Bringing about digital health change

The Internet of Things is tantalising, its very title suggesting an almost mystic kingdom with bubbling cauldrons of technological possibilities.

Through the mists is a future that is tailor-made for projections and it is easy to lose count of how much connectivity promises to do for healthcare.

Cisco predicts a $48bn pot of business could be up for grabs over the next decade as traditional health systems go digital to meet the daunting demands from ageing populations and chronic illness.

A clear vision of the future has been hard to pin down as progress is furred by a lack of cohesion in innovation. Developers have raced ahead with ingenious devices but the key now is to get them all to play together.

Everyone can see the value of using smart phones to monitor aspects of their health but two, three or four of them? Programming and pairing units, dancing through operating systems, is hardly enticing.

But Qualcomm Life's senior vice president and general manager Rick Valencia believes his company's cloud-based 2net platform will give healthcare's Internet of Things a synchronicity so that devices and data capture can work in harmony to benefit patients, clinicians and industry, addressing concerns about maintaining revenue in shifting markets.

“Chronic diseases eat up 85% of healthcare spend and are primarily cared for in emergency departments or doctors' surgeries when, for the most part, it doesn't need to be especially if you can connect with patients and keep them on the right medication,” he says.

“With 2net, we have made the multiple devices from multiple manufacturers work in a kitted way, working together and without the patient having to do much. We have a gateway technology that has a night-light-looking box you plug in a wall to connect to a smart phone and tablet. It automatically captures the biometric data and puts it into the system of our customers so they can analyse it and provide feedback to the patient to inform them what to do next.” 

The San Diego-based company has moved from 'evangelising' about digital healthcare to stoking the fires of innovation with the $10m X Prize competition to devise an earthly version of the Star Trek tricorder used to diagnose conditions from a single unit. A winner from the ten finalists, who have spent three years developing handheld devices that must be able to check 15 conditions, will be chosen early in 2016.

In ten years time we will not recognise the way care was delivered today

Opening up closed health systems
Qualcomm Life's own future gazing says 1.7 billion people will be looking to their smartphones and tablets to take care of their health by 2017 by which time the digital health market will be worth $26bn.

It is forging ahead with European collaborations and has partnered with Roche and Novartis on separate projects and that indicate that industry is aboard. It is running a £100m investment fund with Novartis to target 'beyond the pill' technologies and services.

“The problem is that all the systems in healthcare that manage health and obtain data are closed and do not communicate,” adds Valencia, who has a 25-year track record of telecom innovation and founded Qualcomm's healthcare subsidiary. “We want to build an open platform that creates inter-operability between device manufacturers and provides a point of connection with the patient regardless of where they are. It is an information superhighway that enables data to flow and for caregivers to receive full and continuous health information, as opposed to sporadic check ups.”

Secure and reliable health data, from sensors in the home, wearable tech, patches or ingestible diagnostic devices, provides vital intelligence to spot trends and muscle-up preventative programmes that, via technology, can be personalised rather than a blunderbuss public health approach.

“The intersection of mobile technology and medicine is a very big and important area and over time something that will have a more capitated payment model with governments and insurers paying for outcomes rather than procedures,” he adds. “This means everyone in the value chain is going to have to prove the value of their solution and the outcomes it generates. It will no longer be acceptable to have the best brand with the best sales team because the buyers are going to be much more picky about the proven outcomes.

“Industry sees that as a new reality. They will have to go into their customers and say this works 20% better than the competition and here are the published studies that prove it and the only way you can get to that clarity is by having data from patients.

“It is the future of healthcare and in ten years time we will probably look back and won't recognise the way care was delivered today. In the future, there will be some connected element to every medication, every diagnostic, and every therapy. In any other industry, the key to optimising the product or the service is digitising the data, analysing it and feeding it back be it to an assembly line, building an engine or taking care of someone's health.

“Those that don't switch on will get left behind.”

Working with pharma
Roche believes it is on to a winner with its CoaguChek system, developed in collaboration with QL, to help warfarin patients self monitor so they don't have to travel to and wait in hospitals for weekly or monthly blood tests.

“It has been deployed on a small scale but is seeing very good results,” adds Valencia. “We built a solution around a specific diagnostic device but their intent is to use that as a platform to leverage all of their diagnostic devices. It will expand from Coaguchek. I think they will be one of the first healthcare companies to reach a significant scale with a connected solution like this.”
The potency of generating data is clear in their partnership with Novartis in its pursuit of 'Trials of the Future'.

“The question here is how do we leverage technology to make recruitment and retention of participants easier, to improve the accuracy of the patients' data, make the systems more efficient and analyse the data faster-creating solutions in a trial environment, bring to market as connected therapy?” says Valencia.

“By using tech to get drugs to market faster, Novartis is learning to create digital therapeutics and diagnostics which they will ultimately to bring to market.”

Thinking differently about digital health
But a cultural shift is still needed for a brave new world where patient-caregiver contact is drastically reduced.

“The challenge that concerns me most is that leap of faith from the way healthcare is currently practiced and the way consumers or patients expect to receive care. Getting caregivers to change the way they work is a stressful and scary proposition for them, and patients, particularly in the developed world which thinks that more care, rather than less, is better under all circumstances. “The thing that worries me most about getting this growing at scale is the emotional mindset of industry and those receiving care. We need to encourage them to accept these types of solutions can make a difference and, if we engage with them early, it can avoid the way we get care today rather than getting more of it.”

The intersection of mobile technology and medicine is a very big and important area

He cites the struggle the Danish government is having as it strips out 20% of its hospital beds and invests £1.5bn in telehealth to treat patients at home, adding: “The only message the populous is getting is that 20% of beds are going and they are saying 'how am I going to get good care?' It is a big political challenge.”

Regulators are not a problem, Valencia states, and providers - such as the NHS - have shown openness to change, which is enshrined in the UK government's Five Year Forward strategy.

 “The miracles that can occur just by having the data in a format where it can be analysed are phenomenal. In ten years we will be in an age where we won't believe the amount of time, money and frustration involved in the way we received care.

“By then, we are going to be wearing stuff and it will be around our homes and workplaces. We will even ingest devices. This will help keep us well and mindful of what we need to do to maintain our health.”

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