as they used their brand, engineering expertise, and knowledge of customers. These new entrants are partnering with traditional providers to deliver a more customer-focussed experience of health care. Indeed, the approval of mobile and wearable devices has escalated significantly during 2018. Of particular note was Apple Inc. getting its first FDA clearance for an atrial fibrillation detecting algorithm and an ECG built into its Apple Watch Series 4.7 In January 2018, Apple Inc. also announced it was bringing health records to iPhones and over the course of the year has provided its health records product to a growing number of health systems and hospitals in the US.8
In 2018, big tech companies have demonstrated that they are taking their move into health care and life sciences very seriously. They are developing new, health-related features on their platforms and teaming up with research institutions and developers to create new tools for patients, doctors and other stakeholders in medicine. They are investing heavily in partnerships with start-ups and/or launching new ventures.9 For example, in 2018, Amazon, Berkshire Hathaway, and JPMorgan Chase announced a partnership to cut health care costs and improve services for their US employees and subsequently recruited the renowned surgeon, author, and journalist Atul Gawande to lead their new health care company.10 Amazon also made a foray into pharmacy services by acquiring the internet pharmacy start-up PillPack.11 In June 2018, Microsoft hired two top health care professionals to enhance its open cloud architecture and AI solutions, and focus on partnerships and a cross-company strategy for both health care and life sciences.12 Alphabet Inc. has established a large health care portfolio – with Verily Life Sciences, Google Genomics, Deepmind, Calico and Google Fit.13
One year on, evidence in support of our health care predictions continues to grow, and we continue to believe that 2022 will see a world where new innovation, collaboration and automation has improved the cost effectiveness of service delivery. As noted, our six predictions share three key enablers that are critical to the realisation of the prediction and which will impact the pace and extent of change:
- wide scale adoption of new digital and cognitive health technologies
- recruitment and retention of new skills and talent
- a new approach to regulation.
As 2019 gets under way, these enablers continue to be essential elements in realising a bold future for health care. While 2019 is likely to be challenging, the possibilities are also more exciting. For me the two key questions that need to be addressed as a priority are to what extent 2019 will be the year that:
- providers start to gain more control over health care costs through wider scale adoption of new ways of working?
- patient activation and empowerment become more the norm that the exception?
We will explore these two questions and others that are raised in our predictions report through our research reports and blogs during the course of the next 12 months.
9 https://leanpub.com/tech-giants-in-health care
12 https://www.health careitnews.com/news/microsoft-hires-two-health care-leaders-teases-future-projects