Precision medicine could reduce the gender gap in clinical trials and genetic databases. This will lead to better care and improved outcomes for women and minorities.
An excellent webcast took place yesterday.
The key points are above on the MindMap I did. The presentation is available here: Deloitte_Dbriefs_Empowered_Healthcare_Consumer_Jun2015
The main take-home message: companies really should include the new health care consumer as a stakeholder. The patient has now more power than ever. He/she is more informed, more connected, more commited but also more demanding.
Telemedicine is on the rise. It could be extremely useful for remote areas as well as disabled people unable to visit the GP office. Availability 24/7 is also reassuring for chronic disease patients.
This is clearly one of the main trend in the healthcare industry.
A truly interesting article of the transformation of Medtronic Diabetes business
2015 could be a year to remember as the start of a new era in improved diabetes management thank to digital tools.
Diabetes management at Medtronic & deals history
It started several years ago but back in May 2001, a transforming event took place: Medtronic bought Minimed as well as an affiliated company for USD 3.8 billion. Looking only at Minimed, Medtronic paid USD 3.28 billion for USD 400 million in sales (8.2x 2001 sales). Despite its price, quoted as high by some investors and analysts at that time, the deal rationale was pretty compelling as it allowed Medtronic to enter the diabetes management arena. MiniMed offered a beachhead into the field of technological management of diabetes, one of the fastest-growing chronic diseases in the world and one that affects an estimated several millions of people. The devices produced by MiniMed help patients manage their insulin needs and monitor glucose levels.
Since 2001, several deals and partnerships paved the way up to where Medtronic is today. After having a look at my deals database, I can say that some of them clearly stand out:
– November 2004: agreement with Novo Nordisk on prefilled insulin cartridges;
– August 2007: co-promotion & co-marketing with Lifescan and Bayer of blood glucose meters (in USA together with Lifescan and outside USA with Bayer extended in 2011). These devices had wireless data transmission to insulin pums;
– June 2009: acquisition of PreciSense, a medical device company developing CGM (continuous glucose monitoring) technology. A step forward for “closed loop” systems dedicated to insulin delivery;
– August 2013: acquisition of Cardiocom, a developer and provider of integrated telehealth and patient services for the management of chronic diseases;
– June 2014: global strategic alliance with Sanofi, aimed at improving patient experience and outcomes for people with diabetes around the world. The priority is the development of drug-device combinations and delivery of care management services to improve adherence as well as simplify insulin treatment.
Medtronic has built its Diabetes franchise over the last several years and is still fully committed to be the leader in this field. This pledge could lead to the achievement of the digital pancreas, a fully autonomous device (closed loop system) monitoring blood glucose continuously and adjusting insulin doses as perfectly as the biological pancreas without human interaction. Some researchers already have prototypes, studies are ongoing, universities and hospitals are teaming up. The field is really at its boiling point!
Deals and partnerships in 2015
In this FierceMedicalDevices article, we can see Medtronic advancing its franchise by investing with determination and dedication in new technologies.
Many partnerships have been signed in 2015: Diabeter (a diabetes clinic and research center dedicated to providing comprehensive and individualized care for children and young adults with diabetes), DreaMed (artificial pancreas technology for integration into future Medtronic insulin pumps). Beyond healthcare companies, Medtronic is also expanding its network into consumer electronics with Samsung (integration of mobile and wearable devices to improve disease management with an Android mobile app) and diabetes data with a startup called Glooko. It also partnered with IBM Watson Health for next-generation disease management solutions.
All these deals are clearly accelerating innovation at Medtronic but in a patient-centric fashion as in every deal we can see the benefits for them and the management of their disease. What could be the next step? A deal with Apple in order to nearly fully cover all the mobile OS in the world.
For my conclusion I will quote Medtronic CFO, Gary Ellis: “We’re focused on transforming our diabetes group from a market-leading pump and sensor company into a holistic diabetes management company focused on making a real difference in outcomes and costs,” summed up Medtronic CFO Gary Ellis on the most recent quarterly conference call.
Engaging and empowering patients in disease management is crucial if we would like to build a sustainable healthcare system.
A mind-blowing report from IEEE about the human body’s operating system
Can we harvest digital health data from trackers and sensors to improve our health and well-being? I summarized below what you will find on the IEEE dedicated web page. I was amazed by the variety and depth of all the innovations presented in these pages. Some of them have certainly the power to be game changers in the health care world. I’m looking forward to seeing all the advances coming to life!
Reading the Code
Several technologies are close to the market and will help us monitor our health. A very good example is the biostamps developed by John Rogers from the University of Illinois. These tiny, stretchable and skin-like sensors are able to send information and data to our smartphone alerting us whether something is happening in our body. More and more complex data could be sensed such as blood oxygen, blood glucose and even muscle weakness or sleep patterns.
Another fascinating example that could change the life of Type 1 diabetes patients is the artificial pancreas. It links “data from an implanted blood-sugar sensor to a computer, which then controls how a pump worn on the hip dribbles insulin under the skin through a pipette. In its fully realized form, the machine would take the patient out of the decision-making loop”. Advanced versions of the system are currently in clinical trials. Continuous monitoring is a huge advance in the field of disease management. It could strongly lighten the daily burden of each patient.
Another field where wearable are very popular: athletes. They are always eager to test the last innovation in the wearables arena. Physiological measurements can be extremely useful to optimize training and rest periods, improve performance and avoid injuries. Sleeves, wristbands, sensors equipped with highest technology can really make a difference in the way we monitor and track performance.
A device rapidly diagnosing any medical condition or disorder… Sounds like science fiction, right? Like in Star Trek… Some of you may recall the tricorder. And guess what? It’s about to become reality thank to a competition launched by Qualcomm. 300 teams registered, 10 finalists which are about to deliver their prototypes very soon. Once the winner has been chosen, real life clinical trials will start and we will know if it’s really working as expected. It’s a huge step forward as it will allow the diagnosis (and maybe the start of a treatment) for a lot of people, not only in US or Europe but also in emerging countries where the lack of medical infrastructure is killing human beings…
Analyzing the Code
Technology companies showed their interest in healthcare only recently… It’s welcomed because without technology you cannot do anything with data sets. However, some people are afraid of their data becoming public and being hacked. I think that between these two extreme opinions, we can take the good from both sides and see what this can bring us. “Apple, Google, Microsoft, and Samsung, have all launched e-health initiatives, mostly based around smartphones and wearables. Indeed, the fast-growing health care business would seem a natural next step for the tech giants”. A lot of deals have been signed between pharmaceutical companies and technology firms: Google and Novartis; IBM, Apple, Medtronic & JNJ… These are deals to follow in order to analyze the outcomes. Great initiatives could really emerge and I think we are at the beginning of a new era!
The new era of precision medicine is making a big difference for patients. An open-source platform has transformed the way patients are being treated. Surgery is not always the best option in oncology for example and sometimes drug treatment is much more effective. A thorough and careful analysis of all the parameters will help doctors taking the right decision for the right patient at the right time.
Real-time epidemics modelling could have saved lives. Building treatment centers at the right locations, anticipating the spread of the disease (in this case, Ebola) and how to limit the contagion were several of the criteria used to run the model. We will never know what would have happen without such a model but globally we can say that modelling is critical in disease management. Additionally, it is not the use of a single model that will be helpful but the customized and accurate modelling for each and every epidemic, according to its characteristics.
Changing the Code
Performing surgical interventions at very small scales is becoming a reality. “Thanks to developments in microfabrication and other areas, researchers are pushing the limits on the size and capabilities of objects small enough to move through the human body”. “With the right design, researchers say, a microrobot—or a swarm of them—could deliver a highly targeted dose of drugs or radioactive seeds, clear a blood clot, perform a tissue biopsy, or even build a scaffold on which new cells could grow”. For the time being, tests have only been run in animals.
A new emerging medical field: electrical therapy. Vagus nerve stimulation has the potential to treat several conditions from migraine to asthma, even immune diseases. Progress is very slow and several failures have made history… but new startups are created and renew the interest in this type of technology.
W like Watson, the digital MD. Watson is based on machine learning: “bringing together computer scientists and clinicians to assemble a reference database, enter case studies, and ask thousands of questions. When the program makes mistakes, it self-adjusts. Researchers also evaluate the answers and manually tweak Watson’s underlying algorithms to generate better output. Here there’s a gulf between medicine as something that can be extrapolated in a straightforward manner from textbooks, journal articles, and clinical guidelines, and the much more complicated challenge of also codifying how a good doctor thinks.” Progress is under way.
Google Ventures managing partner’s fascinating view on the next wave of innovations in life sciences
He is a visionary for new technologies, new business models and he’s very smart when it comes to spot the next breakthrough innovation in life sciences. In this context, he wrote a captivating article on the 8 emerging technologies that could revolutionize the life sciences.
I propose a summary below but I agree it is a pure pleasure to read the entire article, so do it!
Many of the technologies that will transform healthcare already exist but have not yet been expoited at their full potential. Here is the list:
1. Artificial intelligence in healthcare – Machine learning and computer power will help drive better diagnosis and improved data analysis in order to support medical decision-making.
2. Understanding the brain – Decoding the brain is the key to find a cure for brain diseases as well as spinal cord injuries. With recent discoveries, we are at the start of a new era! Check here too!
3. Reinventing antibiotics – Widespread use as well as misuse are at the origins of the emergence of resistant bacteria. We have to really focus on this emerging threat by limiting the use of antibiotics and promoting research of new molecules. Have a look here for more!
4. Battling cancer – Amazing progress has been done over the last years and it is not finished yet! There is more to come. Additionally a real innovation will also be to make these treatments affordable for every patient.
5. Genetic repair – CRISPR, the gene-editing technique, allows the replacement and/or repair of any genetic mutation. Wow!
6. Understanding the microbiome – The 2.5kg of bacteria living on us are a treasure trove! The microbiome is an organ in itself, responsible for our health and wellbeing as well as our diseases and bad moods…
7. Organ generation – 3D cell culture and 3D bioprinting could be the solution to our ageing bodies… Spare parts…!
8. Stem cells – How to maintain the regenerative power of stem cells into adulthood?
All these fields are promising and could give hope to thousands of people in the world. More technology into healthcare for increased value is unavoidable. Let’s hope health and quality of life won’t become unaffordable.
Bringing affordable diagnostics to developing countries thank to digital technology! Brilliant & inspiring!
Healthcare transformation ahead
In this excellent article from Nature Biotechnology written by people at PureTech, we have the chance to get an overview of this new exciting field: Digital Medicine.
This convergence of technology and health will lead to several transformations: disease management, research, clinical trials, medical practice,… A new era is beginning!
However, opportunities are doubled by challenges. We need to tackle the lasts to profit from the firsts.
Why do we use digital medicine instead of digital health? According to the authors, digital health is too broad as it also includes apps and products not medically validated but simply focused to enhance people’s wellness and wellbeing.
Digital medicine is defined by “technology and products that are undergoing rigorous clinical validation and/or that ultimately will have a direct impact on diagnosing, preventing, monitoring or treating a disease, condition or syndrome.” (quote from the article p. 457)
Digital medicine themes
1. Continuous and remote monitoring. A tool to detect disease earlier leading to lower healthcare costs.
2. Digital phenotype. A additional layer of information enabling the construction of more accurate disease models in order to better understand them.
3. Remote disease management. Chronic disease management will be nearly effortless and the lack of data gap will allow doctors to improve their medical follow-up of patients.
4. The connected patient. The empowered patient. The engaged and sharing patient. Communities of patients.
5. Interpreting the data torrent. The challenge of integrating large and heterogenous datasets could be solved one day with powerful algorithms and machine Learning.
6. Security and privacy. The obtention of the patient’s consent is crucial and should be much simpler than today.
7. Opportunities and challenges. Increased scientific evidence but reimbursement issues, new field of research based on wearables, changes to patient-doctor interactions, integration of patient-specific data by the doctor.
Digital medicine is unavoidable and doctors will have to integrate this trend in order to optimize their relationships with their patients by empowering them and maintaining a two-way discussion toward a unique goal: better patient outcomes.
Nature Biotechnology Article (free)
More on Digital Medicine
Have a look at my posts on this topic.
Rock Health Founder On The Future Of Digital Medicine – 2015 – TechCrunch (Video)
How Digital Medicine Will Soon Save Your Life – 2014 – WSJ
Medicine goes digital – 2009 – The Economist
Digital Medicine – Implication for Healthcare Leaders – 2003 – Healthfutures.net (a nice document from 2003, projecting the reader in 2013… with futuristic visions sometimes…)
What is digital medicine? – 2002 – D. W. Shaffer (the first article on the subject)
How digital games can inspire and motivate children — and result in better learning outcomes
An extremely interesting article on gaming and its impact on children learning skills will maybe lead to the prescription of game sessions in the treatment of psychological ailments.
We are entering in an emerging field called therapeutic neurogaming.
“It’s built on two basic ideas: First, that the brain is “plastic” for far longer than scientists once believed, so healing can be achieved in schoolchildren of all ages without drugs, through basic neurofeedback therapy. Second, that therapy doesn’t just happen — it requires work and patience and a regular dose of practice.” (Quote from Medium Article)
I’m a strong believer that games will be fully part of our lives and not only part of our hobbies in the near future.
Three years ago I read a book written by Jane McGonigal, an expert in gaming and gamification: Reality is broken. I have only one word: brilliant. She walks you through the gaming universe explaining you all the type of games and how they can be used to improve life, well-being, relationships,… She is about to publish another book in September 2015: SuperBetter: A Revolutionary Approach to Getting Stronger, Happier, Braver and More Resilient–Powered by the Science of Games. I’m really looking forward to it.
It is a real trend we have to count on. The nice fact: it is not a boring trend… it is fun!! and there is probably more to come!!
More on the benefits of gaming:
The Game Believes in You: How Digital Play Can Make Our Kids Smarter – 2015 – Greg Toppo
Cognitive Benefits of Playing Video Games – 2015 – Psychology Today
The Benefits of Playing Video Games – 2014 – American Psychologist
The DeanBeat: Neurogaming is a nascent market fueled by brain games and sensors – 2013 – Venture Beat
Reality Is Broken: Why Games Make Us Better and How They Can Change the World – 2011 – Jane McGonigal + her TED Talk
Gamification to improve our world – 2011 – Yu Kai Chu – TEDxLausanne
Companies or Institutions developing therapeutic neurogaming:
Gazzaley Lab (Neuroracer)
Akili Interactive Lab (Project: EVO)
PlayNice Institute (MindLight)
PuzzleBox (Orbit Helicopter)
Emotiv (EEG for game control)
Telemedicine = high-quality care for a broader population but…
This article, written by Jeremy M. Kahn and published in the New England Journal of Medicine, details the profound implications for the healthcare system. There are 2 main positive impacts:
1. Potential to substantially expand access to high-quality health care. Geographic barriers will be overcome, community-based care will be easier to provide to the one in need, healthcare will be more convenient not only for patients but also for providers.
2. Capacity to substantially reduce health care costs. For every stakeholder, telemedicine has real cost-saving possibilities: for providers, it reduces the time and space needed (more patients can be seen); for patients, it dramatically lowers travel expenses and productivity losses; for payers, it leads to a double-impact with more productivity in one hand (and lower costs) and the ability to have better care for patients living in remote locations.
Despite these advantages, challenges remain:
1. Concerns about effectiveness and cost-effectiveness. Theory is nice (see above) but what about reality? Telemedicine studies are methodologically weak… none of them include patient-reported outcomes. Solution? Do more research in order to prove the real benefits of telemedicine.
2. Technology issues and implementation questions. Solution? Study the context and provide a roadmap.
3. Lack of regulatory and legal frame (especially liability). Solution? Health care régulations revision.
4. No understanding of unintended consequences: financial (more encounters = more costs); interprofessional relationships (lack of continuum between a nurse and a doctor, a team; difficult collaborations as they are not long-term oriented); change in doctor-patient relationship and trust building. Solution? Integrate telemedicine in the current healthcare system; mix telemedicine with traditional face-to-face encounters with patients.
Technology is key in improving efficiency but it has to be used widely and as a complement (and not substitution) to the traditional system.
Another excellent article on WIRED: Video is about to become the way we all visit the doctor
More on Telemedicine: American Telemedicine Association
A survey of US doctors created by Accenture shows improvement in EHR use. Good news!
5 take-home messages:
1. 79% of US doctors are more proficient using EHR. They use EHR to enter patient notes electronically, e-prescribe and receive clinical results
2. They communicate with their patient electronically more frequently and regularly use software-based clinical decision support systems
3. Patients are also engaged with these new tools for requesting prescription refills, email their doctors and access their medical information online
4. EHR lead to a lot of benefits: better patient engagement and satisfaction; improved understanding of their medical condition; more valuable communication with their GP; records accuracy
5. EHR challenges: more user-friendly EHR softwares need to be implemented as doctors complain about the use of EHR; doctors do not always think of accessing EHR of a new patient (seen by another doctor)
Conclusion: the progress shown by the report are good news but there is still work to do and improvements to implement.
More resources on EHR:
My blog posts on digital health
Intro to EHR: Introduction_to_EHR_McGrawHill_2011
Implementing Electronic Health Records in Hospitals – 2014 – Albert Boonstra & al. – BioMedCentral
Integrating Electronic Health Records Into Clinical Workflow – 2014 – Svetlana Lowry & al. – US Department of Commerce
Using Electronic Health Records to Improve Quality & Efficiency – 2012 – Sharon Sillow-Carroll & al. – 2012 – Commonwealth Fund
IBM teams up with Apple and other key health players to be in one of the hottest life sciences fields today: digital health. For more on this topic, check the dedicated category of my blog.
Using Apple’s HealthKit Platform, together with IBM app, will allow users to track their heart rate, calories burnt and cholesterol levels (and maybe much more data in the next future). The next step, if users are willing to do it, is to share these data with medical researchers, doctors and, why not, insurance companies (like in this NYT article). This emerging trend is called Data Philanthropy.
The current trend is now to have deeper ties between the life sciences and tech/IT fields.
It is fascinating to study health data trends from craddle to grave but the biggest challenge is to organize available data and electronic health records in order to better care for the patients and improve health outcomes without increasing costs.
IBM is fully committed as it also indicated it will commercialize dedicated tools for medical researchers, doctors and insurance companies with two goals in mind: support clinical trials (enrollment, data collection & analysis) AND contain healthcare costs. IBM already has a big data computing system named Watson, able to query this huge amount of data and spot trends.
“The average patient will collect a terabyte of medical data in their lifetime. Our analytics will be able to find the dots, the clues that are eluding us, and find new breakthroughs,” said Michael Rhodin, senior vice-president of IBM Watson.
The two other deals done with J&J and Medtronic are showing the real life impact of digital health:
– J&J has asked IBM to build a “coaching system” to ensure patients are fit enough to undergo spinal surgery or joint replacement, and to encourage them to do the right exercises after their operation.
– IBM is also working with Medtronic on a smart diabetes treatment system that would take readings from a patient’s glucose monitor and ensure their insulin pump dispenses the precise amount of drug required.
In this article written by Kim Zetter in Wired, it is explained that drug infusion pumps could be controlled by anybody anywhere. “Hospira systems don’t use authentication for their internal drug libraries, which help set upper and lower boundaries for the dosages of various intravenous drugs that a pump can safely administer. As a result, anyone on the hospital’s network—including a patient in the hospital or a hacker accessing the pumps over the internet—can load a new drug library to the pumps that alters the limits, thereby potentially allowing the delivery of a deadly dosage.”
Awareness should be raised inside and outside the hospital but, more importantly, in the medical technology industry. They should hire experts in security as well as former hackers to make their devices safe enough to be used in any setting worldwide.
Technology will drive more value, patient empowerment, care quality increase and more collaborations
They talked about the landscape as an introduction and more specifically about 2014 digital health funding where Analytics and Big Data were one of the hottest spot together with Health care consumer engagement (see more on page 5 of the slide deck below) or by following this Rock Health link.
Big data is today unavoidable in health care. We need to manage all this amount of information in order to better care for the patients. The transformation will happen quickly as many science and technology breakthroughs are advancing faster than Moore’s law.
Deloitte spotted several trends:
– Harnessing the real potential of the Internet of Things by connecting some of the available sensors and objects in order to create a chosen and deployed network.
– Biosensing wearables allowing a more natural way to interact with the network to select services.
– Cognitive computing augmenting human thinking for enhanced decision-making and quicker data processing.
– Amplified intelligence to increase productivity of workers and helping them.
– Cheap and Good Complexity. No more financial barrier for product design and customization.
– Cyberdefense will be crucial with increased connectivity. Machine learning and predictive analytics will help in this field.
– New roles in top management: Chief Digital Officer, Chief Data Officer, Chief Innovation Officer,… and the need of a Chief Integration Officer to promote collaboration between these functions and the more traditional responsibilities.
Technologies are fundamentally changing the health care landscape. It has implications for all the stakeholders: patients, payers, health care providers, researchers, life sciences and technology companies, governement… But in the end, it will enable the whole system to evolve toward more value (instead of volume), to empower patients/customers, to increase the quality of care and to encourage more collaborations.
“We actually have the tools in the life sciences to achieve anything that you have the audacity to envision.”
This Bloomberg article takes you through the world of Google Ventures and their vision of the future. 36% of their USD 2 billion portfolio is invested in Health & Life Sciences.
“If given the choice between making a lot of money or finding a way to make people live longer, what do you choose?”: it is the statement made by Bill Marris, president and managing partner of Google Ventures.
The Google Ventures investment history in Foundation Medicine is amazing. It created products like its Interactive Cancer Explorer, which is a kind of Google for oncologists, allowing them to do research and devise treatments for their patients. Other compelling companies where Google Ventures invested: Flatiron Health, specialized in cancer big data analysis; DNAnexus, focused on a global bank of genomic information; Transcriptic, operating robot-run small labs. And many more like: AdiMab, 23andMe.
“We aren’t trying to gain a few yards,” Maris says. “We are trying to win the game. And part of it is that it is better to live than to die.”
Bloomberg Article (including an interview with Bill Marris)
A list of some of the projects at Novartis relying on digital health:
- pills and inhalers with sensors that will improve patient adherence by reminding them to take their medicine (Proteus Digital Health);
- clinical tests that rely on Microsoft’s Kinect, the motion-sensing technology used with Xboxes, to measure walking speed and balance in people with multiple sclerosis;
- Google contact lenses that focus automatically and can measure diabetics’ blood-sugar levels from their tears;
- remote monitoring of patients with technologies developed by companies funded through the USD 100 million fund founded by Novartis and Qualcomm.
This article is one among the World-Changing Ideas edited by Fast Company. At-home diagnostic tests can change the way we interact with our family doctor. This article shows several tools that can help us in diagnosing diseases and seeking help by calling a healthcare professional when necessary.
This trend has 2 implications: it can help emerging markets and remote areas but in developed countries it will contribute in containing healthcare costs.
1. Maintaining EHRs (Electronic Health Records)
2. Addressing physician concerns
3. Leveraging meaningful use
Personally, I think it is quite normal as mental health is a long-term ailment and cannot be treated in one single day. We need more long-term perspective on the real outcomes. Another crucial point to mention: in mental health, patients start to feel better when they are heard and understood by doctors, nurses and relatives; when they can put a word on the malaise they are feeling daily; when you take time with them.
Mental illnesses are a huge burden for the society as demonstrated in a recent study by The Economist.
In the next future there will be a combo of chemical drugs supported by apps that will help patients to better cope with their disease and to better adhere to the treatment schedule and regimen.
Find out more:
Akili (video games to treat autism, ADHD, depression, traumatic brain injury)
Pear Therapeutics (linking prescription drugs with apps)
Bravemind (PTSD treatment for veterans)