by Eliot Baker
The explosion of the Internet of Things (IoT) is disrupting the notion of who and what can be monitored and managed—and from where, and for how long. Ubiquitous, connected sensors in our pockets and on our wrists–and many more places—already are producing a torrent of health data. Improvements to that technology and the development of next-gen AI tools will leverage that data to transform personalized care and medical research. Over the next decade, we’ll see the effects of this consumer health data revolution translate to improved patient outcomes and public health, alongside a much deeper understanding of human physiology.
The future of eldercare and at-home healthcare, in particular, will leverage the gathering wave of IoT. All that data and technology will make caregiving increasingly more distributed, from mobile health facilities to licensed individuals delivering care at homes. As AI tools make health monitoring and diagnostic technologies cheaper, faster, and truly intelligent, their data will be connected via platform to distributed caregiving networks. Prices will go down, while the quality of care and living goes up.
Three innovations transformed everyday life over the previous decade. The future of care will grow from the evolution of these platforms and services.
We love the beauty and brilliance of Apple’s design choices and their vertically integrated Mac ecosystem. But 4G broadband and cloud computing technologies catalyzed the smartphone revolution’s advance into uncharted frontiers. Those frontiers are about to be pushed even further. In the Jumanji movie remake, a teenager from 1994 asked a group of 2017 teenagers: “Does ‘phone’ mean something different in the future?” Yes. And it will mean something different again in 2030.
2020 marks the threshold of another mobile inflection point due to:
These are disruptive forces. It’s just a matter of how the value of that disruption, which is expected to be in the hundreds of billions of dollars, will be unlocked.
The FDA will continue to play a valuable and vital role in ensuring, to the extent possible, that new drugs and devices are safe before they are used widely. It is a very expensive process, but a lot of the cost is due to the complexity of designing and managing clinical trials. Technology and platforms can and will help reduce the burden of collecting data, managing trials, helping to improve compliance, and so on.
The big opportunity afforded by IoT for health is leveraging increasingly sophisticated and ubiquitous technology to allow doctors and clinics to reach patients outside the clinical setting, be it for medical or research purposes. Using phone cameras, digital watches and other connected devices with sensors to monitor patient data and, for example, perform blood tests or ultrasound imaging, will expand medical and research activity into the home as never before.
So: the FDA will continue its role of ensuring that new drugs and devices are safe. But the way we conduct trials and–even the types of devices we use–will change dramatically based on the reduction in cost and the improved quality of connected sensing devices. The FDA approval process will be streamlined to keep pace with the velocity of emerging technology and software/hardware updates.
Expect to see big strides in medical research, both in terms of new understanding about diseases and cures, as well as research methodologies and practices. The ultimate better understanding of disease will result in new and better treatments. Drug and medical device companies–and maybe even insurance companies–will benefit from these improvements. Being able to measure patients at home long-term will open up completely new kinds of studies and data sets.
Tracking every beat of every vital function amounts to a trove of data. The potential biomarkers and health metrics contained therein can and will be used to better monitor, manage, and influence our health. This goes far beyond counting steps. We’re talking about comprehensive understanding and analysis of everything from heart, cognitive, and breathing function to mood disorders, and mental fitness (not to mention personal genomics).
AI can improve radiologists’ ability to make diagnoses for all types of medical imaging since all of it is now digital. Some believe Magnetic Resonance Imaging (MRI) is the future of medical imaging at the diagnostic scale that will change the medical standard of care. While MRI has the advantage of no ionizing radiation, it remains very expensive and can take hours to complete full-body scans. Furthermore, it does contain safety hazards that prevent widespread home or “medical mall” deployment due to magnet strength and cryogens. (Low-field scanners without superconducting magnets–if the quality of lower-cost, low-field MRI scanners can rise or be improved by AI, might overcome those cost and safety barriers).
Ultrasound, however, also has no radiation, takes less time to perform, and is less expensive. It is more likely than MRI to see further reductions in cost and accrue more application-specific scanner designs. For instance, the Butterfly iQ is a $2000 pocket-sized, battery-powered ultrasound device doctors and nurses can use for whole-body scanning even in rural communities. The Gates Foundation has invested in and deployed this device in multiple low-resource areas around the globe. It is just one example of how ultrasound is becoming the game-changing diagnostic technology of the coming decade as it gets smaller, cheaper, and smarter.
However… bold is the name of the game here. Choosing MRI as the technology that changes the standard of care is bold at Star Trek levels. Imagine walking into an MRI booth at Walmart, getting a 20-minute full-body scan, and then checking your phone for a report on soft tissue anomalies. In fact, a Xinova-affiliated full-body-scan MRI technology has already been piloted for this vision (and actually detected early-stage cancer of an investor during a product demo).
I am living in Finland and organizing at-home care for my elderly father in Seattle. For now, that translates to doctor and grocery store rides, changing lightbulbs, and cooking nutritious meals. We’re fortunate to have a neighborhood community that are helping support this transitional phase of assisted care.
But someday, his care will require licensed professionals and medical equipment, too. All sons and daughters, from Seattle to Seoul, will face the challenge of caring for those who once cared for us. Given increasing demand and shortages of government funds and labor for elder care (and the fact that people are moving further away from their parents for mid-career opportunities), new systems and approaches to elder care will be a necessary and extensive opportunity space.
Many ventures emphasize single technologies that are easy to use by the elderly. This misses the mark. The most widely impactful approach will be ecosystem-based, as Dean Kamen described in a recent interview on the Killer Innovation podcast. It will involve leveraging technologies from multiple unrelated industries–from gaming to fitness trackers to robotics–and harnessing them into a new system of at-home care. The elderly don’t want to live in hospitals. Nor should they. It’s an expensive, inefficient, and dangerous way to deliver non-critical care.
The service I wish was available would be an Uber-meets-Task Rabbit-meets-iHealth-meets-Meals on Wheels platform, connecting bed and wearable health sensors with a distributed network of vetted care providers. Need a ride? A meal? A health check-in? Concerned about cognitive, balance, and mobility decline? How is that medication working out? What’s up with that weird arrhythmia and those periodic breathless events at night? A network of technology and service providers would be easily available to dig in.
In addition to Kamen’s own IoT-adjacent efforts –and along with his many long-standing health-related innovations like the iBot and home dialysis—there’s a host of interesting startups in this space in Europe. And Andreesen Horrowitz-backed, Silicon Valley startup Honor has raised $115 Million for their national network of home care agencies.
Fortune Magazine’s Death by a Thousand Clicks article does a nice job explaining why EHRs are still causing as many headaches as they are curing them, despite EHR’s great potential to benefit healthcare since its 2009 introduction. EHRs are literally and figuratively killing patients and doctors alike. Nature magazine describes it as an awkward adolescent phase of technology. Vendors’ individual records systems are balkanized; one system won’t speak to the next, frustrating the recording and sharing of patient data. Laughably bad UIs are resulting in doctor burnout and error as they spend more time hassling with data entry than observing patients.
That will change this decade. As Nature notes, new standards like Digital Imaging and Communications in Medicine (DICOM) and the Fast Healthcare Interoperability Resources (FHIR) draft standard will finally help EHRs improve patient outcomes by reducing physician errors and putting more data—from images to full patient conversations—in one easily accessible place. Language processing tech will help doctors focus on their patients rather than data entry. And once that data becomes reliable, AI advances will transform how healthcare is delivered.
Apple and Google are easing access to electronic health records via the mobile-connected FHIR. Entering that projected $38 billion market makes even more sense considering both companies’ investment into health and fitness-facing wearables (namely, Apple Watch and Google’s $2.1 billion acquisition of Fitbit). The tech giants’ linkage to EHRs will bridge the gap between consumer health and medical devices.
The head of a major American health organization once explained to me that insurance companies prefer a healthy consumer who dutifully pays his premiums and then dies a sudden and painless death. That scenario requires minimal care, and thus minimal expense. The enlarging obesity/diabetes/apnea triumvirate is the opposite of ideal for health insurance companies. Sick and chronically ill customers are expensive. They drive up costs for everyone. And steps (literally!) can be taken to reverse their outcomes without surgical or pharmaceutical interventions.
So: IoT meets IoBodies meets predictive analytics to drive a future of dynamic insurance premiums. We are already at an early stage of this; some insurers have partnered with wearable tech to promote fitness. This is only the beginning. AI is enabling predictive analytics of those mountains of data wearables are tracking. Companies including Amazon, Apple, Google, and the epic Walgreens-and-Microsoft healthcare alliance are accelerating this future. Big-tech-meets-healthcare is putting pressure on insurance companies and hospitals to change their traditional models or risk disruption.
A cash-for-fitness-based system is a potentially slippery slope. IoT could be used to punish rather than reward. But I think rising competition in the space will steer the IoT-informed future of insurance in a positive direction.
Eliot Baker is Programs and Content Manager at Xinova. He received his M.S. in Science Journalism from Boston University and has worked in sleep tech in his adopted home country of Finland, in medical research at Harvard University, and as an award-winning journalist and novelist in various locations.
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