A New Year, A New Decade: What’s the next big thing?

Optimum’s recent conference brought together various industry leaders discussing the strides in healthcare and discussions on looking ahead and what is ‘the next big thing that may transform patient care’.

Alongside agreement that science is moving at a breakneck speed, there was a note of caution around over-treatment and the dangers of offering patients too much of what they don’t need.  While the next decade is set to be the most exciting yet in terms of a confluence of all aspects of healthcare – science, clinical medicine and business – the challenge is going to be harnessing the surge in technological expertise to benefit the healthcare system, and there is a sense that we are still a long way off.

Revolution in Data

Speakers compared the revolutionary developments that are coming to the sequencing of the genome 20 years ago.  They talked about a democratisation within the healthcare industry where companies, particularly in the US, are increasingly going straight to patients.  The FDA’s approval of the Apple Watch ECG function, which detects arrhythmias and atrial fibrillations, is an example of how technology is bypassing the conventional route.  Individuals can already map their genome on-line, something that is becoming more sophisticated, affordable and, in terms of speed, is rivalling DNA sequencing available in the clinic.  The panel felt strongly that these developments must not be dismissed as mere gimmicks.  They have serious medical applications for a society with an ageing population.

In the next year alone, more data will be created than has ever been in history.  With this exponential increase comes the challenge of how to hold, process and handle this data.  Organisations seeking to take advantage of this space are mushrooming with a landscape of start-ups and company spin-offs such as Teladoc, Amwell and Good Doctor set to coexist in the electronic triage market.  The goal is a ‘cloud’ system where patients will be able to access their health data from anywhere.  The NHS has established an accelerated access collaborative chaired by Professor Lord Darzi, and is developing software initiatives emulating ‘best in class’ examples from around the world.  In terms of an algorithm or machine-based formula, the NHS’ 111 service is still considered as good as it gets for electronic triage, although there is evidence that certain smaller organisations have been able to reduce the need for GP visits by up to 70% through their triage platforms. Rolling such programmes out across the NHS will involve considerable workforce training and cultural change, something the NHS has begun working on via its Clinical Entrepreneur Programme.

The area of Artificial Intelligence (AI) and its application across medicine remains a subject that raises many questions.  Of the 24,000 articles mentioning AI submitted to The Lancet, only 14 met the scientific standards for inclusion in a recent meta-analysis study of AI.  The potential AI offers for data interpretation is huge; however, one thing remains clear, at present a person and AI is much more effective than a person or AI.

AI & Imaging: The Next Big Thing?

The potential for combining AI with imaging was discussed at length.  Described as a ‘Pandora’s box’, the immense detail provided by state-of-the art scan technologies is both a help and a hindrance in terms of patient outcomes.  AI software that analyses heart pressure data from coronary angiograms is currently being rolled out across 30% of NHS heart units due to its success in significantly reducing the need for precautionary stents.  In oncology, sophisticated imaging can detect disease early, help inform doctors and avoid unnecessary biopsies, however intense screening has harmful side effects and often results in invasive treatments for patients whose cancer could simply have been monitored.  While most cancers are now curable if detected early, this must be associated with effective treatment of the early disease before these technologies can be monetised and rolled out more widely.  Diagnostics remains an area that it is very difficult to make money in.

The future of neuroscience is an even more tenuous topic.  The brain was described as a ‘black box’ and functional brain-computer interfaces are considered by the panel to remain decades away.  While neurostimulation has a role to play, the more progressive areas of neuropharmacology are overhyped. There is undeniable scope for robotics to improve the quality of key-hole surgery for example, however individuals must still be highly trained to work the technology.

The panel rounded off the session by discussing the economics surrounding technologies.  The future lies not in rolling out large quantities of treatments to large populations, but in treating small populations with more effective medicines.  US populations have proved that they won’t pay for broad brush disease prevention schemes, and there remains a real need to address the treatment of chronic disease as well as acute cases – 70% of the NHS budget goes into acute hospitals and yet over 99% of cases in the community are connected with chronic illnesses. Whether it is private insurance or governments who pay, the healthcare industry needs to work out a way of treating people effectively, at scale, in a way that will make a clinical difference.

Clive Cookson, Science Editor, Financial Times chaired the discussion at Optimum’s 11th Annual Healthcare Conferene  on ‘What is the Next Big Thing that may transform patient care?’  Panellists included Tony Young, National Clinical Lead for Innovation, NHS England, Paul Major, Portfolio Manager at Bellevue Asset Management, and Justin Stebbing, Professor of Oncology, Imperial College London.

Article written by Charlotte Hepburne-Scott of Optimum Strategic Communications