In a first article we discussed how healthtech will be key in helping us to move from modern sickcare to a healthcare approach centered around prevention and the promotion of healthy lifestyles. We also discussed how patient medical records can finally be made available seamlessly to both patients and doctors. In this second article we will discuss three more challenges impacting modern healthcare systems, showing how healthtech can improve the way : new drugs are developed , waiting lists and clinicians shortages are addressed, patients adhere to prescribed treatments.

Drug development

The traditional drug discovery process is characterized by its protracted timeline, high costs, and significant attrition rates among drug candidates. While average time and cost for drug development can vary widely depending on the drug, the therapeutic area, and the regulatory pathway, we can estimate that on average drug development from target identification to market approval takes between 10 to 20 years¹. The cost of drug discovery and rollout can range between $2 billion to $3 billion or more², including the costs of research and development, clinical trials, regulatory fees, and the expenses associated with drug failures. This resource-intensiveness not only hinders innovation, limiting the development of potentially life-saving drugs, but it also contributes to the elevated prices of pharmaceuticals, posing a significant barrier to healthcare accessibility for many. It is difficult to fully grasp just how much in silico medical research, driven by the fast evolution of modern generative AI algorithms, can revolutionize drug discovery and development. In biology, historically, medical trials could be carried out in vitro or in vivo: in vivo trials are conducted with a living organism, often animals, while in vitro trials take place in a controlled environment, like a petri dish or a test tube, outside of a living organism. In the 90s a new type of study was introduced  in silico trials. In silico trials, which take their name from silicon-made computer chips, are trials conducted using computational models and simulation, which aim to replicate the biological processes of the human body and its organs. There are three main advantages to the use of AI in drug development: width of research, speed of execution, low costs. In the first phase of drug discovery, AI models with their computational power allow us to evaluate an extremely vast list of options when looking for a molecular target linked to a disease, potentially finding novel and unexplored correlations between molecules and diseases.   Carrying out the disease hypothesis and target identification phase “in silico” empowers laboratories to find potential molecule-disease correlations without the need for expensive and prolonged academic research. In a second phase of the drug discovery process, once the most appropriate target has been prioritized, generative AI helps us design the proper molecule to tackle the target by quickly generating a set of new molecules with the needed properties. These candidates are then prioritized according to how easy they can be made, most promising ones become” lead candidates” and are sent for clinical studies. This is the methodology used by NVIDIA-backedInsilico Medicine, a leading startup in the sector.  InSilico Medicine has recently entered Phase 2 clinical trials with an idiopathic pulmonary fibrosis drug candidate discovered with its AI platform. The cost and timing of Insilico Medicine’s path to preclinical candidate selection? An incredible 2.6 million US dollars and 18 months, against the standard 670 million US dollars in 4.5 years. In silico medical research cannot replace in vitro and in vivo research, which remain central in the clinical validation phases that precede approval and commercialization. However, Insilico Medicine’s numbers show that a proper use of AI can result in a very significant decrease in the financial resources and time needed to get a drug candidate to the first clinical phase.

Long waiting lists and clinicians’ shortage

Healthcare waiting lists represent a significant challenge for many countries, with millions of patients facing delays in accessing essential medical care. In England, this past July, 7.47 million people were waiting to start routine hospital treatment, the highest number since the NHS began to collect data on the issue in 2007³. Long healthcare waiting time is a complex issue, closely intertwined with the shortage for healthcare workers. The clinicians’ shortage is a global healthcare crisis originated by a steep increase in the demand for healthcare services due to population growth, increase in population age and prevalence of chronic diseases. As demand grows, supply is unable to keep up because of the low capacity of training programs and medical schools or budgetary constraints preventing the employment of more healthcare workers.  To this we must also factor in an issue of inefficiency of healthcare delivery, consisting in poor scheduling practices, underutilized resources, inadequate coordination of care.

When discussing healthcare waiting lists and clinicians’ shortages the public often focuses mainly on a need to increase the supply of clinicians, nurses and other allied healthcare practitioners. While this is

certainly part of the solution, the British NHS, which is the largest health organization in the world and the 5th largest employer globally, teaches us that simply increasing the supply of healthcare workers does not fix the issue. What allows countries like Germany, Netherlands, Denmark to have some of the best healthcare systems in terms of waiting time despite providing universal healthcare is their focus around three pillars: maximized supply of healthcare workers through proper funding of employment and training of medical workers; demand control through a focus on primary care and preventative medicine; extremely efficient administrative processes and healthcare delivery.

Healthtech can play a fundamental role in the enhancement of preventative care, as discussed previously. Furthermore, telehealth is proving to be extremely effective in maximizing the efficiency of healthcare delivery, thus optimizing the way healthcare systems respond to rising demand for healthcare services.  Telehealth refers to the use of information and communication technologies for improving the conditions of the patients⁴, it comprises any technology enabling healthcare practitioners to either monitor and treat patients or collaborate with other practitioners while not being in the same location⁵. Two forms in which telehealth presents itself are teleconsultations and remote monitoring devices.  Moving a significant volume of visits online, teleconsultations take weight off overwhelmed treatment facilities and minimize clinicians’ travel time, while also improving care of patients located in remote geographical areas. Teleradiology has experienced significant growth. With many European countries experiencing a lack of personnel to interpret medical images such as X-rays, MRIs, and CT scans, teleradiology broadens the pool of available radiology experts, helping countries address staffing shortages and reducing patients’ wait times. On another hand, remote monitoring devices decrease the need for recurring in-person visits thus saving time and ensuring better treatment of chronic patients. One notable success story in the realm of remote monitoring devices is the use of continuous glucose monitoring (CGM) systems for managing diabetes. In this field, with just under 2 million users and an impressive growth, Dexcom’s CGM G6 device is one of the leading solutions. By eliminating the need for frequent fingerstick tests and empowering individuals with real-time data, Dexcom’s G6 significantly reduces the need for in-person visits and facilitates remote communications between patients suffering from diabetes and their practitioners.

Patient Relationship Management (PRM) systems are also fundamental to the scaling of healthcare operations. PRM refers to IT systems implemented by hospitals or other healthcare facilities to efficiently handle the flow of information and patients. PRM systems significantly minimize waiting lines by ensuring clinicians have fast access to key medical information while facilitating real-time collaboration between doctors on clinical cases.  Through PRM systems, healthcare facilities can automate communications with patients, minimizing no-shows or reallocating unwanted appointments to patients who need them. Finally, PRM systems minimize the amount of time spent by healthcare workers on administrative tasks. One example of this is the possibility to issue digital digital prescriptions and referrals, thus significantly reducing paperwork and administrative delays.

In any country afflicted by long healthcare waiting lists, underutilization of resources must be minimized at all costs. Digital appointment scheduling apps, like Teladoc and ZocDoc in the U.S. and Doctolib in Europe, give patients visibility over medical appointment slots available in their location, allowing them to book appointments or interact with practitioners through the app, thus aggregating patient demand and connecting it to healthcare supply in a more efficient way.  On the other hand, American company Cohealo aims to solve the same underutilization issue, but for medical equipment. Cohealo connects hospitals allowing facilities in need of medical diagnostic equipment to request unused equipment for rent from other facilities.

Non-adherence to prescribed treatments.

Non-adherence to prescribed treatments is an issue which costs people their health, while at the same time costing healthcare systems billions of dollars yearly. Research shows that, if we look at the United States alone, every year around 125’000 deaths are due to non-adherence to treatments, with between $100 billion to $300 billion of yearly costs coming from this issue alone⁶. As the proportion of the population affected by chronic conditions grows, lack of adherence will soon be seen as the serious public health issue it already is. One of the most significant barriers leading to poor medication adherence is poor health literacy and, more in general, the difficulty of patients to understand the importance of drug therapy and properly follow the instructions given by their practitioner.

While it may be shocking to realize that patients don’t take their medications as prescribed about half the time⁷, it becomes easier to get behind this number once we realize how poor we are at managing the post-discharge phase of the patient journey. Today, once they leave a hospital or a clinic, most patients receive a document with a lot of information on their diagnosis and their treatment. The documents are often designed primarily for healthcare professionals, they are in fact written in medical language, which implicitly turns the patient into a passive subject. To tackle non-adherence to treatment, it is necessary to start exactly from the post-discharge phase, making the experience and tools we leave to the patients more interactive, with the purpose of effectively guiding patients through the necessary change in behavior and educating them on the importance of the prescribed drug therapy. A first solution to this issue can be found in the healthtech scope with digital patient support programs (PSPs). Patient Support Programs provide a system of homecare and online-based services to support patients, during their medical treatments. In other words, a PSP becomes sort of a virtual clinic in which patients can move freely to obtain from the specialist all the information necessary to improve their health. PSPs not only serve the purpose of educating patients and guiding them through the needed behavioral change, they are in fact a two-way tool through which the healthcare practitioner can also communicate with patients, measure the outcomes of the therapy and verify adherence. PSPs have proven to be effective in improving patient involvement in the treatment process thus maximizing adherence to prescribed treatments, minimizing hospitalizations, and containing healthcare spending. With 8 million users worldwide, MyTherapy by smartpatient is a leading PSP platform. The medication reminder and health tracking app aids patients suffering from chronic diseases in managing their treatment plans. smartpatient, responsible for developing and maintaining the MyTherapy app, partners with pharmaceutical companies and healthcare institutes, providing to patients disease-specific modules within the app. With the  majority of disease-specific PSP apps produced by pharma companies failing in terms of usage and user satisfaction, smartpatient’s bet on the “operating system” model has so far proven to be successful⁸.

[1] “Biopharmaceutical Research & Development: The Process Behind New Medicines”, 2020, PhRMA (Pharmaceutical Research and Manufacturers of America)
[2] J.A. DiMasi, H.G. Grabowski, and R.W. Hansen, “Innovation in the Pharmaceutical Industry: New Estimates of R&D Costs”, 2016, Journal of Health Economics
[3] “NHS waiting lists hit record high in England”, 13 July 2023, BBC
[4] Roberto Ascione, “The Future of Health”, 2022
[5] Roberto Polifrone, “Sanità digitale: inizia la rivoluzione?”, 2021
[6] Regina M. Benjamin, “Medication Adherence: Helping Patients Take Their Medicines As Directed”, 2012, Public Health Reports
[7] “8 reasons patients don’t take their medications”, 22 February 2023, American Medical Association
[8] “Patient Support in MS: The Service That Nobody Uses?”, 26 July 2021, smartpatient

If you think about technology as simply being able to do more with less, healthcare is a great place to apply those skills”   Steve Krupa, CEO, Psilos Group

On March 11^th, 2020, the World Health Organization officially declared the COVID-19 outbreak a global pandemic. 3 years later there seems to be a shared feeling of disappointment about how little healthcare systems have changed despite often proving to be inadequate when put under the significant stress of COVID-19. While structural and technological progress has indeed been slower than expected, there is no doubt the healthcare sector is experiencing a technology-driven evolution that slowly but inexorably, will change the way we handle our health. Between 2018 and 2022 the healthcare sector has attracted $415 billion dollars in venture capital investment, the highest volume among all sectors globally¹, signaling confidence from the market that there is still plenty of room for innovation and growth in global healthcare. The market’s confidence in the innovations of this historically traditional industry is evident through several positive indicators, such as governments lowering legislative barriers and increasingly opening up to collaborations with the private sector. Overall, we can positively say that a new mindset has been established: healthtech is no longer seen as a nice-to-have “add-on” to healthcare. It is a key ally in the effort to make healthcare more accessible, agile and effective. At the same time, health-tech implementation is a prerequisite to successfully competing as a business operator in the future.

Successful innovators start with current issues to envision what a better future could look like. We will try a similar approach and move through 6 challenges present across the healthcare value chain. Starting with today’s challenges, we will demonstrate how healthtech can improve the way: (1) lifestyles and prevention become an active tool to move from sickcare to healthcare, (2) patient medical records are made available, (3) new drugs are developed, (4) waiting lists and clinicians’ shortages are reduced, (5) patients adhere to prescribed treatments.

Unhealthy lifestyles

While a portion of pathologies are determined by a person’s genetic makeup, many others are linked to a person’s lifestyle. If we look at the United States, it is estimated that one in three Americans is likely to die prematurely from a condition closely related to lifestyle², such as poor diet, smoking, lack of physical activity, excessive alcohol consumption. The focus on lifestyle improvement to prevent pathologies is not new. We can find academic research recommending that major health policies should emphasize reducing unhealthy lifestyles dating three decades ago³. While the importance of lifestyle improvement is clear, we’ve so far been ineffective at supporting people on their path to behavior change. Behavior modification requires continuous monitoring and follow-up, a level of care that is often unsustainable for traditional healthcare systems. Becoming more effective in supporting the population on their path to a healthier lifestyle is fundamental to minimize preventable pathologies. This is crucial in a context of severe scarcity of healthcare resources and steeply rising demand for care.

Digital Therapeutics (DTx) have proven to be an effective support for people as they learn and adapt to a new lifestyle. Digital therapeutics is a fairly new term referring to a group of digital products – apps or software – that can be used as self-standing therapy or in support of pharmacological therapy. Digital therapeutics have been the fastest growing area within the healthtech space in recent years, with global VC funding increasing 4x between 2017 and 2022⁴. As attention from investors rises, so does consideration from regulators. While globlal regulatory agencies are still adapting to the fast growth of the digital therapy space, the American Food and Drug Administration (FDA) has already considered DTx as valid healing interventions for several years. Several DTx products focusing on behavior modification have received FDA clearance for prescription use. One example is Click Therapeutics’ Clickotine, a smartphone app aimed at helping users to quit smoking. Clickotine provides its users with a personalized treatment plan tailored to the user’s smoking habits, history and desired quit plan. The app, which utilizes principles of cognitive-behavioral therapy (CBT), empowers users to monitor their progress over time, providing motivation and craving management tools including guided breathing exercises, distraction techniques, and mindfulness practices. It is important to note that DTx effectiveness is not limited to lifestyle improvements: FDA approval has also been granted for DTx products that tackle chronic insomnia, attention deficit hyperactivity disorder (ADHD), panic and post-traumatic stress disorder, and drug addiction.

Prevention

Perhaps the largest impact digital technologies will have on healthcare will be to shift the focus from therapy to the care of people. Today, the center of care is the hospital, and the focus is on the treatment of acute cases. Our approach to illness is a reactive one as we wait for people to show symptoms before treating them: rather than providing healthcare, what we provide today is sickcare. The “patient journey” begins when a patient enters a healthcare facility, often through the emergency room, and it ends once the patient leaves the facility, with very little thought invested in what happened before or what will come after. As the tools at our disposal change and the proportion of the population affected by chronic conditions exponentially increases, it is time for our approach to care to evolve into a preventative model. If we manage to rely on digital tools and increase resolution at the primary care level, we will also decrease the number of acute cases, decrease healthcare spending and improve medical outcomes, all this while safeguarding hospital bed capacity. Three technologies that will primarily support us in this evolution are wearable monitoring devices, genomics, and artificial intelligence (AI).

Wearable monitoring devices allow for less invasive and continuous diagnostic analyses. They are particularly effective at preventing emergency situations by signaling potential conditions before the appearance of symptoms. By providing practitioners with a continuous flow of data that can be used for clinical decision making, wearable health monitoring devices reduce the need for patients to go to the hospital for routine visits, thus reducing the costs of care while also improving medical outcomes. The development of portable MinION devices by Oxford Nanopore in 2018 started the revolutionary age of personal genomics. Before MinION technology it was only possible to sequence strands of the human genome at a high cost in well-equipped labs. Today, with this technology, anybody can sequence DNA in their pocket for around US$1000. What this means is that we are rapidly moving towards a future where anybody will be able, through DNA sequencing, to learn which pathologies they are most susceptible to and implement preventative safeguards, behaviors, and precautions⁵. Today’s approach to prevention is based on generic suggestions for proper lifestyles. In the near future, pairing the data collected through personal genomics with the computing power of AI and machine learning algorithms, it will be possible to formulate a set of extremely personalized interventions taking into account the genetic predispositions of the individual and environmental factors, significantly delaying the onset of pathologies. But the shift to preventative healthcare enabled by personal genomics and AI will not stop at the individual level. One of the most significant trends in healthcare is that patients are increasingly willing to share their health data if in return they see a benefit to themselves and to the community⁶. Relying on patient consent to data sharing within the context of an international network of interoperable EHRs, collective medical data could be made available to the scientific community for large-scale processing of predictive patterns of pathologies, thus significantly supporting health research⁷.

Patient access to medical records

Data is regarded by many as the new gold in this digital age. When it comes to healthcare, data can make the difference between life and death as doctors rely on accurate patient medical history to make a correct diagnosis. In the past it was general practitioners (GPs) who held a complete view of the patient’s medical history. GPs, often referred to as “family physicians”, were particularly effective at this because they were often treating families across different generations, having therefore visibility over the extensive family medical history and potential genetic predispositions of the patient. While GPs remained anchored to their territory, people did not. It is now increasingly common for people to move nationally and internationally, transiting through their national public and private healthcare systems as well as through foreign healthcare systems. In this dynamic context, as data becomes more abundant and more fragmented across facilities, regions or even countries, we lack a system to collect and safely store medical data for each patient. Therefore, in the century of data, doctors often still make diagnoses relying on a medical history which only concerns the patient’s memory.

The challenge to facilitate patient access to medical records and to integrate records within an always up-to-date medical history is a complex one as it requires governments to develop a virtual space in which to effectively accumulate medical data, while ensuring the safety and interoperability of this data. Electronic Health Records (EHRs) are the obvious solution to the issue. EHRs are real-time, patient-centered digital records that make information available instantly and securely to authorized users⁸. EHRs contain medical and treatment histories of patients, together with information on allergies, immunization dates, radiology images and lab results. EHRs are designed to be shared among different healthcare providers. So why are we still talking about the challenges of access to medical records and medical history maintenance? Let’s take the European Union as an example. Research shows that, while over 80% of the countries in the EU have already rolled out national EHRs, often paired with appropriate legal frameworks and institutional environments, under 20% of countries in the EU have implemented fully interoperable EHRs⁹ Lack of interoperability means many patients may be unable to access or use their data as they switch healthcare providers, or as they transit from the public to the private healthcare system, or if they relocate. The issue with the implementation and interoperability of different national EHR systems is not only a technological one, but also a political one. Francisco Lupianez Villanueva, one of the authors of an extensive report¹⁰ on EHR interoperability from the European Commission, believes that “Europe’s healthcare systems are organized in very varied ways: they are centralized, decentralized, dependent on public insurers, private, etc. This variety means that it is difficult to create a definitive profile, which is a barrier to interoperability at the European level”¹¹. In the case of Spain and Italy, while the level of digitization may be high, the highly decentralized healthcare system results in a lack of interoperability even within the national borders, between different regions. It is necessary to reach an agreement on a common electronic health record format in order to unlock the safe flow of health data within and across borders and ensure patients -and their doctors- will always have immediate access to their updated medical records.

[1] Dealroom
[2] Roberto Ascione, “The Future of Health”, 2022
[3] McGinnis, Foege, “Actual causes of death in the United States”, 1993, JAMA
[4]Dealroom
[5] Roberto Ascione, “The Future of Health”, 2022
[6] “Consumers expect benefits from handing over their personal data”, 08 March 2022, Hannover Re
[7] “Questions and Answers – Commission makes it easier for citizens to access health data securely across borders”, 6 February 2019, European Commision
[8] “What is an electronic health record (EHR)?”, HealthIT.gov
[9] “Interoperability of Electronic Health Records in the EU”, 13 October 2021, European Commission
[10] “Interoperability of Electronic Health Records in the EU”, 13 October 2021, European Commission
[11] Agustín López, “The electronic health record is not yet in force in the European Union”, 22 April 2022, Universitat Oberta de Catalunya