Healthcare delivery in Ireland is in turmoil, with limited resources, waiting lists and access issues, poor staff morale, an aging population, a chronic disease burden, and a rising cost of care and insurance. In most people’s eyes, there has been little positive change over the past 30 years.

However, it is easy to lose sight of the enormous transformations that have occurred in medicine and surgery over this time such as the human genome project, stem cell biology, infectious disease eradication, robotic surgery, drug treatments, drug-eluting stents, implantable defibrillators, percutaneous heart valves, gene therapy and internet search engines, to name a few. Some of these projects have the potential to cure cancer and heart disease, to defer ageing and to extend healthy human life to over 150 years within the next 10 years.

The recent FutureMed 2020 conference in the US gave an enlightened vision of what innovation, information technology and science together have the potential to offer in medicine and healthcare by 2020. FutureMed, an annual international medical conference, explores and drives the future of medicine through exponential, game-changing technologies. 

Exponential game-changing technologies refer to developments that transform the way we do things, usually over a relatively short period of time compared with a linear growth pattern that occurs where technologies are slowly tweaked over time. Exponential defines how growth is not linear or constant but accelerates as it advances. This pace of growth is leading to rapid advancement in many fields, including medicine. Singularity theory suggests that “we will reach a point where the technology that we have created will transcend our own human intelligence and capability. We will be able to merge our biological bodies with technology making us infinitely smarter and stronger”.¹

Exponential growth

Exponential growth is happening because of the ‘6 Ds’ of digitisation: deceptive, disruptive, dematerialise (fit in pocket), demonetise (costs much less) and democratisation (everyone wants it). The most practical examples of this disruption include the evolution of information from library books to the internet; music from records and CDs bought in record stores to iPhones and iTunes; computing from Mac/PC to iPhone and tablet.

Disruptive innovation is evident in medicine: urgent care clinics are disrupting emergency department services; and online medical services are disrupting hospital and general practice services. These services are easy to access at any time and have a low price point compared with traditional equivalents. In the current healthcare crisis, less expensive, easier, more accessible care is preferred by many patients. At the same time many of these disruptive innovations are enabling improved healthcare delivery and may well achieve better outcomes for patients.

The Futuremed 2020 conference encouraged participants to try to solve the world’s biggest problems in areas such as food, energy, water and disease. An interesting viewpoint was made to stimulate potential entrepreneurs that the “easiest way to become a billionaire is to solve a problem that affects a billion people”. 

Innovative ideas come from many sources: the most useful often depend on one’s daily life, for example working in a clinic and identifying individual or patient needs and finding ways to address them. A good example of this is to read the newspaper and identify problems, and then apply oneself creatively to finding potential solutions. Using a disruptive innovation approach may give a fresh opportunity to addressing many of Ireland’s healthcare problems.

Technology and healthcare

Futuremed 2020 covered several areas of exponential game-changing technological growth as applied to healthcare; from information technology and smartphones to robots that care for elderly people living alone. 

Futuremed was presented in a series of interactive workshops, start-up pitches by young medical innovators, a presentation by Google Young Investigator award winner 2013 (a 17-year-old high-school student who invented a computer program that identified new targets on the influenza virus for potential vaccine development), sessions covering big data, artificial intelligence, robotics, patient engagement, connected health and body computing, personalised medicine, preventative health, the future of medical and surgical intervention, the future of the pharmaceutical industry, the future of global health, neuromedicine, regenerative medicine and the future of clinical practice as projected to 2020. 

A major challenge in dealing with the massive exponential growth in knowledge and information is the capacity of the human brain to cope with the volume of data. This is where Google, Microsoft and IBM have a key influence. IBM Watson is a supercomputer that can analyse a million medical articles in minutes and give the reader the perfect ‘PubMed-like’ response to any clinical question based on all available medical literature. Google is investing millions into understanding the ageing process (CalaCo), mapping the human brain and finding a computer system that can think for itself (cognitive computing).²

Robotics in healthcare – science fiction or fact?  

Robotics is already part of the future of medicine and surgery. Robots that move through the body and measure function or visualise systems (nano-robots, cameras); robotic companions in the home (carer, dog); exoskeletons to replace limbs in road traffic accident victims, war victims and amputees already exist. Exponential technology and information systems are advancing to the point of creating robots to perform complete human functions. Drones are being used to deliver orders for Amazon to customers and could be used in hospitals of the future. Robotic technology is used in Ireland for prostate and gynaecology surgery. There is a robotic system for coronary angiography available in the UK that helps to reduce human error and has the potential to improve patient outcomes. 

3D systems represent an amazing technological advance with the potential to make one’s own body parts such as joints, organs (Organovo), stents – sized and fitted to individual needs by integrating imaging (CT/MRI/angiography) – with computer technology, to design a ready-made personalised body part. In the past 3D printers were very expensive; now they are very affordable. 3D printing has been identified as one of the major areas likely to have a game-changing impact in the future.

Another game-changing area in healthcare is body sensor technology. The quantified self movement in the US is driving body monitoring among individuals from all backgrounds. Initially sport and wellness gadgets and smartphone apps that check heart rate and performance and store and interpret them were commonplace; now sensors can measure almost every body function, heart rhythm (the Alive ECG app), sleep, brain activity, stress, blood sugar, pregnancy and so on. Sensors can be worn, attached to devices, put in clothing, in watches, on tattoos, ingested or even implanted. There are millions of sensors of all shapes and sizes, most of which measure the same things. 

What is missing is a way to link all the data and use it in a meaningful way. Efforts in the US to centralise data (mobile body area network) with an evolution towards feedback loops to instruct patients to attend a doctor or to remind patients to take their pills, to exercise or about dietary measures and so on. Homes of the future will have mobile network feedback integrated in bathroom mirrors, appliances, TVs and so on.

Smart companies are adding hardware and software technologies to phones and portable devices such as gene testing on a USB stick. Genia are trying to develop a $100 genome test by leveraging biotechnology to make genetic information universally available. Others are adding devices to phones to allow patients to home test for blood sugar and biomarkers (for example troponin, circulating endothelial cells for heart disease risk, cholesterol testing). Sensors will soon be able to do some of these measures by transmitting from an implanted measuring sensor in a body/blood vessel, removing any need for blood draw.

The Xprise in the US is assessing the final entrants for a $10 million prize to develop a total body scanner (Tricorder) that can be used to self-monitor all ailments (as visualised in Star Trek). The possibilities with smartphones, sensor technology and devices are endless and based on this meeting, millions are already in design.

Wireless body monitoring offers measurable value for healthcare: “a monitored patient has a 48% chance of surviving a cardiac arrest, compared with a 6% chance for unmonitored patients”. This opens up opportunities for monitoring patients at home with smartphones, medical devices, telemedicine, etc. In addition, moving monitoring into the community can free up hospital beds. With the developments in technology, especially smartphone devices, many patients will be able to use their own devices without significant added costs. An interesting comparison is that there are more people in this world who currently own a mobile phone than own a toothbrush.

A major challenge with monitoring is what to do with all the data collected, especially in terms of making it useful to patients and doctors. This meeting drew analogies with how the IT industry has succeeded in managing big data. Sharing open data, using brain and computer collective intelligence, creative hardware, simple user experience, rethinking workflows and experience, and being different are better strategies to adopt in order to make disruptive technologies valuable and game-changing in healthcare. Smart devices and applications that have applied some of these suggestions include: taxi-booking apps such as Hailo; traffic management apps such as Waze; Google Glass (pair of glasses that interfaces with devices like electronic medical records) can function as a camera to live-stream surgical procedures to an audience on their phones or TV screens. These give users access to online resources for problem solving or to communicate with another doctor for advice. A project in Holland is using Google Glass to assist untrained individuals performing CPR in a cardiac arrest situation. The device tells the person what to do, it alerts help and acts as a beacon as to where the ambulance needs to come and it is an audio and visual communication between the CPR person and medical personnel.  

The key with all data is to close the loop between how data science can transform healthcare.

What will the future of healthcare look like? 

The momentum of exponential technology and disruption is such that anyone would be mistaken in believing that it will never affect them directly. Many of us now observe elderly relatives using mobile phones to reserve golf tee times, to book holidays and restaurants, and the ability of children to decipher most apps on a smartphone. In contrast this technology has not completely integrated into our hospitals/healthcare systems, but it is coming; most junior doctors use mobile phones to communicate patient orders inside hospitals and to search drug and medical queries on the internet.

The future of hospitals as seen by US patients looks like a hotel, a place for surgery, perhaps a call centre to instruct patients what to do in response to what their monitors are detecting. Blood tests will move to point-of-care at home or in the community clinic, pharmacy, general practice or other venues. Patients will be telemonitored, there will be room for intravenous treatments out of hospital, perhaps using robotic intravenous line placement. Doctors of the future will become ‘medical engineers’; medical data will be sourced from supercomputers and from other patients. As Larry Page, Google CEO puts it: “Technology ought to relieve humans of repetitive, laborious, tasks, freeing us to be creative, innovative, think or take our leisure.” 

In the meantime, many new devices are emerging that facilitate this exponential growth. Smartphone physical (iPhone ECG, weight, cellscope/otoscope, BP, breathing apps in doctor’s clinic); monitors like Sotera, LifeWatch, Propeller health (for asthma patients a GPS system to warn users of weather, pollen counts in areas); Omada health (a social media community of diabetes patients who share data and motivate each other for better sugar control, risk management, mediated by a diabetes nurse).

Funding question

Funding has traditionally been a challenge that limits scalable innovation. However, an evolving movement is crowdfunding based on raising money from the community/general public/crowd that allow ideas to be researched and developed and marketed. Many of these organisations exist worldwide, for example Indiegogo and Kickstarter. Their greatest value is that anyone can contribute by raising funds to start a project or can invest their own resources to part fund someone else’s research ideas. Many people are themselves interested in being part of technology advancements and improvements in healthcare, providing an ideal value proposition for crowdfunding.

In summary, innovation management represents a realistic opportunity to improve future healthcare delivery in Ireland. Many new technologies will help to provide affordable and accessible solutions. Medicine in the future will be much more precision based and personalised to individual patients and a lot of it will take place outside hospitals provided by humans and possibly robots too.