6/n: Beyond DH innovations – What steer is needed?

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Summary: (reading time: ~ 6 minutes)

Tech developments that can influence Digital Health

• Health Apps
• Robotics
• 3D printing
• Nanotechnology 
• Augmented reality/virtual reality/IoT
• Blockchain
• Quantum computing

What do we need to be mindful of as we are hurried into the potent future? 

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Digital Health has seen remarkable strides in the last decade, and the future is even more exciting. My previous two blogs [here and here] covered the IISc-NSE Talent Sprint course learnings on these aspects. The course focus was on the innovations in the fields of AI/ML and medical imaging. However, the digital disruption in Healthcare is also accentuated by the other areas’ advancements. Simultaneous innovations in multiple fields are creating potent exponential changes in our lives. 

This post covers some of the developments in other related fields. More importantly, we must be cautious as we are pushed into handling super-human capabilities. In the scale of homo-sapiens evolution, the recent advancements happened only a blip of a second ago. Yet, even this short period has pushed us into novel social structures (equality or crumpling family, for example) and economic stricture (paper money or just about a generation has drawn retirement pensions, for example). 

In that sense, we are severely underprepared for even further god-like capabilities. We haven’t internalized the capabilities developed so far yet; historically, new cognitive abilities have taken thousands of years to assimilate and adjust. Nevertheless, despite the short hindsight, we can proactively steer the developments to navigate known challenges. Like Bayesian assumptions, we could minimize some of the invariable growth pangs of adaption. Some of the questions we need to ask are explored in this blog. 

The views are mainly formed from the article: THE FUTURE OF TECHNOLOGY IN HEALTH AND HEALTH CARE: A PRIMER – Canadian … (readkong.com)

Tech developments that can influence Digital Health

Healthcare delivery is a complex set-up with myriad enabler layers. Some of the developments mentioned below have been around for some time but have yet to become mainstream. Some others, like blockchain and quantum computing, are at the bleeding edge yet.

Health Apps: 

Health apps have taken off in the areas like physical fitness and healthy living, facilitating remote consulting and monitoring, medication/ appointment reminders, diagnostic aids, and reference tools. In addition, after the pandemic, mental wellbeing apps have proliferated with regulatory support (e.g., Wyasa https://www.wysa.io/). 

Mobiles are increasingly becoming more capable with various sensors. With growing RAM and cloud access, they might become critical components of edge computing (taking some computing load) while interfacing with increasingly connected IoT devices. MHealth holds the promise of making health care more accessible, affordable, and responsive in countries with scarce health human resources.

Robotics:

Robot-assisted surgery has succeeded in minimally invasive laparoscopic surgery; it is used in diagnosis and treatment in remote locations.  Considerable R&D is happening on robotic exoskeletons, with the potential to assist walking in persons with spinal cord injury and prevent falls in elderly persons.

3D printing:

3D printing is used to develop new surgical cutting and drill guides, prosthetics, and the creation of patient-specific replicas of bones, organs, and blood vessels. It is estimated that 3D-printed prostheses will benefit some 30 million people worldwide, particularly those in low-income countries. A research group at Harvard reported in 2016 on a bioprinting method for creating renal-proximal tubules, a step toward the eventual bioprinting of a human kidney.

Nanotechnology:

Nanotechnology is about the design, synthesis, characterization, and application of materials and devices on the nanometre scale (one billionth of a meter). As a perspective, human hair is approximately 80,000 nm wide! 

Medical nanotechnology has focused on drug delivery and regenerative medicine. Biodegradable nanoparticles deliver drugs to accurately target and help a controlled release. Research is being done to deliver drugs across the blood-brain barrier to treat diseases of the central nervous system and brain tumors. In orthopedics, cartilage replacement and cartilage tissue engineering are being explored. In the future, nanomedicine will contribute to longer-lasting implants and lower infection rates but concludes that it is still in a stage of infancy.

Augmented reality/virtual reality/IoT:

VR simulators help training in laparoscopic surgery, neurosurgical procedures, and echocardiography. A more recent application enables the remote expert to see what the local surgeon sees and the local surgeon to see what the remote expert is doing.

Smart clothing has evolved significantly. Sensors at the wrist, chest and ribs, arm, and caps (EEG) provide multiple bio-marker signals. However, as of now, an efficient solution for comprehensive monitoring of gas detection, motion tracking, and vital sign monitoring in a single device hasn’t yet evolved. 

Smart drugs have been created too. The United States approved the first digital drug in 2017. This is an antipsychotic pill treating schizophrenia, bipolar disorder, and other mental illnesses. The tablets have an embedded chip that mixes with stomach acids and sends heartbeat-like signals to an adhesive patch on the patient that records the dosage and time of ingestion and relays it to a smartphone app.

The above advances are enhancing current Digital Health capabilities significantly, but the two disrupters below might cause the disruption in unexpected ways with potent powers not yet imagined. 

Blockchain:

Blockchain Economy has created new trust mechanisms and has truly transformative paradigms. If you are interested in a more philosophical take, please read here. Blockchain innovations focus has been on the financial services sector so far. But the Healthcare sector, with its complex structure, cost, and reach, is getting attention too. 

The National Coordinator for Health Information Technology issued a challenge in 2016 to develop white papers on applications of blockchain technology to EHRs. The 15 finalist papers cover exciting possibilities like secure storage of EHRs, national interoperability, alternative payment models, and patient-reported outcome indicators for mental health.

An engaging compilation of feature-wise benefits is provided by Tsung-Ting Kuo, Hyeon-Eui Kim, and Lucila Ohno-Machado:

• Decentralized Management: Patient-managed health care records – Real-time claim processing for insurers
• Immutable Audit Trail: Unalterable patient records – Improved claim auditing and fraud detection for insurers 
• Data Provenance: Source-verifiable medical records – Verifiable records for claim qualification for insurers
• Robustness/Availability: Reduced risk of patient recordkeeping – Enhanced accessibility of patient data for insurers
• Security/Privacy: Increased safety of medical records – Increased security of patient medical insurance information for insurers

In 2016 Estonia signed with the firm Guardtime and its blockchain technology to secure the EHRs of its 1.3 million citizens. In the United States, the CareX Blockchain Platform enables patients to manage their health information, seek virtual care and pay for a full range of health care services using tokens on a blockchain.

Quantum computing:

Quantum computing enables perhaps the most disruptive possibilities. The computing power increases exponentially, and the new ways of computing paradigm in the probabilistic outcomes will be unlike anything we have seen in the binary logic today. The application of this capability to the pharma industry is articulated well in this McKinney & Company insight. 

• The current drug discovery and development process is expensive and inefficient — a new chemical entity takes, on average, about $2 billion and ten years to reach the market. In the computer-aided drug design (CADD) process, increasing the accuracy of molecular simulations incurs a punishing exponential computational cost.
• Quantum computing could transform how we think about the simulation of solids, molecules, atoms, nuclei, and subatomic particles, helping to overcome the scaling limitations of classical computational methods. We currently focus on molecular similarity, protein structure prediction, and protein design, but QC would also be relevant to quantum chemistry, QSAR (Quantitative structure-activity relationship) models, and molecule docking. 
• In the long term, quantum computing will enable computational tools for antibody design; it would help create novel antibody structures and motifs for addressing undruggable targets. Large proteins, mainly as antibody therapeutics, are a market worth close to $200 billion.

What do we need to be mindful of as we are hurried into the potent future? 

We know the current shortcomings of Healthcare delivery, and the exciting future offers us an opportunity to steer the Digital Health evolution to be better equitable, accessible, and affordable. 

Some of the questions that we need to address:

1. Customer as Optimal Resource: The patient is the most underutilized resource in medicine. As Healthcare evolves from illness protocols to wellness space, how do we set up healthcare constructs so that patients’ time is valued and they are enabled to be more actively engaged in their health and health care? 
2. Equitable access: How can we ensure equitable access to new health technologies regardless of geographic location and socioeconomic/cultural characteristics? 
3. Siloed legacy systems: Connected health data can create capabilities to advance equitability and reach and reduce costs; what will it take to expand beyond siloed legacy data systems? 
4. Support innovation: How can we better support innovation and commercialization and invest in big data and analytics? Drug discovery is an example of long-tailed inefficiencies, as are the current regulations requiring significant proof of safety, effectiveness, and manageable side effects. The funding, organization, and delivery of health care have not fundamentally changed since the advent of medicare in the 1950s and 1960s. The delivery of health care occurs mainly on a face-to-face basis and is funded based on volume. 
5. Manage Data: How do we manage the data storage? Health information is being captured and linked across many points of the health care system and beyond; who will be custodians and stewards of personal health information? How do we create the capabilities, skillsets, and expertise needed for these data custodianship roles? 
6. Privacy & discrimination: How can patient privacy be protected so that individuals are not discriminated against based on their environment and/or health and health care history? 
7. Educating health professionals: What changes in health education, if any, would promote the more effective use of health information by health professionals? A few barriers are overstressed health professionals, lack of compensation to use digital tools, e-mail, and the requirement for an original signature impeding electronic prescribing. Provision of virtual care across provincial boundaries may require the physician to be licensed in both the physician’s residence and the patient’s home jurisdiction. 
8. Inadequate health information: Daily access to healthcare data is sub-optimal for the healthcare professionals to provide quality care. What information, if any, is missing or inaccessible, and why?

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I currently work full-time at Swiss Re, Bengaluru. The blogs and articles on this website www.balajos.com are the personal posts of myself, Balachandra Joshi, and only contain my personal views, thoughts, and opinions. It is not endorsed by Swiss Re (or any of my formal employers), nor does it constitute any official communication of Swiss Re.

Also, please note that the opinions, views, comprehensions, impressions, deductions, etc., are my takes on the vast resources I am lucky to have encountered. No individuals or entities, including the Indian Institute of Science and NSE Talent Sprint who have shown me where to research, or the actuarial professional bodies that provide me continuous professional growth support, are responsible for any of these views; and these musings do not by any stretch of imagination represent their official stands; and they may not subscribe/support/confirm any of these views and hence can be held liable in any vicarious way. All the information in the public space is shared to share the knowledge without any commercial advantages.