Blog. The future of healthcare. Part 4 of the series ‘Disruption and new business models’

We live in a fascinating and rapidly changing world. Together, technologies such as robots, artificial intelligence, the Internet of Things, self-driving vehicles, 3D/4D printing, solar energy, nanotechnology, biotechnology and quantum computing are initiating a 4th Industrial Revolution. We are witnessing new products, new methods of production and new business models across all industries. This is Part 4 of the series Disruption and new business models, discussing the future of healthcare.

Robotisation

The times when robots were used solely for repetitive and static operations within a factory environment are now behind us. In the world of today, robots are fitted with sensors and therefore aware of surrounding people and objects. They have also become cognitive systems, able to communicate using common language and possessing a capacity to learn. Within the healthcare sector, such abilities allow for the implementation of robots in a variety of settings.

In pharmacies, we find the Consis robot from Willach Pharmacy Solutions playing a major role in order preparation. Surgeries are performed using the Da Vinci; a remotely controlled, extremely precise and stable robotic system. Riba is a robot nurse able to lift patients from a hospital bed. And then we have the social robot, Zora, used in care home settings to carry out tasks such as entertaining the elderly or leading fitness classes. Fears that residents might reject the robot have proved to be unfounded. In practice, these robots are accepted very quickly.

A unique robot type is the exoskeleton which assists, among others, people with traumatic lower limb paralysis when standing up and walking. For construction workers, who must lift heavy objects and materials or regularly make bending or twisting motions, exoskeletons exist which make this work much less intensive.

Personalised medicine and treatments based upon the DNA profile

With the help of genetic research, more and more diseases can be diagnosed before any symptoms begin to appear. We can throw light upon the cause of a disease, predict a prognosis and determine the inheritance factors and genetic risk. Preventive care therefore increases its options with patient or disease specific health advice and monitoring, for example.

DNA profiles increase accuracy when determining which medicines will and will not be effective and what the optimal dosage should be. If one is aware of the presence of specific liver enzymes which break down drugs at a faster rate, the dose can be increased. In this way, we are able to prescribe personalised medicines specific to a particular DNA profile, whereby efficacy increases while any side effects are minimalised. This is not only the case for orphan drugs in the treatment of uncommon or rare illnesses, but also applies to common drugs such as anti-depressants, antihypertensives and pain killers.

The costs involved in the making of a genetic passport – a synonym for DNA analysis – are falling so rapidly that the idea of any person requesting one during a visit to the pharmacy does not require much stretching of the imagination. Commercial ventures are already active, such as iGene established in the Netherlands in 2017. Lifestyle advice is given based on disease prognostics, themselves based upon the DNA analysis of one’s saliva.

A further step forward is the CRISPR-Cas9 method, whereby DNA can be modified.  Research is currently being done on new methods for curative treatments; for example, for lung cancer, AIDS and sickle-cell disease (hereditary anaemia).

3D bioprinting and organs-on-a-chip

It is now possible to print in 3D using a wide range of materials such as plastic, steel and concrete. Experimentation has also begun with the printing of human tissue. Medical applications currently being researched by companies such as Organovo range from the printing of skin and bone to complete functional organs. If this works, organ donation and organ rejection will become a thing of the past.

In 2016, the Netherlands was first in the world to integrate this technology within the field of dental surgery. After scanning the mouth, a 3D printer produced a definitive crown which could be immediately placed in (relative) comfort, rendering those extended waiting times relating to bite registration and temporary crowns obsolete.

And then we have organs-on-a-chip. These are not real organs, but human tissues grown in the laboratory which mimic the function of a particular organ. These offer the opportunity to simulate organ function in miniature when testing new drugs. This means less animal testing and more reliable results, as the effects of drugs on animals can not completely predict the effect of the same drug when administered to a human being; the physiological and anatomical differences are simply too great.

Artificial Intelligence

There are so many different diseases and so many different treatment methods that it is impossible to expect a doctor to know about all of them in detail. This is why doctors specialise and work in teams. But even then, it is impossible to know everything. Artificial Intelligence (AI) changes the rules of the game. For example, IBM Watson offers an AI doctor to support its human counterparts.

Search engines such as Google will come up with a long list of relevant publications based upon search terms, which you must further read up on. Watson, however, offers up the most probable diagnosis along with a treatment plan and projected success rate, as well as explaining the reasons for its conclusions. A doctor can then consider the next step, deciding either upon further testing or coming to a definitive diagnosis. Watson is not a static database, but has a cognitive capacity, meaning its ability to answer questions as well as its precision in the field of diagnostics increases over time.

Another item of interest is Dr Foster. This UK company maintains an international database with statistics relating to mortalities, complications, re-treatments, treatment times and other variables involved in more than 250 diagnoses in approximately 40 different specialisms. More than 40 hospitals from all over the globe are participating, including university hospitals in the Netherlands. By comparing data and sharing knowledge, they can make improvements in quality of care, as well as develop international standards for the treatment of specific illnesses.

Telemedicine (remote care)

Thanks to information and communication technology remote care, otherwise known as telemedicine, can be made available to patients. Surgeons can carry out operations via robots without actually being in theatre. Doctors are able to communicate with patients in other parts of the hospital or even at home via computer screens; many general practitioners offer e-consults via webcam.

It is also very positive to witness the use of robots in the home to remotely monitor patients and offer some forms of home care. Robot Pepper was primarily developed to keep elderly people with dementia company and remind them to, for example, take their medicine on time. He is also able to carry out short conversations, simultaneously recognising human emotion through facial expression and voice intonation.

In 2018, robot Rose is expected to arrive on the market, developed to carry out minor tasks within the home for elderly and disabled groups. Rose will be able to open the door, fetch a drink, warm up a meal and take on specific cleaning tasks.

Quantified Self

It is not only doctors who collect data and base their decisions upon the information they collect. We see more and more people use sports watches and other portable monitoring equipment (wearables) to keep tabs on their personal statistics. Often, the motive is not illness but a preventive consideration. Quantified Self is a movement which collects data to increase self-knowledge using a variety of monitoring systems. Think of heart rate, blood pressure, daily movement levels, sleep rhythm, stress levels etc.

By adding a sense of fun (gamification), people are motivated to live a healthier lifestyle in a subtle way. The Apple Watch, for example, not only calculates how many calories you have burned and how many steps you have taken, but lets you know how many you still need to do in order to reach your goal. Via apps such as looptijden.nl, you can share your personal achievements and compare (or compete) with others for extra motivation.

The announcement of the winner of the Qualcomm Tricorder XPRIZE is expected to take place in the second quarter of 2017. The Tricorder, an idea materialising from the Star Trek movies, must be a portable, wireless device able to fit into the palm of your hand and diagnose 12 different diseases.

Consequences for the organisation of care and the role of the doctor

What happens when transparency becomes the norm? Freedom of information empowers the patient and has led to the democratisation of health care and (unintended) organisational consequences within the sector.

Data and studies from public authority databases, patient associations and commercial businesses provide insight into which doctors and hospitals perform the best and which perform less efficiently. Doctors and hospitals that don’t make the grade, lose business. The result is market concentration (winner takes all), led not by ‘top down’ government legislation, but by patients who review the available treatments and health care providers in search of the best possible care.

The patient who manages his own health takes centre stage with the health care system organised around the patient’s specific needs. Not only do medical specialists have a role to play here, but also general practitioners and company doctors who offer patient’s support as health coaches or health managers.

In the United States Intel, together with health care providers and insurance companies, has established the Healthcare Marketplace Collaborative to improve upon, accelerate and lower the costs of health care and treatments for employees. By the utilisation of Intel’s expertise within the field of supply chain management, new clinical processes have been implemented for common, uncomplicated illnesses. Costs related to the treatment of back pain have subsequently decreased by 24%, while those related to the treatment of headaches have fallen by 49%.

From sick care to health care

In the context of the above mentioned developments within the health sector, we see that more and more attention is being given to disease prevention. In other words, we are moving from a sick care system to one of health care. Once this transition has been made, we will then need to think of an alternative for the word ‘patient’, as those who consciously take care of their health and organise their own health care neither feel like, nor can call themselves, patients.

 

Photo: © 2017 Intuitive Surgical, Inc.

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