How is Technology Reshaping Healthcare?

In these days, to say that healthcare is on an accelerated path of transformation has become a cliché. We know all too well the many pressures we face, which likely have an impact on health.

Just to name a few, these include:

Pollution, climate changes and extreme phenomena;
Regional conflicts challenging world order and multilateralism;
Access and cost of energy and raw materials;
Disruption of production and distribution chains;
Inflation and sovereign debt pressuring public budgets;
Lasting effects of COVID-19 and risk of future pandemics;
Economic, political and climate migrations;
Aging population (chronic diseases) and workforce (availability, deployment);
Disparities in development and access to care.

On a positive note, there is also generalized consensus that technology will offer solutions to mitigate these effects, namely by offering:

Novel treatments (omics), materials (3D printing, nano) and devices addressing underserved needs and patients. Innovation is becoming more precise, as new analytics, real word data, companion diagnostics, monitoring devices and outcome predictors become widely available.
Data storage capacity and communications speed, latency and availability are no longer an issue in most parts of the world.
Processing power reaching unprecedented capacities: processing power continues to double every two years (Moore’s law), while new, cheap, small-scale processors are now performing dedicated AI’s tasks. Quantum computing allows unprecedented complex solving capabilities impossible to do with conventional computing.
Digitization is approaching its tipping point. Standards are becoming widespread; interfaces and data sharing concerns are being addressed. The key is interoperability – “the ability of different information systems, devices and applications to access, exchange, integrate and use data in a coordinated manner, within and across organizational, regional and national boundaries, offering portability in order to optimize the health of individuals and populations globally”. The end goal is to enable data to be shared by researchers, clinicians, and health care providers (HCPs), but also, aggregated, by health authorities, policymakers and managers.
Deployment of AI in all fields of care: from R&D, to HCP-patient interaction, digitization of procedures (text plus speech recognition and summarizing) for inclusion in electronic health records, improvement of imaging and diagnostics, summarizing evidence for clinical decision support, patient monitoring, and the list just goes on and on.

I contend we are reaching a point where the above-mentioned innovations, now smilingly distant and far apart, will become mature and synergistic to trigger sudden changes.

Just in the small “micro-cosmos” of medicines, just take a look at some trends:

Health data is growing exponentially. About 30% of all data generated today is health-related, growing 36% per year, more than any other industry. Annually, each individual generates about 80MB in health data.
Data sharing protocols are being developed to ensure information can circulate between health systems safely and with quality. The European Health Data Space (EHDS) offers a reference framework for the primary and secondary use of health data. And one of the very first areas for data sharing will be related with medicines’ safety and effectiveness.
Health data will be used for the submission, approval, funding, guiding the use, and continuous assessment of medicines in specific patient populations and medical conditions. New initiatives (DARWIN, RWE Alliance) and regulatory frameworks from EU and US (21st century cures ACT) will accelerate use of real-world evidence (RWE) to supplement information considered for regulatory purposes (recently, a new indication for a CDK inhibitor in combination with hormone therapy was approved for male breast cancer using evidence generated by electronic health records).
Health Technology Assessment (HTA) reached the top of EU priorities and international collaboration, with EUnetHTA “joint actions” developing into a permanent assessment framework. Although doubts remain about the binding power of European Relative Effectiveness Assessments (REA), the European Council gave positive opinion to legislation aligning national HTA procedures. And common approaches to value assessment will trigger common evidence requirements at local level.
Technology and data are allowing new models, complimentary to “traditional” cost-effectiveness studies, to modulate, operationalize and measure, in real life conditions, the additional aspects of value that society and different stakeholders are willing to attribute them, such as type of disease, rarity, severity, outcome type (palliative/curative), budget impact and phasing.
AI-enabled decision support systems are starting to appear in multiple healthcare applications and will become ever present in clinical decisions, including diagnostics and therapeutic recommendations. To be effective and trustworthy, AI will be balanced and cross-checked with sound clinical judgment.

But many people think that the pace of transformation will continue to be slow and gradual.

The missing link slowing it all? The human element: the culture, the learning, the leadership, his ethical concerns and need for regulation. From patients, to HCPs, to teachers, managers, regulators, policymakers and politicians.

Mind me, this discussion needs, desperately, to happen. Sooner than later. Fear and very legitimate concerns need to be addressed. Learning needs to happen. Teaching and learning curricula (HCPs, IT, management) need to change, disciplines created as well as ways of assessing new learnings and acquired competencies.

I see a time, not very far away, where we have put in place the tools, structures, and competencies to become much more effective in promoting health, preventing disease, managing care, improving patient experience, managing costs and obtaining the best possible outcomes.

For patient’s sake. For us all.

Luís Rocha

LisbonPH