In this year-end edition of the MM+M Podcast, a panel representing four of this industry’s sharpest minds opines on which transformative trends of 2020 will have the greatest impact going forward, from the body’s adaptation to extraterrestrial life and mental health’s move to the center of our well being, to the rise and fall of telehealth, digital therapeutics and the ongoing disruption by Google, Amazon and Apple.
Professor, Dept. of Management, Seton Hall Univ.
AD, The Gerald P. Buccino ‘63 Center for Leadership Development
Founder & managing director, Kansal & Co.
Chief commercial and strategy officer, Woebot Health
Dr. Francoise Simon
Senior faculty, Dept. of Population Health Science and Policy, Mount Sinai School of Medicine; professor emerita, Columbia Univ.
CEO, Advanced Informatics; COO, DocPanel
Iskowitz: Before we begin, I should mention that this is the same panel that MM+M gathered for a roundtable discussion, circa late February 2020, to discuss pharma’s use of digital to disrupt the life cycle. The world had started to turn its attention to fighting a deadly pandemic and the discussion – despite likely being one of the last in-person, healthcare industry roundtables to take place anywhere in the U.S. – quickly became, shall we say, obsolete. So it’s a pleasure to welcome them all here again to close the loop. Dr. Simon, let’s start with you. What do you think was the most stand-out healthcare innovation trend of this extraordinary year?
Dr. Simon: Sure, it’s no big surprise. The transforming trend was telehealth. Telehealth has grown exponentially in 2020, but it’s now plateauing, or in some cases showing a slight decline. Forrester predicts that e-consults will exceed 1 billion this year, due primarily to COVID-19 but also to ongoing care (especially mental health needs, which is really skyrocketing) and, possibly, the flu season.1 The Epic Health Research Network, which tracks EHR data, showed that volume spiked in mid April for telehealth, with 69% of total visits.2 That was huge, because at that point, there was not that much access to in-person medical facilities. But telehealth dropped by August to only 21% of total – higher than 2019 but a considerable drop.
Another factor – and I’m going to be a little bit counterintuitive here – is that increased use of telehealth doesn’t necessarily translate into a clear preference. Some people use it because they like it, other people because they have to. A Health Union survey of over 2,000 patients with chronic conditions found that nearly 50% have returned this fall to in-person visits, and anybody who uses telehealth still faces significant barriers.3 The JD Power Telehealth Satisfaction Survey found an overall good customer satisfaction, but 52% of the over 4,000 respondents faced at least one barrier.4 Hurdles include limited services – there’s only so much you can do on Zoom or Doximity; confusing technology – audio or video breaking down mid-visit; and lack of awareness of costs – the relaxation of CMS reimbursement, etc., has not really been publicized all that well.
Increased use of telehealth doesn’t necessarily translate into a clear preference…The vendor model has been compared to randomized triaged care, which is not a compliment.
JD Power found that the key driver for telehealth was safety, and that came ahead of convenience. People were afraid to go into medical facilities, and that’s the key reason why, if they had the choice, they chose telehealth. JD Power also noted different satisfaction levels depending on the telehealth source, whether it’s from a major vendor like AmWell, Teladoc, MDLife, or from providers and health systems. The vendor model has been compared to randomized triaged care, which is not a compliment. Patients go online, they wait in a queue and they get connected to the first available doctor, who doesn’t know anything about them, and with whom they don’t have a relationship. So it’s a transitional model, it’s ephemeral.
In a Harvard Business Review article, David Blumenthal, president of the Commonwealth Fund, was fairly negative, writing that a trusting, long-term, patient-physician relationship is the key to good outcomes.5 He also pointed out that telehealth results vary across specialty. Mental health is clearly the no. 1 candidate for telehealth, as it’s been for quite some time. Orthopedics would not be a good candidate, except for maybe exercise training. As a result, most health systems are partnering with vendors – Mount Sinai partners with Teladoc, for instance – to ensure continuity of care and that patients see the doctors they know and trust. Looking forward, my impression is that telehealth will continue to grow, but only as part of a hybrid system that includes multiple care channels, not as an end in itself.
Iskowitz: So telehealth leaves a lot to be desired. That’s important to keep in mind, given that firms like Teladoc aspire to make telemedicine more multidisciplinary. Mony, as COO of a company in that space, would you like to build on that for your point on what you feel was the biggest driver for 2020?
Weschler: My pleasure. What 2020 did is – and I have to look for the silver lining in a pandemic – it opened the door for telemedicine, really opened the door. And what we found confirmed what we knew. Patients kind of like it. And physicians don’t hate it; they kind of like it, as well, if it’s presented to them in a certain manner. The issue with telemedicine and why we’re seeing the return to in-person visits – beyond the fact that healthcare systems have reopened – is because reimbursement is not completely aligned. If you’re going to get reimbursed more for an in-person visit, it’s going to drive everyone toward that, especially from the clinical side.
So there needs to be an alignment with the reimbursement, so it’s at least equal. Maybe, at least initially, we need to incentivize the telemedicine visit and the experience so people can understand it. And it’s not an all-or-nothing proposition, either. It’s just another tool and another way that patients can gain access to their clinicians when it makes sense. Sometimes an in-person visit makes sense, and sometimes it doesn’t. You have this other tool that’s now available that can be used, and it’s just going to get better.
Now, where we have seen tremendous interest and expansion is in some of the other ways to leverage that platform. For example, DocPanel, a company for which I’m the chief operating officer, provides a teleradiology/telecardiology service to imaging centers and hospitals across the country and second opinions across the world. What we saw with the pandemic is elective surgery stopped, and then as things opened up, everyone came back and pretty much overwhelmed the capacities of the health systems, overwhelmed the capacities of imaging centers. We saw mammographies that usually have to be reported within 30 days slipping to 60 days. This is very different than basic coverage. This is bringing specialists to institutions that need that help, that don’t have that talent on staff, that can’t recruit or are simply overwhelmed by the volume. We make it very simple to bring the top-of-the-line clinicians to read those studies for them on an as-needed basis.
We’re the technology platform, and the physicians are independent (they sign on). We make it easy to move the clinical data, from its acquisition from the modalities, to making it available to the specialist and providing them with all the tools they need to properly read those studies (including post-processing and AI) in a very quick timeframe, both for a second opinions or for primary reads back to institutions. This has become very interesting, especially where clinicians were furloughed because elective surgeries stopped. This is the first time in my 30-year career that I’ve ever heard of a physician, like a radiologist or cardiologist, being furloughed because there’s no volume for them. As well, a lot of these clinicians that are in a certain population and of a certain age were asked to do frontline treatment that they haven’t done since medical school. That’s not a very comfortable scenario for a certain type of clinician that’s been doing a very different type of healthcare. So there’s been a lot of interest from the clinical, patient and imaging center sides for that type of telemedicine.
This is the first time in my 30-year career that I’ve ever heard of a physician, like a radiologist or cardiologist, being furloughed because there’s no volume for them.
Because we’re not through with the pandemic, it’s going to continue – both those telemedicine services that bring global access to high-quality clinicians to populations that just don’t have it, as well as the generic telemedicine that has been described by Dr. Simon. The latter type is also going to continue because the clinical encounter is going to take a little bit longer to get back to where things were prior to the shutdown. Telemedicine visits were really high at one point because there was nothing else, and now it’s leveling off. And as soon as reimbursements align, I think we’re going to see telemedicine come up and kind of be in parallel with on-site visits.
Iskowitz: Indeed, when testing and elective surgeries slipped, it was like a grand experiment in reduced utilization of healthcare services. The jury’s still out on the impact on outcomes, but to the extent physicians were furloughed because of lack of volume, which then may have hamstrung hospitals when patients began returning, telemedicine stepped into the breach. Those were very interesting comments about other ways the telemedicine platform is being leveraged. Speaking of healthcare workers, Ruchin, you have some points to make about that, right?
Kansal: Thank you, Marc. I would fully agree with Dr. Simon and Mony that telemedicine has been a bit severe in the pandemic for all of us. What I would say is looking at healthcare very closely – and my wife is a physician who had to quarantine herself at our house for the last six months – one thing we all have to do is really celebrate our healthcare system and our healthcare workers. We really saw the whole industry converge to solve for this pandemic globally. We came together to develop the vaccine at warp speed, and we really demolished a lot of barriers – the status quo that we have maintained so far – which was really refreshing. We’ve embraced new technologies, whether it was mRNA or AI in finding new cures, and we collaborated across institutions and across geographies.
We revisited our regulatory frameworks, did a lot of emergency use approvals. When the need arose, we literally shattered the barriers we had shackled ourselves in and did the right thing. So that’s a reason to celebrate. On the front lines, our healthcare workers really did great. They put their lives at risk to save ours. Unfortunately, a lot of them lost lives, too, and we have to be grateful to them. What’s really paradoxical in all of this is, as Mony talked about, is that a lot of physicians were furloughed. Not only that, a lot of physicians lost their jobs, and a lot of nurses lost their jobs.
You have to scratch your head as to why, in this pandemic, they’re losing their jobs. What that really exposes is how dependent we still are on a fee-for-service system. Despite all the talk about value-based healthcare over the last 10 years, when we literally got into an emergency situation, our economic model for healthcare just did not sustain us, because it’s fee-for-service.
Despite all the talk about value-based healthcare over the last 10 years, when we literally got into an emergency situation, our economic model for healthcare just did not sustain us, because it’s fee-for-service.
On top of that, the last thing that this pandemic exposed for all of us this year is the capacity constraint. When the financial crisis happened, there was a stress test done on all our banks and financial institutions. This pandemic did a stress test on our healthcare system. We kind of almost burst at the seams but have survived so far. It gives us a moment to pause and ask, Are we really over-optimized, or have we really taken all of the safeguards and redundancies away? Is telemedicine the long-term solution to build that redundancy and that safeguard in the system, or do we have to plan for something else?
Even today in a country like the U.S., it can take three days for a COVID test to come back. Can you imagine that? My parents, who are sitting in India, get the test back in six hours. Someone comes to their home, takes a sample, and they get the test back on the phone in six hours. Here, my wife, who by the way is a frontline physician and director for molecular testing at one of the largest hospital systems, got really sick last week. She thought that she had COVID and had to go to a CVS three days later, which is when she could get an appointment to get the test. And it took three days for results to come back. Thank God it was negative. That’s the system that we have right now.
I’m not saying that it’s bad. There’s a lot of reasons to celebrate. But it is also a time to really grapple with things that don’t work and see that as an opportunity to keep moving forward. Overall, I’m really happy that we are in a country where [laughs], with all the crisis and all the politics that we have faced, we still have faith in the system that, if we fall sick, I think most of us will survive. So that’s a good thing and good thing to celebrate.
Iskowitz: Absolutely, and my wife is also a healthcare worker. As a local pediatrician, there have been times when she thought she was sick and needed to get tested. Thank goodness, the system she works for provides access to quick, reliable testing. But what these experiences show is that the country’s overall testing system could stand to improve. Although the FDA just approved a flurry of OTC COVID tests (some of them completely at-home and some requiring a lab to process), we’re still grappling with the lack of a definitive, at-home COVID test. On the flip side, another one of the things from 2020 that we’re celebrating is the greater emphasis on mental health. Monique, you have something to say about that. Would you like to go next?
Levy: I’d love to. I really appreciate all of these comments. Ironically, we were talking about the speed of innovation when we tried to do the roundtable [in February]. And I agree with you, Ruchin, the pandemic really showed us, once and for all, that when incentives are aligned and there’s the right kind of motivation, we can push through and do great things. It feels good that we can put to bed the question of, Is healthcare just not able to move fast? When we want to, we can. We have to just think deeper about why we don’t move faster when we need to.
We can put to bed the question of, Is healthcare just not able to move fast? When we want to, we can.
Also, Dr. Simon, it was so refreshing to hear your point of view on telemedicine, because when you look at the investment community, it tells a bit of a different story. If you were to look at the numbers and the investment, you’d think that we’re about to go to outer space with telemedicine, but we’re really not. It’s still just a tool. And so for me, I’ve been waiting to hear a more sober point of view. And I know some of this research is starting to show that it’s a tool and it’s an efficiency play, or maybe it’s for safety, but it’s not solving for some of the systemic things that are missing in healthcare.
For mental health, I’ve been watching the space with a little bit of concern. Because talking about this issue of capacity, when we’re talking to early partners, what we’re picking up is that they were at the brink to start with, and now just the wait lists and the demand and the speed of progression of mental health decline across all communities – whether it’s teenagers, maternal health – is really accelerating, in a negative way, the rethinking of the system. It’s exposed systemic gaps.
Telehealth is often talked about as being able to solve that, and I don’t know if it’s going to. It might help some efficiencies and some matching of people to therapists, but what we really see is a severe lack of trained therapists to be able to scale. And no amount of “fixing the pipes” is going to solve that. Nor will it solve for standardizing quality.
For mental health, what we really see is a severe lack of trained therapists to be able to scale. And no amount of ‘fixing the pipes’ is going to solve that.
So again, many good things: We’ve shown ourselves that we can get on a portal, remember our passwords [laughs], even figure out how to troubleshoot the video. And our doctors don’t have horns on video. And we can make this work. We can have multiple portals and it’s not a big deal – you know, we have multiple media services. All of those issues can be put to bed, but we have to think about capacity and quality. And people can get sicker fast, so we don’t really have much resilience built into the system to help people with mental health.
Iskowitz: Great points there, especially the one about putting to rest the question of whether healthcare can move fast. It’s proved that it can. We saw that in many historically slow-moving areas, from regulatory frameworks that facilitated FDA emergency use authorizations, to ironing out the legalities and licensure rules that facilitated access to telemedicine, to the overnight adoption of digital detailing and marketing, not to mention the vaccine development efforts.
Levy: Marc, you’re also seeing that for digital therapeutics. The FDA is leaning in, CMS is leaning in. Similar to what you just said, there is a lot more acceptability that these services are less in the realm of fringe thinking and more the idea that they are true health solutions. So I agree with you, even in my direct field here and in digital therapeutics.
Iskowitz: Certainly, and we’ve seen the value proposition change for digital therapeutics. Some that were thought of as-nice-to-haves prior to the pandemic suddenly became more essential because of safety and the inability for people to go to the doctor. Thanks for those comments, Monique. Let’s turn our attention to the future. I’d like to hear from the panel as to which innovations that gained traction this past year will really have staying power. Ruchin, how about we start with you on that one.
Kansal: I think 2021 is going to be the year of taking a breath, and then just recovering from the cyclone the healthcare system has been through this year. There are many trends we will certainly embrace more, like telemedicine and digital therapeutics, as tools and technologies going forward. As I try to figure out where the long-term trend line is – not just 2021 but 2030, 2050 and maybe 2100 – what has been interesting through this year is that on one side, we have been following the news of the vaccine and the pandemic globally and how everyone is addressing that.
On the other side, it has been really interesting to see that we have made quite a few strides in space exploration: NASA announced a competition to figure out sustainable economic models to live on the moon; Russia declared that Venus is its backyard; Elon Musk is sending quite a few rockets into the sky; and everyone from Morgan Stanley to PriceWaterhouseCoopers is talking about the SpaceFund and how to invest in space. Now, if space is the next final frontier after 1986, when William Gibson’s book came out, then we are getting so close to it.
The biggest challenge to space exploration, as I see it, is that human bodies are not built for extraterrestrial life. How do we reconcile that? So on one side, space exploration and human bodies don’t necessarily go hand-in-hand. On the other hand, I’m seeing mRNA, CRISPR, genomics. I’m seeing that Google figured out protein structure. There are molecular machines, miniature med-tech, etc. And there are technologies today that if we move away from the Darwinian system of evolution and we start to adopt those technologies in our body, we can actually live an extraterrestrial life.
For me, this becomes really exciting. I’m almost calling it the Fifth Industrial Revolution, where adapting to extraterrestrial environments through health technology will be the long-term trend. I don’t say that because that’s interesting; I say it because it is not a matter of if, it’s a matter of when. Health technology has the power to make it possible. I see quite a bit of investment happening in that space, and I think that will be a very interesting trend to follow. Just to wrap it up, we all talked a lot about telemedicine as a tool. What is interesting is that telemedicine actually came from NASA. It was developed so that physicians on planet Earth could consult with astronauts.
Adapting to extraterrestrial environments through health technology will be the long-term trend.
Levy: Can I make a comment? I love this idea, and sometimes I joke about how it’s time to move on to another planet. But what I’m struggling with in this pandemic, and especially since I’ve worked in the mental health space for so many years, is that we barely know how to live on this planet as humans. I’m really struggling with why it is that we can put people and be talking about going to Venus, and we still cannot be fully actualized human beings.
Look at how many mental health problems we have. Forty six percent of adolescents are facing mental health problems. There are still disparities in maternal health. We just haven’t figured it out here. How can we speed up thinking there? I know some really brilliant people are creating computational psychiatry, and I think we’re going to see a new generation of drugs there. Ruchin, you came from a company that’s working on the frontier there, and many companies are going to be doing great things in the next 10 years. But still, we’re so behind. I remember talking about telemedicine in 2000 when we were like, “When is it going to take off?” And it’s taken us 20 years to be pushed through a pandemic to make 50% of people use it. How can we just be healthier people living on this planet? This is very worrying to me.
Kansal: I would say you are basically raising an age-old question. If you look at when the first ships left Portugal or Spain to explore the Eastern world, it’s not that Portugal had solved for all of those problems. They say necessity is the mother of all invention. I say curiosity is the mother of all exploration. [Laughs] As human beings, we are curious creatures, and that’s why we explore. And we have explored planet Earth, and now some of us are going to explore space, and that’s how advancement happens. So it’s not that we have solved everything here. There’s a lot of work to be done here, and maybe in the future the haves and have-nots will be the people who are here and the people who exit here. So we’ll see how society unfolds and how things resolve. There’s a lot of work to be done on both fronts, frankly, and then a lot more to be done on planet Earth. That’s why I said I project to 2030, 2050 and 2100 – not 2021 – because in 2021 mental health is something that we really have to focus on. That’s the “must” problem, not the luxury of exploration.
Levy: That was really well said.
Iskowitz: Absolutely; thank you for taking a historical approach there, Ruchin, and a futuristic one, as well. Monique, since you were speaking on the topic of mental health and the existing, yet-to-be-fulfilled need there, what does that look like in 2021?
Levy: One of the areas that we’re very excited about is this technology that we’ve been building out – relational agents. The early testing and builds were done and started 15 or so years ago at MIT. And we’ve built our own proprietary technology on a relational agent that is a text-based, conversational agent driving our CBT [cognitive behavioral therapy]. And this is a truly scalable solution. It enables us to provide not just the content in psychotherapy but also the process that you have to go through to actually do the modulation and go through the different steps at the moment of need.
I’m really excited about this technology for its ability to start bringing back the working alliance that’s needed to advance therapy. Dr. Simon talked about trust earlier [in the patient-physician relationship, as being the key to good outcomes]. We think that this is a really important part of digital therapeutics. You really can’t get this promise of CBT or digital therapeutics without introducing this working alliance, which relational agents will be able to do. We’ve tested our working alliance in huge samples, we now have it in various products, and it’s extremely promising that we’ll be able to use this as a basis of being able to bring scaled solutions to people.
Iskowitz: I’m not sure you count it in the same category, but I’m thinking about all of the self-service technologies – chatbots, conversational agents – that have been pressed into service over the last 10 months and that filled some of those systemic gaps you mentioned, Monique. It’s great that they’re coming to mental health, too. Now I know, Dr. Simon, that as part of your outlook for next year, you touch on mental health. So how about if you go next.
Dr. Simon: I totally agree with Monique’s point, that telehealth is not a magic solution; it doesn’t solve systemic problems.6 A lot of academics now are looking at social determinants of health and the inequities between the wealthy and underserved populations, which have grown, and inequities across ethnic groups, which also have grown a lot in 2020. We see that as continuing in 2021.
To digress from healthcare for a moment, I’d like to comment on education. There’s going to be a very long period of recovery in education. There are more and more articles now for the children about something called “learning loss” in 2020, and that’s a whole generation, a whole cohort of children, who have had inadequate conditions to learn, some in crowded homes, others with inadequate access to technology, etc. And then the field of higher education – keep in mind the impact, especially in the STEM area, the fact that international students were not able to come to the U.S.
I see reported losses from tuition, etc., to universities of about $50 million per institution in 2020; hiring freezes, whereas we absolutely need those faculty; cost reduction, etc. Ruchin may agree with me, but we’ve been doing Zoom lectures forever now, and they absolutely don’t equal in-person interaction. You don’t have the campus connections for students. You don’t have the interaction in the classroom. And think of medical education: How can you do lab classes, remotely? That’s just not possible. So there’s a whole year, which is one, partly lost for students in terms of quality of education, and which has severely damaged universities and colleges. That’s the negative side.
The second comment, which is more the positive side, is that what we’re seeing now – and it’s accelerated in the COVID era – is a massive infotech investment in healthcare. There’s now a convergence – it’s almost not two industry sectors that we have with infotech and healthcare. Every infotech, from Google to Apple to Microsoft, etc., is acting possibly as an enabler, but maybe as a disruptor of healthcare.7 So Amazon started with the PillPack acquisition for $1 billion.
Now they’re all getting into a data aggregation. Amazon and Microsoft are developing cloud-based services to help hospitals with health data. Google has just launched the Health Study app, focused on respiratory illnesses like COVID-19. It’s partnering with Harvard Medical School and Boston Children’s Hospital to allow patients and in clinical trials to self-report and to answer survey questions.8 Amazon has launched the Amazon Health Lake that centralizes and structures data from different sources. Microsoft is partnering with United Health on a tool called ProtectWell, which is really a daily self-triage tool for employees.9
And I will add one thing on the negative side, cybersecurity. It’s not going away. The hacking isn’t going anywhere. We’ve had mounting cyberattacks through 2020. It started in 2017. The first massive ransomeware was called Wannacry. It spread worldwide, brought to a stop the U.K. National Health System, disrupted over 80 hospitals. Now this fall, one of these cyber attacks shut down the computer systems of Universal Health Services, which has 400 hospitals and behavioral clinics in the U.S. and the U.K.10
Health data are a key target for cyber attacks, because they are extremely valuable. And the loss of data may not be apparent as fast as banking data, for instance, which you know right away that you’ve been hacked. With health data, some claims may be reimbursed six months later, and so it takes a very long time to see the attack and to correct it. I’d like to know what the other speakers’ opinions are on cyber security and if we are moving toward solutions or not.
Iskowitz: That was a great rundown, Dr. Simon. In terms of cyber attacks, that was one of the few agenda points from our earlier roundtable that perhaps wasn’t rendered totally irrelevant by the events of the last 10 months. Mony, given your long career on the healthcare IT side – which no doubt involved dealing with cybersecurity issues – what’s your view on getting a handle on attacks on health data, and give us your outlook for next year.
Weschler: First, I’d like to comment on what the prior speakers spoke about, especially Dr. Simon. Certainly, we saw tremendous changes in not only in health tech but in ed tech, as was mentioned. It was kind of remarkable, because God forbid this pandemic would have happened 20 years ago, it would have been a completely different impact on our population. Zoom and all of these other virtual meetings aren’t great and they’re not a replacement, but they certainly held us together for a while. And think about the future: no more snow days. [Laughs] I mean, the kids, on a snowy day in New York, can be on Zoom. And I hope that doesn’t happen. I hope they still get their snow days.
But anyway, as a data scientist, I’m very excited. And what people don’t realize, because it’s not spoken about, the only way that any type of vaccine was able to get developed was because a lot of the data-blocking regulations and everything else that prevents us from sharing data were suspended and removed. And once that opened up, the ability to model and to release massive computing power and AI globally, really is what helped achieve this vaccine in record time. It could not have been done in the old way. Technology is the tool that enabled it – and, of course, brilliant minds and everyone else working together – but certainly, we have to look at the technology that opened up the door. And what I’m seeing and anticipating and am really excited about is – and look at CMS, with their new anti-blocking rules and regulations – is when we open up and we start sharing data, of course in a HIPAA-compliant and secure way, we can do that.
Let’s about the truth behind the cyber. The reason why we’re vulnerable is because every healthcare organization is trying to recruit cyber scientists to protect their individual organizations. This is not the core competency. This is something that shouldn’t be handled hospital by hospital. We will fail in that manner. There are not enough cyber and security experts out there. And when they’re recruited, they’re recruited to far more interesting and higher-paying positions than working for your local hospital. So this is something that I would say we need to share on. There’s no competition there. Everyone needs to be protected and everyone wants to keep running. Nobody wants to go through any type of ransomware, where your database and your EMR are locked up and your healthcare stops. Because let’s face it, we can’t go back to paper, it’s not going to work.
The reason we’re vulnerable is because every healthcare organization is trying to recruit cyber scientists to protect their individual organizations. We will fail in that manner.
So this is something that we should all collaborate on across the board to protect our organizations. Only with that type of power, where we actually get on the same page, will we be able to protect ourselves from the cyber threats that are going to happen. It’s not an if, it’s a when. And as long as we try to do that individually, we will fail. This is something that we need to wake up and collaborate on and put our heads together. That way, we’ll be able to recruit the best experts in that and create an umbrella around the healthcare systems to protect us while allowing for the sharing that’s required for research and development and population health, and everything else that we’re trying to do. Because the data is the key, and we need to figure out a way to do that in a compliant and secure fashion, but also to open up the data for us to be able to succeed and continue to move forward.
The worst thing that can happen is we lock back down, go back into our silos until the next pandemic. It’s like, “Okay, mission accomplished. Let’s go back to the way it was yesterday.” What we should do is push forward and continue and appreciate what can be accomplished when we release technology and data and work together to continue to drive that, both as a healthcare community and also on the technological component. It’s not a technological limitation. We can see already what cloud computing systems can do, from Google to Amazon to Microsoft. They can do remarkable things. It’s our culture that is not incorporating that and doing it and pushing forward to really demand security and sharing, for the best for our populations. And that can be global, as well, and that should be. That’s my outlook. When we work together, we’re better. And we can do it if we collaborate in certain fashions to protect the privacy and the rich data that we’re starting to collect in healthcare. Which is far more complex than fintech, far more complex and far more interesting – and far harder to do institution by institution. It has to be almost a national effort.
I’d also like to touch on what’s here to stay, which is sensors. Sensor technology is out of control. It’s moving very fast. We’re seeing commercial vendors like Apple releasing FDA-validated components from pulse oximetry to cardiac monitoring in a commercial watch. That’s the beginning. It’s just giving us a taste of what the future is like. And if you want to talk about big datasets that require huge data lakes and processing power to make sense of, it’s that type of technology and those types of sensors that are going to be able to drop so much information that will really help us tune the fidelity of personalized treating of patients. It will make personalized medicine really possible, but we need to work together.
Iskowitz: Collaboration – it’s a great point to end on. I want to thank everybody for explaining how 2020 exposed the weaknesses of the health system, as well as the bright spots and the causes for celebration, from mental health to telemedicine – and tele-mental health – and from health data liquidity and digital therapeutics to the ongoing disruption by Google, Amazon and Apple – and to human space exploration. We covered some of the most significant pandemic innovations of 2020 and how they will spur us on to bigger and better things in 2021 and beyond. Besides the fact that these are all areas that are going to be ongoing elements of MM+M’s coverage, that was just a very stimulating conversation. And I want to thank you all.
1. Jeff Becker, “Benchmark your Covid-19 Digital Strategy”, Forrester Research, June 9,2020
2. Bradley Fox, J. Owen Sizemore, “Telehealth: Fad or the Future”, Epic Health Research Network, August 18, 2020
3. Covid-19 Survey: Telehealth Will Remain Convenient Alternative, Health Union, December 7, 2020
4. ”Telehealth Patient Satisfaction Surges During Pandemic but Barriers to Access Persist, JD Power Press Release”, October 1 st , 2020
5. David Blumenthal, “Where Telemedicine Falls Short”, Harvard Business Review, June 20, 2020
6. 2021 has been called “a defining year for healthcare transformation.” The highest growth area is expected to be mental health. Forrester forecasts 138.5M tele-mental health visits in 2021, accounting for 31% of consults. However, barriers to virtual care will persist, including cost, physician availability and in-network coverage. Drivers of telehealth will be consumer preference, omnichannel communication tools and next-generation devices for remote monitoring. (Arielle Trzcinski, Jeff Becker, Judy Weeder and Greg Barber, “Predictions 2021: Healthcare”, Forrester, October 20, 2020)
7. The Apple Watch EKG function is FDA-approved, and it is used in a major cardiology study with J&J and also used in many clinicals, including a Covid-19 study at Mount Sinai. There may be several models of virtual care: on-demand urgent care to avoid ER visits, e-consults with long-term doctors for chronic conditions, near-virtual visits with “near home” sites such as labs and retail clinics, and “hospital at home” services, which health systems need to offset their elective surgery losses in 2020. (Oleg Bestsennyy, Greg Gilbert, Alex Harris, Jennifer Rost,”Telehealth: A Quarter-Trillion-Dollar post-Covid-19 Reality?”, McKinsey, May 29,2020)
8. Dave Muoio, “Google’s New Research App Shows Participants How Their Data Is Driving Research Insights”, MobiHealth News, December 9, 2020
9. Bruce Japsen, “United Health Group, Microsoft Partner on Coronavirus ‘Return To Work’ Venture”, Forbes, May 15, 2020
10. Heather Landi, “UHS Hit with Massive Cyber Attack as Hospitals Reportedly Divert Surgeries, Ambulances”, Fierce Healthcare, September 30, 2020