Dr Jason Arora, discusses how technology is shaping the future of medicine.
I’m a health systems guy and these lists are about health technologies that have moved health systems forward, rather than deep or niche technologies. When I left medical school in 2011, the best tech was highly concentrated in the hospital. We lagged behind other industries in processing power, elegance, simplicity, and consumer focus. We still do. Now, we’re seeing tech utilization across the full continuum of healthcare. In fact, advancements in healthcare have been increasingly grounded in tech over the past 10 years, and will continue to be so at an exponential rate. A lot of what we’ve seen has naturally been reliant on the evolution of tech more broadly. But, as we know, healthcare tends to lag behind. That is beginning to change because of the growing role that tech is playing in healthcare, across the continuum. Whilst we’ve had amazing science and tech in healthcare for ages, we’re now really trying to move healthcare from art to science as a whole.
The best health tech powering our healthcare systems: 2010-2020
Digital health records
Patient information is the currency through which health systems process, exchange, and interpret information. Most patient data was (and much still is) contained within written notes. Whilst the earliest electronic medical records (EMRs) were created over 40 years ago, we’ve only seen the mass shift in health information go from analogue to digital in the past 10 years. And still, the trend continues today. This has been the foundation for some of the other major shifts we’ve seen.
You can now search for health information online, simply by typing in your symptoms. While the results might be misleading for patients, this unprecedented access to health information has been a major driver of the shift in patient power. No longer is the doctor the keeper of all knowledge and information about the patient.
Beyond health information, you can now book your appointments online, order prescriptions, message your doctor, and so on. Taking healthcare online has created a new medium for information exchange between patient and health system, and between health system players themselves. Whilst health systems still remain heavily siloed and lack connectivity, a health system without internet connectivity, at the very least, is now unthinkable.
Smartphones have given patients access to a plethora of tools that are extremely useful for capturing and transmitting useful health information: internal sensors, a camera, the ability to create custom apps, etc.
We now have mobile apps for healthcare that cover all sorts of things: medical records - with the patient now having access to their own records and being able to take these with them, wherever they go; diagnostics - for instance, taking photos of lumps and bumps or using the camera to examine the eye in the absence of specialised equipment; prescriptions can now come to your phone; we have wellness trackers for steps taken, hours slept, calories consumed, etc; we can use apps to help coordinate patient care away from the hospital, and doctors and trainees can message other doctors for advice.
This is playing a huge role in making healthcare more personalised, more real-time, and on empowering both the patient and the doctor further.
With the increase in access to health information, the need to track health behaviours away from the hospital, and the Instagram generation getting obsessed with looking fit and healthy, we’ve seen a huge rise in the use of wearable devices for fitness. Fitbit - one of the best known - was founded in 2007 and starting selling fitness trackers pretty soon after, but we didn’t really start to see these being uses by the masses until a few years later.
Not too long ago, most surgeries were performed by making large incisions in patients - so called ‘open’ procedures. These are associated with more complications and longer recovery times. We then saw more surgeries performed using ‘minimally invasive’ techniques - cutting small holes and inserting cameras to guide instruments inside the body. These tend to lead to fewer complications and quicker recovery times. One of the latest methods is robotic surgery, which - whilst being approved for use around 20 years ago - has been widely adopted by hospitals over the past 10 years. These ‘robots’ are actually robotic systems/machines, controlled by a doctor, which allows them to perform procedures with better accuracy and control. Since then, we’ve seen the widespread use of smart health watches and more specialist wearables, such as mobile ECG monitors.
Whilst we still have a long way to go to understanding the human body, nothing better represents the ‘final frontier’ than the brain. We are still trying to understand how the brain really works, but in the last 10 years, we’ve managed to link thoughts to the control of implants and prosthetics, which is a pretty amazing feat. As human and machine become more integrated in the years to come, we’ll see more of this, and it’ll go a long way to helping us better understand just how this amazing organ works.
The best health tech that will power our healthcare systems: 2020-2030
Artificial intelligence (AI)
Advances in computer power and the availability of large amounts of data are driving an AI revolution. AI is THE buzz term in healthcare at the moment. But what is it, really? AI is when computer systems are able to perform tasks that normally require human intelligence. AI goes a step further than something like a calculator, which is pre-programmed to perform the same task, in the same way, every time. An AI-based system can actually ‘learn’ and solve problems.
Our first goal has been to get AI to do monotonous tasks for us – to reduce costs, increase efficiency, and reduce error. There are lots of examples across many industries – from smart email categorization to Siri and Alexa. In healthcare, we’re already using AI for some simple tasks such as appointment scheduling and voice-to-text transcription. But more interestingly, we’re starting to use it to support medical decisions. One of the first examples we’ll see widely adopted is AI-supported imaging diagnostics – that is, using AI to diagnose a medical condition by looking at a scan (e.g. an X-ray or MRI). The AI tool – in its ‘training’ - will have been fed many scans, been told what is what, and then and will learn from pattern recognition just what a certain disease looks like – just like a doctor. Because a computer today can look through more scans than a human can in a given amount of time, to improve its ability to recognise these patterns, it can be more accurate. Whilst the use of AI is not without its risks - computers can still interpret things incorrectly because of a failure to understand context and nuance - it is likely we’ll likely see further experimentation and deployment of AI across healthcare in the coming years.
Data and personalised medicine
When your doctor sees you, they’re seeing a human being. But, what they also see is a collection of data/information, which they need to use to make a diagnosis, pair you with the best treatment, and then monitor your recovery. With the rise in the availability and specificity of healthcare information - from data on your day-to-day activities right down to your genes - we should start to create highly specific data profiles for patients, such that we can target the right technology, to the right patient, at the right time, in order to optimise the outcome for the patient.
We’ve seen the release of VR glasses and platforms for gaming and movies, we’ll also see VR deployed widely in healthcare. Two of the earlier focus areas will be mental health (simulated reality to help people deal with addiction, phobias, post-traumatic stress, etc) and medical training (e.g. simulated surgery, just like the popular old flight simulator video games!)
Telephone consultations with doctors have been around for a while. The problem is that the doctor can’t see you, and you can’t see the doctor. As we know from our personal lives, video calls are better than telephone calls, which are better than text messaging, for cutting through all the nuances of remote human communication. What we’re starting to see now are platforms for secure video consultations between doctors and patients, particularly in general practice - where a good conversation may suffice. Anything more than that, and the doctor can call you in for a physical examination and any other investigations that might be needed. This will help make things more convenient, reduce no-shows, and lower costs for the health system, without (if deployed correctly) adversely affecting patient outcomes.
Just like other tech, medtech needs to be produced in a factory. And just like other tech, we’re always looking for faster and cheaper ways to make tech. 3D printing - where we use a machine to construct a physical object from a 3D digital model by laying down several thin layers of material in succession - is poised to transform the medtech industry. We’ll be able to develop prosthetics, devices, anatomical models for surgery planning, and maybe even replacement organs in the future. All at lower cost, with greater ease, and with better customization.
Many of you will have seen drones for photography, and you’ll have heard about them being used for military surveillance and to deliver your Amazon packages. But drones will also being used to transport medical supplies, drugs, transplant organs and blood units, birth control, etc to remote areas, to beat the ambulance to an emergency. Getting stuff from A to B in healthcare (just like other industries) will always be needed, and where ground transportation fails for short distances, we’ll certainly be using the air.
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