Donna Marbury

Experts agree that forecasting the future of healthcare technology isn’t difficult: machine learning, artificial intelligence (AI), and cloud technologies that apply to clinical, workplace, and financial processes will have better and richer incorporation into the industry.

But to get there, healthcare executives need to be laying the cultural foundation today for the technology changes coming in the next decade.

For example, investing in AI over the next five years could cost, on average, more than $30 million per organization, according to a survey of 500 healthcare executives by OptimIQ that was published in November 2018. However, 38% of employers and 20% of health plans believe they would see a return on that investment in four years or less. Ultimately, 94% of respondents see investments in technologies, such as AI, as the clearest route to affordable, accessible and equitable healthcare in the future.

But in order to realize those future possibilities, a culture shift needs to happen in healthcare today, says Tom Lawry, director of worldwide health for Microsoft. The future of healthcare technology relies more on the culture and framework being created by clinical and business leaders today, he tells Drug Topics.

“What really is going to be needed in the future is not just the breakthroughs in technology, but breakthroughs in creative thinking and the ability of leaders to think differently when redeveloping their processes to leverage the power of the technologies rather than trying to insert these new technologies into a framework,” Lawry says.

Anil Jain, MD, vice president and chief information officer for Watson Health at IBM, says that healthcare organizations will need to shake the stigma of being bureaucratic and slow to adapt so they can be agile enough to adopt future technologies.
	“Healthcare organizations need to start to push the agenda that says innovation is important to healthcare. People outside of healthcare view the industry as very conservative, very slow to adapt,” Jain tells Drug Topics. But when you talk to people inside the industry, we all think we’re moving very, very quickly. The key is for these healthcare organizations to get involved in the national debate, at the advocacy level and advising others on what the industry needs, so that movement is made collectively.”

These experts have given their insights on where healthcare technology will be the most impactful in the next decade.

Although devices collecting digital data are important to healthcare, how that data is shared is the most essential part of the equation, Lawry says.
	More than 90% of healthcare organizations are widely using the cloud to host applications, according to a 2017 Healthcare Information and Management Systems Society (HIMSS) survey on cloud use. However, the industry is still using the cloud for separate functions, such as clinical apps, data hosting, and backup, and not in a holistic fashion. The survey found that though there is a high level of cloud usage at healthcare organizations, the functionality is still limited.

Use of cloud integration has allowed for data from different healthcare silos to be shared, and as more organizations continue to connect those dots, and Lawry says that it will transform the industry.

“Everyone’s digitizing their data, whether that’s electronic medical records or X-rays. But digitizing data doesn’t do anything other than that. It changes data from one form to another instance,” Lawry says. “The transformation that’s brought about by the cloud and bringing that data together allows for all kinds of interesting things. That to us is the number one transformational aspect going forward for the next few years.”

Artificial intelligence has been a part of the healthcare for years, but experts believe in the next decade it will be a regular part of the industry. 

A survey of 200 healthcare professionals by Intel Corporation, released in July 2018, found that 37% of respondents were using AI in limited ways, and 54% believe that there will be widespread AI adoption in the next five years.

John Doyle, director of business strategy for Worldwide Health Industry at Microsoft, says, moving forward, we should expect to see AI infused into all aspects of clinical and operational workflow.

“We are early in the journey for cloud and AI adoption today, but we are already starting see some amazing progress being made, and we expect this continue and with a broader adoption of applied AI in areas such as the clinical interpretation of complex datasets, intelligent medical images, voice integration, and real-time insight of streaming medical devices and sensors data,” Doyle says.

As a new generation of consumer-focused services aim to merge patients and consumer journeys, applied AI will disrupt how patients engage with healthcare providers today, Doyle says. “Applied AI has the potential to reduce the complexity of how healthcare data is captured and analyzed, examples of this include how intelligent voice integration and bot technologies are being used during virtual consultations to reduce the time spent entering data by both patients and clinicians, and how pretrained clinical knowledge can be applied at the point of care.”

The ability for clinicians to meet with patients via web and mobile portals is essential for chronic care management, says Rhonda Collins, DNP, RN, chief nursing officer at Vocera, and founder of the American Nurse Project.

“A majority of this country is still rural. So, we need to rely on technology to fill gaps in human connections in healthcare-telehealth will be more important going forward, as infrastructure and technology continue to improve. Hospitals and clinics will need to prepare for a world that technology is making smaller,” Collins says.

A 2017 report issued by the Federal Communications Commission found that 50% of U.S. counties house people who both have high occurrences of chronic diseases and a greater need for broadband connectivity. The commission called this “double burden,” and incidents can be as high as 60% in rural counties.

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“That makes a remote consultation with a doctor or video chat very difficult, but the situation is improving, and over time, I think at-home remote care will be most valuable in rural areas, where technology use is far more practical than a long drive to see a doctor,” Collins says.

As telehealth expansion continues through Medicare reimbursements, patients are still unclear about its availability and use. A survey released by Healthline in August 2018 found that 46% of Medicare Advantage members were unsure if telehealth was an option, and 37% stated telehealth was not offered even though it is.

Collins adds that hospitals are still lacking full-scale wi-fi and consistent cellular service, which impedes integration of telehealth and other mobile health offerings.

“These basic issues make it very difficult to bring technology in to provide extraordinary care and connectivity to all patients everywhere. Infrastructure upgrades are a must, and that should be the focus of many hospitals, so they can leverage great technologies that improve the lives of patients and clinicians alike,” Collins says.

Though smart phones, smart watches and other smart devices are being used by consumers, a focus on “smart” hasn’t translated to healthcare solutions, says Kai Patel, MD, MBA, senior vice president of digital health at Flex, a solutions provider that builds intelligent products.

“By and large, many healthcare solutions lack meaning. They are not smart,” Patel says. “The data from them is either not collected at all or it is collected, and it stays in some type of local environment which inherently limits the value you can derive from that.”

Patel says in the next decade drug delivery devices such as insulin pens, biologic auto injectors, inhalers, and smart packaging for pills will become commonplace and enhance both clinical and business operations in healthcare. The goal of tracking this data is to add to the landscape of behavioral insights that can help enhance patient care. Patel says the ability to observe how patients use chronic therapies both inside clinical settings and at home or inpatient care settings is enhanced by integrated cloud and artificial intelligence use.

“Most of that technology is already there, so in the next five to 10 years it’s about unlocking that data. Once you can unlock that data, we will really be able to see progress using artificial intelligence and machine learning within those data sets,” Patel says.

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Jain says IBM Watson is currently studying concepts around prescribing digital therapies that can be powered by blockchain and artificial intelligence and can be tailored to patients’ behavior.

“Wouldn’t it be really interesting if I prescribed an antidiabetes tablet, and I’m also prescribing an app on the patient’s smart phone that makes sure that they stay somewhat adhering to the medication? If they have any side effects, they’re educated about when they should see the doctor or when they could just simply ignore them,” Jain says.

Smarter therapies could also prescribe diets that work in conjunction with medications and give patients more feedback on their progress, he says. “The idea is that we have to go beyond the pill. As a physician, there has to be a better way to virtually have eyes on the patient even when they’re not in my exam room four times a year for 15 minutes.”

In the next decade, clinicians will have the ability to use blockchain, machine learning, and artificial intelligence seamlessly to provide specialized care to patients, says Jain.

“The biggest thing is going to be our ability to use these advanced technology enablers to get much better at doing personalized medicine and personalized healthcare with our patients,” Jain says. “Because the back-end healthcare technology is crunching all of their clinical data and administrative data, looking at their genomic profile, looking at their social determinates of health much faster than any human physician or clinician could, and combining that information in a trusted way.”

Jain says that fitness trackers are currently collecting siloed data, but are an important part of the equation when the data can be integrated along with other health determinants. Ultimately, he says more personalized treatments, especially for chronic conditions, would increase adherence to care plans.

“Essentially a clinician will have the ability to say, instead of just practicing in an evidence-based way, we’re going to combine evidence and personalized choices to give patients a much higher likelihood of being successful at the first set of treatments that are offered, instead of going back and forth a few times trying to figure things out,” Jain says.

Collins says she is hopeful that the workflow technology the healthcare field adopts over the next ten years will match and adapt to technology that people are used to in other areas of their lives.

“Before a hospital shift, someone can sit in their cars and buy movie tickets, make dinner reservations, and chat with friends-all from their smart phones. They then enter the hospital for a day’s work, and many times, the technology landscape is entirely different,” Collins says. She fears that antiquated processes and devices in healthcare workplaces will be a deterrent to tech-savvy millennials.

“When millennials go to work at a hospital, we are asking doctors, nurses and care teams to step back 20 years and use landline phones, fax machines, pagers, and overhead calls-all of which downgrade and add complexity to our millennial workforce. They carry a heavy burden every day working with patients in stressful hospital environments, and the very basic technology they’re using only adds to the stress,” Collins says. “Furthermore, we are adding to cognitive loads by forcing them to remember procedures and how to use outdated technologies they are not naturally accustomed to using. So, over time, antiquated technology that doesn’t mirror what is used in our personal life and is not secure will be eliminated. As younger people continue to enter the workforce, many hospitals will be forced to modernize.”

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Healthcare execs need to lay the cultural foundation today for upcoming technology changes

Six Healthcare Technologies Coming in the Next Five Years 

Blockchain technology is creating more ways for healthcare to increase safety and efficiency by decentralizing data. Nearly half of healthcare companies report that they are developing blockchain solutions, according to a 2018 global blockchain survey by PricewaterhouseCoopers Health Research Institute.

Blockchain is defined as an open record of transactions, or a ledger, that can be managed by and distributed to several stakeholders instead of being maintained in one location. The stakeholders are a part of a network that can add data to the ledger, and transactions can be vetted by the network. As the network verifies and accepts transactions, a block of data is created. Several transactions are linked in a chain, with each block building upon the data of a previous block.

Because the integrity of the data is distributed across several blocks, data tampering is more difficult, and transactions are easier to trace. In healthcare, this allows for several stakeholders from different silos, including providers, payers and pharmacies, to have access to data.

As the industry grapples with increased fraud and waste as opioid abuse continues to rise, blockchain technology can add more security and accountability to the distribution process, says Carly Guenther, managing director of life sciences supply chain for Accenture.

“Many controlled substances are still prescribed using paper prescriptions, which will only be identified during the dispense/claim adjudication transaction phase,” Guenther says. “With blockchain, we could create a secure distributed ledger that allows witness identification to be recorded at the appropriate times.” Blockchain enables real-time access for authorized individuals to view controlled drugs transactions. Stakeholders could include law enforcement, researchers, clinicians, and payers, she adds. Accenture estimates roughly 30% of business costs are locked up in point-to-point messaging, she says. 

“Once blockchain is fully adopted across the supply chain, we will be able to fully optimize the supply chain network and ecosystem, which will create a significant value internally and externally to all organizations,” Guenther says. “From the manufacturer to the patient, the flow of goods and information will enable even new business models and help drive a more patient-focused supply chain.”

Though the benefits of blockchain in pharmacy are numerous, the industry has to overcome hurdles before the technology can be deployed to its fullest potential, says Darryl Glover, PharmD, MBA, chief clinical officer at Gerson Lehrman Group.

“The main silo is that the members of the supply chain, manufacturers, wholesalers and inpatient/outpatient pharmacies, have not historically worked constructively together and have a lack of trust in each other’s motives,” Glover says. “It is exactly this lack of trust that makes blockchain powerful. It can serve as a bridge to interconnect these parties and allow them to share information more readily as trust develops.”

Glover says deploying blockchain in a pharmaceutical supply chain requires stakeholder to have interoperable communication. “Blockchain serves as a bridge between and within the individual organizations to connect their systems together that do not readily communicate with each other. The data would definitely be more secure, and the network could be extended to include patients,” Glover says. “In this way, all of the members of the supply chain would be involved, and this then opens up possibilities for gaining access to data that was not previously possible.”

Using blockchain in the supply chain can also reduce the risk of fraudulent drugs infiltrating the supply chain. “Counterfeit pharmaceuticals are now considered to be the world’s largest fraud market. Blockchain technology could provide an answer,” Guenther says. “Packages have labels that are scanned at every point along its journey from factory to pharmacy. These labels would connect to a blockchain system.”

A collaborative effort between Lipscomb University and a nonprofit pharmacy in Tennessee will use blockchain technology to provide drugs to customers who are underinsured. In November 2018, the university announced a collaboration using technology created by RemediChain that allows patients to donate their unused oral chemotherapy drugs to patients with financial difficulties.

Using blockchain, RemediChain is growing its network of prescription drugs that can be redistributed in an effort to eliminate waste in the industry. The company accepts prescription donations from patients across the country. When a donation is accepted, it receives a date, time, and location “stamp,” and is entered into the blockchain system. That medication is then tracked along every point in the chain of custody until it is either taken by a patient or properly destroyed.

RemediChain is already being used in a statewide, nonprofit pharmacy in Iowa, and Philip Baker, PharmD, CEO of RemediChain, says they plan to deploy the technology across nonprofit pharmacies across the country.

“RemediChain will allow us to tap into the vast amount of unused medicine that lies in the hands of patients and distribute those medications to our network of charity pharmacies all over the country,” Baker says.

In the next five years, more blockchain solutions connecting manufacturers and distributors to track chain of custody will be common place, Baker says.

“In 10 years, we’ll see pharmacies that run on their own cryptocurrency (or token), eliminating the need for pharmacy benefit managers and third-party payers,” Baker says.

However, Guenther says because specialty pharmacies and independent pharmacies are small, they probably will be the last dispensers to link up to any blockchain ledger because of the complexity and expense.

“Lack of specialty pharmacy participation will be a hurdle to success because last-mile delivery of the therapy to the patient is critical, and the cost of specialty drugs are material to payers,” Guenther says.

But even small and independent pharmacies can see the benefits are deploying blockchain in the immediate future, Glover says.

“Blockchain is the right tool if there is a need to create an interoperable network between systems that do not readily connect to each other or there is a need for business or regulatory reasons to have true data provenance,” Glover says. “The only investments that need to be made are in connecting the systems to the blockchain and creating a user interface. Blockchain technology itself is free to use and some time would need to be invested to create a private blockchain, or it could be outsourced.”

Up Next: Where to start with Blockchain..

Carly Guenther, managing director of life sciences supply chain for Accenture, says pharmacies should consider three things before planning to invest in blockchain technology:

Start with the business challenges that need to be addressed. There are plenty of use cases that do not make sense for blockchain, so nailing down the priority use cases that are relevant for blockchain is a critical first step.

Plan and Design for Proof of Concept					

This allows for experience to be gained on the power of the technology, appreciation of what is required for broader scale success, and the ecosystem/partners that need to participate.

Investments in proof of concepts are generally fairly light, but they provide significant value in learning how to take an organization’s utilization of blockchain to the next level.

Donna Marbury is a healthcare, technology, and business journalist based in Columbus, OH.

The emergent technology is adding security and accountability to distributions, and will likely connect manufacturers and distributers in the near future.