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2019 Digital Health Prediction 1 : Apple, Amazon, Google or Microsoft acquires electronic record systems provider Epic (Epic Systems Corporation) to gain a foothold in Healthcare. The acquisition will effectivey be a "trojan horse" unlocking access to data, clinical technology, mobile technology, paying clients and research. Epic's market focus is large healthcare organizations and academic medical centers. Apple, Amazon, Google or Microsoft all need to combine the latest academic and medical research with massive patient/clinical data sets and their proprietary machine learning, deep learning and neural network algorithmns. In Q1 2017 Epic launched a new program App Orchard – serving physician practices and hospitals to help them build customized apps. The program also supports independent mobile app developers who target providers and patients. App Orchard, for its part, lets developers use a FHIR-based API to access an Epic development sandbox. This will allow the developers to address issues in connecting their apps to the Epic EMR. Previously, Epic wouldn’t let mobile app developers connect to its EMR until a customer requested permission on their behalf. In addition to providing the API, App Orchard will also serve as an online marketplace along the lines of Google Play or the Apple app store. However, end users won’t be able to download the app for their own use — only software developers and vendors will be able to do that. The idea is that these developers will create the apps on contract to customers. 2019 Digital Health Prediction 2 : Voice technology will be the first step to personalising pharma. By the end of the year we will see the use of Virtual Assistants by patients to help interact with their health data and "transact" via voice technology to order repeat prescriptions, pain management and medication requests. Google Voice, Siri, Cortana and Alexa will finally have connectivity to raw and comprehensive up-to-date data. Voice technology also has massive potential for clinical drug trials. Orbita, a provider of voice-first software for connected home healthcare and ERT, a global data and technology company focused on minimising risk in clinical trials, have recently put their heads together to research the potential of voice assistants to improve patient engagement and optimise data collection in the clinical trial setting. Their solution enables patients to use the power of voice to complete interactive surveys, verify completion of care tasks and report health concerns while clinical trials investigators and coordinators can use built-in analytics to track user engagement and respond to user input. 2019 Digital Health Prediction 3 : Healthbots will increasingly focus on solving automation problems in Healthcare, such as workflow data entry and fraud detection. Healthbots will become the new generation of chatbots, an additional layer on-top of the previously established eco-system of messaging apps. Healthbots will start to take over systematic and repetitive tasks like booking appointments, checking patients’ IDs, checking insurance information and coverage, asking for medical history and drug intake, and giving information about side effects and drug interactions. ( Source : Bots in healthcare: interview with Thomas Schulz, Organiser of Botscamphttps://research2guidance.com/bots-in-healthcare-interview-with-thomas-schulz/) 2019 Digital Health Prediction 4 : Mobile phone manufacturers will follow Apple's lead on connecting to hospital EHRs using FHIR. Samsung, HTC, Nokia, Motorola will roll out native apps that can use FHIR to pull hospital and medical practice data onto their devices. In September 2016, Google Acquired Apigee, the leading provider of FHIR based API’s effectively stealing a march on its competitors, however we are yet to see the application of Apigee's technology in connecting hospital EHRs with Android (mobile operating system developed by Google) using FHIR. After years of ambition, hype and hope .... 2018 will be the year, digital health is on FHIR :) 2019 Digital Health Prediction 5 : We will start to see the growth and adoption of "Persuasive Architecture" and 'Captology' in Digital Health - websites, mobile platforms and applications in healthcare becoming far more persuasive. Persuasive Architecture refers to a website, mobile platform or application that has been designed and developed in such a way as to convince users to take action. Captology is the study of computers as persuasive technologies. This includes the design, research, ethics and analysis of interactive computing products (computers, mobile phones, websites, wireless technologies, mobile applications, video games, etc.) created for the purpose of changing people’s attitudes or behaviors. One challenge of mobile health applications for example is the capability to establish long-lasting behaviour change among patients and their respective health care provider, or both. Early research by academics Mustafa Moosa Qasim, Mazida Ahmad and Mazni Omar in their paper "Analyzing Persuasive Mobile Healthcare Architecture Using Systematic Process Design" are leading the way in understanding how Persuasive Architecture can result in better patient outcomes. 'More broadly within the healthcare domain, the prospective value of persuasive mobile technology is seen in changing individuals by incorporating persuasion features into the design of mobile phone technology. In this regard, most of the researchers have paid attention to develop persuasive applications, but they yet failed to provide guidance on how the persuasive guidelines can be implemented, in particular in software architecture." https://www.researchgate.net/publication/320273454_Analyzing_Persuasive_Mobile_Healthcare_Architecture_Using_Systematic_Process_Design The Stanford Persuasive Tech Lab performs research into computers as persuasive technologies and its ethical use. It is part of H-STAR, the Human Sciences and Technologies Advanced Research Institute at Stanford University. The study of persuasive technology began at Stanford in the 1990s. As a Stanford doctoral student (1993-1997), BJ Fogg used methods from experimental psychology to demonstrate that computers can change people’s thoughts and behaviors in predictable ways. His thesis was entitled “Charismatic Computers.” BJ Fogg went on to found the lab in 1998. Persuasive technology is now a global area of research and design. In the early days, the lab was doing research, conducting classes, and organizing events at Stanford. Author - Lloyd Price https://www.linkedin.com/in/lloydgprice/ https://twitter.com/lloydgprice

Suddenly, everybody’s talking about ambient computing. I blame Intel, and I’ll tell you why in a minute. Ambient computing is real. It’s the next megatrend in computing. Ambient means “in the air” or “present on all sides” or “all around us.” To interact in an “ambient computing” context means to not care and not even necessarily know where exactly the devices are that you’re interacting with. When IoT devices and sensors are all around us, and artificial intelligence can understand human contexts for what’s happening and act accordingly and in our interests, then ambient computing will have arrived. In the past, computing existed inside a computer, which you saddled up to and consciously used. In the future, connected computing devices will be all around us, and we’ll always be interacting with them, even when we don’t know or think about it. As I told you last year, ambient computing isn’t a specific technology, but a general way to interact with digital devices and the internet. As with many technology revolutions, the buzzword ambient will precede the actual technology by many years. In fact, the marketing buzzword is suddenly here in full force. The actual technologies? Not so much. Instead, we’re on the brink of a revolution in what you might call “semi-ambient computing.” Intel dragged ambient computing into the spotlight a couple of weeks ago by unveiling a prototype laptop it calls an Ambient PC at its Technology Open House at Computex in Taiwan. The Ambient PC gets its label in part from a touchscreen edge that functions while the laptop lid is closed. The edge-screen shows icons, calendar information (it's running a calendar app in the image up above), buttons for controlling audio on the device and the laptop (while still closed), and microphones make the laptop work like an Amazon Echo appliance, offering Alexa just a wake-word away. Most interestingly, the laptop has a 360-degree camera that can log you in as you approach it using Windows Hello. It’s a stretch to call Intel’s Ambient PC idea an example of ambient computing. It basically does things while closed that regular laptops can do only when open. Containing these functions with the closed lid doesn’t make it ambient, just usable in a new configuration. I still want one. Alexa, are you ambient? Amazon’s Alexa virtual assistant shows up in many physical appliances these days, including Amazon’s own Echo and related lines of smart speakers and smart displays. Alexa, Siri, Google Assistant and Cortana enable hands-free interaction with information, “skills,” the internet and communication and are, as such, semi-ambient computing products. The best fraud prevention finds customer behaviour anomalies As digital security threats multiply online, companies are using predictive algorithms and machine learning to detect fraud—especially in financial services. They’re not fully ambient because they can’t yet use AI to synthesize several sensors to understand context. For now, they mostly operate through voice. When I’m having a conversation and mention Alexa, the Echo wakes up and says it doesn’t understand. And that’s right. Alexa has no ability to understand the context of my use of the A-word. The new Google ‘wave’ Rumors are circulating that Google’s next smartphones, the Pixel 4 line, may come with Soli built in. I told you in January about Google’s Project Soli, which may be called the “Aware” sensor or feature in the Pixel 4 — again, according to unconfirmed rumors. Soli or Aware capability means the Pixel 4 may accept in-the-air hand gestures, such as “skip” and “silence” during music playback. The new Google “wave” is a hand gesture. The ability to wave away music with a hand gesture brings the smartphone into the semi-ambient computing era. It basically adds natural hand gestures to natural-language processing. There’s no reason to believe that the Pixel 4 will synthesize these actions into context. The truth is that ambient computing for consumers is years away, and will likely first emerge in cars. As consumer electronics appliances, cars have an advantage for the introduction of sensors. The reason is that drivers and passengers are a captive audience — it’s clear where to point the sensors and even possible to build them into seats and seatbelts. The context of human activity or intent is also easier to guess in a car. Over the next five years, an increasing number of cars will gain the ability to identify the drivers and passengers (and adjust settings and preferences accordingly); monitor the driver for sleepiness, drunkenness and distraction; and safely wrench control from the human and pull over if necessary. Grocery stores will also become consumer-facing ambient computing locations. Amazon’s Go stores are already semi-ambient computing systems, where customers essentially shoplift with Amazon’s permission, and then pay for the nabbed items automatically. Smart glasses will one day function as consumer ambient computing devices. With advanced machine learning, glasses will monitor gaze and drip information about what we see into our ears (or though bone conduction), and provide context and extremely effective virtual-assistant functions in a seamless way. But the first place ambient computing will appear for real is in businesses, enterprises and healthcare facilities. Microsoft is going all-in on ambient computing, according to reports. Under the Surface brand, Microsoft is expected to release a range of ambient computing devices, features and services that probably involve its Cortana virtual assistant. Looking behind the scenes, it appears that Microsoft sees ambient computing as a concept for businesses and enterprises. In posted job listings, Microsoft says that its “Ambient Computing & Robotics team is creating applications for the era where computer vision, AI-based cognition, and autonomous electro-mechanicals pervade the workplace. We are using this convergence to transform physical work in construction sites, logistics yards, baggage handling areas, hospital corridors, factories, restaurants, farms and more.” Microsoft was mocked for its “Clippy” assistant, which the company released in 1996 as a way to provide friendly help for people using Microsoft Office. In the future, Microsoft may release what will essentially be a Clippy that works, because it will understand human context through AI. We’ll also see ambient computing showing up in medicine. Healthcare Nuance, the venerable speech-recognition company, is working on ambient computing for healthcare called Ambient Clinical Intelligence, or ACI. It works through a smart speaker mounted on the wall of a doctor’s examination room, which also has a camera. By applying deep learning to speech and visuals, ACI is able to document doctor visits. The idea is to enable the doctor to pay full attention to the patient, without worrying about writing everything down. ACI should start showing up in medical centers next year. Google also briefly talked last year about a healthcare assistant called Dr. Liz., which was described by former Google CEO Eric Schmidt as an ambient computing virtual assistant for doctors. We’ll see if Google ever ships a Dr. Liz product. Yes, ambient computing is real, and the Next Big Thing, showing up first in business, enterprises and healthcare. Source : https://www.computerworld.com/article/3402959/why-ambient-computing-is-just-a-marketing-buzzword-for-now.html

Goldman Sachs recently produced a 30-page report based on the the work of five research analysts focused on Amazon's likely ambitions to enter the Healthcare and Pharmaceutical industries. Some of the most notable predictions the report makes are ... 1) "Amazon could move into digital health by using the Echo in clinical settings and developing tools for telemedicine and remote patient monitoring. "Imagine seeing a virtual doctor on your Amazon app, having it prescribe you a certain medication, and then tapping a 'buy now' button -- all without leaving your home." 2) "Rather than replacing pharmacies right away, Amazon might start by partnering with a pharmacy benefits manager (PBM), which acts as an intermediary between payers, like health insurers, and the rest of the health system. That would provide "access to patient data and the potential to cross-sell related products." 3) "Amazon could also become an online pharmacy, retail and online pharmacy, integrated PBM and online pharmacy, or handle drug distribution to pharmacies. Leaving Pharma aside, I agree with Goldman Sachs and believe Amazon can disrupt the Healthcare industry within the next 2 years based on the following 5 steps and by executing their highly successful modus operandi .. Step 1 : Collect all the Data Legacy Issues - " Amazon's new team is currently looking at opportunities that involve pushing + pulling data from legacy electronic medical record systems.” Medical Records - "Amazon is looking for a machine learning director with experience in healthcare IT & analytics and knowledge of electronic medical records” Hospitals - "Amazon Web Services has hired health experts to beat out Microsoft and Google for contracts with large hospitals & pharmaceutical vendors” Amazon are clearly tackling one of the biggest issues in healthcare, the fact patient data and medical records are stored on legacy systems. This is a very smart approach because once Amazon has access to patient data and medical records, it can run machine learning algorithms across these large data sets to identify patterns, behaviours and potentially fraud. Step 2 : Own the Infrastructure My prediction is Amazon’s next move will be similar to Google’s acquisition of Apigee, the leading provider of FHIR based API’s. Amazon will acquire a FHIR based API company with specialist knowledge of healthcare & pharmaceuticals and then integrate it into Amazon Web Services to offer a market leading software as a service model. Infrastructure in Healthcare is all about scale, and scale is exactly what Amazon has ... Amazon Web Services’ Global Infrastructure operates 44 Availability Zones within 16 geographic Regions around the world, with announced plans for 14 more Availability Zones and five more Regions in China, France, Hong Kong, Sweden, and a second AWS GovCloud Region in the US. Step 3 : Distribute the Infrastructure Amazon have a history of building developer networks and actively encouraging 3rd parties to build on top of their infrastructure, healthcare will be no different. In the next 2 years expect to see "Amazon Health Dev Days" and workshops as Amazon invest heavily in distributing their technology across the healthcare market. Interested in building an Alexa powered voice commerce solution for older people in care homes to order presents for their grand children, no problem ... Interested to building a mobile application for your cousin with diabetes, no problem.. In May 2016, Amazon started giving away its most sophisticated personalisation technology. DSSTNE (pronounced “destiny”), an open source artificial intelligence framework that the company developed to power its product recommendation system. Now any company, researcher, or curious tinkerer can use it for their own AI applications. “We are releasing DSSTNE as open source software so that the promise of deep learning can extend beyond speech and language understanding and object recognition to other areas such as search and recommendations,” the Q&A section of Amazon’s DSSTNE GitHub page reads. Step 4 : Personalise Online Amazon has the best recommendation engine in the world, they were very early into massive machine learning projects to offer personalised products to every customer based on many inputs ... Purchased shopping carts = real money from real people spent on real items = powerful data and a lot of it. Items added to carts but abandoned. Pricing experiments online (A/B testing, etc.) where they offer the same products at different prices and see the results Packaging experiments (A/B testing, etc.) where they offer different products in different "bundles" or discount various pairings of items Wishlists - what's on them specifically for you - and in aggregate it can be treated similarly to another stream of basket analysis data Referral sites (identification of where you came in from can hint other items of interest) Dwell times (how long before you click back and pick a different item) Ratings by you or those in your social network/buying circles - if you rate things you like you get more of what you like and if you confirm with the "i already own it" button they create a very complete profile of you Demographic information (your shipping address, etc.) - they know what is popular in your general area for your kids, yourself, your spouse, etc. user segmentation = did you buy 3 books in separate months for a toddler? likely have a kid or more.. etc. Direct marketing click through data - did you get an email from them and click through? They know which email it was and what you clicked through on and whether you bought it as a result. Click paths in session - what did you view regardless of whether it went in your cart Number of times viewed an item before final purchase If you're dealing with a brick and mortar store they might have your physical purchase history to go off of as well (i.e. toys r us or something that is online and also a physical store) Now imagine all these factors and more applied to Healthcare ... Step 5 : Personalise Offline The final piece of the jigsaw, integrating your online customer experience with your offline customer experience. Imagine a world where Amazon recommends and personalises your food shopping based on your health? You have "opted in" to recommendations of what food to buy based on your medical record and medical history. You "click and collect" your order at the local Amazon Whole Foods and potentially pick up any medication you require. So now I have a "plant based diet" personal to me based on Amazon's machine learning algorithm which calculated the latest scientific research from tens of thousands of medical journals .... The ultimate online/offline customer experience could be only years away, order via your Amazon mobile app lying in the bath on Friday night, collect your Amazon order on Sunday morning from an Amazon Whole Foods store because you have a few questions to ask or wait for the Amazon delivery driver to knock on your door ... Let's continue the conservation and debate how quickly Amazon can disrupt Healthcare, tweet @lloydgprice :)

Platform domination is a feature of several industry sectors, especially ones where there is a winner-takes-all outcome that is hard to replicate or compete against. Google dominates search. Amazon dominates e-commerce. Facebook dominates social media. And so on. In several industries, dominant incumbent firms have also developed their own platforms to get in front of disruptive innovation. Research by consulting firm McKinsey suggests that across sectors in developed economies, a single digital platform prevails 75% of the time, citing examples of Daimler, Nike, and Unilever. So, how far away is healthcare from a platform-dominated digital business model? Over the past few years, several healthcare focused cloud-based digital platforms – or health clouds - have been announced by big tech firms such as Salesforce, Microsoft, and Google. These platforms are intended to emulate the winner-take-all models that we have come to see in social media or search advertising. The McKinsey report notes that industries with lower digital maturity, such as Pharma and healthcare, see a lower level of prevalence of platforms, citing the lack of network effects, which require a large section of market participants to elect to participate in a single dominant platform, as one of the primary reasons. In a recent conversation on my podcast, John Sculley, former CEO of Apple, stated that platform technologies have revolutionized industry after industry with one big exception – healthcare. Let’s explore a few of the reasons for why that is the case. Most platforms fail, regardless of the sector they operate in A study of 250 platforms, published in the Harvard Business Review, provides a sobering view of the prospects for platforms in general. For every VC-fueled Uber and Airbnb that goes for world-domination through first mover advantage and network effects, there are several that do not make it past their fifth anniversary. The reasons range from late entry to mispricing, lack of trust, and not paying attention to competition. Healthcare has historically been a low-trust economy, with payers, providers, and pharma companies in largely adversarial relationships in a zero-sum game. For platforms to succeed, market participants must share data and invest in collaborative initiatives to improve healthcare outcomes and reduce costs for the sector. The closest we have come to this ideal in healthcare is in health information exchanges (HIE), and even those have failed to gain traction due to a variety of issues. Users are slow to adopt digital health platforms For a platform economy to succeed, consumers have to use the platforms. Even telehealth platforms, seen as a transformative way to deliver healthcare, are seeing relatively low adoption rates among physicians (the American Hospital Association has documented the key issues – including coverage and reimbursement by Medicare for telehealth visits). Analyst Mary Meeker’s widely read annual Internet Trends Report suggests that consumers are using digital health tools primarily for basic activities such as online health information and for researching provider ratings. This suggests a gap between the billions spent by big tech firms on building platforms, and the market’s readiness for the platforms. It is all about the data, and who owns it Healthcare IT has been bedeviled by interoperability challenges, as everyone knows. For now, the custodianship of the data rests with health systems and their electronic health record (EHR) vendors. There is growing activism about handing over the ownership of the data to consumers (including a proposed CMS rule that will make it mandatory for consumers to be provided access to all their medical information), but we are still in early stages. Even if we were to get to grips with secure and seamless data exchange among participants in the health IT ecosystem, there is growing realization that the fundamental building block for driving innovation, namely a universal patient identifier, does not exist (recent legislative action could change that). Big tech firms, for their part, have to overcome a general lack of trust by consumers for sharing personal medical information on their platforms. Notwithstanding their relative lack of digital maturity, healthcare enterprises are choosing their own pathways for adopting digital platforms. Health systems are choosing a combination of best-in-class point solutions and enterprise-scale platforms, sitting alongside their core EHR systems, to reimagine patient and caregiver experiences. Health insurance companies have firmly adopted consumerism as the focus of their digital efforts. They are providing the emerging marketplace with pricing information, health and wellness counselling, and treatment alternatives. Pharma companies are looking hard at digital therapeutics to extend brand revenues by building digital “wrappers” around their products, and to develop new drugs-as-software that cost a lot less to develop and monetize compared to traditional drug discovery models. So far, one thing is clear. No single tech firm seems positioned to dominate healthcare in the short term. The market seems to have plenty of room for companies - incumbents, innovators, or startups - to carve out a role in the digital transformation of healthcare. For all these reasons, platforms are only just gaining significance, and it may be early days yet. John Sculley, who is an advisor to RxAdvance, a company looking to disrupt the PBM industry with a PBM cloud offering, thinks that healthcare industry platforms are probably the greatest examples of digital health enablement. He also believes that we are going to see more and more success stories by 2020 and beyond. Perhaps the new players will demonstrate that healthcare is just as important an opportunity for platform technologies as all those other industries have been. Source : https://www.cio.com/article/3404529/how-close-are-we-to-platform-domination-in-healthcares-digital-business-models.html

Allow me to raise this question: what will happen to a pharma company’s diabetes, respiratory or cardiology drugs if in 10 years time, we are able to fully use 3D organ printing? Well, it would most likely disrupt its traditional business models of selling drugs for those diseases, wouldn’t it? It seems that there is hardly any event, article or discussion on healthcare that is not loaded with the term disruption, or in its milder version, transformation. Yet, the true consequences for all healthcare stakeholders are often the elephant in the room. Many incumbents seem to still believe (or at least hope) that disruption is all about technology or digital innovation, and that it will stop there and not touch the very essence of their businesses or roles within the healthcare system. Indeed, there is a very strong chance that they are dramatically wrong. It is perfectly alright to be skeptical. We have been talking about disruption and transformation in healthcare for a very long time and in many places and markets, nothing seems to have substantially changed. If we take Germany as an example, the country still spends around 35% of total healthcare expenditures on hospitals, 17% on drugs and about the same amount on doctors. Guess how the distribution of expenditures was 15 years ago: yes, it was almost exactly the same (with slightly higher expenditures on drugs then). If we look at disruption as being innovations transforming markets or sectors and improve simplicity, convenience, accessibility and affordability, we need to come to the conclusion that in many places, there is still a long way to go. So why should healthcare stakeholders bother? What is different this time? I think that there is one element in the healthcare arena that has the potential to fundamentally change the whole scenery: the shifting expectations of citizens, patients and doctors. This is often referred to as the “Amazon-Effect” and leads to a situation where individuals in the healthcare system are no longer willing to accept receiving care in silos that do not communicate with each other, being thrown into an anonymous hospital machinery that does not care about their wants and needs, or being obliged to tediously decipher their medical data (if at all they get a hold of them). Doctors will be increasingly reluctant to push heaps of paper through hospital corridors and not having instant access to patients’ health status, diagnostics or medication. Digitalization in healthcare is about managing the changing expectations of citizens, patients, and medical professionals CDO’s of healthcare related organizations and enterprises should move away from trying to apply digital technology, solutions and services to their traditional ways of operating. They might miss the point, as their existing business- and operational models could vanish in the not-so-far future. And the strongest driver behind all of this are the consumers – and to an increasing extent – the providers of healthcare. Simply because the established ways of working and the provision of healthcare services are not serving peoples’ wants and needs anymore. The emergence of a mix of a game-changing dynamics Apart from shifting expectations, there are other drivers and catalysts that will strongly contribute to disrupting the healthcare system as we know it. The new thing about this is, that all of it is happening at the same time: Regulatory changes: in many countries legislation is finally adapted to provide a solid regulatory base for digital solutions and services to be used and to foster. The same is true for the usage of aggregated health data and respective AI-based innovations. Even in slow-moving countries such as Germany, such legislative changes are currently being launched. New reimbursement rules: apart from a reliable legal basis, innovation leading to disruption needs a second prerequisite to flourish, namely a scalable business perspective. With the introduction of favorable reimbursements for e.g. digital solutions and services, this is by now well under way in many countries. Changing social norms: citizens do not look to doctors as the single source of knowledge anymore. Whereas in previous generations, individuals willingly accepted to be sheep-like recipients of healthcare services, nowadays, they have grown into critical and confident healthcare customers. Genomics-based therapies and reproduction technologies: in areas such as oncology, we start to better understand the role of genetic dispositions in the proliferation of cancer. This allows for a much more targeted therapeutic approach. These new therapy approaches will gain a foothold in more and more disease areas, as well as in diagnostics or prevention. Moreover, new reproduction technologies such as 3D organ printing will significantly alter and improve current therapies. How to ride the disruption wave in healthcare – start developing your future game plan One could for sure get lost amidst the plethora of articles, papers and events on the subject. Do not put the cart before the horse and let yourself be drawn into a premature technology discussion. First of all, start by developing scenarios on how the world could look like for your organization or your markets and address questions such as: what are your customers’ expectations, what are the relevant technological innovations, will there be new players in your market space, how does this affect your organization, your people and your future role in the system? Developing the future game plan should be the starting point of your disruption ride. It is only afterwards that you should start to think about how e.g. digital technology can support you in achieving the often needed organizational transformation, your future operations and your wanted position. And bear in mind: disruption is by nature not linear. Especially in healthcare, it will rather happen on a market-by-market basis instead of on a national level. And in most cases it will unfold itself in certain fields or pockets across the healthcare system and not invade the system as a whole right from the beginning. Finally, how long will this take to unfold? Well, how long did it take to replace horse-drawn carriages with cars: about 8-10 years? I think this is a fair estimation. Source : https://research2guidance.com/disruption-in-healthcare-what-will-be-the-new-normal/

British telecom operator Vodafone with the backing of the UK Department for International Trade has bagged a £100m contract to help Egypt develop a new health insurance IT system in the lines of the NHS. The contract won by Vodafone will be an important part of the Egyptian government’s push to introduce NHS-style universal healthcare for every citizen in the country. Egypt wants the IT system to support a new primary healthcare system identical to the one that operates in the UK. Vodafone will be partnered by DXC Technology, which is already engaged in providing the IT infrastructure services across the NHS supply chain. The duo will join forces to create a digital healthcare services platform to enable the launch of Egypt’s universal health insurance scheme. The project will start off as a pilot in Port Said, before it is introduced to four other governorates and then throughout Egypt. Vodafone is among the major telecom operators in Egypt with 40 million subscribers, which is twice the number it has in the UK. The Department for International Trade said that the contract to Vodafone comes as British firms and government are working in tandem to carry out a variety of other healthcare activity, to share the benefits of the NHS and British pharma industry with Egypt. UK Secretary of State for International Trade Liam Fox said: “We in Britain are proud of our NHS and how it provides access to healthcare for everyone. I myself used to be an NHS doctor before becoming an MP, so I know how important it is. “It is a system that is respected around the world and we want to help other countries do what they can to secure the same benefits for their people. “That’s why we’ve stood by Vodafone as it sought and secured this contract which, as part of the Egyptian government’s reforms, will help revolutionise healthcare for people here – It is the beginning of an Egyptian NHS for the Egyptian people.” Source : https://www.governmentcomputing.com/healthcare/news/vodafone-egyptian-nhs-contract

The insurance industry is changing, and its changing fast. The forces driving the change in insurance include skyrocketing healthcare costs, rising protection gap and a shift in the way consumers prefer to interact with brands. These new realities are pressuring the insurance industry to embrace insurtech. Prudential is among those in Malaysia’s insurance scene that have adopted this digital doctrine. Nic Nicandrou, CEO, Prudential Asia, revealed to us that the group as a whole has stepped their tech investment to over £400 Million this year. On Malaysia’s front we were also informed that they are looking to invest over RM 250 million in these key areas; removing inefficiencies, improving customer services, and increasing accessibility to Prudential’s services. Part of that renewed focus into digital technologies and insurtech is their soon-to-be-launched digital health tool, Pulse. We were given the opportunity to take sneak peek at the beta version of their app during their media preview session. Though Pulse made its first appearance at Singapore Fintech Festival 2018, Nic shared with us that Malaysia will be the first market that they will be debuting Pulse. A Glance at Prudential’s New AppThere are 4 key functions to Prudential’s AI powered digital health tool — Health Assessment, Symptom Checker, Online Consultation and Dengue Alert. All these functionalities were made possible thanks to partnership with startups like Babylon Health, DoctorOnCall and AIME. One of the the flashier functions within the Pulse app is the “digital twin”. Once you’ve completed a very detailed interaction with its chatbot, the app will generate an interactive diagram of your body along with some helpful graphs. The colours represent the level of health risk of each of your organ. When you tap on one of the organs it will list down what are the risks you face and recommend options that you can take to improve the situation. According to its partner Babylon, the symptom check function uses over 50 million data points to provide users a diagnosis. The app will then recommend if a visit to the doctor is needed.Should that need arise users of the may opt to use their built in tele-health capabilities to get a consultation from certified doctors via video calls. Once that’s done users can have medicine delivered directly to their doorstep and payments can also be made within the app using credit/debit card and your Boost e-wallet. The myriad of services offered within the app is definitely a step in the right direction for Prudential, this is especially true in Malaysia where 71% of health related searches happens on the mobile and the fact that 23% of apps downloaded are health related apps. We were also pleased to learn that this app is also made available to non-Prudential customers. However, there are some areas that the app requires improvement. The necessary interaction to generate the health assessment report is too lengthy, which took roughly 15 minutes to complete. While it is understandable that such level of detail is necessary to generate an accurate report, perhaps it might work better to gamify that aspect of it and get users to complete that interaction in phases. Another area that would benefit from some fine tuning is the language that’s used, while it’s clear that effort has been made to use simpler language there are still quite a number of medical jargons that many users might find difficult to understand. For a beta version of the app it is pretty refined and I’d imagine they will iron out some of these minor kinks prior to an official launch. The beta version of the app is now available for download in Google Play and Apple Store, it is a free-to-use app with the exception of the online consultation service. Source : https://fintechnews.my/20652/insurtech-malaysia/prudential-insurtech-pulse/

San Francisco-based workplace communication platform Slack filed for its IPO on Friday and underscored the healthcare privacy regulation it will need to clear as it boosts its health play. Slack noted the importance of holding onto its Health Insurance Portability and Accountability Act (HIPAA) compliance — which, if breached, could land the company in hot water with steep fines and criminal penalties. Slack announced that its file upload feature was compliant in February, but its direct messaging and channel communication features between health providers isn't yet cleared. It's likely that HIPAA compliance will extend to communication features within months. Here's what it means: Healthcare represents a large market opportunity for Slack if it sorts out HIPAA compliance. There's likely appetite among healthcare players for more convenient communication tools. For example, news surfaced in May 2018 that 500,000 healthcare staff in the UK National Health Service (NHS) were using instant apps like WhatsApp and Facebook Messenger to communicate, due in part to frustration with NHS-approved communication tools. If Slack's security is on par with current communication platforms used by health organizations, it could compete on convenience. The industry is reeling from cybersecurity attacks, creating a large market opportunity for vendors of secure communication platforms. The US healthcare industry suffered a record 365 data breaches in 2018 — up about 2% year-over-year (YoY) from the previous high of 358 breaches in 2017. This should lead health firms to invest in secure tech that mitigates high costs that data breaches impose. The bigger picture: Slack's healthcare-specific risks are reflective of the challenges that await non traditional digital entrants in healthcare. Lyft and Uber both shed light on potential regulatory risks as they expand their health plays. In their respective IPO filings, Uberand Lyft highlighted they may become subject to additional federal and state healthcare regulations. Both ride-hailing giants partner with health systems and insurers to offer transportation for patients. Lyft indicated that breaching healthcare privacy laws would expose the company to up to $1.5 million in penalties. And tech behemoths like Amazon and Google have to navigate low consumer trust. For example, only 11% of US consumers are willing to share health data with tech companies. A low level of trust could drag on consumer use of big tech's healthcare services, limiting the impact they have on the industry. Source : https://www.businessinsider.com/slack-healthcare-play-2019-4?r=US&IR=T

Intro to TestCard TestCard.com is a UK domiciled startup revolutionizing the direct to consumer healthcare diagnostics market. The company has innovated a delivery mechanism that allows conditions to be diagnosed immediately in the comfort and convenience of home. TestCard enables an individual to take ownership of their health, making laboratory level information accessible and painless and thus enfranchizing the individual and ultimately democratizing healthcare. The company’s innovation is a diagnostic urinalysis (urine test) kit embedded into a postcard. The ‘TestCard’ and the accompanying TestCard app, are not only a reliable and non-invasive alternative to costly and time-consuming doctor visits; but crucially, serve as an early diagnosis tool that prompts earlier medical intervention and treatment. What is TestCard? TestCard enables an individual to take ownership of their health, making laboratory level information accessible and painless and thus enfranchising the individual and ultimately democratising healthcare. What is the TestCard solution ? TestCard is a revolutionary urinalysis system, which combines the accuracy of medical lab tests with the latest in mobile technology. The user simply applies urine to the pull-out strip (applicator) imbedded in the postcard and, using the TestCard app, holds their mobile device above the TestCard enabling the app to deliver an immediate result. Simple for the end user, effective and instantaneous. Mobile App Medical jargon is confusing and can cause further patient anxiety, therefore TestCard delivers a clear interpretation of results in language that is easily understood. Given the natural tendency of the patient/consumer to delay health monitoring and screening through conventional doctor visits, TestCard fills a growing gap in the healthcare market. Source : http://www.testcard.com/

Doctor-appointment booking app Doctolib has been valued at more than a billion dollars after raising new funding, adding to the surge of interest in health-care startups. Founded in 2013, Doctolib operates a doctor’s appointment-booking app and related management software, and has been growing services of video-based consultations and digital prescriptions, similar to Britain’s Babylon Healthcare Services Ltd., and Doctor On Demand Inc. in the U.S. Doctolib’s 150 million-euro ($170 million) round announced Wednesday was led by U.S.-based growth equity investor General Atlantic, the startup said in a statement. In France, Paris-based Doctolib is the latest unicorn technology upstart in a club that includes cloud storage supplier OVH Groupe SAS, car-sharing app Blablacar, and music streaming service Deezer SA. The latest round is Doctolib’s third in just over two years, after the company acquired Lagardere’s online medical platforms in France and expanded to Germany. Fewer small businesses raised money in the EU last year compared to 2017, but the size of the average round got bigger, according to a data compiled by Tech.eu, which tracks VC activity. There were 2,975 funding rounds, for a total amount of 24.7 billion euros, the data showed. Doctolib said it receives 30 million online visits from patients every month and has partnered with doctors and hospitals in France and Germany. Existing shareholders Eurazeo SA and French state-backed fund Bpifrance participated in the new raise, Doctolib said in its statement. The company will use part of the money raised to expand to new countries. Source : https://www.bloomberg.com/news/articles/2019-03-20/french-ai-health-care-app-doctolib-hits-1-1-billion-valuation

Navigating the new digital healthcare landscape is challenging for everyone. The global healthcare landscape is rapidly changing with digital technologies becoming increasingly normalised into the everyday delivery of healthcare. But how does this change how healthcare organisations provide and deliver care? In the future, the digital landscape might span everything from patients to wider healthcare delivery organisations (Figure1). Patient-facing technologies are at the centre, reflecting the impact that this new ecosystem of self-monitoring and decision support will have on their experience and quality of care. Other technologies are broadly categorised as professional-facing and organisation-facing depending on their primary user and value in enhancing individual patient care or improving care systems. The electronic health record straddles the system as a whole, reflecting the pivotal role it plays in any digital strategy. It is the foundation upon which many of the other applications are built. Navigating this new landscape is challenging for organisations and their leaders and there are many pitfalls. There is no doubt, however, that technological transformation will be one of the major differentiators between successful and unsuccessful providers over the next decade. The pressures of cost and expectations of quality mean that doing nothing is not a sustainable option. Deploying information technology in healthcare The history of health information technology (IT) has certainly not always been smooth. Examples of spiralling costs, slow take-up and elusive productivity gains are found in virtually every health system around the world. Why has healthcare delivery been so resistant to digital transformation, and when big investments have been made, why have strategies so often failed to pay off? Based on my experience at both local and national levels, perhaps the most important lesson of all is that becoming a digitally enabled healthcare provider isn’t about replacing analogue or paper processes with digital ones. Where implementations have failed, technology has often simply been layered on top of existing structures and work patterns, creating additional workload for healthcare professionals. For me, the technologies that have released the greatest immediate benefits have been carefully designed to make people’s jobs or the patient’s interaction easier, with considerable investment in both the design of the tool and the redesign of ways of working. A pattern I’ve seen time and again is the great expectations of new technology clashing against an initial period of frustration and reduced productivity. Benefits eventually materialise — often after two or more years — but weathering this ‘digital dip’ is an important hurdle that has led to many transformation strategies being scaled back or even abandoned. A case in point is electronic health records (EHRs). These are an essential foundation to any digital strategy, but rarely do they produce any immediate benefits to the frontline. In reality, most organisations see an initial phase of added inefficiencies before the tools that work off the EHR (patient flow management, e-prescribing, automated alerts and data transfer) are developed, implemented and get to work. The unexpected pain of the initial EHR implementation has caused many providers to get stuck in the dip — unable to roll back to previous systems, but unwilling to invest further to get the benefits. Seven lessons on realising opportunities I have found that substantial gains in terms of productivity and health outcomes are possible — and have been demonstrated — from specific areas of health IT. As the history of frequent disappointment and failure shows, however, digital technologies will not deliver these improvements on their own. Through my digital transformation experience with healthcare providers around the world, I have identified seven key lessons from those that have successfully realised the benefits and overcome the setbacks. Seven opportunities to drive improvement Looking at the highest performing and most digitally enabled healthcare providers around the world, as well as ‘frugally’ innovative organisations in emerging economies, seven improvements in productivity and quality of care stand out. The way ahead for technology in healthcare – a 10-year view Computing will be much more ubiquitous, but much less visible Much less time will be spent by staff on administrative tasks and routine communication, as automation, voice recognition and natural language processing become more commonplace New roles and competencies will be added to the managerial cadre as the shift to digital healthcare continues — most importantly advanced analytic capabilities Organisational and professional boundaries will be far less visible, as integrated information technology systems dissolve many of the current divides between primary, secondary and tertiary care. Source : https://www.worldhealthcarejournal.com/newsdit-article/a8e44e3d25d77722d64fd0ae337ca864/?fbclid=IwAR2et2bWodHKuHRGfF05R6iGFWDDamgUSjeM4N1eSQaSg_jCbwQA8ZekBxE

Patient portals and personal health records (PHRs) have both received considerable praise for their role in increasing patient engagement. However, distinguishing between the two forms of health IT tools can often be difficult, due to nebulous definitions and overlapping features. Patient portals give users an online view of their health data, as do PHRs. And by giving patients access to this information, both tools put the patient at the center of care and help incorporate them into their own care team. But a closer look reveals some subtle differences that are nonetheless important for keeping these different options straight in the minds of patients and providers. Here are some of the key features of each of these technology types and a breakdown of what each term really means. TETHERED PERSONAL HEALTH RECORDS VERSUS PATIENT PORTALS A tethered PHR, as defined by the ONC, is an online interface tied to an EHR with which patients may view and sometimes interact with their health data. “The patient accesses the information through a secure portal,” ONC says. “Typically, patients can view information such as lab results, immunization history or due dates for certain screenings. These are called tethered PHRs or connected PHRs. When a PHR is connected to the patient’s legal medical record it is protected under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.” The ONC’s definition of a tethered PHR is very similar to the definition that the agency provides for patient portals: A patient portal is a secure online website that gives patients convenient 24-hour access to personal health information from anywhere with an Internet connection. Using a secure username and password, patients can view health information such as: Recent doctor visits Discharge summaries Medications Immunizations Allergies Lab results Some patient portals also allow patients to: Exchange secure e-mail with their healthcare teams Request prescription refills Schedule non-urgent appointments Check benefits and coverage Update contact information Make payments Download and complete forms ONC appears to use the terms interchangeably, as have other healthcare organizations, including AHIMA. In a 2015 report, AHIMA researchers indicated that tethered PHRs were no different than portals. “Tethered PHRs, also known as patient portals, allow patients to access relevant medical information from their provider,” the team wrote in its abstract. The California Health Care Association likewise considers tethered PHRs and patient portals one in the same, stating the following of patient portals and PHRs: Is a secure website through which patients can access a PHR Often contains information from a patient’s EHR Is usually “tethered” to a healthcare organization with applications that build on an EHR Enables users to complete forms online, communicate with providers, request prescription refills, review lab results, or schedule medical appointments Can enhance patient access and increase administrative efficiency and productivity Tethered PHRs and patient portals offer several benefits to patients, typically including patient-provider communication through secure messaging capabilities and access to care through online appointment scheduling. Secure messaging capabilities offer just as many benefits to the provider as they do the patient, allowing the provider to build a relationship with their patients while streamlining their workload. “Providers are trying to have relationships with these individuals and be able to effectively communicate with that population” using online portals, says Zach Wood, Cerner’s Director and General Manager of Member Engagement. “Having bi-directional messaging between the patient and provider, not only is convenient on both sides, but it saves an administrative burden as well,” he continued. “And being able to show that health record to the patient enhances the communication lines and provides self-service which is great for the patient and the provider.” These tools are becoming increasingly necessary for providers looking to improve patient engagement. According to a report published by AHIMA, patients who access their health information via any form of personal health record can improve their health literacy, giving them the power to make their own health decisions and engage in meaningful conversations with providers. “Patients who have accessed their medical records have reported a broader knowledge base of their own health concerns, the ability to communicate more effectively with their physicians, initiation of efforts to improve their health, and decreased utilization of healthcare services,” the report says. “PHRs can help make patients aware of their health conditions, which could initiate changes in their healthcare plan.” Other studies have also indicated that patient data access via PHR or patient portal can help improve outcomes. Patients who can review and revise clinician notes can see better patient safety outcomes, for example. WHAT IS A STANDALONE PERSONAL HEALTH RECORD? The ONC defines a standalone PHR as: “[A system where] patients fill in the information from their own records and memories and the data is stored on the patients’ computers or on the internet. Patients can decide whether to share the information with providers, family members, or anyone else involved in their care. In some cases, information can be downloaded from other sources into the PHR.” Patient data management is the major distinguishing factor associated with standalone PHRs. The system is entirely patient-controlled, and providers can only view the data when their patients provide them access. This may help to ensure that sensitive data stays within the user’s control, but managing a standalone PHR can be an immense undertaking for patients. Patients are in charge of aggregating all of the data included in their standalone PHR, as well as coordinating how much data they’re going to share and with whom they will share it. According to one article published in the Journal of the American Medical Informatics Association, this important patient responsibility can be extremely burdensome. “An individual’s PHR can only be useful if the person understands the importance of maintaining and coordinating health-related documentation and activities with health care providers,” the article authors wrote. “Consumer-related interface, technology, and access issues specific to PHRs are not yet well understood.” Standalone PHRs also lack the provider interaction that often leads to meaningful patient engagement, a missing link that may have led to the downfall of Google’s and Microsoft’s PHR offerings back in 2012. Google launched its standalone PHR, Google Health, back in 2008 as health IT began to gain traction through government incentives. However, the company failed to spark consumer interest, and eventually shut down the product on January 1, 2013. While there were multiple factors that may have led to Google Health’s demise, limited provider interaction with the data and few motivational components were arguably most significant. “[Google] basically offered a place to store data,” said Adam Bosworth, an original Google Health developer, in a 2012 interview with TechCrunch TV. “Our data shows people don’t really want a place to store data, per se,” Bosworth continued. “They want to do something fun and engaging. If it’s not fun, if it’s not social, why would they do it? Yes, they want to be healthy, but they need more than that. They need the encouragement and even the pressure of friends. They need the constant pressure, constant reminders.” More current PHRs have started to address these issues. Although standalone PHRs still require patients to take the initiative to involve their providers with the technology, tethered PHRs/patient portals allow the patient to interact with the provider. PHRS, PATIENT PORTALS, AND INTEROPERABILITY HURDLES Standalone and tethered PHRs offer several of the same patient engagement benefits, and they also suffer from several of the same disadvantages. With all of these data storage options and ongoing industry struggles with interoperability,there are many opportunities for data to become siloed. For standalone PHRs, interoperability can cause issues for patients who want to offer a provider access to their data. A patient’s PHR may not work well with a provider’s EHR, making it impossible for the provider to access a full view of the patient’s health record. As of 2013, only 60 percent of clinician EHRs could connect to PHRs, according to data from the Workgroup for Electronic Data Interchange. This problem can also occur with patient portals. A patient may have one portal for their primary care physician, as well as two more for their optometrist and dermatologist. The portals for all three of these providers may not be interoperable, causing a problem if the PCP needs to view the medication history from the dermatologist. Health IT developers are working on overcoming these interoperability barriers.Some vendors, such as Epic Systems, have made significant progress integrating patient portal information from multiple providers. “In the past, if you had two MyCharts from two different Epic providers, you’ve had two different MyCharts,” said Epic founder and CEO Judy Faulkner. “You can use a single sign-on for them, but the charts have been separate. And if you have another vendor’s patient portal, you have three different portals, and so on.” “We have now changed MyChart so that everything is all together no matter how many iterations of the portal you have – or if you have a portal from other vendors,” she said in a 2016 interview with HealthITInteroperability.com. “So you, as the patient, can see all your appointments, no matter where they’re from, and all your meds and everything else all together, which is very neat.” Both standalone and tethered PHRs present issues with patient-generated health data. Providers express trust issues with PGHD, stating that potentially inaccurate patient data can inform a detrimental treatment plan. “Providers are wary of the legal implications of PHRs,” said researchers in the aforementioned JAMIA article. “For example, courts might apply negligence standards in cases where practitioners rely on inaccurate patient-entered PHR information to make suboptimal decisions about care.” According to one recent study on PGHD and PHR integration, health policymakers need to create a standardized system for using the data. This will make PGHD use more manageable at the point of care and mitigate some concerns regarding liability for PGHD use. It could also allow providers more time to verify data accuracy before using it to determine treatment. “Designers should focus on easy-to-use interfaces, automated [PGHD] collection, and communicating PGHD only when directly relevant to a given patient visit,” the researchers concluded. “Finally, policymakers and clinical leaders may need to better demonstrate clear clinical usefulness or provide other incentives for practices to routinely incorporate [PGHD] in EHRs.” While patient portals and PHRs do have their differences, they both still drive users towards the overall goal of improving patient engagement. Determining which technology is better for achieving better patient engagement may be in the eye of the beholder. Different patients and providers have different preferences, making them predisposed to preferring one system over another. By understanding the differences between patient portals and PHRs, as well as patient preferences, providers can better decide which tool could be a better fit for fostering patient engagement. This article was originally published on February 17, 2017. Source : https://patientengagementhit.com/features/how-do-patient-portals-and-personal-health-records-differ