Three reasons why digital health is different to digital publishing, music or telecoms
US company Proteus Digital Health announced on Monday that they will build their first international factory for ingestible sensors in the UK, with NHS and UK Government partners. Today, Silicon Valley Comes to the UK and Nesta publish a snapshot of the new generation of medical technologies that Proteus is part of.
One of the longest interviews I did for the paper was with Proteus’s CEO Andrew Thompson, a Brit who has lived in Silicon Valley for decades.
What struck me about his vision for digital healthcare was that it is shaped by the particular challenges and opportunities of the health sector, rather than general features of digital technologies.
For sure, digital health has features in common with digital transformations we’ve seen in other sectors. Portable devices are decentralising healthcare in the same way that the printing press moved from central warehouses into the office and the home. With each stage or wave of decentralisation, technologies become more affordable and convenient. Stanley Yang has a background in consumer electronics. He brought this knowledge of consumer-facing sectors to medical technology. His Neurosky EEG devices headset measures beta waves associated with human emotional response and concentration. Historically medical professionals, including neurologists, behaviour therapists and psychiatrists used EEGs as a diagnostic tool. Yang saw something in this new portable version that could make it successful in the consumer technology market.
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But successful digital health technologies must also be sensitive to the unique features of the healthcare sector.
I have picked out three of these features - three reasons why digital health is different to digital publishing, music or telecoms – giving examples of how companies respond to each:
Globally, the death rate from chronic disease is double the death rate from the combination of all infectious diseases (including HIV, tuberculosis, and malaria), maternal and perinatal conditions and nutritional deficiencies. In 2009, UN Secretary Ban Ki-Moon called the burden of chronic disease “a public health emergency in slow motion”.
50% of patients with a chronic disease fail to take their medicine correctly. Proteus Digital Health aims to improve this by monitoring adherence for those on long-term medication. They put a tiny ingestible sensor inside a tablet. It is powered by contact with stomach fluid and sends a unique signal to a patch worn on the torso. The patch transmits the ingestion data, along with other information about the patient's physiology to a secure smart phone or tablet app. The patient elects whether they want to share the data with doctors, family or friends via the app.
Cambridge Cognition’s software is used in several hundred clinical research sites testing patients’ cognitive function. This can help with diagnosis of disorders that impair cognitive function like dementia. Cambridge Cognition's built a product for biomedical research before they reached the mass market. Without that test bed, they would not have produced the software platform, nor had the validation required for selling back into the healthcare system. Digital health technologies have to generate clinical validation data to show that they works - in particular doctors will not start adopting new technology until it is safe and is clinically proven. Many digital health technologies today are still unproven promises of great things to come.
Cambridge Cognition use real time data streaming and visualisation across research sites in fifty countries to can check patient responses against expectations, and to recommend modifications as clinical trials progress. Their research team use patient information to continuously test the underlying software, providing phased update of reference standards for assessing patients. Their Chief Scientific Officer, Andy Blackwell, characterised Cambridge Cognition as a central part of a burgeoning applied neuroscience and technology community in the UK.
DNA Guide's Alice Rathjen wants the web to evolve into an Internet of Human Beings, as a way to help us share genetic data and biometrics more responsibly. Her vision is a future where individuals hold their own portable personal health records, including traditional health records. These would also include three other types of information: genetic, physiological and lifestyle. Everyone could choose where they register this information: “human beings would become top level domains on the web, with the ability to take themselves offline.” These .bio domains would send out information to individuals in an RSS feed, regularly updating them on how their data is used.
DNA Guide is developing technical systems to enable people to give highly specific consent - deciding which part of a genome is shared. It also lets researchers annotate a genome, giving detail on the quality of sequencing and analysis. The DNA Guide system could produce better quality control and more dynamic updates and consent.
Behind Alice's vision of a .bio domain owned by each individual - with a variety of domain registrars for genetic data - is a desire to avoid creating a Facebook for health data. The technologies for managing large populations of genetic data are so powerful that human autonomy must be built into these systems by design.
Our paper goes on to imagine a near future where portable personal healthcare is the norm, building on technologies already under development. This is intended as a provocation for investors, policy makers and entrepreneurs thinking about catching this new medtech wave.
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