GAFAMS, STARTUPS & INNOVATION IN HEALTHCARE by PHARMAGEEK

Two-thirds of the attendees polled at a recent innovation summit by The Economist agreed on one thing: health care is the sector that will benefit most from artificial intelligence (AI) technologies.

 

In health care, which is in the midst of an industry transformation and a digitalization of key aspects of patient engagement and care management, the role of data, analytics and AI are central to the organizational mission. However, it is easy to get caught up in one aspect or another when extolling (or decrying) the role of AI, while ignoring the near-term potential as well as the limitations of the technology.

 

How can AI play a role in health care today? In the words of S. Somasegar, a venture capitalist, there are three ways in which AI can impact a business today. Upwards, meaning that AI can take on intelligent capabilities that enable a higher level of interaction with humans; downwards, implying an ability to reduce costs; and outwards, which is to take AI to the edges of our computing infrastructure.

 

Voice recognition and natural language processing (NLP) technologies help us move up in health care by enabling remote-monitoring and home health care through a “natural” interface with humans. In the health care enterprise, NLP technologies can “read” complex medical literature and provide doctors and clinicians with intelligent choices for diagnosis and treatment options.

 

With the emergence of cheap computing and storage infrastructure, AI technologies help manage vast arrays of servers and networking equipment, detecting and remediating the most common problems without human intervention. “Purpose-built” hardware with inbuilt AI capabilities are becoming the norm in high-volume and time-sensitive operations that require running machine-learning algorithms on large data sets and doing it at low costs.

 

The notion of edge computing, a paradigm that takes analytics and AI to the edges of a computing infrastructure, has lately become important in the context of the Internet of Things (IoT) and smart devices. In health care, the proliferation of intelligent devices, in and out of hospital settings, has created many new opportunities. Tom Bianculli, Chief Technology Officer of Zebra Technologies, a firm that provides mobile devices, scanners and RFID-enabled tags used in hospital environments, talks about “digital diaries” that can log every minute and every second of a device’s operation in the context of patient care. Using a network of tags and near-field communication equipment, Bianculli is now able to track a mobile device in a caregiver’s hands as she makes her way through a hospital floor, recording and analyzing everything from her precise location to her pace of walking to the direction in which she is headed with the device. Extending it to outpatient or even home health care, the deployment of intelligent devices that can analyze data at the “end point” and sending it back to a back-end system can save lives by reducing the time involved in alerting caregivers to medical emergencies.

 

To some, all of this may sound futuristic. However, it doesn’t have to be complex use cases and high risk situations involving patient lives that determine whether AI is suitable for a health care institution. The vast majority of AI use cases involve “low-hanging fruit” that automates aspects of operations that are routine and repetitive in nature. AI can release humans from mundane tasks and enable them to work on more exciting and value-added tasks. In some industries with an acute shortage of skilled human resources such as health care, this may even be a necessity for long-term sustainability. 

 

The use of AI technologies comes with responsibilities as well. In the wake of recent disturbing news about a driverless car causing a fatal accident and the alleged misuse of Facebook profile data to influence the last presidential elections, there was a somber tone to the discussion at The Economist event. The gathering of AI technologists and industry leaders using AI to advance their business goals paused to reflect on how AI can be force for good and bad. Among the concerns: AI technologies by themselves may not reveal any inherent biases, but may unleash all manner of biases that reflect the biases of the humans who design the systems. There is a growing sense that AI should be used not just for the right predictions, but also to make predictions for the right reasons. While AI is coming on par with humans in aspects such as reading radiology images, the same neural network algorithms have potential for discriminatory profiling based on facial recognition and other decisions that have implications for society. The usefulness of AI models also depends on the data sets: as an example, selective representation of demographic profiles in a data set can give rise to biased conclusions on populations represented by that dataset.

 

The underpinning of success with AI lies in the underlying data. Fortune 500 companies are spending up to 50 percent or more of their IT budgets on information integration today, and no sector is more acutely aware of this than health care, with its complex environment of proprietary electronic health record (EHR) systems and emerging data sources. Unlike in other sectors such as consumer finance and retailing which are long used to multi-channel engagement with customers based on an omni-data capability that can aggregate and integrate data from a wide variety of sources, health care remains more siloed today than any other sector. The implications for AI adoption are clear: it will be slower than in other sectors.

 

Finally, having the data and the AI capability doesn’t ensure improved quality or reduced costs in health care. You need intervention models in place to do something with the data and have care plans for doing the preventive intervention, which can be challenging if the data is incomplete (as often the case with EHR data) or outdated (as with health insurance claims data). In an era of high-volume and high-velocity real-time data, these limitations will restrain the adoption of AI technologies.

 

As computing costs drop and AI technologies mature, health care and other industries will have to invest and catch up or get left behind in the great digital transformation under way. As someone said to me, there is a penalty for inaction. That penalty may be too big a cost to pay for most enterprises today. 

In my book, The Big Unlock, I describe the four major categories of technology providers as Custodians, Enablers, Arbitrageurs, and Innovators. Each of these categories of providers has staked a claim to reimagining the digital future of healthcare.

 

First, the Custodians: These are the big electronic health record (EHR) vendors like Epic and Cerner who have the data and the workflow. As systems of record, they enjoy the long-term strategic commitment of the health systems they serve and are the first port-of-call whenever a health system decides to enable new functionality for enhancing the patient and caregiver experience. 

Systems of record have certain limitations and are arguably weak in several areas, such as advanced analytics, which is critical for a digitally reimagined healthcare experience. Along came the Enablers to address this problem. Big technology firms such as Google, GE Healthcare, Microsoft, Salesforce and IBM’s Watson Health business have built technology stacks that integrate multiple emerging and traditional data sources, including EHR systems, and have incorporated some proprietary data sources as well, such as images in the case of GE Healthcare.

 

These big technology stacks include inbuilt advanced analytics capabilities that can deliver insights to power digital health experiences. Google’s Deep Mind, for instance, recently analyzed eye scans from over 125,000 patients to build an algorithm that could detect diabetic retinopathy, the number one cause of blindness in some parts of the world, with over 90 percent accuracy. The company claimed the accuracy of the analysis was on par with board-certified ophthalmologists.

 

The Arbitrageurs are mostly technology agnostic consulting firms such as Accenture and Deloitte, as well as India-heritage firms such as Wipro and Infosys, that rely on information and labor-arbitrage models to build digital experiences from scratch using the preferred technology tools that exist in health systems.

The Last Mile problem

All three categories of technology providers described above have stopped short of building ready-to-deploy digital health experiences, which leads us to the Last Mile problem in healthcare. Despite the powerful computing and data analytics infrastructure that big technology firms have invested in, there is a shortage of viable, proven digital health experiences for health systems and their key stakeholders in healthcare delivery i.e. patients and caregivers. The challenge – and the opportunity – has fallen to the fourth category of technology providers, namely the Innovators.

By definition, the Innovators are typically startups that have come up with a whole new way of addressing an existing problem with technology-enabled healthcare experiences, or for filling a gap in the current healthcare experience with technology. Digital health startups raised an estimated 11.5 billion in 2017, and money continues to pour into the sector, despite the slow pace of exits. Despite the promise, a report by IQVIA indicates that while over 318,000 health apps and 340 consumer wearable devices are now available worldwide, 85 percent of the apps had fewer than 5000 installs. The few apps that did reach critical mass demonstrated strong clinical evidence, robust integration with the established workflow integration, and high user ratings – prerequisites for any digital health solution looking to break into the health systems marketplace.

Addressing the bottleneck

The need for last mile applications is enormous, and yet the innovation ecosystem has not built and implemented viable applications fast enough and at scale to meet the demand. Common challenges include:

• Extended cycles to hit prime time usage: most health systems follow a traditional approach that takes promising new solutions through the phases of a free pilot, paid pilot, and enterprise adoption. The process could take years, and many solutions remain in "pilot purgatory" for an extended period, often failing to break through to enterprise adoption. Health systems need a newer, more agile model, to assess and deploy promising solutions more quickly and efficiently
• Too many standalone solutions: the digital health landscape is littered with thousands of point solutions that stand in isolation, with no established connectivity to systems of record which is the price of entry for any new solution. Health systems are loath to sign up dozens of point solutions and take on the burden of integrating and managing these solutions. They prefer to default to the many solutions that EHR vendors have built or are actively building (or claim to be building) that effectively make stand-alone solutions redundant, despite the superior experience architectures that startups are known for. A potential approach for startups is to align with one of the big Enabler companies who, through established relationships with health systems, can create a pathway to adoption and growth.
• An absence of scale: No single platform addresses all the needs of a digital health enterprise today, unlike the mature enterprise resource planning (ERP) systems of the manufacturing and financial sectors. There is a significant opportunity for Enables companies to build ready-to-deploy innovation ecosystems through partnerships with digital health startups. However, Enabler platforms too have increased and are at risk of becoming too fragmented to present a real alternative to health systems looking for scale and velocity in the digital transformation journeys.

The digital transformation of healthcare is in its early stages, and the gold rush is underway. Wanted: creative approaches to solving the Last Mile problem and unifying the fragmented ecosystem of point solutions and stand-alone technology enablement platforms.

A recent study on blockchain adoption in health care by Blackbook Market Research indicated that a large percentage of payers surveyed, and a small but growing percentage of providers, were either considering deploying or were in the process of implementing, some blockchain solution sets. Blockchain appears to have moved from the awareness and education phase to actual deployment of solutions.

 

“Blockchain can solve two of the biggest problems in health care today," says Lidia Fonseca, CIO of Quest Diagnostics, a leader in lab testing services. She is referring to the gnarly issues of interoperability and data quality. While data quality has long been an issue in health care, the interoperability challenge is a legacy of the massive digitization of patient medical records over the past eight years which have left us with proprietary electronic health record (EHR) systems that don't "talk" to one another. The result is inefficiency and waste, as stand-alone information systems slow down processes and create redundant work. 

Taking a look at the healthcare blockchain pioneers

Some technology solution providers, including IBM and Change health care, along with a number of other companies listed in the Blackbook Research study, have made initial moves in establishing blockchain capabilities and launching solutions. Federal agencies such as FDA and CDC have expressed interest in applying blockchain to find solutions for public health issues.

 

Amazon, with its long-awaited entry into health care, recently announced the launch of blockchain templates for health care, aimed at making it easier for developers to create blockchain-based projects and deploy blockchain networks via open source frameworks. In a sense, Amazon has started the democratization of the blockchain-enabled application development, something we saw before with machine learning algorithms in the wake of the big data and analytics hype a few years ago.

 

A group of large healthcare enterprises, including large payers such as Humana and United Health Group (UHG), along with Quest Diagnostics, UHG subsidiary Optum, and Multiplan Health recently came together to launch a blockchain pilot program to solve for one of the most significant data challenges in health care today – provider data management. Provider data, a fundamental enabler for all manner of healthcare transactions, is a key building block for processing claims and maintaining up-to-date provider directories. Today, most provider data is stored in siloed and independent databases. Provider data quality is estimated to be a $2.1 billion problem today, according to a report by CAHQ, a non-profit alliance focused on creating shared initiatives to streamline the business of health care. By streamlining the inefficiencies in provider data maintenance, participants can have a "single source of truth." It is estimated that up to 75 percent of provider data management costs can be eliminated using blockchain solutions.

What it will take for blockchain initiatives to succeed

While blockchain is coming of age in health care, we’re still in the early stages of the hype cycle for blockchain. The initial mania around bitcoin, the very first use case for blockchain, is now giving way to more carefully considered use cases for business with tangible benefits. Healthcare, a sector that generally lags in the adoption of technologies, is currently in a wait-and-watch mode; notwithstanding the high levels of interest among payer organizations, the Blackbook survey also points to low levels of interest among health systems, citing the undetermined cost of blockchain solutions as the major issue that stops health system executives from committing to a timeframe for deploying the technology. Our best hope is that the early pilots will bring tangible proof points and provide more confidence to the industry in the technology.

 

Health care is a team sport and so is blockchain. The more participants there are in a blockchain network, the better it is for the network and the industry. Pilot programs such as the provider data management initiative by Quest Diagnostics and others will need a much higher level of participation across the industry to reap the benefits of the network effects.

 

As with most transformative technologies, the big challenge is usually not the technology; it’s managing culture and workflow changes, driving collaboration, and an execution focus. In blockchain, there is an added dimension of a commitment and willingness to work across company boundaries, which is an entirely new paradigm for most health care enterprises.

In a unique development, a group of health care industry executives has come together to launch a peer-reviewed blockchain journal to share both the positive and the negative experiences with blockchain in health care.

 

The potential for blockchain to improve health care operating efficiencies is significant. High-value use cases include revenue cycle management, supply chain, clinical trials, and provider data management. The initial pilots will need to demonstrate the real benefits of the technology and lead to higher adoption of blockchain in the coming year.