Bertalan Meskó, MD, PhD
Finally, we can say that the surreal year of 2020 is behind us as we welcome a new year rich in potential for digital health and (hopefully) full of good news! Even though the year that went by was dominated with news regarding the novel coronavirus, there were also other important developments in the digital health world; some of which were also shaped by the pandemic.
As such, before diving into what lies ahead of this field in 2021, let’s take a step back and contemplate 9 take-aways about digital health from 2020. These can give us further insights into how those relevant trends will shape up in the near future.
1. Proteus failed, but digital pill technology did not
In 2017, Proteus made headlines for developing the first-ever FDA-approved digital pill. As recently as 2019, the digital pill pioneer was valued at $1.5 billion. But then in 2020, Proteus filed for bankruptcy. The downfall of this digital health unicorn was attributed to many factors from poor management to overpriced pills.
Nevertheless, a company’s downfall doesn’t necessarily mean the downfall of the technology. Indeed, studies showed that digital pills help in improving adherence among populations with adherence issues. Other companies like etectRx and Infármate are also working on digital pills of their own. Otsuka Pharmaceutical, Proteus’ former partner, even acquired the dethroned digital health unicorn; a move that acknowledges the potential of digital pills in pharma. However, the downfall of the once-leading company signifies a steeper slope ahead for those aiming to bring their digital pills to the market.
2. Digital contact tracing didn’t deliver on its promise
With the rapid rate of COVID-19 transmission, governments around the world turned to technology for assistance. This assistance came in the form of contact tracing apps. Once downloaded, it could help health officials determine who has been in close vicinity of someone infected.
But using these apps came with a huge privacy and data security risk. Such methods laid bare sensitive, if not embarrassing, details of citizens in South Korea. Moscow’s QR-based system, dubbed as a ‘cyber Gulag’, monitored citizens’ movements in order to track the contagion. Contact-tracing apps used in the U.K. and Qatar showed vulnerabilities to hacks, which could expose private data.
Even though hundreds of thousands of dollars were invested in developing these apps, adoption rate remained low among the population. For instance, in New York only about 5% of the state’s population downloaded the COVID Alert NY contact tracing app. Researchers from the University of Oxford estimate that around 60% of the population should use these apps for them to be effective. The reality shows that we are not ready for digital health apps that breach our privacy even for our benefits.
3. Investments in digital health bloomed
2020 was the year of digital health investment, quite literally so. Before the year’s end, by Q3 2020, the amount of investment totalled $9.4 billion. This exceeded the largest annual sum of $8.1 billion in 2018, which previously held the title of record-breaking year.
This boost in investment that the digital health industry received was further accelerated by the COVID-19 pandemic. Indeed, investments were directed mostly towards companies offering on-demand healthcare services and remote care, which are solutions to real needs amidst the pandemic. We further analysed the 24 technological trends we consider the most promising and ripe for investment in the early 2020s in our latest e-book. Be sure to take a look!
4. Virtual events replaced in-person ones
Yearly, thousands of in-person medical conferences are held. But that’s only during pandemic-free years. The need to limit physical contact forced in-person medical events to be postponed or cancelled in 2020; as of those physical events that did take place in 2020, several reported of COVID-19 infections of attendees. But this setback also gave medical events the opportunity to adapt with the times, go past mundane PowerPoints and go digital.
Indeed, virtual events don’t only offer an alternative to physical events, but enhance events altogether. If done right, they can be more inclusive, engaging and visually insightful in ways traditional events cannot be.
5. The FDA did not increase access to its list of approved medical A.I.
In September 2020, The Medical Futurist Institute (TMFI) published a study in the prestigious npj Digital Medicine journal. In it, the authors pioneered the first open access, online database of FDA-approved A.I.-based algorithms. Given the booming healthcare A.I. market, such a comprehensive database will become increasingly important. However, leading regulatory bodies failed to provide one themselves. Even the FDA, which took the lead in regulating the technology, did not come up with one; hence it was used as an example in this study.
While the TMFI study’s authors are continuously updating the database, they also called for regulatory bodies to take it over or launch their own; given that they have the resources to better maintain such a tool. But neither the FDA nor other regulatory authorities showed interest in doing so. We did finally manage to get in touch with the Digital Health team at the FDA; and they confirmed that they would like to introduce us to an A.I. consortium. However, they mentioned that they won’t take the database over. We hope that the U.S.-based regulatory body will take notice of its importance in 2021; but in the meantime, the database will be maintained by the original authors.
6. Telemedicine went mainstream
Lockdowns and the need to practice social distancing while still providing access to healthcare catapulted telemedicine to what’s essentially an accepted mode of medical practice.
Before the COVID-19 public health crisis, 82% of U.S. consumers did not use telemedicine services. As the pandemic erupted, some services’ use increased by a staggering 158% in the same country. The adoption showed that unnecessary physical hospital visits are avoidable and telemedicine can serve as a bridge for this purpose.
7. The globalised aspect of digital health was highlighted
As part of the definition of digital health, the democratisation of healthcare is emphasised. Companies offering quality digital health services from fitness trackers to at-home microbiome tests can reach patients and consumers wherever they are (save for some shipping restrictions). We discussed this aspect at length in our articles and the COVID-19 pandemic helped make that point.
Amidst the current circumstances, patients turned to digital health solutions en masse; even though the company offering these services is located in another country or continent altogether. Cancer patients continued their treatment thanks to telemedicine. Demand for wellness apps and fitness wearables surged under the current circumstances. Even seniors embraced health tech during the pandemic. This trend is set to continue as the adoption has already taken off. But along with this adoption, stringent regulations must be enforced to ensure that quality in both performance of the service and data protection is offered.
8. Not all digital health technologies make it to the market
Even though digital health investment received a massive boost and technologies like telemedicine and wellness apps became commonplace in 2020, not all technologies made it to the market that year. There’s one promising solution in particular that we failed to see getting adopted for several years in a row: 3D-printed casts. They outperform traditional casts in many ways as they are custom-fitted, waterproof, easily removable, and even prevent infection and muscle atrophy. However, such casts still aren’t seen in common practice.
This poor adoption is attributable to several causes. For one, evidence around the effectiveness of 3D-printed casts is rather lacking. Their production is also slow in comparison to traditional casts. Additionally, its cost can be off-putting. For example, a 3D-printed cast from CastPrint costs around €100.
But now that 3D printers are widely adopted in hospitals following their importance in the pandemic to meet demands with in-house production of equipment, 3D-printed casts might become more common. There are also companies like Xkelet and CastPrint pushing the solution forward in the hopes of upgrading existing gypsum casts.
9. “Smartwatch patients” highlighted the need for a cultural transformation
When people show up at a clinic following an alert regarding abnormal cardiac measurements from their smartwatch only to learn that it was a false positive reading, many will blame the technology or the adopters for potentially overburdening the healthcare system. A 2020 study from Mayo Clinic researchers about the Apple Watch’s abnormal pulse detection feature called for caution regarding such cases.
However, these “smartwatch patients” aren’t at fault nor is the technology. Rather than avoiding those digital health solutions, physicians should embrace them and guide patients regarding when to take measurements with wearables and when to seek medical attention. In short, a cultural transformation is required. While there is a considerable learning curve to this transformation, it can be achieved by the concerted effort from every stakeholder across the healthcare landscape; from physicians through patients to policymakers.
This concludes our 2020 digital health take-aways. We eagerly look forward to the developments in the field in 2021; and we hope that you do too as we will be sharing our analyses through our e-books and weekly articles.
Dr. Bertalan Mesko, PhD is The Medical Futurist and Director of The Medical Futurist Institute analyzing how science fiction technologies can become reality in medicine and healthcare. As a geek physician with a PhD in genomics, he is a keynote speaker and an Amazon Top 100 author.
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