F60 2020: Redefined experience, further progress of DTx and new expectation about investments, quantum computing

Nine opinion leaders in digital health - John Nosta, Rafael Grossmann, Aline Noizet, Brian de Francesca, Irma Rastagayeva, Eugene Borukhovich, Maneesh Juneja, Nana Bit-Avragim, and Levi Shapiro - answered a seemingly simple and open-ended question: What are your predictions about trends in digital health and healthcare in 2020?

Before diving into the future, here is a brief overview of some of the digital health-related news that resonated in media in 2019:

1. Telemedicine becoming a new normal in the US

Becker Hospital Review made a list of 106 hospitals and health systems that launched telehealth services in 2019. It is fair to say that telemedicine is becoming a new normal beyond chronic care management.

2. Tech giants leaving marks in healthcare

Last years were marked by announcements of tech giants moving into healthcare. 2019 showed some of their results.

Amazon went live with its new health service Amazon Care. The service includes both virtual and in-person care, telemedicine via app, chat and remote video. Amazon also enables follow-up visits and prescription drug delivery in person directly at an employee's home or office.

Amazon and JPMorgan announced new health insurance plans as part of Haven joint venture.

Google got into partnership with Ascension hospital network and got access to the health records of millions of Americans. The news also polarized the public regarding whether this is a sign of exponential progress in better patient care or is it patient data theft that might harm individuals.

3. Germany leading eHealth in Europe

Germany's health minister Jens Spahn is poised to turn Germany from a country which has been lagging behind in eHealth development in the EHR space due to data privacy concerns, to a pioneer in national eHealth development in Europe. As reported by Healthcare IT news, the Digital Supply Law passed in November enables doctors to prescribe apps to patients, and the German statutory health insurance could reimburse these apps. passed in November the Digital Supply Law proposed by health minister Jens Spahn. This means that doctors will be able to prescribe apps to their patients, which can be reimbursed by German statutory health insurance, a step forward for a country that has not been seen as a frontrunner in this race so far.

While countries are developing their national digital health strategies, it seems that cross-border data exchange efforts are also bearing fruit in Europe. Finland became the first country worldwide to exchange e-prescriptions together with Estonia, with the new cohorts joining 2020-22.

4. For AI, look at China

Chinese company YITU Healthcare published the first peer review article in Nature about the use of natural language processing in healthcare diagnostics. The company used natural language processing (NLP) to achieve high accuracy rates on par with doctors when reading electronic health records and generating patient diagnoses. This was the first time for a top medical journal to publish research findings related to employing NLP technology in making clinical diagnoses.

5. Pharma stepping out of the digital therapeutics space

While there is a lot of optimism about digital therapeutics in the digital health community, Pharma seems to be is losing excitement to be a part of the game. Novartis division Sandoz terminated its commercialisation of Digital therapeutics designed by Pear Therapeutics, and Proteus Digital Health's failed its investment round. Pear Therapeutics and Proteus are the two most promising digital therapeutics leaders.

2020: Redefined experience, further progress of DTx and new expectation about investments, quantum computing

Experience shift

Experts predict a positive future for digital therapeutics, expect rethinking of the financing models and valuations of startups, anticipate changes in experiences of patients receiving care as well as doctors providing care.

Speaker, Strategist, and Digital Health Evangelist John Nosta believes the focus on experience will guide development in digital health. The partnership between physicians and tech will be enhanced, and involvement of patients in innovation will increase: "When we think about health, the role of patient empowerment seems almost generic. However, I believe we need to look at it from the perspective of the physician. Physicians need to shift out of their predictable and complacent role in technology. I believe that there is a certain clinical hegemony that will make physicians less inclined to adopt innovation due to patient safety and clinical fear. I still think that we have to shift the physician mindset into a more techno forward perspective.

We need to see the emergence of the physician and technology partnership. Almost like a technology group practice, if I dare be that bold. The role of the physician will be extraordinarily important and physicians will be the primary conduits to the patient, but the heavy lifting, the cognitive aspects of care will be shared by technology. I believe this makes physicians both concerned and threatened.

On the technology side, I believe that the role of data as a window into patient management will continue to emerge. There will be advanced analytics that will move beyond the traditional role of image evaluation and pattern detection to find unique and new combinations of various clinical data points that will help drive diagnostics and therapeutic modalities in new directions."

Experience enhanced with VR

Among the early adopters of technology is speaker, healthcare futurist and VR surgeon Rafael Grossmann. He believes that VR reached a point where we are not only talking about the technology's potentials but enacting them. "Within the next three years platforms like Magic Leap and Hololens 2 will redefine how we interact with the digital world and how we communicate and interact between ourselves. For learning, diagnostics and intraoperatively, these platforms will be very helpful. I believe that spatial computing (VR/AR/XR) and AI algorithms will redefine how we practice and teach healthcare across medicine in general. The best physician is the one augmented by AI algorithms."

On the treatment side, VR is already used in many areas. Industry observer, social media influencer, digital storyteller and an all around innovation catalyst Irma Rastegayeva sees Virtual Reality (VR) applications to manage chronic pain and reduce distress are gaining traction in hospitals. "Using VR for PTSD increased in 2019 and use of such Digital Therapeutics will continue to grow in 2020, including novel approaches for conditions such as Chronic Obstructive Pulmonary Disorder (COPD) and developmental disorders," says Rastegayeva.

Apart from new technologies, coaches will be an integral part of the enhanced experience, says Eugene Borukhovich, Head of G4A. "The word experience as in health experience will become much more used by many companies, as a lot of tech IP has been developed over the last few years. As many people say, human intelligence will continue being better than AI. Therefore, the importance of health coaches will come in play more in more, as Dtx companies as well as hospital systems that cannot sustain administrative staff from the cost perspective, will move the health guides even closer to the edge of the health consumer and the patient."

Another fundamentally changed experience are becoming clinical trials.

Irma Rastegayeva: "Virtual or remote, clinical trials are starting to gain traction. They can help increase trial enrollment, decrease drop-out rates and potentially gather more data with better patient comfort. Trial measurements, such as vital signs, could be automatically captured by wearable devices and seamlessly shared with clinical and research teams. AI and other technologies can identify changes in patient behaviour and activity patterns and immediately alert study investigators.

Another important advantage of decentralized clinical trials is the potential for continuous outcome measurement, which may provide a better assessment of the drug efficacy compared to less frequent measurements taken during hospital visits, which is typical in traditional trial protocols."

2. Positive future for digital therapeutics

Medication prescribing and drug development are also evolving with DTx. WHile DTx had a rough year because or partnership terminations, digital health opinion leader believe they have a bright future ahead.

Digital Health Connector Aline Noizet argues 2020 will be key for digital therapeutics because it will bring clinical evidence the market is expecting to prove DTx are actually working. "We will also have a clearer idea of what business model works," says Aline Noizet.

Irma Rastageyeva: "A recent report by Juniper Research found that the market for Digital Therapeutics will expand rapidly over the next 5 years, growing over 1,000% to reach more than $32 billion in revenues in 2024 with biggest applications for DTx projected to be diabetes and weight loss, generating more than $19 billion in the next 5 years.

While the term Digital Therapeutic may still be unfamiliar to many, these therapies are here to stay. Digital Therapeutics (DTx) are becoming a new category of medicine, poised to address chronic and other hard to treat conditions. While much work remains for digital therapies to be integrated into and across the traditional healthcare ecosystem, Digital Therapeutics will "increasingly influence the way healthcare is delivered and consumed across the world."

And Eugene Borukhovich sees the focus in investment sense will turn from Pharma to Tech giants: "I predict that next year Dtx companies will cuddle a little bit closer with tech giants. I think some of the tech giants will start paying much more attention to digital therapeutics."

3. Tech giants moving forward, on-premise healthcare increasing in the US

Levi Shapiro, Founder, mHealth Israel believes no one can match Amazon's power to innovate due to the free capital available for innovation. "The pieces are in place. Jeff Bezos conditioned the capital markets to tolerate long-term losses in low margin sectors in the pursuit of market share. No healthcare company can match Amazon’s unique assets, fulfilment capabilities or economies of scale. The recipe for healthcare disruption- begin with access to free capital, sprinkle in a dash of fulfilment leadership, stir a heaping of consumer and SME data, add a side of national retail footprint (Whole Foods), and mix in the internal sandbox for experimentation known as Haven. Voila…in 2020, the 25% of US households with an Amazon Echo will look to Alexa for healthcare information and services." He also sees that many US providers will fake their way toward top line growth via M&A or revenue cycle improvement. "Nearly all will address their weak balance sheets through cost-cutting. The real winners will be Providers undertaking non-traditional approaches. That means an increasing number of Providers will announce their own venture capital funds. US providers will also begin to move beyond their own geographies and increase their share of the revenue from outside the United States through licensing and partnerships. Finally, Providers will take further steps into biopharma development, including pre-commercialization funds and partnerships for early-stage drug development."

On-site health clinics are an increasingly common novelty introduced by the US employers, and the trend will continue to grow, observes Irma Rastegayeva: "What used to be a rare perk by hot tech companies like Google, technology-enabled employee health and wellness programs are now a much more frequent occurrence. The on-site health clinics are designed to save money for employers by increasing employee attendance at work by saving time on off-site medical appointments, but they also emphasize preventative healthcare and improve the patient experience.

According to a survey by Mercer, one-third of the US employers with at least 5,000 employees offered general medical worksite clinics in 2017. This employer trend to deploy novel care delivery and DigitalHealth-enabled solutions to keep their workforce healthy and reduce overall healthcare costs will continue."

4. Europe: retail health and new innovation efforts

Levi Shapiro sees Europe as the new frontier in digital health development: "Until the election of a new US President, the United States is trapped in the status quo. The real nexus for innovation will shift to Europe. Regional governments, smaller countries and progressive health ministries will have more latitude for experimentation and digital adoption. The biggest change, however, will come from the EU’s largest economy- Germany. The regulatory changes implemented in November 2019 are laying the groundwork for Germany’s transition to digital health powerhouse. The catalyst will be Health Minister, Jens Spahn, and the rotating EU presidency held by Germany in the second half of 2020. Startups, get ready to say “Grüß Gott” to the German market."

A forward-thinking leader and the next gen healthcare ecosystem builder Nana Bit-Avragim, expect the rise of retails health in Europe. "Here the core value will be how retail businesses can act on to improve people's experience. Patients will gain improved access to care, retail will develop and grow and new business models, physicians will have more flexibility and choices, and investors acquire long-term, stable returns.

Last week, Ping An is China's biggest technology-powered financial service group, with its arm in healthcare, signed a strategic collaboration with Merck, a German multinational pharmaceutical, chemical and life sciences company. According to the joint media release, Ping An Good Doctor and Merck will also jointly explore how to break down the barrier between online and offline healthcare.

Fast evolution of consumer health will open new opportunities for healthcare providers to democratize it. That means living rooms to become homspitals."

5. Rethinking of knowledge transfer and fundraising models in digital health.

"We have to democratize the processes of knowledge translation. The universities and research institutes need new strategies, new incentives and new metrics for radical innovations. The major question will remain how to catalyze innovations in health and life sciences," says Nana Bit-Avragim who also believes changes need to happen in investment models: "I predict more experiments with Incentives in investment areas: payment-for-results, outcome-based payments, value-based contracting etc., Partnerships driven by local communities. We have to look for sustained financial models: long-term contracts also help with certainty until the benefits appear and bring the anticipated return-on-investment."

6. Quantum computing and telecommunications regulators

Brian de Francesca, CEO of VER2 telemedical company based in Dubai and active in the Middle East and Africa, expect increased involvement of telecommunications regulators ii digital health as well as advancements in quantum computing. "Companie will start engaging with your country's telecommunication regulators because digital health will be stillborn without the understanding and support of the telecom regulators. We will see a quantum leap forward, in understanding if and when quantum computers will be commercially viable for healthcare applications. When this day eventually comes, the entire healthcare industry will be blindsided by the massive impact this will have on all aspects of care. The pharma industry in particular, will totally be re-engineered for the better. I also believe that countries of Africa will start utilizing Artificial Intelligent in healthcare at a broader an more rapid pace, that the more developed countries."

7. 3D printing is on

Irma Rastegayeva and Nana Bit-Avragim also have their eyes on biotech development, especially 3D printing.

The 3D printing industry is estimated to grow to approximately $6 billion by 2024, according to the 3D Printing Progress, notes Irma Rastegayeva. "There are many current medical applications of 3D printing, including Prosthetics, Dental Applications, Tissue, Organs, Bones, Muscle and Skin. Beyond actual use in medical treatment, this technology plays a role in medical research, surgical planning, medical education and training and even in drug delivery. The emerging applications of 3D printing technology in the medical space that we will see in 2020 and beyond include ligaments, fully functional bionic eye, entire complex organs, like lungs, and 3D-printing of personalized drug delivery devices, not just medications themselves. The precision, speed and cost-effectiveness of 3D printing ushers a new era of personalized patient care."

Nana Bit-Avragim is following three areas closely:

3D Bioprinting with pioneering Cellink the US/Swedish company that strives tol 3d-print human tissues and organs,

CAR-T cell therapy is a new type of cancer immunotherapy that uses the patient's own T cells to fight certain types of cancer,
CRISPR-Cas new "prime editing": a new gene-editing tool called prime editing allows for greater precision and control over DNA edits compared to the popular CRISPR-Cas9 system.

8. Shifts in the mindset about innovation, knowledge transfer and financing

Digital Health Futurist Maneesh Juneja sees a change in the motivation of organizations to innovate. He believes the new driver will not be solely profit:

"What I see as a trend in 2020 is that organizations in healthcare are not thinking only about what are the best clinical outcomes or how can we make the most profit from services. They are starting to think about trust, responsible innovation, ethics, values, and humanity. What is the impact of our new product and services on society? Is it going to widen social inequality, or can it be used to decrease it? How can we work with communities we are looking to serve to ensure they are designed for the right people, and we get their feedback from the beginning? People are starting to think more about innovations that go above and beyond healthcare to make a difference in society."