Martec’s Law encapsulates the greatest management challenge of the 21st century: how do we manage relatively slow-changing organizations in a rapidly changing technological environment? It is a hard problem. As shown in the graph above, we know that technology changes at an exponential rate. This is the phenomenon of Moore’s Law — and, more broadly, Kurzweil’s Law of Accelerating Returns. But we also know that human organizations don’t change that quickly. Changes in behaviour and culture take time. There are only so many changes in people, processes, and technology that an organization can productively absorb at once — at least without a major disruption. So approximately speaking, organizations change at a logarithmic rate — much slower than exponential technological change. What is the answer? What can Healthcare and the NHS do? 1) Recognize that they and patients live in a world of perpetual change, they are never going to be fully caught up ever again. It’s the journey, not the destination. 2) Decide which technology changes to embrace and which to forgo, at least for the moment. Healthcare providers can only absorb a tiny fraction of changes into their existing organizations at any given point in time. Therefore, they must strategically choose the few they believe will have the greatest impact. 3) Let the others go. Trying to change too many things simultaneously leads to disaster. Instead, they should ruthlessly prioritize the subset of changes that best align with their strategy. How should Healthcare and the NHS adapt to change? Evolutionary or Revolutionary? Option 1 - Evolutionary Organisations can't slow the rate of technological change, but they can improve the rate of change in an organisation to a certain degree. Option 1 - Revolutionary Eventually, organisations must "reset" to a new technological baseline, but such transitions are extremely disruptive. What do you think? Please share your thoughts by tweeting @lloydgprice :) Source : https://chiefmartec.com/2016/11/martecs-law-great-management-challenge-21st-century/

Armed with a mouse and computer screen instead of a scalpel and operating theater, cardiologist Benjamin Meder carefully places the electrodes of a pacemaker in a beating, digital heart. Using this “digital twin” that mimics the electrical and physical properties of the cells in patient 7497’s heart, Meder runs simulations to see if the pacemaker can keep the congestive heart failure sufferer alive — before he has inserted a knife. The digital heart twin developed by Siemens Healthineers is one example of how medical device makers are using artificial intelligence (AI) to help doctors make more precise diagnoses as medicine enters an increasingly personalized age. The challenge for Siemens Healthineers and rivals such as Philips and GE Healthcare is to keep an edge over tech giants from Alphabet’s Google to Alibaba that hope to use big data to grab a slice of health care spending. With health care budgets under increasing pressure, AI tools such as the digital heart twin could save tens of thousands of dollars by predicting outcomes and avoiding unnecessary surgery. A shortage of doctors in countries such as China is also spurring demand for new AI tools to analyze medical images and the race is on to commercialize products that could shake up health care systems around the world. While AI has been used in medical technology for decades, the availability of vast amounts data, lower computing costs and more sophisticated algorithms mean revenues from AI tools are expected to soar to $6.7 billion by 2021 from $811 million in 2015, according to a study by the research firm Frost & Sullivan. The size of the global medical imaging analytics software market is also expected to jump to $4.3 billion by 2025 from $2.4 billion in 2016, said the data portal Statista. “What started as an evolution is accelerating towards more of a revolution,” said Thomas Rudolph who leads McKinsey & Co.’s pharma and medical technology practice in Germany. Crowded field For Siemens Healthineers and its traditional rivals, making the transition from being mainly hardware companies to medical software pioneers is seen as crucial in a field becoming increasingly crowded with new entrants. Google has developed a raft of AI tools, including algorithms that can analyze medical images to diagnose eye disease or sift through digital records to predict the likelihood of death. Alibaba hopes to use its cloud and data systems to tackle a shortage of medical specialists in China. It is working on AI-assisted diagnosis tools to help analyze images such as CT scans and MRIs. Siemens Healthineers, which was spun off from German parent Siemens in March, has outpaced the market in recent quarters with sales of medical imaging equipment thanks to a slew of new products. But analysts say the German firm, the Dutch company Philips and GE Healthcare, a subsidiary of General Electric, will all come under pressure to prove they can save health care systems money as spending becomes more linked to patient outcomes and as hospitals rely on bulk purchasing to push for discounts. Siemens Healthineers has a long history in the industry. It made the first industrially manufactured X-ray machines in 1896 and is now the world’s biggest maker of medical imaging equipment. Now Chief Executive Bernd Montag’s ambition is to transform it into the “GPS of health care” — a company that harnesses its data to sell intelligent services as well as letting smaller tech firms develop apps feeding off its database. As it adapts, Siemens Healthineers has invested heavily in IT. It employs some 2,900 software engineers and has over 600 patents and patent applications in machine learning. It is not alone. Philips says about 60 percent of its research and development (R&D) staff and spending is focused on software and data science. The company said it employs thousands of software engineers, without being specific. Medical revolution Experts say the success of AI in medical technology will hinge on access to reliable data, not only to create models for diagnosis but also to predict how effective treatments will be for a specific patient in the days and years to come. “Imagine that in the future, we have a patient with all their organ functions, all their cellular functions, and we are able to simulate this complexity,” said Meder, a cardiologist at Heidelberg University Hospital in Germany who is testing Siemens Healthineers’ digital heart software. “We would be able to predict weeks or months in advance which patients will get ill, how a particular patient will react to a certain therapy, which patients will benefit the most. That could revolutionize medicine.” To this end, Siemens Healthineers has built up a vast database of more than 250 million annotated images, reports and operational data on which to train its new algorithms. In the example of the digital twin, the AI system was trained to weave together data about the electrical and physical properties and the structure of a heart into a 3D image. One of the main challenges was hiding the complexity and creating an interface that is easy to use, said Tommaso Mansi, a senior R&D director at Siemens Healthineers who developed the software. To test the technology, Meder’s team created 100 digital heart twins of patients being treated for heart failure in a six-year trial. The computer makes predictions based on the digital twin and they are then compared with actual outcomes. His team hopes to finish evaluating the predictions by the end of 2018. If the results are promising, the system will be tested in a larger, multicenter trial as the next step to getting the software approved by regulators for commercial use. Siemens Healthineers declined to say when the technology might eventually be used by clinics or give details on how its digital heart, or models of other organs it is developing such as the lungs and liver, could be monetized. In data we trust Both GE and Philips are also working on versions of digital heart twins while nontraditional players have been active too. Drawing on its experience of making digital twins to test bridges and machinery, French software firm Dassault Systemes launched the first commercial “Living Heart” model in May 2015, though it is only currently available for research. Philips sells AI-enabled heart models that can, for example, turn 2D ultrasound images into data that helps doctors diagnose problems, or automatically analyze scans to help surgeons plan operations. Its vision, like Siemens Healthineers, is to add more complexity to its existing heart models by pulling together scans, ECGs and medical records to create a model that can predict how a heart will respond to therapy in real life. For now, such software is still in the early stages of development and companies will have to work with regulators to thrash out how predictive models can be approved before doctors are willing to trust a diagnosis generated by a machine. Access to high-quality data with enough variation will be crucial, as will be the ability to interpret that data and turn it into something medical professionals can use, say experts. In particular, models will have to be trained on rare cases as they get closer to perfection, said Vivek Bhatt, chief technology officer at GE Healthcare’s clinical care solutions division. “It’s going to be extremely critical to have an ongoing process for getting more data, getting the right kind of data and getting data with those unique cases,” he said. The established medical technology players say their long-running relationships with hospitals and research institutes and vast networks of installed machines will give them an edge over new tech entrants. Siemens Healthineers, GE Healthcare and Philips say their databases are fed with a mixture of publicly available data, data from clinical trials or from collaborations with hospitals — as well as some data from customers. All the data is made anonymous and only used with patients’ consent, they say. Still, some campaigners and academics worry about patients’ data being used primarily by companies as a commercial tool. Boris Bogdan, managing director at Accenture’s life science practice in Switzerland, believes the ownership of data is a gray zone that could lead to a patient backlash if companies start making fortunes from it. “When Facebook started nobody really cared who owned the information,” he said. “Now that people understand that Facebook earns tremendous money with their data, questions like data privacy, data usage and data monetization are becoming more visible.” Source : https://www.japantimes.co.jp/news/2018/09/02/world/science-health-world/medical-technology-firms-gets-personal-digital-twins/#.W4uqj62ZOV4

The NHS’s biggest hospital trust has signalled its intention to spend up to £400m on an electronic patient record system, in one of the biggest tenders of its kind. The tender, issued by Manchester University NHS Foundation Trust (MFT), vows to create a “best in class” data management solution that will deliver “measurable clinical benefits” and an “extremely impressive return on investment”. It forms part of a nationwide drive by NHS Digital to make the health service paperless by 2020. The unit is determined to rid hospitals of their dependence on outdated tech, promising that better use of data will grant patients greater control over their health, empower their carers, reduce the burden on medics and give rise to new treatments. But it has a long way to go. Last year, researchers found that the health service was the world’s biggest buyer of fax machines and owned 10 per cent of its pagers. “[The electronic patient record solution] will bring a number of benefits, including improving the patient experience, for example by reducing the need for patients to give the same information to different members of staff and reducing delays in accessing paper medical records,” a spokesperson for MFT told NS Tech. The trust also hopes that the technology will improve patient safety by identifying medication errors and infection risks, and the quality of care by reducing unwarranted variation in treatments. The price of implementing electronic patient record systems varies wildly between trusts, and is dependent on their size and the complexity of the individual organisation. In March, for example, Leeds and York NHS trust committed to paying Careworks just £2.5m to delivering such a system. Commenting on the level of funding allocated to the patient system, a spokesperson for MFT said it was now the largest trust in the UK. “It is responsible for running a family of nine hospitals across six separate sites, providing a wide range of services from comprehensive local general hospital care through to highly specialised regional and national services. A future EPR solution needs to meet the whole of the Trust’s specialist and complex needs.” The contract lasts a decade, but the tender notice specifies that the trust is looking for the partnership to last for “the next 15 years or more”. Businesses have until 6 September to apply. Source : https://tech.newstatesman.com/public-sector/electronic-patient-record-system-manchester-university-nhs

Introduction to Nomadeec Nomadeec is the most intuitive and secured mobile telemedicine platform for Emergency professionals. Compact, light and extremly intuitive, it allows to set up a complete digital assessment of the out-patient, featuring photos, videos, Scores, 12/18L ECG. Nomadeec accelerates medical decision-making to maximize the patient's chances of winning. The solution features an innovative mobile application on 4G tablet with a set of Bluetooth connected medical devices and a fully secured webApp for real-time patient review by EMS or Expert physicians. Nomadeec and HoloForge Partnership Designed through a partnership between medical software company Exelus and HoloLens developer HoloForge, Nomadeec leverages the gesture-based commands of the HoloLens to give practitioners access to customizable modules for patient assessments, clinical exams, and patient profiles. With Nomadeec, HoloLens can also act as a heads-up display for monitoring a patient's vital signs, as the platform can connect to numerous types of medical devices, such as ECGs, thermometers, stethoscopes, and ultrasound devices, via Bluetooth. And when practitioners need a second opinion from a medical professional, the Nomadeec system can connect them to those medical experts via video conference. While Exelus and HoloForge emphasize Nomadeec's HoloLens capabilities, the platform is also compatible with smartphones, tablets, and smartglasses running on iOS, Android, or Windows. Nomadeec, leader for Emergency telemedicine The Nomadeec platform allows the EMS to consult the assessments of all the primary care effectors, and establish, if necessary, a videoconference. These prehospital patient reports, enriched by vital parameters, ECGs, photos and/or videos, are then shared with the recipient service and integrated directly into the patient file of the hospital. Sources : https://hololens.reality.news/news/hololens-app-hopes-offer-paramedics-augmented-reality-assist-during-emergencies-0181981/ http://nomadeec.com/en/

New agreement enables analysis of anonymised patient data using clinical artificial intelligence technology to accelerate medical research, help find new treatments and improve patient care. Sensyne Health Limited (the "Company"), formerly Drayson Health, a British clinical AI technology company, announces today that it has signed a Strategic Research Agreement (SRA) with Chelsea and Westminster Hospital NHS Foundation Trust. The agreement will allow Sensyne Health to analyse anonymised patient data using clinical artificial intelligence (Clinical AI) technology*. The agreement also includes a new research collaboration between the parties in digital health and biomedical research. The purpose of the research is to derive new insights that will improve the care of the Trust's patients and help to find new treatments. Chelsea and Westminster Hospital NHS Foundation Trust will receive a £5 million equity stake in Sensyne Health and will also benefit from royalties that arise from any discoveries. The royalties the Trust receives will be reinvested back into the NHS which can fund further research and help deliver higher quality patient care at lower cost. Research will be undertaken to the highest standards of information governance and data security in accordance with the Caldicott Principles and data protection legislation. Lesley Watts, CEO, Chelsea and Westminster Hospital NHS Foundation Trust, said: "We are always seeking ways to improve the care we deliver to our patients, whilst ensuring patient information is safe and secure. This exciting and innovative partnership offers the potential to unlock new digital health treatments, allowing us to continue to deliver the very highest quality of care to our patients now and in the future." Lord (Paul) Drayson, CEO of Sensyne Health, commented: "We are delighted that the Chelsea and Westminster NHS Foundation Trust, a leading acute Trust in the heart of London, has joined our research partnership in clinical AI alongside South Warwickshire and Oxford University Hospitals NHS Foundation Trusts. Together, we aim to make new discoveries that will improve care for patients, accelerate medical research and provide a return back into the NHS." The new agreement builds on an existing relationship with Chelsea and Westminster Hospital NHS Foundation Trust, formed in September 2017, when the parties announced a global first, piloting Sensyne Health's wireless environmental sensors in intensive care units at Chelsea and Westminster Hospital. About Sensyne Health Sensyne Health is a healthcare technology company that creates value from accelerating the discovery and development of new medicines and improving patient care through the analysis of real-world evidence from large databases of anonymised patient data in collaboration with NHS Trusts. Any analysis of anonymised patient data (and hence the Company's access to it) must be pre-approved for each programme on a case-by-case basis by the relevant NHS Trusts. This is to ensure that the purpose of the anonymisation and the proposed analysis are subject to appropriate ethical oversight and information governance, including conformance with the Caldicott Principles, UK data protection law and applicable regulatory guidance. Sensyne Health, which recently changed its name from Drayson Health, is based in the Big Data Institute at the University of Oxford's Old Road Campus. For more information, please visit: www.Sensynehealth.com About Chelsea and Westminster Hospital NHS Foundation Trust It is one of the best performing Trusts in the country. It employees around 6,000 staff and has recently been rated as 'Good' by the Care Quality Commission (CQC), and Outstanding for use of resources by NHS Improvement. The Trust operates two hospitals, one in central London, the Chelsea and Westminster hospital, and one in Isleworth West London, the West Middlesex University Hospital. *What is 'clinical AI'? Clinical AI is a highly specialised field of AI which uses machine learning algorithms, including deep learning in tandem with human clinical expertise and big datasets with which to train the algorithms. Clinical AI is particularly concerned with the analysis of data acquired during routine clinical care of patients, in order to derive clinically-useful results such as to improve patient outcomes and to discover new insights about the use of pharmaceutical compounds to treat patients. Source : https://www.londonstockexchange.com/exchange/news/market-news/market-news-detail/other/13738790.html

Sponsored by IBM Security and conducted by Ponemon Institute, the 2018 Cost of a Data Breach Study found that the average cost of a data breach globally is $3.86 million, a 6.4 percent increase from the 2017 report. Based on in-depth interviews with nearly 500 companies that experienced a data breach, the study analyzes hundreds of cost factors surrounding a breach, from technical investigations and recovery, to notifications, legal and regulatory activities, and cost of lost business and reputation. ​IBM-Security-Data-Breach-Calculator-2018 This year for the first time, the study also calculated the costs associated with "mega breaches" ranging from 1 million to 50 million records lost, projecting that these breaches cost companies between $40 million and $350 million respectively. "While highly publicized data breaches often report losses in the millions, these numbers are highly variable and often focused on a few specific costs which are easily quantified," said Wendi Whitmore, Global Lead for IBM X-Force Incident Response and Intelligence Services (IRIS). "The truth is there are many hidden expenses which must be taken into account, such as reputational damage, customer turnover, and operational costs. Knowing where the costs lie, and how to reduce them, can help companies invest their resources more strategically and lower the huge financial risks at stake." Hidden Figures – Calculating the Cost of a Mega Breach In the past five years, the amount of mega breaches (breaches of more than 1 million records) has nearly doubled - from just nine mega breaches in 2013, to 16 mega breaches in 2017. Due to the small amount of mega breaches in the past, the Cost of a Data Breach study historically analyzed data breaches of around 2,500 to 100,000 lost records. Based on analysis of 11 companies experiencing a mega breach over the past two years, this year's report uses statistical modelling to project the cost of breaches ranging from 1 million to 50 million compromised records. Key findings include: Average cost of a data breach of 1 million compromised records is nearly $40 million dollars At 50 million records, estimated total cost of a breach is $350 million dollars The vast majority of these breaches (10 out of 11) stemmed from malicious and criminal attacks (as opposed to system glitches or human error) The average time to detect and contain a mega breach was 365 days – almost 100 days longer than a smaller scale breach (266 days) For mega breaches, the biggest expense category was costs associated with lost business, which was estimated at nearly $118 million for breaches of 50 million records – almost a third of the total cost of a breach this size. IBM analyzed the publicly reported costs of several high profile mega breaches, and found the reported numbers are often less than the average cost found in the study. This is likely due to publicly reported cost often being limited to direct costs, such as technology and services to recover from the breach, legal and regulatory fees, and reparations to customers. What Impacts the Average Cost of a Data Breach? For the past 13 years, the Ponemon Institute has examined the cost associated with data breaches of less than 100,000 records, finding that the costs have steadily risen over the course of the study. The average cost of a data breach was $3.86 million in the 2018 study, compared to $3.50 million in 2014 – representing nearly 10 percent net increase over the past 5 years of the study. The study also examines factors which increase or decrease the cost of the breach, finding that costs are heavily impacted by the amount of time spent containing a data breach, as well as investments in technologies that speed response time. The average time to identify a data breach in the study was 197 days, and the average time to contain a data breach once identified was 69 days. Companies who contained a breach in less than 30 days saved over $1 million compared to those that took more than 30 days ($3.09 million vs. $4.25 million average total) The amount of lost or stolen records also impacts the cost of a breach, costing $148 per lost or stolen record on average. The study examined several factors which increase or decrease this cost: Having an incident response team was the top cost saving factor, reducing the cost by $14 per compromised record The use of an AI platform for cybersecurity reduced the cost by $8 per lost or stolen record Companies that indicated a "rush to notify" had a higher cost by $5 per lost or stolen record This year for the first time, the report examined the effect of security automation tools which use artificial intelligence, machine learning, analytics and orchestration to augment or replace human intervention in the identification and containment of a breach. The analysis found that organizations that had extensively deployed automated security technologies saved over $1.5 million on the total cost of a breach ($2.88 million, compared to $4.43 million for those who had not deployed security automation.) Regional and Industry Differences The study also compared the cost of data breaches in different industries and regions, finding that data breaches are the costliest in the U.S. and the Middle East, and least costly in Brazil and India. U.S. companies experienced the highest average cost of a breach at $7.91 million, followed by the Middle East at $5.31 million. Lowest total cost of a breach was $1.24 million in Brazil, followed by $1.77 million in India. One major factor impacting the cost of a data breach in the U.S. was the reported cost of lost business, which was $4.2 million – more than the total average cost of a breach globally, and more than double the amount of "lost business costs" compared to any other region surveyed. One major factor impacting lost business costs is customer turnover in the aftermath of a breach; in fact a recent IBM / Harris poll report found that 75 percent of consumers in the U.S. say that they will not do business with companies that they do not trust to protect their data. For the 8th year in a row, Healthcare organizations had the highest costs associated with data breaches – costing them $408 per lost or stolen record – nearly three times higher than the cross-industry average ($148). "The goal of our research is to demonstrate the value of good data protection practices, and the factors that make a tangible difference in what a company pays to resolve a data breach," said Dr. Larry Ponemon, chairman and founder of Ponemon Institute. "While data breach costs have been rising steadily over the history of the study, we see positive signs of cost savings through the use of newer technologies as well as proper planning for incident response, which can significantly reduce these costs." About IBM Security IBM Security offers one of the most advanced and integrated portfolios of enterprise security products and services. The portfolio, supported by world-renowned IBM X-Force® research, enables organizations to effectively manage risk and defend against emerging threats. IBM operates one of the world's broadest security research, development and delivery organizations, monitors 35 billion security events per day in more than 130 countries, and has been granted more than 8,000 security patents worldwide. For more information, please check www.ibm.com/security, follow IBMSecurity on Twitter or visit the IBM Security Intelligence blog. Source : http://newsroom.ibm.com/2018-07-11-IBM-Study-Hidden-Costs-of-Data-Breaches-Increase-Expenses-for-Businesses

The Mayo Clinic recently announced it is entering into a transatlantic partnership with the University of Oxford and Oxford University Hospitals NHS Foundation Trust to collaborate on improving healthcare and making scientific discoveries. As part of the new agreement, Mayo and Oxford will share a physical location in London expected to open in early 2019 as an independent business subsidiary. “This transatlantic partnership will bring together leading researchers and clinicians from around the world,” Oxford University CEO Bruno Holthof, MD, said in a statement. “Together we will be able to attract more talent and funding in order to create better health outcomes for our patients.” Mayo Clinic Vice President Gianrico Farrugia, MD, sees the culturally aligned organizations – Oxford University, Oxford University Hospitals and Mayo Clinic – "collaborating to drive better results for patients in all areas of medicine.” “Mayo Clinic and Oxford University medicine are truly global brands in health care,” says Sir John Bell, GBE, Regius Professor of Medicine, University of Oxford. “This unique collaboration will allow these world-class institutions to work together in research, teaching and clinical care to make advances in medicine. It will also reinforce the role of the UK as a major health care centre. I very much look forward to working with our distinguished colleagues from the Mayo Clinic to deliver innovation to patients.” Overview of the partnership The 5 potential areas for collaboration are - 1) Research projects 2) Educational interactions and endeavours 3) Practice pilots to focus on leading improvements in quality 4) Integration and outcomes delivered 5) The exchange of resources to support research, practice and educational activities So are we seeing the beginning of a new partnership strategy emerging in healthcare? Yes, I believe we are witnessing the start of a new phase of strategic partnerships in healthcare which will potentially deliver the "triple aim" and for the first time create IP which can be used to start a new cycle of innovation. I will explain why .. A) "Each organization brings a depth of expertise and achievement" - classic partner model of building on each others strengths, together we are stronger strategy Oxford and the Mayo Clinic are two highly respected and well known brands on either sides of the Atlantic in healthcare. This is like Apple partnering with Nike, two brands trusted by millions joining forces. Trust is an important factor in healthcare and when you add two brands together, you inevitably create a multiplier effect. B) "Financial surpluses generated from these activities will be used to help advance clinical education and patient care, and to fund vital medical research" - sharing success unlocks funds for new research and so the cycle begins Advancing clinical education and funding vital medical research is the first step in delivering better patient care and more positive outcomes. Breakthroughs in technology, new clinical pathways, pre operative assessments, recovery times, theatre and surgical advancements creates IP. Intellectual property which can be shared within the ecosystem for the benefit of all. IP can also be monetised in the form of patents, contracts with other healthcare organisations and providers. C) "Oxford University’s Medical Sciences Division comprises 5,500 academics, researchers, NHS physicians and administrative staff along with over 3,000 graduate and undergraduate students, who sustain an extensive and exemplary portfolio of research, teaching and clinical care" - sharing knowledge at scale and comparing outcomes in two different healthcare systems will only increase the quality of research and care 5,500 academics, researchers, NHS physicians and administrative staff 3,000+ graduate and undergraduate students Plus the Mayo Clinics' infrastructure of staff and students is a lot of people, 14,000 maybe? Sharing knowledge between two highly regarded providers of care and academic institutions will inevitably create competition and transparency in a positive way. Peer reviews, group discussions, pilots, A/B tests, multivariate tests will no doubt raise the bar even higher and produce breakthroughs at the speed and scale not seen before. Conclusion This new model of strategic partnership combining depth of expertise and achievement, advancing clinical education and patient care, funding vital medical research, sustaining exemplary portfolios of research, teaching and clinical care effectively delivers the "triple aim" of healthcare and for the first time creates assets in the form of intellectual property. These assets can then be used again to fund new projects and research, potentially unlocking a positive cycle of innovation ..... self funding and self sustaining innovation. Improve the patient experience - most likely to come from pilots testing hardware or medical devices, lower waiting times due to better capacity management Achieve better health through improved outcomes - most likely to come from of new clinical pathways, pre operative assessments, recovery times, theatre and surgical advancements Manage or reduce costs - most likely in the form of less staff needed per task or procedure, new and cheaper drugs, medical devices or equipment Create intellectual property - most likely in the form of software, hardware or medical devices.

Improved cancer treatment, greater chance of pregnancy and faster heart scans are just three benefits brought to healthcare by UK companies attracting investment from Coutts clients. One business we support claims its technology could potentially save the NHS £200 million a year. Our clients have invested in med-tech businesses through the Coutts Investment Club, which introduces financially sophisticated, high net worth clients looking for opportunities to invest in exciting new private companies. To celebrate the 70th anniversary of one of healthcare’s greatest innovations – the National Health Service – here are five companies following in that institution’s footsteps, into which our clients have invested millions since 2015. 1) CREAVO MEDICAL TECHNOLOGIES Creavo has developed a heart scanner that could save the NHS £200 million a year, according to the York Health Economic Consortium. The portable scanner is designed to relieve the pressure on A&E departments by establishing if someone has a serious heart problem soon after admission. It helps doctors rule out a life-threatening condition early – without the need for invasive, time-consuming and costly monitoring. 2) LIGHTPOINT MEDICAL This medical device company has created ground-breaking imaging technology to help cancer surgeons visibly identify and remove all cancerous tissue during an operation, while sparing nearby healthy tissue. This can reduce the need for additional surgery. 3) QUANTUMDX DNA tests in 20 minutes – that’s the benefit this Newcastle-based business brings to healthcare. The company has developed a handheld, low-cost and easy to use device called Q-POC. This powerful tool can be used for diagnosing, managing and monitoring emerging infections and drug resistance. “Such changes can be scary when they concern something as important as our health. But like most innovation, what is new today will almost certainly be commonplace tomorrow.” 4) FERTILITY FOCUS Every year 12 million women start trying to have a baby, according to the CIA World Factbook. Fertility Focus aims to help those still struggling after six months. Their main product is OvuSense, an internal temperature sensor that significantly increases the chance of pregnancy by predicting ovulation 24 hours in advance. 5) SKY MEDICAL TECHNOLOGY This company has developed breakthrough technology to help prevent deep vein thrombosis, help heal wounds and speed up recovery after surgery. It can be particularly useful for elite athletes. The device straps behind the knee, stimulating blood flow throughout the lower part of the body. This aids the recovery of those unable to boost blood circulation by walking. DISRUPTIVE TECHNOLOGY These companies are part of a new age of innovative enterprises using technology to transform how healthcare is delivered. They are a great example of how the UK has become an exciting place for the development of new, innovative technology – not just in healthcare but across a number of sectors. Investment Strategist Lilian Chovin says other areas of disruption within healthcare where we are likely to see growth include robotics and online consultations with doctors, or ‘telehealth’ as it is known. He says, “Robots will improve the speed of procedures, while speaking to a doctor via an app should lead to patients being seen faster and reduced infrastructure costs for the industry – money that can be put to good use elsewhere for patients. “Such changes can be scary when they concern something as important as our health. But like most innovation, what is new today will almost certainly be commonplace tomorrow.” A HEALTHY SECTOR FOR PORTFOLIOS The healthcare sector as a whole remains one of our favourite themes from an investment perspective. Our exposure focuses on medical technology, health insurers and biotechnology, while our more general equity positioning means we have exposure to large pharmaceutical firms and US-listed companies. In addition, we are directly invested in three healthcare firms which sit within our global 30 basket of holdings. Source : https://www.coutts.com/insight-articles/news/2018/uk-med-tech-revolution-as-NHS-turns-70.html

Why is consumer healthcare an attractive market for startups? Market Size: The market for DTC healthcare products is truly massive. It’s hard to pinpoint an exact number, but Euromonitor International sizes consumer healthcare products at ~$700B in global annual sales. Total U.S. healthcare spend is $3.5 trillion annually, and consumers are increasingly bearing a higher percentage of this cost of care, particularly as people shift to high deductible health plans. As people pay more money out of pocket for their healthcare, they begin to expect the quality of experience they find in other great consumer companies. The power dynamic is evolving as people who were previously “patients” are now becoming “consumers.” Companies who treat them as such will be rewarded. Retention: Many healthcare products have a form of built-in retention. If a product is maintaining, improving, or monitoring, your health, you likely will use it frequently and for an extended period of time. Margin / LTV: Consumer healthcare products is one of the highest margin sectors in the global economy. Incumbents such as Pfizer and Johnson & Johnson enjoy EBITDA margins of 35–45%. Retail/OTC drugs gross margins are significantly lower than pharmaceutical manufacturers but are still healthy. Most startups start by working with an industry partner with an existing supply chain, but eventually many of these startups will vertically integrate at scale, which will improve margins. The existing margin profile of many healthcare products allows startups to compete by offering lower prices to consumers, while still maintaining attractive unit economics. The margin profile and subsequent high LTV of this category allow for significant customer service, and customer acquisition spend. Regulation: While regulation is a risk (which I will speak to), it can also serve as a competitive moat. In consumer healthcare, it can take years to properly set up a company, find the right partner, and get various approvals. Broken consumer experience: The current care model of a doctor visit resulting in a written prescription followed by a trip to a brick and mortar retail pharmacy is a one-size-fits-all model that doesn’t do any one thing particularly well. In this market, each of these product areas have different prescription, cost, delivery, adherence, retention models that may necessitate unique product/go-to-market models. New companies can drive down cost, improve customer experience, and even improve outcomes through personalization, improved adherence, and expanded access. What changes are enabling and propelling the shift to DTC in healthcare (aka WHY NOW)? Telemedicine: Telemedicine is a critical enabler of this market because it supports remote evaluation, diagnosis, prescription, and ongoing treatment. When a customer has an existing need, such as for birth control or acne medication, they can order online, and a doctor can evaluate and prescribe their appropriate therapy asynchronously on the backend. This common operating model enables companies to sell direct via online channels and reduces the customer friction of an in-person visit. Data: Today, healthcare DTC companies, can create brands that directly engage with the end consumer. These new companies, armed with first- party data, can internalize product pain points and quickly adapt to their customer’s needs. Targeting specific types of people is now possible with social media marketing. Many of these products only serve a certain type of consumer who may be reachable at scale through digital marketing channels. With these inputs, companies can now efficiently target specific age ranges, genders, locations, incomes, and psychographic profiles. Cutting out the middlemen: DTC flips the value chain of healthcare products on its head. Selling products directly allows startups to pass savings on to the end consumer, rather than giving margin to third parties such as distributors, doctors, and retailers. Also, the increase in high deductible plans makes consumers more price sensitive in categories where they might not have been previously. Incumbents see DTC potential: Manufacturers and distributors who are tied to legacy distribution channels and sell commoditized products feel the pressure to innovate and are now open to partnering with new DTC brands that can target and engage the end consumer more effectively. Increased transparency: Social media, online reviews, and increased access to information have contributed to greater transparency and awareness in the healthcare industry. Brand authenticity matters more as the decision-making and purchasing power shifts from industry practitioners to consumers faced with choice. A survey run by Fortune/GHG found that a minority of millennials view doctors as the single best source of healthcare information (41%, vs. 68% of non-millennials). Consumer consciousness: People care more about what is going into their bodies than they have before and are spending more on elective healthcare products. An example of this is the skincare market, which has been growing at a 10% CAGR for the past five years. What are the major risks in the category? Regulation and operational excellence: Operating in a highly regulated environment is fraught with obstacles, and regulatory compliance is imperative. Many of these products require FDA approval and clinical oversight. The bar on quality is significantly higher when people’s health is at stake, as it should be. Companies that bend the rules will quickly find themselves out of business, which is not the case in all other VC-backed industries. One way companies can reduce the burden of navigating the regulatory environment is by creating a new brand around an existing FDA-approved product. Competition: Competition is omnipresent, both from new startups and industry incumbents with large balance sheets. There are few network effects in this area, which could make it hard for startups to survive if incumbents invest meaningful capital behind building DTC operations. Startups need to find creative ways to scale efficiently and should be prepared to navigate competition, regulation, and even litigation. In certain categories, the barriers to entry can be low, which is why you see five or more companies spring up in a short timeframe chasing the same market. This can manifest in increased acquisition costs, churn, and decreased capital efficiency. If you can’t already tell, I am super excited about this space! If you are building a Healthcare Consumer Products company at any stage, I would love to chat. If I am clearly missing a company, please email me and I will add it. You can find me at teddy@greycroft.com Source : https://www.linkedin.com/pulse/direct-to-consumer-healthcare-teddy-citrin/

Some of the US' leading health systems, including Cleveland Clinic and Oakland, California based Kaiser Permanente, are highlighting group medical appointments as a way to give patients expanded healthcare access and help providers see more patients, reports the Washington Post. Seven report insights: 1. Cleveland Clinic offers over 200 types of shared appointments, such as groups for diabetes or heart disease, male and female wellness, osteoporosis, prenatal and postpartum issues, chronic pain and cancer survivorship. 2. Rather than rushing through a one-on-one appointment, patients can meet with eight to 10 peers and a physician to discuss health challenges, nutrition and exercise for an hour or more each month. "When we think of advances in healthcare, they're always technology or medication or vaccines, and it's really time to look at the healthcare model," said Marianne Sumego, MD, internist, pediatrician and director of Cleveland Clinic's shared medical appointments. 3. Group appointments let providers see more patients than their usual schedules allow, which could prove particularly beneficial when considering the looming physician shortage. 4. Ten percent of family physicians offered group appointments in 2015, up from 5.7 percent in 2005, according to data from the American Academy of Family Physicians cited by The Post. During his time as a psychologist at Kaiser, Ed Noffsinger, PhD, pioneered group medical appointments. Dr. Sumego, who was one of the original providers, brought them to Cleveland Clinic in 1999. Shared appointments are now considered an important, standardized part of care options Cleveland Clinic offers. 5. Each year, more Cleveland Clinic patients participate in shared appointments. The health system's internal surveys suggest a high level of patient satisfaction, especially when taking access to care into account. Additionally, the health system addresses privacy concerns by requiring patients to sign confidentiality paperwork and by having its staff remind patients "how we really want to respect [all participants] and keep the information within the room," Dr. Sumego noted. Dr. Sumego fields a number of calls every week about shared appointments. "I think it's gaining traction," she said. "Our success indicates that it's very sustainable, viable, and that it's well received." 6. Several years ago, Joanna Stark, MD, an obstetrician with Kaiser Permanente Santa Clara Medical Center in California, saw two women in back-to-back appointments who were both 28 weeks pregnant and asked similar questions. Noting this, Dr. Stark searched for a way to bring these patients together. "I'd have more time to answer their questions, and they'd also maybe make a friend," she explained. 7. While researching shared medical appointments, which Kaiser now offers at facilities nationwide, Dr. Stark found Centering, a licensed group-appointment model developed for prenatal care in the 1990s. These sessions have consistent start and end times, one-on-one time with providers as well as group time. Dr. Stark highlighted the comfortable, less formal environment of these sessions. "Patients call us by our first names,” Dr. Stark said. “We don't wear our white lab coats. We dress more casually. We're all at the same level," she said. "There will be somebody who says, 'What do I do about my hemorrhoids?' and you feel like, 'Oh, I'm not alone, I'm not the only one.' And it just normalizes it. And that is just such a reassuring thing for people." Source : https://www.beckershospitalreview.com/quality/why-cleveland-clinic-kaiser-are-touting-group-appointments-for-patients.html

Silicon Valley Bank, Zinc.vc and The Up Group recently hosted a breakfast on ‘Female Health Innovation’, often known as FemTech. The event brought together the ecosystem of founders, investors, scaled organisations and advisors and was chaired by Nooman Haque, MD at Silicon Valley Bank. The discussion was diverse, covering the reality of the market segment, the link between physical and mental health, and how B2C models are slowly forcing the big health authorities in the UK and US to change. CVC’s recent acquisition of the women’s health division of the Israeli drug developer Teva for $800m created a company dedicated to contraception, fertility, menopause and osteoporosis. Opening the discussion, it was clear this is an underserved segment. Recent analysis from Frost and Sullivan shows this market to be worth up to $50bn by 2025. This is driven by the fact that 90% of primary healthcare decisions are made by women. Women are also 75% more likely to use digital tools for their healthcare and spend 29% more per capita on healthcare compared to men. Reaction of Health Authorities – There is a perfect storm for FemTech to emerge now. Firstly, national health organisations around the world have less money to spend than ever before. Therefore some of the solutions which involved long term low cost solutions are being looked at closely to reduce these costs which would otherwise be absorbed. Secondly, direct to consumer wellness is forcing health organisations to look at how they respond to and leverage these types of innovation. Finally the combination of female founders, ‘Women making products for Women’ and a period of sustained innovation in connectivity, data and hardware has meant more products coming to market and getting funding to begin their growth journey. The link between physical and mental health – Many of the attendees stressed that when women experience physical health problems, there are almost always mental problems that link to that also. Whether that be loss of confidence, relationship or sexual problems. The long term impact of this can be far greater than the treatment of the physical symptoms. This has also meant the ability to attract talent and resource to this group of companies has been easier given how purpose driven many of these organisations are. Most health businesses are really tech businesses – Many of the founders in the room immediately looked to find a Co-founder who would be the CTO or Head of Product from day one. The challenge in the room is that you have to be really careful on making recommendations about health unless you are very, very, very sure of your data. There is not a clear line between what would be B2C wellness and what would count as a health care product and therefore be subject to approval by the likes of the FCA. Unlike quicker pizza delivery or improved download speeds, getting health data wrong means more than cold pizza and buffering. The group will continue to meet and create the ecosystem in a segment which is attracting more investor attention and can solve problems in an historically underserved market. Source : https://ww2.frost.com/frost-perspectives/femtechtime-digital-revolution-womens-health-market/ Source : http://www.theupgroup.com/2018/06/femtech-the-rise-of-female-health-innovation/

Digital identity system for patients to access their health records The NHS is planning to roll out a digital citizen ID scheme for patients across the UK - with 'video selfies' touted as a potential verification tool. Presenting to technology suppliers at an event hosted by industry trade body TechUK last week, NHS Digital's lead on Citizen ID, Adam Lewis, outlined plans to trial a digital identity system for patients to access their health records as part of a wider rollout of digital services. Lewis said the plans would see patients register through their smartphones by providing their unique NHS number, showing a form of photo ID on camera and recording a short video, according to the Health Service Journal (HSJ), which broke the news, and later confirmed by NHS Digital. He added there would also be physical locations where patients without the means or capability to video themselves could register, as he demonstrated a prototype of the system at the event. NHS Digital will commence testing on private beta within the next few months, with a public beta starting towards the end of the year or early next year. The system itself - which is yet to be built - will cost £85 million through to March 2019, according to papers released to HSJ under the Freedom of Information (FOI) Act. The plan, which is in its very early stages, will not involve capturing or storing biometric data for one-time verification, but may use biometrics, such as fingerprint scanning or facial recognition, as part of multi-factor authentication for users to access an app in future. 25 million people within five years NHS Digital declined to comment directly on the project, although it labelled Citizen ID "a key element to future digital health services" in a tweet sent during the TechUK event. NHS England and the Department of Health both declined to comment, instead referring IT Pro to NHS Digital. Although Lewis, during his presentation, claimed the system will aim to reach 25 million people within five years, NHS Digital played down this figure as speculative. In Whitehall's own Government Transformation Strategy, it sets out a similar goal to get 25 million people using Verify, another form of confirming people's identities online, that is an initiative of the Government Digital Service. The NHS's digital ID plans feed into a wider roadmap to digitise health services across the UK, outlined by NHS England chief digital officer Juliet Bauer in February. "We're engaging developers inside and outside of the health and care system; letting them know that the digital NHS is open for business to encourage innovation that will raise the bar on the standard of digital health and care tools and services for patients," she said at the time. "And we're also working closely with CIOs and CCIOs locally to support them in commissioning, developing and implementing the very best digital services for their unique populations." The health service has already taken steps to realises its ambitions in recent months, for instance, calling in February for developers to submit their digital health applications for inclusion in its Apps Library, which offers a catalogue of verified and trusted tools to help patients manage their healthcare. According to the NHS's roadmap for digital health and care services, Citizen ID will be ready by 2019/20, in conjunction with an app that is set to be released by the end of the year. The NHS is trying to digitise many aspects of how it delivers services, but has experienced problems in doing so. All 200 NHS trusts failed cyber security assessments earlier this year, conducted after last year's WannaCry ransomware attack that forced more than 40 hospitals to postpone operations. Meanwhile, the body has been criticised for data-sharing deals with the Home Office and private companies like DeepMind. Source : https://www-itpro-co-uk.cdn.ampproject.org/c/www.itpro.co.uk/identity-and-access-management-iam/31119/nhs-to-trial-video-selfies-to-verify-patient-identities?amp