Healthcare Predictions 2018

healthcare predictions for the future and top 10 healthcare predictions for 2016 and 10 big healthcare predictions for 2016
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Published Date:13-07-2017
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Document Variables Document Title Template Document Subtitle Subtitle Healthcare and Life Sciences Predictions 2020 A bold future? Boilerplate text to go here Designed and produced by The Creative Studio at Deloitte, London. xxxxxATo start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. The Deloitte Centre for Health Solutions The Deloitte Centre for Health Solutions, part of Deloitte UK, generates insights and thought leadership based on the key trends, challenges and opportunities within the healthcare and life sciences industry. Working closely with other centres in the Deloitte network, including the US Center for Health Solutions in Washington, our team of researchers develop ideas, innovations and insights that encourage collaboration across the health value chain, connecting the public and private sectors, health providers and purchasers, and consumers and suppliers.To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Foreword Deloitte UK’s Centre for Health Solutions has published numerous reports on the current and future issues of the healthcare market place – our insights drawn from primary research, desk research, significant interaction with our clients and stakeholders in the health and life sciences sector, and from the depth and breadth of capability within our global network. Our work is typically precise and evidence based, focused on the challenges of today and the solutions of tomorrow, building on prior research. We have perhaps been cautious in our views. This report is entirely different. It is deliberately challenging about the future world, perhaps even provocative. Our work draws on observations of trends, events and small but bold steps that – if accelerated through to the year 2020 and beyond – paint a picture of a world that is very different from today. Executive teams across healthcare and life sciences organisations often ask – “do you have a paper setting out the challenges of our future market place? We have a strategy working session next month and need some insights, challenge and a little provocation.” This document aims to fulfil that requirement. In this report we set out ten provocative statements predicting the world of 2020. Each prediction is articulated and brought to life through a series of portraits which imagine how patients, healthcare professionals and life sciences organisations might behave in this new world. Our predictions lean more towards an optimistic view of the future, although we recognise that many in our industry are sceptical about the constraints and therefore pace of change. We describe the big trends rolled forward to 2020 and some of the constraints that will need to be overcome. We also provide examples and evidence, based on the here and now, that show that the predictions are perfectly plausible, perhaps inspiring and surprising Our industry is changing quickly – requiring a bold response that is often difficult to implement – and yet organisations struggle to understand how to respond effectively and build a sense of urgency. We hope this report creates rich dialogue and enables a move to action. Certainly throughout Deloitte – we have had enormous fun discussing these predictions and sharing our experiences. We hope you have the same experience within your own organisations as you peruse this report and reflect on your current situation and future scenarios. Karen Taylor Hanno Ronte Simon Hammett Director Partner Partner Deloitte UK Centre for Health Solutions Monitor Deloitte EMEA & UK Healthcare & Life Sciences Lead Healthcare and Life Sciences Predictions 2020 A bold future? 1To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. What we know today and estimate about tomorrow Trends in healthcare and life sciences Average life expectancy in Meet the over 65s – OECD countries in 2012 was by 2018 they will number some 580 million – 10% 80 YEARS, an of the global population – increase of 5 years since or one in every: 1990: Japan has the 4 Japanese highest at 84, with UK 81 5 Western Europeans and US 79, China 75 and 2 1 10 Chinese India 66 years Developed markets remain The number of people with the main spenders on diabetes globally is healthcare – 77% of global 382 million, spend in 2014. Developing around I in 4 are Chinese. markets are forecast to increase There are more diabetics their share from 23% in 2014 in China than the combined 3 to 32% by 2020 populations of Germany 2 and Portugal Growth in average annual Total global pharmaceutical healthcare spending 2014 - spending is expected to 2018 is expected to range increase by 6.9% a year from 2.4% in Western Europe from USD1.23 trillion in 2014 to 4.9% in North America; to USD1.61 trillion in 2018. and from 8.1% in Asia and Oncology is expected to Australia to 8.7% in the remain the main contributor 2 Middle East and Africa 2 among therapeutic areas Generics will take a larger Med tech industry sales are share of total global medicine expected to increase from spend, increasing from 27% USD 363.8 billion in 2013 to (USD 261 billion) in 2012 to USD 513.5 billion in 2020. In-vitro diagnostics 36% (USD 421 billion) 2 4 will be the top segment by 2017 Sources: 1. Life expectancy data, World Health In 2013, across the Organisation, 2012. See also: G7 markets, there was http://apps.who.int/gho/data/node.main.688?lang=en a companion diagnostic 2. 2015 Global life sciences outlook: Adapting in an deal nearly every working day – era of transformation. Deloitte DTTL, 2014 3. Informa Plc Market Line Extracted October 2014 226 deals, 4. Medicines Outlook through 2017 IMS institute 3 up from only 8 deals in 2009 for healthcare informatics 2To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Ten Predictions for 2020 Provocative insights – both evolutionary and revolutionary External environment shaping predictions Health consumers in 2020 1 Informed and demanding patients are now partners in their own healthcare 4 Healthcare delivery systems in 2020 2 The era of digitised medicine – new business models drive new ideas 8 Wearables and mHealth applications in 2020 3 Measuring quality of life not just clinical indicators 12 Big Data in 2020 4 Health data is pervasive – requiring new tools and provider models 16 Regulatory compliance and patient safety in 2020 5 Regulations ree fl ct the convergence of technology and science 20 Internal industry performance shaping predictions Research and Development in 2020 6 The networked laboratory – partnerships and big data amidst new scrutiny 24 The pharmaceutical commercial model in 2020 7 Local is important but with a shift from volume to value 28 The pharmaceutical enterprise configuration – the back ofc fi e in 2020 8 Single, global organisation responsible for insight enablement 32 New business models in emerging markets in 2020 9 Still emerging, but full of creativity for the world 36 Impact of behaviours on corporate reputation in 2020 10 A new dawn of trust 40 Healthcare and Life Sciences Predictions 2020 A bold future? 3To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Health consumers in 2020 2020 Informed and demanding patients are now partners in their own healthcare Prediction Individuals are better informed about their genetic prolfi e, the diseases they have and might have, and the availability of healthcare. Expectations of healthcare and better outcomes for themselves and loved ones are at their highest. The ‘quantie fi d self’ has embraced prevention and is devoting time, energy and money to staying healthy. When ill, patients demand specic fi treatments; they are also willing, in part, to pay. Patients are true consumers, they understand they have options and use information and data about themselves and providers to get the best treatment at a time, place and cost convenient to them. The 2020 world Conquered constraints in 2020 • Healthcare organisations now engage with patients • Consumers accept that they are largely responsible through social media, regularly gauging their for their health – incentives for good behaviour needs and driving them to appropriate products are now firmly established – from reductions in and services for their budget and healthcare co-payments to lower taxes (for example, for not requirements. smoking). • Online patient communities have grown • Privacy and security of data remain concerns, but exponentially and are rich sources of crowd-sourced there is an understanding of the benefits of sharing data, with rating systems for drugs and healthcare data. provision. • Payers and providers embrace complex patients, • Advanced analytics on patient chatter in these having invested in analytics and programmes that communities gather health information, providing lead to new care pathways. a better understanding of which treatments deliver • Clinicians go from being reluctant to engage with the best outcomes, allowing real time tailoring of electronic health information from wearables to pharmaceutical messages and services. They also active engagement in developing and improving the provide early alerts on diseases, such as influenza. technology. • Businesses and governments work with communities • Most patients in developed countries now have of patients, hospitals and payers to identify best access to their own electronic health records, and practice and cost-effective treatments. decide who to share it with. • New provider and industry models, including mutuals and other forms of collaboration and cooperation, help decrease costs and improve care. Note: All elements on this page are from a perspective of 2020 and are fictional 4To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. News snippets from 2020 • Launch of new on-line interactive courses for primary care doctors on how to get the most out of new technology and how to deal with knowledgeable, health savvy, patients; many of whom are often better informed than their doctors. • ‘P4-Medicine’ is the new norm – medicine that is Predictive, Preventative, Personalised and Participatory. The new participating platform, PatientPeoplePower.com, was last night’s worthy winner of the award for the most inu fl ential patient advocacy movement in 2019-20. The 2020 patient portrait Mary knew that she was at risk of developing breast cancer as, following her mother’s death from the disease, genetic testing showed she was carrying the same gene. Her more immediate worry, however, was that her recent weight gain meant her diabetes was becoming more difc fi ult to control, as well as increasing her risk of breast cancer. It all started when she had to give up work to look after her seriously ill mother and eating became her main form of comfort. Data on her smart phone app showed her health was worsening. What’s more, her diabetic nurse specialist had messaged her every two weeks for the last three months to get her to come in, based on the continuous streaming of her health data, including her home weighing machine, to her health record. She also knew she wouldn’t be eligible for the new breakthrough drug with weight control benet fi s she had found for her Type 2 diabetes, if she failed to get her BMI down to an acceptable level. She hoped her new online support group and the ‘Be the Local Loser’ gaming competition on her smart phone will help her lose weight and reduce her health risks. A pharmaceutical marketing manager view in 2020 The new social media department has been operating for three years and has enjoyed a number of notable achievements in supporting key brand launches and winning several new media awards. The department was singularly responsible for helping both patients and payers understand that not only was the efc fi acy of the drug and service package superior to the previous care packages, it also encouraged the right behaviour change in patients, creating long lasting health, and thus cost benet fi s. It was also responsible for building a new form of trust between patients, doctors and the pharmaceutical company. Healthcare and Life Sciences Predictions 2020 A bold future? 5To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Evidence in 2014 2014 Patients becoming more like consumers “ While most industries have embraced the idea that the customer comes first, healthcare has lagged far behind. No more, the recognition has finally dawned on healthcare providers that meeting the challenges of today rests on their ability to put the customer at the centre of everything they do, changing from a paternalistic approach to a patient-centred approach that will recast the deal between patient, providers and payers.” Sarah Thomas, Director, Deloitte US Center for Health Solutions, Deloitte Services LP How comfortable are you, or would you be, with the following types of interaction? Do you currently maintain an electronic health record of any kind for yourself, not counting the record(s) any of your doctors Consulting with a doctor or other health professional through a video connnection 20% 32% 37% 12% might maintain for you? (e.g. FaceTime, Skype) US consumers’ use of electronic health records, Using a computer or mobile device to across all age groups, has doubled in the last five send or receive an image related to a years from eight per cent to 16 per cent 22% 33% 34% 11% personal health problem, to or from a doctor or other health professional 20 Using a video, computer program, or Chart shows percentage of the total mobile app to learn more about or 27% 35% 26% 11% 16% sample who represented ‘yes’ choose between treatment options 15 Adressing a health concern through an 11% 10% email or text with a doctor or other 27% 35% 29% 9% 10% 9% health professional 10 8% 0 20 40 6 total sample0 80 100 120 Chart show % of total sample Very comfortable Somewhat comfortable Not comfortable Not sure 5 2008 2009 2010 2011 2012 2013 Source: Deloitte US Centre for Health Solutions, 2013 Consumer Survey Segmentation Source: Deloitte US Centre for Health Solutions, 2013 Consumer Survey Segmentation New entrants are transforming healthcare. For example, US retail outlets are becoming serious primary care providers by expanding their services in response to consumer demand. Providing cheap, fast, convenient care, seven days and evenings a week (when finding a primary care doctor can be a challenge). Services include access to vaccinations, screening and management of chronic conditions. Most retail clinics accept insurance and all take cash payments. Increasingly, the clinics are aflfi iated to, or have partnerships with, their local healthcare systems; enabling them to share data and access patients’ electronic health records. Consumers do not need to make an appointment, reasons for the visit are entered onto a digital screen and the consumer is usually seen by a nurse practitioner or physician assistant within minutes. In October 2014, Walmart opened a series of new clinics, limited to markets where people are uninsured or under-insured, have a high rate of chronic diseases or struggle to get access to medical care, as well as places where it has a large number of employees. Visits costs USD 40, (about half the industry standard) or just USD 4 for Walmart US for employees and family members with the company’s insurance. A pregnancy test costs just USD 3, and a cholesterol test USD 8. See also: http://www.marketwatch.com/story/wal-marts-new-everyday-low-price-a-40-doctor-visit-2014-10-17 6To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Evidence in 2014 Patients becoming more like consumers Healthcare and Life Sciences Predictions 2020 A bold future? 7To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Healthcare delivery systems in 2020 2020 The era of digitised medicine – new business models drive new ideas Prediction The home is where much of the medical care takes place. It is no longer conn fi ed to clinicians in the clinic or hospital. The ubiquity of digital communication means that many doctor-patient contacts are now virtual and deliver care to the patient in their home. Specialist hospital treatment is reserved for trauma and emergency surgery; local day care organisations deal with most elective surgery, while chronic and long-term conditions are managed in the community. Care is provided via accountable care (type) organisations for a defined patient population, which take on the population risk. New funding models include year-of-care tariffs, pooled budgets, capitation or personal health budgets. The 2020 world Conquered constraints in 2020 • Web-based portals that enable regulatory compliant • Tele-mentoring, in which a remote surgeon can help (and reimbursable) video interactions between guide an on-site surgeon/robot, has full regulatory patient and clinician are now supported by a wide approval and clinician support. array of web-integrated wireless monitoring devices. • Clinician resistance to adopting telehealth and • Healthcare productivity has been revolutionised mHealth solutions has been significantly reduced, including reducing travelling and waiting times, and now that regulatory agencies and funding bodies inconvenience by providing routine contacts through have clarified their positions on the safety and telemedicine-enabled clinical e-visits, supported efficacy of the technology and new tools help by digital diagnostic tools which facilitate physical clinicians synthesise the data provided. examinations at a distance. • New funding models enable payers to commission • Robotic or robotically enhanced surgery is for outcomes for a defined patient population from commonplace, utilising robotically enhanced surgery vertically integrated accountable care organisations platforms to access detailed radiological information in every health economy. while allowing the surgeon enhanced visualisation of • Giving patients ownership of their own data has the surgery with his/her 3D goggles. allowed a shift to patient-centred and outcome- • Key technologies have become established: based delivery models. For example, 3D printing of medical devices • The silos between hospital and community care and organs; ‘scar-less’ surgery with entry via the have been reduced by designing care pathways oesophagus rather than skin incisions; and nerve cell around the patient, with hospital doctors and nurses transplants that improve the functionality of heart- running clinics and delivering care in the community failure, stroke, and paralysis patients. and primary care staff providing in-reach services to community and specialist hospitals. Note: All elements on this page are from a perspective of 2020 and are fictional 8To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. News snippets from 2020 • Record numbers of clinicians access patient records on multiple devices – and access the same record that the patient can access and augment with their own data. • Survey confirms that the convergence of biomedicine, IT, health data, wireless, and mobile have transformed medicine from an art to a data driven science, providing the right care, in the right place, at the right time and at affordable cost. • The last UK hospital announced it is now paperless, including an integrated electronic health record accessible by patients and clinicians. It is now planning to use these data to revolutionise service design. • Seventy-five per cent of all surgical operations are now carried out in ambulatory centres or units. The 2020 patient portrait Javier’s on going-treatment for his cancer could not be more different to that of his father’s treatment for the same cancer. Javier’s treatment, except for the surgery, which was performed in a local hub of a famous cancer specialist hospital, was all delivered at home as part of the new shift to providing care in the home, including chemotherapy, physiotherapy and nutrition support. His family too was now more integrated into his care, had a better understanding of what was happening to him and how they could help. Javier and his named family carer had access to an on-line 24/7 call centre and to a cancer care navigator for any issues or questions that arise. A provider view of 2020 digital healthcare In our recent board meeting we agreed a refresh of our IT strategy to reduce departmental siloes. We agreed to: • deploy a Knowledge Management (KM) solution to give clinical data context based on the latest clinical guidelines, and allow more effective clinical diagnosis and treatments • upgrade our electronic health records (EHR) to real-time clinical tracking and interaction with patients in their home • join the remote Intensive Care Unit Monitoring consortium, which already manages 600 of our town’s hospital beds. Healthcare and Life Sciences Predictions 2020 A bold future? 9To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Evidence in 2014 2014 The rise of connected health “ Technology alone, such as the smartphone, is not a silver bullet for healthcare. Instead, success lies in the convergence of digital health and human interaction. It also relies on developing partnerships which harness technology, while providing trust-based, patient-centred care; and balances person-to-person engagement with the efc fi iencies provided by technology.” Sara Siegel, Deloitte Partner, Healthcare Strategy and Consulting Patients Know Best (PKB) – a patient owned Since 2008 Kaiser Permanente Northern California (KPNC) has operated an healthcare record system. Patients monitor their own inpatient and ambulatory care electronic health record system for its 3.4 million vital signs, and link to a PKB app or website via some members. The number of virtual ‘visits’ has grown from 4.1 million in 2008 to 100 or so wearables and other devices. Information 10.5 million in 2013. It also provides a suite of mobile and tablet applications enabling is retrieved, uploaded and shared with doctors (and members to exchange messages with their doctors, create appointments, relfi l researchers if patient agrees). When the results are prescriptions, and view their lab results and medical records. The smartphone app outside the norm both clinicians and patients are supports self-service transactions while the tablet app focuses on prevention, health alerted. PKB integrates fully into any health records analytics, and achieving KPNCs ‘total health’ vision. In 2013, some 2.3 million telephone system, including the UK NHS secure network, and is consultations were made via mobile phone compared to around 64,000 in 2008. available for use by patients and clinicians worldwide. Source: Copy righted and published by project hope/health affairs, Robert Pearl, Kaiser Permanente Northern California: Experiences with internet, mobile and video technologies, Health Aff. 2o14 Source: http://www.patientsknowbest.com/ Vol.33,no.2, 251-257. The published article is archived and available on-line at www.helathcaffairs.org Mercy, the fifth largest Catholic health system in the US, has developed a program called SafeWatch as a solution to a shortage of intensivists. Critical-care specialists (both doctors and nurses) work in a telemedicine hub, monitoring patients in the Intensive Care Unit (ICU) 24 hours a day. They identify abnormalities, uncover potential problems and assist with care when a patient’s attending physician is not in the ICU. Other hospitals in the area can utilise these services for overnight cover. Indeed, specialists in the hub monitor more than 450 beds in 25 ICUs across a five-state region. Benet fi s include: a 15-20% reduction in ICU mortality rates, a 10-15% reduction in ICU length of stay, reduced code blues, signic fi ant reduction in ICU nurse turnover and improved patient satisfaction. Source: http://mercytelehealth.com/services/safe-watch/safewatch-faqs/ Artic fi ial Intelligence (AI) systems are now being deployed in medicine to help pharmaceutical companies prevent drug – drug interactions and help clinicians interpret diagnostics. Handheld accessible portals will soon be able to apply the power of a cloud-based Watson to health and medicine, enabling the clinician to enhance the speed, accuracy, and cost-efc fi iency of diagnostics; obtain decision support for applying evidence-based data sets; and choose the most appropriate therapy for an individual patient (drug, device, or surgical intervention). See: http://www.kauffmanfellows.org/journal_posts/exponential-technologies-across-health-care/ The Netherlands approach to homecare Buurtzorg Nederland is a not for prot m fi odel that uses a countrywide team of 6,500 nurses in 360 teams, treating around 70,000 patients a year. The nurses have full autonomy and provide the totality of care needed, empowering the patient through building strong personal and community relationships. Supported by hand held technology and freed from excessive rules, the nurses deliver signic fi ant efc fi iencies. They have reduced the hours of care needed per patient by 50 per cent while improving quality. With only 35 back ofc fi e staff, and 15 coaches, this model keeps costs low and delivers high staff and patient satisfaction. http://www.kingsfund.org.uk/sites/lfi es/kf/media/jos-de-blok-buurtzorg-home-healthcare-nov13.pdf 10To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Healthcare and Life Sciences Predictions 2020 A bold future? 11To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Wearables and mHealth applications in 2020 2020 Measuring quality of life not just clinical indicators Prediction Wearables shape the quality of life of today’s consumer, capturing and tracking how people live with and manage their condition. Consumers and providers integrate information from multiple devices seamlessly to create a comprehensive view of the individual. Wearables are now adopted widely (beyond keep-t fi and health fanatics) and specialist medical (bio-sensing) wearables are affordable. The new clinician/patient partnership is based on improved awareness, self-management and prevention strategies, replacing the paternalistic approach of old. The 2020 world Conquered constraints in 2020 • The tipping point for broad adoption of wearables • Convenience of data collection, medical accuracy of has been reached – wearables are used voluntarily data and interoperability between devices/analysis and are recommended as part of prevention and tools have been addressed. wellness protocols. • ‘Quality of life’ metrics are now standard in clinical • The next generation of wearable devices are trials. interoperable, integrated, engaging and outcomes • While privacy is still a concern, effective regulation focussed. The technology has become much and corporate branding have made consumers more cheaper and more sophisticated and the data quality willing to share their device data – from activity has improved. trackers to medical oriented data. • Wearables now continuously monitor a broad range • Patients have learnt to share different types of data of physiology – from posture to brain activity. in different ways, linking their data to now standard • Biosensing devices analyse and compare with other electronic medical records; with patients ensuring devices and ‘interact’ with the medical literature. the accuracy of their own medical record. • Extensive use in clinical trials allows tracking of • Consumer engagement with their data has led to quality of life, not just efficacy and safety. better medication adherence and management of chronic disease; a clear return on investment (ROI) • Treatment plans now include ‘wearables’ as a for providers. prescription – monitoring the sickest patients and helping to better control healthcare costs. • Wearables have made the home an extension of the hospital, allowing those who have received care to rapidly transition home. • Patient reviews and ratings evaluate the new health apps and technologies, based on an agreed industry standard for app integration. • Biosensing devices are as much the realm of start ups as non-traditional health companies, creating a big new industry, with the winners still emerging. Note: All elements on this page are from a perspective of 2020 and are fictional 12To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. News snippets from the 2020 wearables monitoring market report • The latest report on this new market highlights how a new French start-up company is targeting new heart health indicators. The start-up found an early indicator of heart attack in the analysis of heart beat data streams from a wearable ECG monitor. • Another small company has demonstrated how a doctor can get a better sense of vascular risk using its proprietary algorithm to analyse a patient’s credit card bill and supermarket loyalty card, and thus their diet and behaviour. The 2020 patient portrait Akil’s 82 year old father is sadly losing his mobility and his dementia appears to be worsening. But with new technology he can live at home – for example, Akil gets an alarm if his father does not open the fridge daily. Akil himself uses wearable devices to optimise his exercise, sleep and nutrition, as well as alerting him to the risk of his biggest health worry – an asthma attack. By understanding the triggers of his asthma, he is healthier than he has been for a while, and is enjoying the reward vouchers he receives from his employee plan for healthy living. A pharmaceutical company compliance meeting in 2020 The introduction of the new drug monitoring device was a revelation last year in 2019. There was a run on the device by patients who were prescribed the drug. It was almost accidental that a ‘system of care’ evolved, incorporating the drug, the wearable device, the education service, the social media feedback loop and payer response to the outcomes data and value pricing. It made it difc fi ult for the other ‘me too’ drugs to launch. Healthcare and Life Sciences Predictions 2020 A bold future? 13To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Evidence in 2014 2014 The rise of bio-sensing technology “T he wearables industry is growing rapidly, fueled by a mix of both innovation and hype. These devices have the potential to revolutionise healthcare through remote monitoring, disease management and early detection. However, wearables will have to transform from fitness tools of the healthy to valid, reliable accessories for even the sickest among us.” Harry Greenspun, MD, Director, US Center for Health Solutions. Deloitte Services LP Venture funding of biosensors and wearable HealthPatch is a sensor fitted to a disposable and technology increased five times from 2011-2013 adhesive patch that can be placed on the chest and (to 283 million), more than double the growth of can be used to monitor both acute and chronic digital health during the same period. In 2014, some diseases. Biometric data and changes in vital signs 90 million wearable computing devices will be shipped, are wirelessly sent to, and monitored by doctors and of which approximately 74 million will be biosensing, patients via bluetooth. The sensor collects continuous, although current trends suggests around half will clinical-grade, multimodal data that can be used to likely be simply a fad unless consumers and healthcare perform accurate analyses on countless important providers can agree on their worth. health parameters, such as sleep studies (duration, sleep staging, and sleep apnea studies), gait analysis, See also: http://rockhealth.com/2014/06/future-biosensing- wearables/Source: http://www.patientsknowbest.com/ arrhythmia detection, respiratory rate, fall detection, heart rate variability, and temperature. Source: http://www.vitalconnect.com/news/introducing-the- healthpatch To date wearables have been somewhat of a novelty, however industry researchers agree that wearables are now entering the commercialisation phase. While Examples of how wearables might transform information and understanding of some practical challenges remain (including design, peoples health status ease of use, standards, privacy and cost); the interest among healthcare providers, industry and consumers is Wearables invade the market growing. As a result: Hearing device to boost • the number of mHealth apps that are published hearing on the two leading platforms (Apple and Contact lenses Android ) has more than doubled in only 2.5 that monitor years to reach more than 100,000 apps as of glucose levels Heart rate Q1 2014 monitor patch • the mHealth market revenue reached 2.4 billion Wrist bands in 2013 and is projected to grow to 26 billion that monitor by the end of 2017 (still less than one per cent of heart beat, the global healthcare market) blood pressure, calories burnt Smart pills that • the major source of income for mHealth app monitor medication publishers is expected to come from services -intaking behaviours and body response (69 per cent) • the top app users already collect several Insole sensor hundred million of vital parameters per month. that measures Source: research2guidance mHealth developer economics report. weight bearing, May 2014. See also: http://mhealtheconomics.com/mhealth- balance and developer-economics-report/ temperature 14To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Healthcare and Life Sciences Predictions 2020 A bold future? 15To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Big Data in 2020 2020 Health data is pervasive – requiring new tools and provider models Prediction For many countries healthcare data has become a national infrastructure priority and attracts signic fi ant funding (similar to the building of highways in the US in the 1950s). As a result, patients themselves, clinicians and healthcare ofc fi ials use healthcare data to transform diagnosis and treatment to improve outcomes and healthcare productivity. Pharmaceutical companies now collaborate fully with patients and healthcare systems using data to develop better treatments, launch them faster and price according to improvement in health outcomes. The 2020 world Conquered constraints in 2020 • Healthcare systems recognise the value of existing • Public recognises benefit of appropriately used and new data sources (for example, Electronic personal health data. Health Records, patient provided data) and have • Significant national funding for IT and health data created governance to allow data access and infrastructure provides access, but also protects sharing, formed data partnerships and are changing confidentiality and controls use of patient data. how care is delivered on the basis of data insights. • The quality of and regulatory environment for • Use of healthcare data becomes a measure of patient generated data (from fitness trackers to national economic development. other real time monitoring devices) has improved • Pharmaceutical companies have built, bought and and consumers have more say over, and are more hired new capabilities (data management/analytics) trusting of, how data is used. and partnerships (with payers and hospital systems) • Clinicians have real time data from patients and use to use Big Data across the value chain from discovery analytical tools to use comparative data for day-to- to value pricing. Data has blurred boundaries day decision making. between traditional research and development and • Pharmaceutical companies are a more trusted commercial functions. partner to the healthcare system, with a successful • New data driven competitors disrupt the research & track record in partnerships across diagnostics, data development (R&D) model with a focus on data and analytics, private and public care provision. outcomes as opposed to the science only. • Pharmaceutical companies have developed data • Genetic testing is accepted as actionable approaches to deal with complexities of different information. health system maturities. Note: All elements on this page are from a perspective of 2020 and are fictional 16To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Annual report of an independent real world data service centre in 2020 • Now in its fifth year, this fully functioning ten year partnership is delivering results. A partnership between a pharmaceutical company, a data management and analytics company and a primary and secondary care healthcare system has generated demonstrable results of improved patient outcomes. • It has answered fundamental questions on clinical service design and treatment pathways (for example: the role of education in changing behaviour) and insights on timing of the use of specic fi drugs in specic s fi ub-populations. • The service centre is now the focus for new drug development with the addition of biomarker and genomics data for a sizeable number of patients. The 2020 patient consultation Nadia, a patient in her late 30s with severe asthma has been referred by her primary care doctor to a hospital specialist for a review. Her doctor is concerned that the health care data, she provides regularly, which is captured by her watch and smartphone, shows a deterioration in her condition. He has also mapped her readings to a new weather app which shows details of the level and types of air pollution at the time of exacerbations in her condition. In preparation for the referral appointment the specialist has compared her data, including the results of pre-ordered tests of her genetic sequencing, to patients with the same biomarkers and risk stratic fi ation and has searched for details of whether any of the successful treatment options currently being trialled by the hospital could be suitable. The system flags Nadia’s eligibility for a new trial, which the specialist discusses with her and together they agree to a personalised treatment plan which she subsequently shares with her primary care doctor. The pharmaceutical data centric enterprise The company has just completed a major transformation to align functional roles to integrate real time, real world data into the worko fl w of development research, outcomes and personalised reimbursement monitoring. The company created a centre of excellence for real world data analytics with the appropriate protocols and training for staff to analyse and interrogate the signic fi ant volumes of internal and external data. It required hiring a completely new breed of people – the data scientist who combines commercial, scientic fi and technological ‘know how’. Healthcare and Life Sciences Predictions 2020 A bold future? 17To start a new section, hold down the apple+shift keys and click to release this object and type the section title in the box below. Evidence in 2014 2014 Digital devices and electronic patient records contribute to data explosion The rise of personalised medicine is supported by a rapid decline in the costs of The era of electronic medical records (EMR) has genome sequencing Cost of sequencing human genome 2001-14 n fi ally arrived along with a data explosion. Big data is 98,262,072 100,000,000 The rate of progress in genome ubiquitous and is helping to enhance patient care at sequencing has outpaced much lower costs. The traditional stethoscope is now Moores law since 2008 10,000,000 a museum piece, replaced by digital ones that record, Moores law 1,000,000 analyse, and synchronise examinations with mobile phone apps. 100,000 Source: Dainel Kraft, Exponential Technologies Across Healthcare, Kauffman Fellows report 2011. See also: http://www. 8,272 10,000 kauffmanfellows.org/journal_posts/exponential-technologies- across-health-care/ 1,000 Jan Jan Jan Jan Jan Jan Jan Jan Jan Jan Jan Jan Jan Jan 01 02 03 04 05 06 07 08 09 10 11 12 13 14 Source: National Human Genome Research Institute Today we live in an era of ‘one size fits all’ medicine, with many drugs not working on 50% or more of the population. Source: Daniel Kraft, Exponential Technologies Across Health Care, Kauffman Fellows report 2011, Volume 2. See also: http://www.kauffmanfellows. org/journal_posts/exponential-technologies-across-health-care/ It took at least one week to sequence a genome in 2011, now it takes only about a day. Source: http://www.businessinsider.com/illumina-genome-sequencing-growth-2013-10ixzz3IgUk672f) In December 2013 The U.S. Preventive Services Task Force recommended that women who have one or more family members with a known potentially harmful mutation in the BRCA1 or BRCA2 genes should be offered genetic counselling and testing. Source: http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/brca-related-cancer-risk-assessment-genetic- counseling-and-genetic-testing New business models: ‘Beyond the pill’, outcomes and real world data are providing health data and transforming what is possible Supply drivers Demand drivers Medical & patient data Rollout business models Electronic health records (EHRs), tied to patient outcomes health sensors, social media, that also reduce medical and genomics create rich new errors and improve quality data sources for analytics Big Data analytics Discover and deliver Cheap computing power targeted and personalised and sophisticated analytics therapies with real world drive insights into patient evidence of impact behaviour, treatment costs and R&D Mobile/mHealth Influence patients Pervasive mobile and smart Health information behaviours ‘beyond phone adoption creates new the pill’ and sustain technology enabled engagement models within engagement outside the opportunities daily routines traditional care setting Healthcare professional digital workflow Drive population Increasing integration of EHRs management, protocol and telehealth driving new driven patient risk pool digitally-enabled coordinated and stratification workforce models of care management Source: Monitor Deloitte 18 Cost per genome (£)