Tamer Shahin
CEO of Nuviun

How data (and not technology) is reshaping the future of healthcare

Although we frequently hear how the increased use of technology is changing the world of healthcare, the mounting power of this wave is really built upon that which resides within: data. It’s the data which is derived from technology’s increased use which drives such change, and it possesses massive potential to reshape the future of healthcare. Here, we examine a common term in relation to healthcare, data, and technology —Digital Health— to better understand its role in what lies ahead.

What is Digital Health?

Digital Health is the application of digital and genetic technologies to the delivery of health and healthcare. Digital Health reflects the merging of several fields: the Human Genome Project and genome sequencing technologies, Electronic Health Records (EHR) and Health Information Technology (Health IT), Big Data, Personalized Medicine, and Social Media.

Digital Health reflects the merging of several fields: the Human Genome Project and genome sequencing technologies, Electronic Health Records and Health Information Technology, Big Data, Personalized Medicine and Social Media

Each field has developed quite independently and has enjoyed impressive and unique successes. However, as each field moves forward, their most promising and potentially fruitful expansion does not come from “business as usual” as in independent development, but instead by a mutual integration for a common purpose. This integration is called Digital Health. It seeks to form advantageous synergisms among disparate, yet complementary fields. Digital Health promises to change the way that physicians practice medicine and pharmaceutical companies develop therapies. It also encourages patients (people) to participate more in their own healthcare.

Digital Health encompasses two other recent movements in healthcare: eHealth and mHealth. eHealth is defined as the use of electronic processes to support the delivery of health care. This may include EHRs, consumer health informatics, provider health informatics, e-prescribing, and telemedicine. Similarly, mHealth stands for mobile health and refers to the use of mobile devices to deliver health care. mHealth may include the use of personalized computers, mobile smartphones, and tablets, but increasingly includes devices that collect personal health information, such as biological sensors and monitors. The World Health Organization and most other organizations consider mobile health as an extension of electronic health. Thus, mHealth is often discussed as a part of eHealth. By extension, Digital Health necessarily includes the concepts of eHealth and mHealth.

Digital Health embraces electronic and mobile technologies but also seeks to exploit salient developments in human genome sequencing and personalized medicine. Digital Health is considerably larger in scope than simply mHealth or eHealth because it seeks to incorporate concepts, information, and technologies from several rapidly advancing fields.

State of the art in digital health

Digital Health takes advantage of two major revolutions that matured in the late 20th century, the genetics revolution and the digital revolution. In the late 1990s, we unlocked the code to every human gene. At the same time, personal computers and the Internet became a welcome necessity and convenience in our daily lives. While the scientific underpinnings and technical developments were hard fought victories in the late 90s, the last decade was one of miniaturization, proliferation, and application. Our phones carry computing power and speed that could not be matched by room-sized computers of the past. The Internet is, or will soon be, a ubiquitous presence on the globe. Digital Health capitalizes on this unprecedented power, availability, and affordability to deliver a new form of personal and global health care. We are swiftly applying the technologies of the recent past and reaping the fruits of that scientific labor.

Perhaps the most salient feature of the last decade of advancement is that the technologies are not only more empowering and accessible, but also more affordable. The Human Genome Project took more than a decade to complete. Then, an additional decade later, commercial entities now offer personalized whole genome sequencing within a matter of weeks for under $100. The cost and time involved in this process has dropped so that it is conceivable for personal exome or whole-genome sequencing to become a part of standard healthcare screening, perhaps as early as birth.

Perhaps the most salient feature of the last decade of advancement is that the technologies are not only more empowering and accessible, but also more affordable

Wearable sensors and real-time data acquisition (personal data quantification)

The Digital Health complement to personalized genomes is the Quantified Self. The Quantified Self seeks to record and analyze the human experience using various sensors, monitors, and digital acquisition devices. The Quantified Self is self-awareness through self-monitoring; the assumption is that by tracking personal data, one can achieve better health, wellbeing, and longevity.

Putative mHealth devices include accelerometers that measure accelerations/decelerations and body/limb displacement, gyroscopes that sense angular velocity, and goniometers that measure joint range of motion, electromyography, GPS signaling and others. Some of these hardware components are found in typical smartphones, while others may be worn or (in the near future) implanted. As devices are miniaturized, they can be interwoven in fabrics or impregnated into ultrafine “second skins”.

Big Data/Big Health

The amount of information that is created by just one “Quantified Self” is enormous. It almost boggles the mind to think of the data generated by a “Quantified Population.” However, just as the cost of personal genome sequencing is dropping, so is the cost of digital data storage (and both are miniaturizing). It is therefore feasible to contain the data that makes up a “Quantified Self” or even data across a population. This concept of collecting massive amounts of data of organized and unorganized data is called Big Data.

When the data is collected in the health arena, it is often referred to as Big Health. Importantly, Big Health also refers to the unique advantages that emerge from the availability of large amounts of health data. Big Data and Big Health are core components of Digital Health. Big Data is not simply a concept for the future. Large collections of identified and de-identified health information exist in a nascent state already. For example, various government agencies have been collecting information from EHRs, pharmacy records, and related data sources for several years. These agencies use this data to track the delivery of health care, assess relevant disease endpoints, track outcomes, and reduce medical spending.

Big Data is not simply a concept for the future. Large collections of identified and de-identified health information exist in a nascent state already

Conversely, several companies specialize in collecting, curating, and providing de-identified patient health information. They may also sell access rights to entities interested in various forms of research. Big Data/Big Health offers the ability to perform virtually limitless retrospective clinical studies. De-identified health data can be used to study epidemiology of diseases, health care economics, and comparative effectiveness. As with any dataset, the more points that you have, the higher the statistical power of the analysis. As Big Data becomes more manageable, searchable, and amenable to analysis, researchers will be able to ask questions that were formerly considered impossible to answer. Moreover, as the number of people who participate in personal data quantification increases, one could envision the use of Big Data in prospective studies as well.

Electronic Health Records

Most healthcare providers have used Electronic Health Records (EHR) or Electronic Medical Record (EMR) in their practices. Because of the flexibility and potential for growth, the preferred term is now EHR, as opposed to EMR, since it more accurately describes its scope as a repository for patient’s health data. While the transition from paper records to EHR has been far from seamless, most would agree that a well-designed EHR is a powerful tool in the practice of medicine.

Current EHRs carry an electronic version of an array of records, including progress notes, allergies, laboratory reports, and medications. The digital EHR is no longer limited by the physical restraints of a paper chart. Data can be collected from various sources and collated into an intuitive, physician-directed interface.

A highly usable EHR is a critical component of Digital Health in the clinical arena. Physicians will require a central, portable repository of patient data that can be easily accessed and actionable. Just as the patient’s paper chart has been the central repository of all clinical data in the past, present, and future, the EHR will house clinical and personal health data. By digitizing the record, however, the amount of searchable, usable data that can be contained in EHR far exceeds any paper chart.

A highly usable EHR is a critical component of Digital Health in the clinical arena. Physicians will require a central, portable repository of patient data that can be easily accessed and actionable

The Cloud

The Cloud is an often discussed, but rarely defined concept. The Cloud is simply off-site data storage that is available through any internet-accessible device at any time. It only requires definition since the history of personal computing has been to store data locally, in hardware that was localized on the same site as the user. On-site or local data storage greatly limits the potential uses of the stored data. By uploading data to the Cloud, off-site servers can provide credential-verified and secure access to multiple users at the same time. Data files in a centralized server can be modified simultaneously and updated continuously, thereby ensuring constantly updated and up to date content. Moreover, access to the data is portable. It is not limited to a file in one doctor’s office.

Cloud computing is a necessary development for truly comprehensive EHRs and is thus important for the expansion of Digital Health. Telemedicine Cloud computing and Digital Health applications lend themselves to telemedicine which is the practice of medicine in which the clinician and the patient are physically separate but at the same time, connected by a digital interface.

Potential Barriers to Digital Health

There are several barriers to widespread physician adoption of Digital Health. Most physicians are reluctant to adopt new healthcare strategies without significant proof that they are safe and effective. While it is common to choose therapies that have been tested in large-scale, blinded, controlled clinical trials and that have emerged from rigorous regulatory scrutiny, Digital Health applications are not scrutinized to the same degree.

In addition, it is unreasonable to expect physicians to personally evaluate or to even keep abreast of incremental developments in the field given the sheer number of mHealth technologies. In much the same way, there is a mismatch between the availability of personal genome sequencing (learning your personal DNA code) and applying that to the practice of medicine. The technology is ready and relatively inexpensive, but considerable work remains to make those findings clinically relevant. Physicians will require support through (likely years of) basic and clinical research studies in order to integrate genome sequencing into the physician-patient consultation.

While the benefits of EHRs/EMRs are becoming self-evident to most physicians, as the number of results and options within an EHR increases, so does the time and energy required to assess and manage those results. For any Digital Health enterprise to be successful in the hospital, it must be straightforward for the patient, but also for the physician. Digital Health software and EHRs will need to possess a sophistication such that large amounts of data are properly and rigorously analyzed before they are presented to the physician.

Any successful Digital Health technology must be user-friendly—bearing in mind that the user is both the patient and the physician. Patient privacy will be of paramount importance in the future of Digital Health. While users of social media products are notoriously free with personal information, they are generally more guarded with personal health information. Any developing Digital Health technology, especially EHRs and Big Data applications must assure users and regulators that personal health data is secure.

Another obstacle that is less often mentioned (but no less important) is the mechanism by which physicians will bill for Digital Health in the clinic. The long-term success of Digital Health in the clinic must include a mechanism for physicians to be reimbursed for their time and effort. In one respect, increased access to patient data will help inform clinical decision-making and will improve outcomes. To get to that point will require significant physician involvement. Plainly said, without a financial incentive for physicians, Digital Health will not enjoy complete clinical integration.

The other issue that goes hand in hand with reimbursement/compensation is regulatory control of Digital Health. Regulatory bodies acknowledge the rapid advances of Digital Health technologies and provide guidance to an industry that is hungry to innovate. If regulatory guidance and approval lags, so lags the field as a whole and physician engagement.

Digital Health is growing rapidly, but is still in its early life stages. Many of the aspects described above are not fully developed and certainly not fully integrated. While one can have their genome sequenced for $99, they will receive little more than an unintelligible diary written with a four-letter alphabet. Likewise, just because someone can collect every joint position and theta brain wave and upload it directly to the Cloud does not necessarily mean that the data is useful, instructive, or that it can even be analyzed. At its heart, Digital Health is an awareness in which separate, powerful technologies are ripening at the same time. With proper integration, it can provide an unprecedented level of personal health care.

Digital Health is an awareness in which separate, powerful technologies are ripening at the same time. With proper integration, it can provide an unprecedented level of personal health care

The Future of Digital Health

Individualized Treatments

Because of the potential power of digital and genetic technologies, there have been dozens of possible future Digital Health applications proposed. However, some are more immediately relevant for the physician. Digital Health offers a completely re-conceptualized version of personalized or individualized medicine.

Truly Designer Drugs

Personalized genome sequencing has the potential to identify genetic susceptibilities early in life, in many cases at a point in which early intervention can make a difference. However, that is only the first promise. Why do pharmaceuticals work for some people and not others? Heterogeneous responses appear to be related to an individual’s DNA sequence variants. In essence, knowledge of a person’s genome not only predicts susceptibility to genetic diseases and disorders, but it also predicts response to available treatments.

Rapid Response to Outbreaks

If you imagine a world in which most people use wearable sensors, possess and use medical apps, and have a portable EHR, it is not too hard to imagine a powerful epidemiological tool. Potential outbreaks could be identified and authorities could be dispatched immediately. This could shave several days off current response times. With outbreaks of highly contagious and virulent diseases, the time to respond is often the difference between containment and pandemic. Thus, widespread, voluntary, digital self-monitoring could have important public health implications.

The Digital Health Landscape

As has been noted, Digital Health is a broad term that covers a lot of territory—all healthcare-related applications, technologies and delivery systems that result from the confluence of medicine, genomics and the technologies that comprise the digital space.

It includes a variety of overlapping sectors such as Health IT, telehealth, eHealth, mHealth, EMR/EHR, personal genomics, quantified self, Big Data, gamification, Health 2.0/social media, medical imaging, sensors and wearables, and health and wellness apps. Interoperability is the final link in the chain that we strive for to put it all into play. In short, Digital Health is a big, interactive, and exciting world with massive potential to create great change.

Our Digital Health Landscape represents the connected nature of the digital health world—where one sector depends upon the other to produce best results. It’s not to scale—and not meant to be. As the digital health revolution expands, so will the visibility and importance of various sectors.

 

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Success stories


  • Doctoralia

    Frederic LlordachsCo-founder
    2007 Year founded45 Employees3M€ Turnover

    Doctoralia

    Frederic LlordachsCo-founder
    2007 Year founded45 Employees3M€Turnoverwww.doctoralia.com
    • Company mission

      Doctoralia is the leading global platform connecting healthcare professionals and patients, transforming and improving relations between the two. It offers tools that help boost the online visibility of healthcare professionals, as well as helping them find more patients and better manage them. At the same time, it brings healthcare to users, giving them a place where they can ask questions, give opinions and find the best healthcare professionals for their needs.

    • What innovation do you bring to the market?

      We started in 2007, the year the iPhone was launched, thinking that sooner or later people would end up looking for a doctor online. This allowed us to get out ahead of this phenomenon of the masses, as posting information about doctors is becoming more and more useful. The Doctoralia search engine, unlike others, allows users to search not just by the doctor’s name or city, but also by medical specialization and sub-specialization, and even by a specific disease or insurance company, which aims to encourage more and more people to search for doctors and specialists online. What sets us apart is the number of doctors in our database, well above the competition, and the number of monthly users, which makes us an attractive tool for doctors and healthcare professionals to establish an online presence.

    • What is the most important milestone you’ve reached so far?

      We’ve hit 120 million users a month, 3.5 million visits from registered medical centers and professionals, 2.5 million pages viewed monthly through our “Ask an Expert” service, and service in 20 countries around the world.

    • What would you like to read about the company in the news a few years from now?

      That a Catalan company, from Barcelona, is the leading platform in the world helping patients find doctors and giving healthcare professionals an online presence and digital tools.

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  • Intelligent Pharma

    Ignasi BeldaCEO
    2007 Year founded19 Employees700k-1.3M€ Turnover

    Intelligent Pharma

    Ignasi BeldaCEO
    2007 Year founded19 Employees700k-1.3M€Turnoverwww.intelligentpharma.com
    • Company mission

      To conduct in silico research projects for the pharmaceutical, agrifood, cosmetics and petrochemical industries, as well as developing customized scientific software for these sectors.

    • What innovation do you bring to the market?

      Here at Intelligent Pharma we reinvest a large part of our income in developing innovations in many different disciplines of science and technology that have an impact on our sector. Some of these disciplines include artificial intelligence, high-performance supercomputing, cloud computing, statistical modeling, physics/chemistry, etc. This makes us one of the most cutting-edge companies in our niche.

    • What is the most important milestone you’ve reached so far?

      Having conducted more than 150 research projects for companies around the world. We currently have clients throughout America, Asia and, of course, Europe. So, more than a specific milestone, our satisfaction comes from contributing our grain of sand to all of these research projects, many of which have led to innovations that help improve patient quality of life and, in the best cases, save lives.

    • What would you like to read about the company in the news a few years from now?

      That a drug we have helped identify or optimize is saving thousands of lives.

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  • Medtep

    Pablo PantaleoniCEO and Co-Founder
    2011 Year founded30 Employees500k€ Turnover

    Medtep

    Pablo PantaleoniCEO and Co-Founder
    2011 Year founded30 Employees500k€Turnoverwww.medtep.com
    • Company mission

      For people who are concerned about their health, Medtep provides a digital platform that makes it easier to adopt behavioral changes by following clinically proven prevention and treatment plans.

    • What innovation do you bring to the market?

      Nowadays, most platforms only focus on follow-up and collecting data using smartphones and third-party apps, without any other value added. Medtep adds value to these solutions with a validated, multidisciplinary, personalized ecosystem in which the doctor-patient relationship goes beyond the doctor’s office. Plus, the Medtep treatment and prevention plans don’t only aim to control the user’s health, they also foster healthy life habits that improve quality of life.

    • What is the most important milestone you’ve reached so far?

      On one hand, we’ve consolidated our internationalization process by opening offices in San Francisco (USA) and Mexico City (Mexico), and now have more than 120,000 users.
      On the other, we’ve closed a round of funding for $2 millions, which has allowed us to expand the team and accelerate the pace of growth.

    • What would you like to read about the company in the news a few years from now?

      Obviously, we’d love to read about the company’s growth and positive results. However, nothing would please us more than to learn that Medtep has led to a paradigm shift and helped improve quality of life for patients around the world. After that, success on other levels will surely follow.

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  • Mint Labs

    Paulo RodriguesCEO
    2013 Year founded6 Employees12k€ Turnover

    Mint Labs

    Paulo RodriguesCEO
    2013 Year founded6 Employees12k€Turnoverwww.mint-labs.com
    • Company mission

      Mint Labs’ mission is to study the brain and develop tools to predict, detect and diagnose neurological disorders.

    • What innovation do you bring to the market?

      Mint Labs is a cloud computing platform for advanced clinical research. We help specialists and researchers get the most from their data. We are an advanced image-processing and visualization company focusing on the brain; specifically, we use MRI technology.

      There isn't any tool currently on the market that can match the analysis capabilities and performance of the Mint Labs platform. That makes us the latest generation of monitoring and diagnostic technology for brain disorders. Our competition’s technology in the field is obsolete or much more basic. They simply provide storage on the cloud without our technology, which provides advanced image analysis and advanced imaging tools used exclusively by expert doctors.

    • What is the most important milestone you’ve reached so far?

      After several pilot programs, our first revenue was a very significant milestone for us. It confirmed that, in addition to doing something that was technologically cutting edge and highly innovative in the field of brain research, we also have great business potential.

    • What would you like to read about the company in the news a few years from now?

      In a couple of years, I’d like to see how our understanding of the brain and brain disorders has significantly increased, and how Mint Labs and our unique collection of data on the brain has been key in accelerating research and development of new treatments for brain disorders. I’ll be very proud to say that someone used Mint Labs to develop a new treatment for dementia or multiple sclerosis.

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  • Social Diabetes

    Victor BautistaCTO - Product Development Manager
    2012 Year founded6 + advisory board + medical board Employees300k€ Turnover

    Social Diabetes

    Victor BautistaCTO - Product Development Manager
    2012 Year founded6 + advisory board + medical board Employees300k€Turnoverwww.socialdiabetes.com
    • Company mission

      To allow diabetic patients to control their condition, leading a normal life and preventing complications, with the safety of a CE-certified medical device.

    • What innovation do you bring to the market?

      The device adjusts a patient’s insulin levels according to their real needs and habits, not the theoretical habits a book says they should follow. At the same time, as it learns from the patient’s history, it helps avoid nighttime hypoglycemia, which can lead to a diabetic coma or death.

    • What is the most important milestone you’ve reached so far?

      The most important milestone is undoubtedly the more than 90,000 downloads of our mobile app, due only to word of mouth, patient recommendations, without doing any sort of marketing or investment. We’re very thankful and will always continue to listen and pay attention to the users’ suggestions and ideas for improvement. We are also thankful for the numerous awards we’ve received, certifications and recognitions, and the confidence governments, hospitals, corporations, pharmaceutical laboratories, insurance companies and national and international bodies have shown in us.

    • What would you like to read about the company in the news a few years from now?

      That the device has saved thousands of lives.

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  • Universal Doctor

    Jordi SerranoCEO and Founder
    2008 Year founded10 Employees300k€ Turnover

    Universal Doctor

    Jordi SerranoCEO and Founder
    2008 Year founded10 Employees300k€Turnoverwww.universaldoctor.com
    • Company mission

      To improve communication between healthcare professionals and patients who don’t share a common language, and to become the multilingual healthcare system tool of the future.

    • What innovation do you bring to the market?

      We develop medical translation applications that adapt to each user and technology.

      So, on one hand, we’ve evolved with the changing technology, from CDs in the early days to flash websites, html, and multiplatform tools that allow users to access the information from any sort of device.

      On the other, we tailor the service to each client, developing specific apps for pharmacies and developing smart dialogs that allow healthcare professionals to build their own repertoire of personalized questions for their patients to answer.

      More than 150 universities, governments and hospitals, among others, are now using our technology.

    • What is the most important milestone you’ve reached so far?

      International implementation of our technology in hospitals and healthcare institutions in countries like Spain, Belgium and Norway, as well as our mobile versions, which have been downloaded by more than 300,000 people. In 2014, Universal Doctor received the World Summit Award for medical applications from the United Nations.

    • What would you like to read about the company in the news a few years from now?

      We want to be a multilingual digital channel that can be adapted and customized by any healthcare location in the world. Hopefully one day you will be able to touch a wall in a hospital and see a Universal Doctor video in 72 languages. We aspire to be not only software, but a channel.

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* Tamer Shahin, PhD, is the CEO and chairman of the executive board at Nuviun, the leading emerging industries knowledge resource portal. Nuviun specializes in bringing emerging industries to the mainstream through a blend of cutting edge and traditional platforms such as an innovative collaborative online information portal, second-to-none industry conferences and exhibitions, roundtables and seminars, and business intelligence and partnering.