The only issue on which Mr Corbyn’s Labour Party scores well amongst the British public this election time is on the National Health Service. That is because the NHS, for all its great work, is struggling to keep pace with demand.
There’s one key statistic that thinking people need to understand about the NHS. Economic growth is just shy of two percent (for now) while demand for NHS services (given increasing longevity, more complex treatments, immigration and unrealistic expectations) is rising at more than four percent per annum.
Technological innovation is therefore a necessity. Only technology can check the exorbitant rise of healthcare costs and improve health outcomes. The future of healthcare is mobile and digital.
Trying to connect you…literally
Imagine if you could connect yourself to a robot doctor via the internet. You could have a thermometer in your ear constantly relaying your body temperature. A blood pressure and pulse monitor could sit unnoticed in your carotid artery and another device implanted in your heart could carry out an electrocardiogram (ECG – or EKG if you are American) whenever required. Other devices could monitor your cholesterol (good and bad), body fat, muscle mass and the rest.
And then imagine that all this data about your health is being beamed to a robot doctor who never sleeps and which exists for one purpose only: to maximise your health and well-being.
In fact, it’s quite conceivable that all of these monitoring functions could be accomplished by a single microchip implanted in your neck, of which you will never be aware. British dogs are all microchipped these days – and I have never yet met a pooch who complained.
(The microchip might also have other non-healthcare functions such as the ability to open your front door or to activate your self-driving car without the need for keys. But that is another story).
Well, if microchipping humans seems a bit too science-fiction for you, just consider that most of these monitoring functions can already be accomplished today by apps downloaded onto your smartphone. Or, alternately, there are a range of devices that can be worn like watches to achieve the same result.
It seems that more of us want to take ownership of our own healthcare by monitoring our health parameters. I know that this kind of thing can become obsessive and anti-social. (Like those annoying people who take photos of their food and then try to work out its calorific value before they eat it – by which time it has gone cold.) But if these parameters were tracked by a wise, patient and kindly machine then any sudden changes in those parameters could flag up an underlying health condition…
The first tentative steps by the NHS into digital healthcare
There are many developers producing healthcare systems and apps, but the official wisdom is that such systems are only likely to become mainstream if they are developed in collaboration with the NHS.
Two new medical apps which can help people to monitor their health at home are, according to a spokesman from the Royal Society of Medicine, about to be distributed by as many as four NHS trusts over the next year[i]. These apps have been developed by the Oxford Institute of Biomedical Engineering and have already been subject to trials at the Royal Berkshire NHS Foundation Trust.
The first – GDm-health – monitors gestational diabetes, a condition which affects about one in ten pregnant women in the UK. The smartphone app enables women to send blood glucose readings that they take at home directly to their clinicians. The clinicians will automatically be alerted to any readings that require follow-up.
There are many developers producing healthcare systems and apps, but the official wisdom is that such systems are only likely to become mainstream if they are developed in collaboration with the NHS.
The second is being used to manage chronic obstructive pulmonary disease (COPD), a condition that affects over one million people in the UK. People with COPD use a finger probe to measure their heart rate and blood oxygen saturation. Then they manually enter the results into the app which transmits them to the clinicians. Over time, the app learns the individual patient’s normal range of oxygen saturation levels. If the level falls below that “normal” range then a red flag is raised for the clinicians.
In the 12-month clinical trial for this app hospital admissions by COPD sufferers were reduced by 17 percent and doctors’ visits by 40 percent. That represents an incredible cost-saving for the NHS for a minimal outlay. And while it costs money to develop such apps and to initiate their use, the marginal cost for each additional user is effectively zero.
A third product called SEND is an iPad app used by nurses to input critical health parameters for each patient as they make their ward rounds. Its algorithms issue early warnings if a patient’s condition is deteriorating.
It has to be said that, while sales of Fitbit’s (NYSE:FIT) personal devices soar, the NHS has entered this space very late and very tentatively. According to New Scientist, it has taken eight years to develop these very basic aps. That says something about the inertia inherent in the public sector.
Babylon Health – the art of robo-diagnosis
The flow of health data from the microchip in your neck or from a wearable device on your wrist is one thing. How that data is crunched is another. Diagnostic technology increasingly uses disease models and smart algorithms, based on the data-mining of ever-enlarging health databases.
Babylon Health, the internet robot doctor available throughout the UK about which I wrote last year, raised US$60 million at the end of April to fund expansion of its online robot doctor model[ii]. The Financial Times reported that a wealthy Egyptian family is the new backer.
The company’s previous $25 million funding round was led by AB Kinnevik, the Swedish investment vehicle. The FT reckons that Babylon is now worth more than US$200 million. Babylon’s previous investors include Jon Wright (co-founder of Innocent Drinks), and Demis Hassabis and Mustafa Suleyman, founders of DeepMind, the AI outfit bought by Google (NASDAQ:GOOGL) in 2014 for $500 million. They are still advising the digital health start-up.
Babylon started out by working with a number of health authorities in London to trial its chat-bot triage service as an alternative to the NHS’s 111 telephone helpline. It then built an AI-enabled symptom checker into the Babylon released in July last year. The company claims that it has provided medical advice to over 250,000 people since then.
The medium-term objective is to provide an AI-powered diagnosis capability. Dr Ali Parsa, founder and CEO of Babylon, said in a statement:
“Babylon scientists predict that we will shortly be able to diagnose and foresee personal health issues better than doctors, but this is about machines and medics co-operating not competing. Doctors do a lot more than diagnosis: artificial intelligence will be a tool that will allow doctors and health care professionals to become more accessible and affordable for everyone on earth.”
Your voice gives you away
Canary Speech (a private US company) is developing algorithms that can detect if people have incipient conditions like Parkinson’s or Alzheimer’s just by listening to their voice over the phone. It has done this by analysing calls made to an unnamed major American health insurer over a 15-year period. They have fine-tuned speech pattern analysis by identifying key vocal cues and have identified vocal markers for depression, stress, dyslexia and other conditions.
It is a very basic human trait that we judge others – on so many levels – by their speech. (I can normally tell during the early morning MI editorial conference call if a fellow writer has a hangover!). But to pinpoint the beginnings of specific conditions by voice analysis alone is revolutionary.
Whether we like it or not, in ten years’ time, every time we speak on the phone a robot somewhere will be making and recording insights into our state of health.
There is moral hazard here. If health insurers were able to exclude clients that they deem will be more likely to succumb to debilitating illness through wizard software, then insurance would be denied to those that need it most. And no doubt that awful information – that you have incipient Alzheimer’s but don’t yet know it – will be sold on to other service providers.
But whether we like it or not, in ten years’ time, every time we speak on the phone a robot somewhere will be making and recording insights into our state of health.
Royal Philips – intelligent catheters
Catheters are medical devices that are inserted into the body to deliver medication, treat diseases or perform surgical procedures. We know from inscriptions that they were used by the ancient Egyptians who employed rolled-up reeds and stalks (without anaesthetic!).
New catheters manufactured by the Dutch healthcare giant Royal Philips (SWX:PHI) are equipped with miniature imaging technology which can guide clinicians through a patient’s body. This enables them to treat cardiovascular disorders and diseases without the need for traumatic surgery.
Miniature cameras are only part of the imaging technology. Audio sensors around the tip of the catheter can also create images using a type of echo-sound system. Earlier this year Philips launched an image-based technology platform called Azurion which can combine information gleaned from catheters and other devices with patient databases in one user interface.
The devices alone are not enough. Philips has developed powerful software to help clinicians to analyse and interpret the huge volumes of data derived from X-rays, biopsies and even genome analysis in order to facilitate faster and more accurate diagnoses.
Another platform, the Philips CareSensus home monitoring system is designed to help seniors who live at home to maintain their independence by means of intelligent sensors placed discretely around the home. At the opposite end of the human lifecycle, Philips’ uGrow platform captures data from baby monitors and thermometers and combines this with data about the baby’s feeding and sleeping patterns. Big Brother is watching baby.
Philips enjoys strategic alliances with many major hospitals and universities including the Massachusetts Institute of Technology (MIT).
Robotic surgery
Robot surgeons have already been developed which can perform intricate procedures with super-human accuracy. If you are unfamiliar with this amazing concept I recommend that you check out some of the videos dedicated to this topic available on YouTube and the Facebook Science Nature (Robotic Surgery) page.
The Royal Marsden Hospital in Chelsea, London has been conducting robotic surgery since 2007 using the Da Vinci S surgical robot, and is now the largest provider of robotic surgical procedures for prostate and bladder cancer in the UK. Consultant Surgeon Mr Chris Ogden has operated on over 1,500 patients using the Da Vinci S. The robot makes an incision through a tiny hole, a technique known as minimally invasive or laparoscopic surgery. This reduces the pain and blood loss associated with open surgery, shortens the patient’s stay in hospital and accelerates recovery.
The Da Vinci S robot was developed by Intuitive Surgical (NASDAQ:ISRG). Other robot surgeon manufacturers include Verily (formerly Google Life Science), the Nebraska-based start-up Virtual Incision Corporation and the French innovator Medtech SA (EPA:ROSA).
Currently, such robot surgeons are located inside hospitals but as they get smaller and more reliable they could surely perform operations in patients’ homes.
Wearables are us
About 200 million wearable fitness devices were sold last year with various functionalities from step counters to calorie estimators to sleep quality monitors. (I generally know if I’ve had a good night’s sleep – but never mind). Manufacturers include Fitbit (NYSE:FIT), Nike (NYSE:NKE), Garmin (NASDAQ:GRMN), Apple (NASDAQ:AAPL), Withings (a so-far private French company) and Samsung Electronics (KRX:005930).
About 200 million wearable fitness devices were sold last year with various functionalities from step counters to calorie estimators to sleep quality monitors.
For dog nuts with mild Asperger’s there is FitBark, a device attached to a dog collar which helps owners to get their mutts to peak fitness. Based in up-state New York, they are apparently seeking finance. Pet tech is a growth industry, with the global market predicted to reach US$2.36 billion by 2022, according to Grand View Research[iii].
Making sense of it all
Innovative healthcare technology which is portable and which can be connected to the internet has the potential to take the focus of healthcare away from hospitals and into the home – or anywhere that “the patient” happens to be.
We tend to have an instinctively industrial view of healthcare, based on the notion of hospitals as factories where health outcomes (surgery, medication and treatments) are manufactured. Instead, we need to move to a post-industrial, digital mindset where prevention is better than cure, where all treatments are customised to a specific patient’s needs and where we can avoid traumatic invasive (and expensive) surgery altogether.
In the UK our National Health Service is predicated on the industrial hospital-as-health-factory model. Hospitals treat people; but they often also make them sicker – look at the prevalence of hospital-borne infections such as MRSA. If we really want radically to improve health outcomes we are going to have to change the way we think about healthcare. Orthodox political thinking is opposed to market forces in the NHS; but in the private sector there is no limit to the rapid uptake of digital healthcare technology.
In these pages I have previously imagined that there could be a dynamic financial system without banks; similarly we can envision a better healthcare system without hospitals at all.
NHS Hospitals are bureaucracies where healthcare data collection has been rudimentary at best up until now. Technical experimentation is discouraged and management is often characterised by inertia. It took about four years for the management of the Mid-Staffordshire NHS Foundation Trust to work out that they were systematically killing patients in numbers that would make Hannibal Lecter proud. Two junior nurses were suspended.
The millennials will have no problem adapting to the post-industrial model of healthcare based on wearable devices, implants, robot doctors and robot micro-surgery delivered at home. (Or, for that matter, on space ships heading for Mars). Which is just as well since, by the time they reach old age, unless it reforms itself radically, the NHS will long since have become financially unsustainable.
[i] New Scientist, 18 February 2017, article by Matt Reynolds, page 11.
[ii] See: https://techcrunch.com/2017/04/25/babylon-health-raises-further-60m-to-continue-building-out-ai-doctor-app/