What is Digital Health and who will the main players be?

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According to the Indian billionaire and former founder of Sun Microsystems, Vinod Khosla, “in the next 10 years, data science and software will do more for medicine than all the biological sciences together”. Dramatic as this statement is, we are already seeing how smart-phones in people’s pockets are starting to replace devices and procedures more commonly associated with GP surgeries and even hospitals. Digital Health has arrived.

PMICoverWikipedia defines Digital Health as:

The convergence of the digital and genetics revolutions with health and healthcare with the goal of reducing inefficiencies in healthcare delivery, improving access, reducing costs, increasing quality, and making medicine more personalized and precise.

The hope put simply is that this digital revolution will create better health care. A recent article by James Temple in the technology review site Recode, looked at this battle to own digital health which has now started with many of the tech giants including Apple, Google, Samsung and even WebMD’s all staking a claim. According to Temple, each of them are introducing a new type of service to collect data from the new fitness trackers and apps that are becoming available and to become the data platform of choice.

Apple is expected to launch their much talked about iWatch this autumn on the back of their announcement of ‘HealthKit’, their new health data sharing platform incorporated as part of their new operating system. This ‘watch’ in conjunction with their existing iPhone devices will not just tell the time but be able to track all manner of a wearer’s fitness and health including blood pressure, heart rate, blood oxygen level, body temperature, ECG and lung function. Samsung’s have already launched their similar S.A.M.I. framework in May as have Google who launched their Google Fit at their recent developer conference.

Each is trying to become the consumer platform of choice for health applications, a one- stop shop for your biometric data as well as personalised insights and health content. No one is quite sure how it will play out – but at this stage no one wants to miss out. Health offers these companies an opportunity to differentiate their technologies, to tie consumers into ecosystems and provide the next source of information that can be tapped for consumer insights.

Despite great announcements, to date the take-up has been slow and somewhat cautious by consumers who are not yet convinced that fitness devices, apps and services should matter to them. Even worse, whereas they may be happy for Apple of Google to track and share their heart rate or steps taken with other apps, they might not be too happy if this was shared with marketers or insurance companies. There is also a ‘so what’ attitude and most apps haven’t really excited the buying public.

But progress is rapid and these new devices and apps will get better and more accurate. The potential here is shifting the whole basis of healthcare from treating disease to preventing it. There is also the potential that perhaps, with enough data from enough people, these new technologies will help discover long-sought cures for diseases.

Who uses these devices?

The burgeoning industry is not without its issues. A recent online survey found that half of the people who own a fitness tracker no longer use it, with about a third dropping off within the first six months. A quick office poll here was even less flattering with an estimate that almost all were dropped within the first 2 months. What was also discovered probably not surprisingly was that trackers were for the most part used by those at either end of the health scale – the ultra-fit early adopters and those at the other end of spectrum with health issues who needed to monitor their activities and progress, and in real need of insight and motivation.

The rest of us only tend to think about health when we’re not well, consulting with Doctor Google when we’ve got that some strange pain or ailment only to forget again as soon as the condition is resolved and go back to previous behaviour the rest of the time.

This is one of the key issues concerning these new devices – why will healthy people monitor and track their health continuously for potential diseases that may be years away if at all?

The Social Media revolution where we swap and exchange all manner of personal details and activities won’t extend as far as health information. Could we be incentivised? Could we be made to do so for by government health battling obesity and diabetes?

Better devices, better apps

Digital Health companies will have to figure out how to deliver something of real, perceivable value. This would seem like an obvious statement but for the array of copycat devices cluttering the market today. Fitness trackers that measure steps, sleep and calories are very commoditised at this point –and the data is really only a backwards look at past activity, not a measure or assessment of one’s actual state of health.

No one has as yet come up with a “killer app”, but most observers believe it will start with better sensors. For the moment, companies are experimenting broadly, trying everything in the hope that something sticks.

In May, Samsung showed off its concept for the Simband tracker, saying it could integrate third party sensors that would monitor heart rate, hydration, blood pressure, respiration and glucose concentrations, among other things. Apple, which plans to unveil a smart watch later in October, appears to be working on an array of novel sensors and Google have already announced as part of their Google Glass research that they have a contact-lens which will detect blood sugar levels in tears.

A company in Israel has already earned limited approval to sell a bloodless glucose monitor in certain parts of Europe that uses a clip-on earlobe sensor. Others are working on wearable’s that monitor respiration, body position, brain activity and more.

Any such device that would allow diabetics to monitor their blood sugar levels, adjusting their diets or medications accordingly, without painful skin pricks would be a major breakthrough not just for patients but for everyday consumers who would better understand how diet affects health in real time. Dr Krishna Yeshwant working with Google Ventures compares it to people driving in more fuel-efficient ways when dashboards show fuel efficiency changes as one accelerates. If consumers see that eating a piece of cake immediately spikes their blood sugar, it might make themmore conscious of the effects of their actions. They’ll start to think twice before indulging – especially people already at risk for developing diabetes.

Big Data, Better Data

Key to the major technology companies is the data they will be collecting. They already have vast amounts of data on their users but adding biometric data gives them even greater insights.

A major concern for them however is the reluctance of consumers to use these devices and hand overtheir personal data until they see some benefit of how this information helps them. So central to this will be the personalised element that any new technology can provide, so that the platforms can help make the data more relevant, to the degree that they collect information from multiple sources and try to deliver unified individual insights from it.

As devices and sensors get better they will provide more accurate and useful data enabling them to move from making ill-defined “wellness” predictions to delivering information with clinical validity that doctors and researchers can put to use. Certainly input would be required from the medical community to make this advance.

Perhaps the most interesting detail in Apple’s unveiling of HealthKit, which aggregates data from fitness trackers, medical devices, apps and the phone’s own sensors , was the announced partnership with the Mayo Health Clinic and Epic Systems, a major provider of digital health records in the US. This suggests the data can feed into the official records for patients at clinics using Epic’s data systems; i.e. this ‘wellness’ collected data

will start to become part of your medical records. In Ireland for example, there is no reason why a future system might not be available for private clients of somewhere like Blackrock Clinic, with direct links to their data system and notification features to its consultants.

The Promise

A real-time feed of medical data into clinics and hospitals means your doctor can be alerted and can respond in the event ofa medical event. Thismodel has already emerged with companies like Medtronic in the US which develops a heart monitor that can inform doctors in the case of a cardiac event.

Devices will increasingly make medicine more convenient and deliver quicker and more accurate results. They could be used in the home and could be a significant boost for tele-medicine, saving people the cost and hassle of going for physical appointments. Thanks to plummeting prices and increasing speed of DNA sequencing, genomic data can also be incorporated. A recent global gathering in Dublin by HealthXL (http://healthxl.co) a collaboration of major corporations, challenged the healthcare and technology industries to develop new ideas around digital health to radically improve health and save lives. They believe these ideas will come from using digital health discoveries in the specific areas of big data, remote monitoring and behavioural change.

The bigger promise here is that collecting increasingly complete and granular medical data from millions and millions of people both healthy and sick, will offer fresh insights into the causes and possible cures for diseases. Everyone will effectively be enrolled in a global medical study of a length and scale unimaginable. According to Temple, “things that look like anomalies could reveal themselves as patterns. Genomic differences that make people more or less susceptible to diseases may light the way to better diagnoses and treatments”.

What might all this mean for Pharma?

The overriding premise to all this is a shift from treating disease to preventing it. In reality it means earlier detection which should hopefully mean better and more successful treatment. It may mean opportunities for Pharma to look at earlier treatment options – variations of existing products that could be marketed as early stage solutions.

There is also the possibility that large data capture from ever increasing patients means a large scale continuous clinical trial. This self-collected patient data may ultimately lead to better cures and treatments, possibly facilitated by Pharma getting access to and using this data. Society may deem that this anonymised data is of global and human importance and should there be available to all researchers to improve treatments.

There may be smaller scale and more local applications too. There is no reason why this monitoring and data capture could not be done in conjunction with clinics here in

Ireland. Pharma could help and assist them to better understand their own data and possibly using these new monitoring and tracking devices, setup clinical patient data trials. Certainly clinical trials in their current format may radically change in the coming years.

The disruptive change will only increase as according to Khosla, “Eighty percent of what doctors do, tech can do at a fraction of the cost”. What might this mean for doctors in the future?

Colm Lynam (@colmlynam)


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