Five themes from Connectivity In Medical Technology 2017

Key component technologies for connected devices have been developing and expanding in capability and at lower costs, driven mostly by the consumer products industries in response to consumer pull and innovative new digital business models. 

Medical and healthcare devices with data connectivity are increasingly prevalent.  Those devices that already had electronics were the first adopters as the added cost of connectivity technology was not significant, for example portable infusion pumps. For devices where the core functionality is mechanical only, the cost of added electronics technology remains a key challenge.

Most speakers and delegates agreed that many in the MedTech industry believe that further developments and reductions in the cost, size and power demands of the core connectivity technologies are coming soon and these will further open up well established low cost mechanical medical devices, indeed, connected inhalers and pen injectors are already entering this ultra-cost competitive market.

While many acknowledge opportunities for and benefits of software ‘Apps’; speakers and delegates recognise that the interoperability of systems that connect devices and Apps with other healthcare data remains a key challenge for all parties involved in healthcare provision.  In addition, integrity, maintenance and cybersecurity of such connected systems presents new challenges, attracting Regulators’ interest and new guidance.

An interesting opportunity that Pharma and MedTech are identifying is the use of connectivity to significantly enhance clinical trial studies.  Several speakers discussed the many challenges and failings of existing trials, for example, due to un-reliable records and participant drop-out rates.  Connected technologies offer many potential benefits including; accurate data that does not require user input, study monitoring to identify and possibly intervene early if a device or user is not able to follow the protocol, as well as the capture of realistic behaviour data across the entire period, not just at moments of planned use.  This offers potential cost savings and shorter durations for clinical trials.

A consistent message in many discussion topics is the importance of engagement of patients; recognising the rapidly growing trend for people to increasingly use technology to understand and track their well being, their medical conditions, as well as their social media and everyday actions.  Connected wearables such as Fitbit, apple watch and many other consumer products are now commonplace.  Individual health related data is growing at an extraordinary rate.  Cecelia Bufton quoted an estimate from IBM Watson Health: “The average person is likely to generate more than one million gigabytes of health-related data in their lifetime.  Equivalent to 300 books”.
Ref: https://www-03.ibm.com/press/uk/en/pressrelease/46609.wss

The world of Healthcare, Pharma and MedTech needs to fully recognise that the vast majority of people have become completely at ease with booking cinema tickets and banking online but are frustrated that they cannot engage with their medical care as easily.  One speaker gave an example from a recent conversation with their elderly mother along the lines of…. “Why can I book my hair appointment online but have to wait weeks for my consultant to write to my GP, who then writes to me with an appointment date that doesn’t fit with my schedule?”  Another speaker highlighted that it is no longer fair to say that the older generation are not digitally engaged, many have been engaged by their grand children. Health related subjects is one of the consistently highest Google searches.

The connected world has already learnt that consumers engage when they understand the benefits, as long as it is at their convenience and isn’t a burden. 

Getting it right is key; speaker Simon Wilson quoted a source from Digital Trends, that… “While 79 percent of users will give apps a second chance after it failed to impress them on the first go, that number plummets to just 16 percent that will go back for a third attempt”.
Ref: https://www.digitaltrends.com/mobile/16-percent-of-mobile-userstry-out-a-buggy-app-more-than-twice/

Doctors and healthcare workers are under huge time pressures, they just don’t have time to take on additional new tasks.  They have extensive rules to follow and records to fill in, often in disparate systems. Yet despite these constraints and pressures, most recognise there are huge benefits and savings if they can help their patients to keep healthier, better monitor and manage their conditions and avoid significant events and hospitalisation.

Several speakers discussed that connected health data systems offers clear opportunities to capture extensive information, but the challenge is understanding what is relevant and concise so that clinicians can help advise their patients.

From the experiences of new and developing systems some key insights were shared at the conference:

• Doctors just don't have the time to download and read through data from devices. Even though many doctors are ‘tech savvy’, they often lack the IT facilities to interface with so many separate systems.
• Doctors need more information than dose history and some condition monitoring data.  They want to know about relevant context, which might for example be food intake, exercise, air quality or even mood and sleep quality.  Without the right context the data doctors may consider it to be useless.
• Doctors need to trust the information they use, they don’t have time to check it for accuracy.  If they believe they cannot trust the data then they are unlikely to look at it.

An example reportedly gaining significant engagement from doctors, nurses and patients and delivering benefits to the healthcare providers was presented by Henrik Ibsen who explained how these key insights and understandings has led OPENTELEHEALTH to develop their scalable remote patient monitoring system.  Their concept is simple in essence:

• Each doctor can design and set outcome rules via a digital health form for one or more health conditions that can include contextual questions they can define.  Once the form is designed the Doctor can approve and lock it – so they know and trust that it is just the relevant information needed.
• Patients use an app to interact and respond with the form, which also allows importing of data from connected devices.
• Nurses can monitor many patients via a digital dashboard where the custom rules that are pre-defined by the doctor will flag up only the relevant items for attention or referral.

Henrik went on to explain that critical (and often possibly ‘hidden’) implementation and evaluation issues that need to be considered for such systems are:

• The automation of system deployment and software updates.
• System surveillance and ensuring high-availability.

A significant consumer behaviour in the connected world is the adoption of new ways of engaging with service providers: Consumers are now more willing to sign up to services with monthly fees for the likes of Amazon Prime, Netflix and Spotify.  How might this be relevant to the provision of healthcare?  Many of the biggest global business players as well as new start-ups are looking at this question.

A number of speakers noted that Apple, Google, Amazon, Microsoft, IBM and many other global giants who are already sophisticated operators in the connected world are expanding ever further into healthcare.  Big data analysis and augmented intelligence is expanding ever faster.

Compared to the world of Healthcare provider, Pharma and MedTech, these global giant digital organisations are relatively agile and adapt their business models into new areas either through their own initiatives or collaborations or by acquisition.

An impressive array of new start-ups and venture funded businesses are seeking to innovate and change the healthcare markets with niche and system level connected offerings, but will they gain sufficient traction and engagement?

Pharma businesses have been slower in following and engaging the connected world.  The Regulatory Bodies are still working out how to apply existing rules and are creating new rules to react to the changing world.

Most speakers believe the opportunities and benefits are significant, but the number of options and directions means it is not clear which routes will emerge the strongest.

Perhaps consumer engagement and level of trust in certain organisations and systems will be key?

The unanimous consensus from the conference was that connectivity in medical and healthcare systems offers significant benefits including:

• Improved (patient) population health and well being provided at individual level through ongoing lifestyle support including online engagement.
• Improved management and control of chronic conditions, delivered in the community and remotely.
• More effective targeted treatments to those that really need it.
• Reduced hospital visits and time spent in hospital.

These and other benefits offer significant cost savings to the existing payers and healthcare systems. Healthcare providers, insurance companies and politicians all say that prevention is better than cure.  Connected healthcare offers significant opportunities to support this.

However, most healthcare systems, especially centrally funded systems, have their budgets allocated to the major treatment centres, typically hospitals.

The vested interests in the huge budgets combined with the complex array of stakeholders presents a key challenge for policy makers and politicians.  It is not yet clear when and how the willing words will be backed up by real actions and critically to changes in the structure and allocation of the healthcare budgets.

Technology vs Implementation: Components for device connectivity technology are ready now; there will be further improvements in reducing size and costs, and also power management. The challenge space is around system infrastructure and interoperability with cybersecurity a focus of the Regulators.

• Patients are Consumers: Pharma and healthcare providers need to think of patients as consumers of connected information, they need to see the benefits without additional burdens.
• Clinicians: Engaging clinicians and hospitals is key, but they are hugely stretched and have no time for additional burdens.  Contextual information is key to the relevance of event data.
• Players: Pharma companies are waking up to connectivity, indeed connected devices are already on market and connectivity is the new norm in some areas, but there are giant global organisations entering from the internet and connected digital world.
• Payers and politics: Who pays?  Where is the funding currently located?  The UK and many other countries put the majority of their budgets into treatment care, rather than preventative healthcare.  Connected technology offers some of the biggest financial benefits by keeping people out of hospital.  Is there the political will to recognise this and change the funding silos?