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Disruptive healthcare technologies

An interview with Dave Fletcher, MD of the Oxford digital agency White October, and long-time supporter of Digital Health Oxford. Reposted from article on the Horizon2020 website

Ahead of the Disruptive Technologies 2016 conference, Portal spoke to White October’s Dave Fletcher about digital technologies in the healthcare space

A highly motivated thought leader, challenging and addressing the built environment industries to embrace technology and better provide solutions fit to serve the needs of 21st Century society, Dave Fletcher heads White October, a web design and development company which ‘creates digital products by putting people first’.

Portal spoke to Fletcher ahead of the Disruptive Technologies 2016 conference in London, UK, on 29 September (where his presentation focused on ‘advancing the relevance of the built environment to the needs of 21st Century society through ideation’) to discuss digital innovations in the healthcare space and how disruptive technologies stand to progress in this arena.

Which areas would you say stand to benefit the most from the potential of disruptive technologies, and how?

Within the field of digital health, the greatest potential is perhaps to be found in diagnostics monitoring and predictive analytics. However, these areas may also be the hardest areas to work in. Much of the successful innovation that has been seen so far in digital health technology has been technology that is relatively easy to implement and which isn’t hampered by many of the obstacles normally found when innovating in the healthcare arena, such as regulations. As such, there is a sense that a lot of the greatest disruption is yet to come and, moreover, is going to be achieved by those who have the tenacity and budgets to invest in achieving their goals.

For physical diagnostics equipment manufacturers, it takes a significant amount of time to develop a product, to get it validated and receive regulatory approval, and then get it to market. This process is much longer than that experienced in other markets, and the same applies to any digital disruption in health. It will therefore be those who are willing to do the hard work who will reap the benefits.

The disruptive potential of technology in healthcare is already evident, as demonstrated by your MyPace app. How can traditional healthcare structures be adapted to keep pace with revolutionary diagnostics and clinical advances?

For me, this centres on the development of new accepted methods of validating digital solutions. The great power of digital innovation, which is typically achieved using data to intuitively enhance a system in such a way that it is constantly refined and improved, is in its iterations. However, that simply doesn’t fit with traditional methods of validation in healthcare. For instance, if you are going to do a randomised control trial (RCT) for a drug, that drug is never going to change, and so that RCT remains valid for its lifetime. When it comes to digital technologies, on the other hand, as soon as you make a single code change to your algorithm, then any evidence you have alongside becomes invalid. As such, there is a real need for a much more sophisticated approach to the validation of healthcare technology, and while there are people investigating this, and who are working to find a solution, we are not there yet.

How far would you say businesses and consumers are equipped with the kind of technical proficiency necessary to best take advantage of disruptive technology? How can businesses make sure they are not left behind?

This is a big problem, but is nevertheless rapidly improving. We now live in a world of connected services; three years ago, if you wanted to develop your own AI solutions then you had to start from first principles, and you needed some really smart people in your organisation to achieve that. Now, there are multiple AI services available which massively reduce the barrier to using a lot of emerging technologies which wouldn’t have been accessible just a few years ago. This, from a business perspective, is becoming increasingly easier to make things happen.

When it comes to consumers, I don’t think that we need to worry. Many people are at home with technology in their everyday lives – smartphones being just one example – and many technology innovations which impact on consumers occur outside of the healthcare sector – in that sense, healthcare needs to catch up.

Of course, there are issues with regard to consumer technologies, particularly in areas such as data privacy and accessibility. For instance, there are clinical questions about what information a patient should see about themselves and when they should see it; should they have access to the results of a diagnostic test before they have had a chance to speak to their clinician, for example? Healthcare professionals have a duty of care to their patients, and there is a sense that this could be undermined if a patient has access to results before they can be properly explained and, moreover, before adequate support can be offered should those results be particularly serious.

These are areas that need to be thought about, and this is further complicated by the fact that some of those innovating in the digital health space are doing it without the direct involvement of clinicians. This can mean that they are failing to make themselves aware of the concerns that clinicians will raise. Any work that is happening in this sector needs to involve a clinician in the team, and, moreover, a relationship with a healthcare provider needs to be established.

How difficult is it for small businesses and SMEs to achieve that?

It is very difficult, but it is getting easier. Those companies who go to the effort of understanding the structure and dynamics of the healthcare providers and of building relationships are the ones who succeed.

There are efforts being made by hospitals and universities to make those connections easier for organisations, and they are creating spaces or schemes that allow entrepreneurs to get direct access to a healthcare provider, and this is certainly going some way to making this happen.

Increasing use of technology in areas such as health and payments/banking have inspired new concerns about data privacy and security – how can these fears be effectively managed while at the same time allowing space for technology and innovation to grow?

It is right to highlight the potential vulnerability of data being held by a lot of these systems, though to an extent these are solved problems – our financial institutions have been solving these problems for decades and, it can be argued, their data represent a far more tantalising target for an attacker than the information contained within the healthcare sector.

However, not all new entrants into the digital health space are taking it as seriously as they ought to, and it is up to the healthcare providers and commissioners to demand high standards of security from those involved. And, perhaps more so than any other institutions, they are very well set up to do this.

Yet, if you look at the security breaches and data leaks that have happened in recent years, it is clear that they don’t come from the healthcare sector – it is organisations like LinkedIn and Dropbox, etc. who become the victims of hackers and the like. Most healthcare providers have information governance personnel and teams, as well as very strict security policies in place to ensure that the same doesn’t happen to them.

What are your thoughts on national and European-level initiatives, e.g. Horizon 2020 and similar funding instruments, to support disruptive innovation?

The European framework programmes are really excellent opportunities and more organisations should consider looking to them for funding. The structure of the various instruments within Horizon 2020 are also very good; they encourage risk taking and sometimes even demand it, while at the same time providing significant financial support for that risk. H2020’s SME Instrument looks particularly excellent, especially when compared to the Seventh Framework Programme, in that much of the bureaucracy we experienced there seems to have been pared away.

There is a lot of work involved in applying for these funds, and so anyone considering making an application needs to ensure they are ready to invest the necessary time and effort. They also need to not only do it once; there are so many of these funding instruments out there, and once you’ve gone for one you have to go for others – there should be no half measures.

Posted in Guest blog, General on Mar 10, 2017