The Future of Health

How Digital Technology Will Make Care Accessible, Sustainable, and Human

Roberto Ascione

• Publisher: Wiley
• Year: 2021
• ISBN:
  9781119797319
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Learn how the future of medicine is being unlocked—one digital innovation at a time

The Future of Health is an insightful and comprehensive overview of the past, present, and future of digital health. Accomplished health innovation leader Roberto Ascione delivers a practical exploration of how the latest digital technologies are transforming the practice of medicine and redefining health itself by making it more accessible, sustainable, and human.

The book includes practical, real-world examples from the United States, Asia, and Europe of technology applications, companies, and start-up that have changed—or will change—our relationship with our health and the healthcare system. Readers will also find:

• How our health is becoming increasingly consumer and connected while technology is empowering patients in completely new ways and deeply transforming the doctor-patient relationship
• Discussions of how the training of medical professionals, particularly doctors, has changed—or needs to change—to meet the new digital reality
• Examinations of how new technologies will allow doctors to dodge many of the administrative and regulatory burdens they currently face each day
• Treatments of the ability of new technologies to unlock new, holistic ways of practicing medicine, with a focus on latest developments such as Digital Therapeutics and Virtual Reality
• Reflections on how digital health is fostering a shift "from cure to care" and will unleash a human-sized future for a more accessible, ubiquitous, and sustainable healthcare

The Future of Health is required reading for medical practitioners and the managers of pharmaceutical companies. It will also earn a place in the libraries of medical device companies and healthcare entrepreneurs seeking an incisive treatment of the impact of digital technology on all aspects of healthcare. Also, the general public, interested in understanding how to take better control of their own health through digital technologies, will find this book insightful and easy to comprehend.

PART I
Digital Reflections

Digital technologies are part of our life flow. We use them to study and work, to connect with people, and also to do our grocery shopping, entertain ourselves, and find love. Health is not an exception albeit it is a much more recent discovery.

Through the usage of social media and other digital platforms we constantly create and nurture our digital footprint, often passively or without recognizing it. Despite this, many of these information or data points are relevant for our own health, even if we are not yet leveraging them to the fullest.

Cheaper, smaller, faster computers together with ever-evolving form factors from laptop to wearable and beyond have been enabling all-new use cases and practices, showing us that it is possible to quantify our health experiences. Over time, this has inspired a continuous evolution of personal medical devices, adding an objective and quantitative dimension to health and medicine that was completely unheard of only 10 years ago.

Novel technologies also unlocked access to the human genome, popularizing a practice which, only few years back, was extremely expensive and available only to academia and primary research. In other words, for a few hundred dollars we can get our full genome mapping, and for even less we can investigate our genetic set-up regarding specific areas or conditions.

This unprecedented amount of data, originated both by digital and genetic signals, needed completely new strategies and computer-science solutions, which we often refer to as AI, to make sense of them.

AI and more appropriately data science are not only giving order to this vast amount of data but are also allowing us to correlate it with medical observations, unveiling connections and cause–effect implications which, in certain cases, we did not even imagine in the past.

Once these connections are scientifically proven, we can start to introduce them into the medical practice, often allowing for predictions of future evolution of certain disease states even before such a disease would develop.

Most of these innovations are coming from what we now identify as digital health startups, brave teams of young innovators and experienced professionals, often including doctors and other health-care professionals, engineers, designers, and patients, who are not afraid to challenge the status quo of health care and the implied inaccessibility, inconvenience, and uncertainty that are huge problems in the industry. This movement has been increasingly fueled by venture capital investments, which have been propelling this sector since 2011 and further accelerated through the Covid-19 pandemic of 2020.

All of this is having a profound impact on health care and its determinates, including health literacy, access to care, ability to connect to the right health-care resources, cost of diagnoses and therapies, prevention strategies, and more.

The first section of this book will review the most important technology innovations and provide examples of startups using them to foster this radical transformation of health care as we know it.

CHAPTER 1
Devices, Sensors, and Signals

From Wearables to Ingestibles—Toward the Invisibility of Digital Health

Perhaps the most striking case of a radical health-care transformation, from a media point of view, was the launch of the Apple Watch on September 9, 2014. In reality, the market for wearables and network-connected devices had already been established for some time, especially in the sport sector: smart bracelets that calculated the number of steps taken in a day, the calories consumed, the amount and quality of sleep, and a whole host of other data were already on the market well before Apple launched itself into the enterprise.

According to Forbes, the wearables market was worth $27.9 billion in 2019 and is estimated to reach $74.03 billion in 2025. The sector includes smartwatches, fitness trackers, wristbands, and all those wearables that control physical activity or other vital parameters. And this value, according to estimates, is bound to grow even more. Technological developments have been leading to a progressive miniaturization of the components, to such an extent that nanotechnology-based devices are already available in the health-care field. (Nanotechnology refers to technological structures smaller than one nanometer, one billionth of a meter.) This advance allows for more precise and less invasive diagnostic analysis, or tools that can even carry out intervention therapies at the molecular level. As is often the case in the field of technology, while the instruments become more powerful and complex, their cost of production is constantly decreasing, making the various devices accessible to an ever-widening range of consumers. The great ductility of the materials produced makes it possible to integrate processors and sensors into nearly every object of everyday use: shoes, T-shirts, appliances, toys, balls, racquets—everything can be made smart and connected at the cost of just a few dollars. And in the health field? The adoption of digital devices is a natural and inevitable process. The possibility of remotely monitoring the various devices connected to the network, the miniaturization of the components, and the evolution of the various sensors to become increasingly precise and reliable, allow the creation of wearables that can track diverse vital parameters without being uncomfortable for the wearer. This reduces (or even excludes) the need for a patient to go to the hospital or to visit a health-care professional for ongoing tests for conditions that need constant monitoring. For example, a health-care professional can monitor a patient's health remotely by accessing, in real time, data transmitted by a pacemaker connected to his or her mobile phone. The possible variations are endless.

Among the first pioneering therapies based on wearable technology, we remember the solution developed by Proteus Digital Health: a pill with a built-in micro-sensor. Once the pill is swallowed, the microcircuit sends signals to a patch on the patient's skin, which in turn communicates with the dedicated app on the patient's smartphone.

Roberto's View

We have gone from carrying with us very heavy and very expensive laptops with minimal computing power by today's standards, to using handheld computers, smartphones, tablets, and wearables. The process continues with the miniaturization and low cost of these devices reaching a point at which they are even ingestible. The widespread dissemination of these instruments among the public makes it possible to gather a quantity of information that was previously impossible. And this information, as it accumulates and we learn how to process it and act consequentially, begins to take on an ever-higher value from the standpoint of health care. We are, therefore, witnessing a widespread use of tracking instruments, created in the wellness or sports world, that are finding new applications in other areas. Indeed, ever-more-powerful algorithms analyze vast amounts of data, and correlations between this data and the most common pathologies are being discovered. On this basis, a new category of markers, called digital biomarkers, has been created. These are beginning to be examined in exactly the same way that normal blood tests are examined. In other words, researchers begin to monitor signals that may be related to particular disorders and then validate them with the idea of having markers that can be used to identify particular pathologies digitally in the future. For example, for attention disorders and Alzheimer's disease, applications of this type already exist and are currently undergoing clinical trials. Of course, in order to transform a normal process, we must identify a digital marker that is actually valid and scientifically sustainable. For example, there is a trial that is examining whether a certain type of continuous electrocardiogram (ECG), made with very low-cost sensors that could be incorporated into T-shirts, is predictive of major cardiac events, such as heart attacks. Let's imagine that this becomes possible and that, in the next few years, the sensors are so inexpensive that any T-shirt can make this kind of prediction. As a result, the management of a critical health event such as a heart attack (which requires immediate intervention in the place where it occurs) could be achieved with a routine operation such as an angioplasty.

Such sensors would be able to signal the likelihood of developing a certain pathology, and thus prompt the individual to schedule a specialist visit. This would completely change the management and treatment of a pathology as we imagine it today. Important transformations are taking place regarding the management of the personal data of each one of us: just think of the latest versions of the iOS and Android operating systems, in which real computerized medical records dedicated to the consumer/patient have been introduced. The symptom journal is a feature already embedded in operating systems that allows users to collect a large amount of information in a structured and processable way. A considerable number of clinical trials already have access to a much larger database than before. This data has been generated by participants thanks to the presence of these integrated applications in most smartphones.

Apple Watch

Apple Watch was certainly not the first instrument on the market among the wearables. However, it has been one of the cornerstones in the health-care revolution. Through not only its built-in functions, but also scenarios it makes possible, it has proposed itself as a common interface to numerous health apps that can communicate with it. This is why the Apple Watch has turned out to be a very important instrument for increasing a patient's adherence to their health-care program. In fact, specific apps can send alerts to remind a person to take a particular medicine, or they can use the Apple Watch's sensor network to make predictions about certain pathologies and recommend specific health checks.

Since 2019, Apple Watch users can take part in the three medical studies launched by the health-care giant in collaboration with leading academic and research institutes, to monitor women's health, investigate the correlation between heart rate and mobility signals, and assess the impact that the daily exposure to sound has on hearing.

In the same year, the ECG function was made available to all the users of the Apple Watch Series 4. The ECG app makes it possible to record the user's heart rate and rhythm using an electric heart sensor, and then to check the recording for the presence of atrial fibrillation (AF). The ability of the app to accurately classify an ECG recording as AF was tested in a clinical trial involving about 600 subjects. The app had a 98.3 percent sensitivity in the classification of atrial fibrillation, and a...

Table of contents

• Cover
• Table of Contents
• Title Page
• Copyright
• Dedication
• Preface
• Part I: Digital Reflections
• Part II: Human Reflections
• Conclusions: A Radical Shift
• Appendix: Speeches by Roberto Ascione
• About the Author
• About Healthware
• Acknowledgments
• Index
• End User License Agreement