Heartbeat has trained the binoculars on the future and asked some of the leading researchers to estimate how they think health technology will change the conditions for patients in a digital world.
The digital healthcare system
Jakob Bardram, who is a professor at the Department of Health Technologies at DTU, is among other things co-founder of Monsenso and DataFair, companies specialised in digital health technologies. Jakob Bardram is not a futurologist, but he does see general tendencies that are likely to extend into the future.
”There is a development, where we are moving from acute treatment to focus on treatment that is more continuous. For example, that a patient’s EKG is not only monitored when he is admitted or when he visits his GP, but monitored continuously over a longer period of time, to tell more about the patient’s state of health. We also see a trend where prevention, monitoring and treatment relocate from the hospital to people’s homes, and a shift from single points of data collection to monitoring, while people live their life. We are moving from a reactive healthcare system that waits for the patients to visit towards a more proactive and preventive dialogue with citizens at risk.
"By improving technology and making it more user-friendly, we can push it into society and then it will have quite a different impact."
Professor Jakob Bardram
We see that health services that used to be centralised at the doctor’s office or at the hospital are now delivered more broadly in society by a number of private operators, which are less oriented towards the medical doctors and more focused on the patients. And within the digital area, we notice a movement from information technology towards health technology.”
People’s health is valuable
Jakob Bardram points to the current trend where major investments are allocated into health technology, significantly increasing the value of companies that develop health technologies.
”This is evident for example from giants such as Google and Apple acquiring digital health technology companies. This privatization creates medical equipment for consumers, which is very user-friendly and has an attractive design. For example the OneDrop solution for diabetes, which both has a blood sugar monitor and an app for your smart phone.”
Furthermore, Jakob Bardram observes that medical equipment and consumer electronics increasingly integrate.
“If for example we look at Apple Watch, which is now approved as medical equipment to monitor heart rhythm, it can identify heart rhythm disorders and has a built-in fall detector. In the longer run, we will see that private companies supply healthcare solutions based on such health technological solutions. This goes for portable as well as implantable equipment.”
Jakob Bardram also emphasises monitoring of atrial fibrillation, a condition that causes an irregular and often an abnormally fast heart rate. Electrocardiogram (ECG) is used to monitor the condition, it registers the electrical impulses that are sent through the heart making the heart beat regularly.
”When you monitor ECG in an out-patient clinic, you get a result for that specific point in time. You do not know what is going on in the patient’s everyday life. You have no knowledge about the patient’s behaviour and condition or what triggers atrial fibrillation such as excessive load or lack of sleep. But with several days of data collection about the patient, you can start looking for patterns that can explain the patient’s problems.”
We now have systems, which can detect if a patient experiences atrial fibrillation with 98% accuracy. This is far better compared to what a cardiologist can detect. And we know that early intervention has a major significance in relation to heart infarcts. Here, artificial intelligence can help single out patients in risk, and treatment can be administered early on. The patient does not even have to go to the hospital, because the contact between the medical doctor and the patient can take place digitally.
Free-for-all
”We will to a greater extent see digital biomarkers that indicate something is wrong, or that a disease is on the way. It will be distributed from the public healthcare system as well as private actors. Right now, it is a ‘free-for-all’ area, where we see products advertised as devices for psychic as well as somatic diagnostics.
We will most probably see further regulation for medical consumer equipment. The authorities will bring the area in order, and in the future, there will be stricter regulations for ‘real’ medical equipment. We will see this expanded to other areas than we are used to. For example that we can go to the pharmacy and get an ECG or rent equipment to take home. By improving technology and making it more user-friendly, we can push it into society and then it will have quite a different impact.”
10 years from research to application
Further surveillance of patients’ and citizens’ behaviour is under way. From registering if the pill packaging is opened – indicating that the medicine has been swallowed – to more comprehensive monitoring using artificial intelligence and algorithms, which communicate to healthcare staff if critical measurements are identified. According to Jakob Bardram, the development is moving in this direction for somatic diseases as well as mental diseases.
”We have psychiatric patients, who feel safe knowing that a nurse keeps an eye on them and knows if they get into trouble. If we imagine this situation distributed broadly, we could go from a reactive to a proactive healthcare system. Instead of patients going to the A&E or contacting on-call GPs when they have an acute problem, the healthcare system could to a larger extent have continuous contact with citizens and knowledge about how they are doing. Currently, this is not possible, and there are a lot of challenges in collecting data on such a level. But we usually say that the subjects we are working with on a research basis today are ready for application in 10-15 years.”
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