Future Watch: Health and wellbeing in a digital age vision 2025, part I

Future Watch: Health and wellbeing in a digital age vision 2025, part I

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  Future Watch Health &Wellbeing in the Digital World – Vision 2025 Part I Transformations in care delivery 2019
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  2 Future Watch forSmart life Finland program Part I 5 March 2019 Transformations in care delivery – the drivers and economic imperatives for anytime, anywhere care Topics to be covered in 2019, follow the newsletter to get latest updates: Business Finland Health newsletter  The move towards Population Health Management and the role of Preventative Medicine – an integrated and holistic approach  The Digital Health Ecosystem in 2025  Key enabling Digital Solutions supporting Individual Centric Health & Wellbeing through 2025  Next Generation Solutions – R&D and Investment Focus  Consumerism and Participative Healthcare – Paradigm shifts in the next decade
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  3 Chapter Page Number ProjectScope, Objectives, and Methodology 4 Executive Summary 6 Transformations in care delivery – the drivers and economic imperatives for anytime, anywhere care 9 1.1. System wide challenges that need to be addressed globally 12 1.2. Health system goals 20 1.3. Consumer / patient centric challenges that need addressing 25 1.4. Wellness management – prescriptive or ownership based 30 1.5. Alternate care locations 38 1.6. Patient management 65 Contact Contents
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  4 Back to Contents REPORTOBJECTIVES AND METHODOLOGY
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  5 Report Objectives &Methodology Healthcare as an industry is transforming. The concept of wellbeing is increasing in importance. Living environments are evolving (smart homes/assisted living/robotics/etc.). Technologies and innovations are having major impacts. Individuals are taking more control. Business Finland commissioned this report on the landscape of developments that will impact the delivery of Health & Wellbeing, to better understand the anticipated transformations, impacts and opportunities to support its strategy for ensuring Finland is well positioned to take advantage of such trends and to help drive better decision making for all stakeholders in Finland. Frost & Sullivan (F&S) compiled this report by using existing data and secondary research inputs from public information sources to profile future projections in terms of healthcare delivery transformations, to understand the economic imperative in key geographic markets, and to look at the activities of key digital health firms across the globe. We also conducted selected primary research interviews with futurists in medical device and life sciences firms, stakeholders from digital health solution providers, key opinion leaders from the provider sector and R&D stakeholder to understand their views of developments, adoption, and sustainability of the new solutions. Based on the gathered data, F&S conducted holistic analysis of the ecosystem and needs to identify unmet and evolving needs. This helped build a list of digital health solution areas across patient touch points along their care pathway, and will also help define new service and business models. We hope this substantive report will help add value to insight and decision making by all stakeholders in the Finnish healthcare ecosystem.
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  6 Back to Contents EXECUTIVESUMMARY
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  7 Source: Our Worldin Data, The Lancet Diabetes & Endocrinology Journal, Stanford University Executive Summary Integration of digital health tools in care continuum is critical to support the current models of care delivery, which are struggling to meet rising demand with limited infrastructure and resources. Demand for healthcare services has escalated due to various factors including a rapidly ageing population, rising prevalence of chronic diseases, and increasing costs for care services. Healthcare systems are responding to the increasing demand by evolving toward an ‘anytime, anywhere care’ model. The emphasis is on shifting the locus of care from hospital to a patient, by enabling a patient with technological tools. For individuals, becoming empowered pertains to gaining a stronger sense of control over one’s circumstances as well as a greater sense of well-being and satisfaction. Digital technologies serve an important role in helping people connect with both peers and advice givers/seekers to share information. Use of wearables is picking up and aiding this trend. Care systems are shifting away from traditional fee-for-service (FFS) toward fee-for-value reimbursement that rewards providers based on the quality of care rather than the quantity of care. Value-based care comes with increased financial risk. Therefore, care delivery must be re- engineered to ensure economic viability under this new business model. Consequently, providers are developing new digital strategies for better alignment of care processes to ensure collaboration with key stakeholders, including patients and their families, to ensure optimal health outcomes and maximum reimbursement. Smart hospitals and telemedicine are key enablers in this regard.
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  8 Executive Summary (continued) By2025, digital health will start to come of age – favourable reimbursement policies toward clinically relevant digital health applications will expand care delivery models beyond physical medicine to include behavioral health, digital wellness therapies, dentistry, nutrition, and prescription management. As tech-savvy Millennials are expected to overtake the Boomers population by 2025, the connected healthcare ecosystem will continue to evolve. This will provide the impetus for mainstream adoption of IoT concepts (such as wearables, mHealth, and telehealth) by healthcare organizations to deliver much anticipated anytime/anywhere care. US, Estonia, Sweden, Finland, Denmark, UK, Spain, Japan, China, and South Korea represent countries with highest penetration of e-health among consumers. Tech-savvy consumers in these countries are actively adopting digital tools to maintain and enhance their wellbeing. F&S analysis suggests that a Finland-based company can enter these global markets. However, it would need to have a global presence and strong brand recognition among consumers. It would also need to abide by data privacy and security laws, which differ by countries/regions. Examples of global companies that have launched digital health products worldwide include Fitbit, Xiaomi, and Apple.
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  9 PART 1. TRANSFORMATIONSIN CARE DELIVERY Back to Contents
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  10 Source: Our Worldin Data, The Lancet Diabetes & Endocrinology Journal, Stanford University Transformations in care delivery – discussion Evolving societal needs are straining current healthcare systems, making it imperative to transform care delivery Healthcare delivery systems across the globe strive to meet three core objectives: improving the quality of care, increasing access of services, and reducing per capita costs of healthcare. Major societal strides taken in the past century have made it imperative for care delivery systems to challenge their status quo in order to meet the ever increasing demand. Most important social changes during the past century include the rise in average life expectancy and population. While in 1900, the global population stood at around 1.6 billion and on an average people didn’t expect to live beyond 40 years of age, today the global population is above 7 billion with people living above 80 years of age in many parts of the world. In parallel to the rising population there has been an increase in the adoption of technological solutions, which have reduced the need of manual labor. This is encouraging a sedentary lifestyle where people are consuming fast food, with minimal exercises. These societal changes are producing a rapidly unfit population which is prone to chronic disease such as diabetes, cancer and cardiovascular disorders. There is a pressing need for care delivery to evolve in order to meet the challenges posed by evolving social dynamics. Hospital systems, with their limited infrastructure and funds, cannot meet the needs of such a large patient cohort. For instance, it is estimated that the number of adults with type 2 diabetes is expected to rise from 406 million in 2018 to 511 million in 2030 due to ageing, urbanization, and associated changes in diet and physical activity. Amount of insulin needed to effectively treat type 2 diabetes will rise by more than 20% worldwide by 2030. Without major improvements in access, insulin will be beyond the reach of around 40 million adults with type 2 diabetes who will need it in 2030.
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  11 Source: Our Worldin Data, The Lancet Diabetes & Endocrinology Journal, Stanford University Transformations in care delivery – discussion By 2025, digital health will come of age. Healthcare organizations will adopt IoT concepts (such as wearables, and telehealth) to deliver anytime/anywhere care. Healthcare delivery systems need to lay the onus on people. Instead of clamoring for meeting the increasing demand, which will be difficult to meet due to limited resources, healthcare delivery systems should try to spur individuals toward a healthier lifestyle. Focus should be on prevention of disease rather than trying to remedy it. People should be sensitized toward using digital technologies to monitor their health. Payers need to innovate medical insurance models, such that there are economic incentives for people to stay fit, such as lower co-pay and deductibles. Such moves will prompt individuals to take more responsibility for their health. Another direction which governments need to review is decentralization of healthcare services. There is a need to reduce loads on hospitals. Government should promote healthcare at the community level. If a person gets sick, care should be available at a primary care center in a retail pharmacy. Such a model will help reduce the load on over burdened hospitals, which should be used only in case of emergency, critical care. To further reduce load on hospitals and create capacity for people who need it more, people recovering from chronic conditions or post operation should do so at their homes, instead of hospitals. Smart digital technologies can help in this regard.
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  12 Back to Contents 1.1SYSTEM WIDE CHALLENGES THAT NEED TO BE ADDRESSED GLOBALLY
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  13 • On onehand, rising population, aging population and more patients with chronic and multiple co-morbidities are putting immense pressure on current healthcare systems, which is expected to rise by 2025. • On the other hand, governments are struggling to balance healthcare budgets with other expenses. This is resulting in an overburdened infrastructure and healthcare workforce, which has little scope for expansion. This imbalance in demand and supply is expected to balloon further by 2025, presenting serious challenges for global healthcare systems. Increasing number of Chronic patients Source: United Nations, World Health Organization System wide challenges If nothing is done, these challenges are strong enough to cripple economies. System-wide Challenges Unbalancing Healthcare Demand & Supply Rising population Ageing population Shortage of healthcare professionals Limited healthcare infrastructure Burgeoning healthcare budgets falling short of expected outcomes SUPPLY DEMAND
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  14 Source: United Nations GlobalChallenges Rapidly rising population pressurizes healthcare systems in India and China • The current model of sick care is unsustainable due to a number of compelling reasons — rapidly rising population burden tops the list. • As per the United Nations, Asia and Africa will have significant population growth, putting immense pressure on their already stressed healthcare infrastructure. World Population Distribution by Region (billion, 2015-2100) Rising population World Population to 2100 (billion) By 2025, the global population will reach 8.1 billion. India is expected to surpass China as the most populous country in the world, with around a 1.5 billion population.
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  15 Source: United Nations’World Population Aging Report Global Challenges Rapidly ageing population demands more healthcare services • The share of the elderly population (aged 60 and above) is set to rise, while the share of the working adult population to support this elderly population remains constant, and even drops after 2030. 20 18 16 15 14 28 25 24 24 21 42 45 45 45 43 10 12 15 16 22 0 5 10 15 20 25 30 35 40 45 50 2000 2015 2025 2030 2050 0-9 10-24 25-59 60 & above Population (%) Population Distribution by Age Group, Global, 2000-2050 The young children (0-9) population base is likely to decrease marginally; however, populations of all other age groups are set to grow Elderly population is rapidly increasing, and the population base of adults to support them is decreasing, making it a challenge Ageing population
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  16 Source: World HealthOrganization Global Challenges Lifestyle changes are increasing chronic disorders • Chronic diseases kills around 42 million people each year, equivalent to more than 70% of all deaths globally. By 2025, the number of people dying due to chronic disorders is likely to increase to 48 million. • Cardiovascular diseases account for most deaths, or 18.5 million people annually, followed by cancers (9.5 million) and respiratory diseases (3.9 million). • Key factors behind rise in chronic diseases include tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets. Increasing number of Chronic patients 10.2 12.0 3.9 4.4 9.5 10.8 18.5 20.6 2018 2025 Others Respiratory diseases Cancer Cardiovascular diseases Total 42 48 Number of Death by Type of Chronic Disease (million, 2018-2025)
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  17 Source: World Bank,Health Expenditure and Financing – OECDstat (2017), Our World in Data Global Challenges Disconnect between healthcare spending and patient outcomes • The world is grappling with a significant disconnect between health spending and actual patient outcomes. • Developed countries including the US, Switzerland and Sweden, spend higher than the rest, and yet that does not lead to a proportionate increase in life expectancy. Life Expectance vs. health expenditure, Global, 1970 to 2015 Ballooning healthcare budgets yielding little gains Lifeexpectancyatbirth Per capita health expenditure
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  18 Source: OECD.Stat Global Challenges Whilepatient population surges, hospital infrastructure remains limited • While healthcare budgets expand, majorly due to rising expenditure on medication, expansion of hospital infrastructure has been poor. • During 2011 and 2016, it was observed that except China, most major countries in the world witnessed a decrease in the total number of hospital beds. Limited Healthcare Infrastructure 0 1000000 2000000 3000000 4000000 5000000 6000000 2011 2012 2013 2014 2015 2016 China Japan Russia US India Germany France UK Spain Number of Hospital Beds (2011-2016)
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  19 Source: Mercer’s USHealthcare External Labor Market Analysis (2017). Global Challenges Shortage of healthcare professionals • By 2025, a surge in demand of healthcare professionals is expected globally. However, there is lack of proper infrastructure and budgets to train the required number of professionals, which is expected to lead to a large demand- supply gap — For instance in the US alone, it is expected that by 2025, there will be a gap of 680,400 healthcare workers. Healthcare Occupations With Projected Supply Gaps Through 2025, US Widening gap between supply and demand of healthcare professionals Occupation New job openings by 2025 Expected workforce gap by 2025 Home health aides 423,200 446,300 Nursing assistants 407,396 95,000 Medical and clinical lab technologists 49,400 58,700 Medical and lab technicians 60,717 40,000 Nurse practitioners 51,445 29,400 Physicians and surgeons, all other 102,970 11,000
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  20 Back to Contents 1.2.HEALTH SYSTEM GOALS
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  21 Source: WHO, ‘Here'san incentive that really makes people exercise more’, CNN (February 2016) Health system goals – discussion Health system goals vary between the developed and developing nations of the world Wide heterogeneity exists between the global healthcare systems. While the developed countries such as the US and the UK have large funding, and access to all the latest and cutting-edge technologies, developing countries such as India and China struggle to meet even the basic healthcare demands of their populations. Developed health systems are aiming at increasing the accountability of patients. Their focus in on spreading awareness and educating the people. One of the most celebrated examples of this is Finland’s ‘North Karelia’ project, where the country’s health system introduced a variety of activities and innovative programs such as nationwide TV series and Cholesterol-lowering competitions that resulted in reduction of heart attacks incidence rate by 75%. Similarly, workplace wellness programs are gaining popularity in the US, and more than 80% of large employers are now using some form of financial incentive to increase physical activity. Health systems are promoting the use of self-health monitoring apps to motivate people to stay healthy. In developing countries, healthcare systems are focused on increasing access to care for their citizens, especially in the rural areas. Countries such as China and India are exploring various digital options to increase penetration of healthcare services. For instance, China has launched a ‘Healthy China 2030 Program’ in which it is investing in digital health tools for providing equitable access to healthcare—overcoming the rural-urban divide, and efficient utilization of healthcare resources.
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  22 Source: European Commissionpolicy on transformation of health care in the Digital Single Market (April 2018) Health system goals – developed countries Europe aims to increase funding to accelerate innovations in digital health Secure access and exchange of health data Health data pooled for research and personalised medicineAmbition: Citizens securely access their health data and health providers can exchange them across the EU. Actions • eHealth Digital Service Infrastructure will deliver initial cross-border services (patient summaries and ePrescriptions) and cooperation between participating countries will be strengthened. • Proposals to extend scope of eHealth cross-border services to additional cases, e.g. full electronic health records. • Recommended exchange format for interoperability of existing electronic health records in Europe. European Commission policy on transformation of health care in the Digital Single Market, 2018 Ambition: Shared health resources allowing targeted and faster research, diagnosis and treatment. Actions • Voluntary collaboration mechanisms for health research and clinical practice, starting with “one million genomes by 2022” target • Specifications for secure access and exchange of health data. • Pilot actions on rare diseases, infectious diseases and impact data. Ambition: Citizens can monitor their health, adapt their lifestyle and interact with their doctors and carers Actions • Facilitate supply of innovative digital-based solutions for health, also by SMEs, with common principles and certification. • Support demand uptake of innovative digital-based solutions for health, notably by healthcare authorities and providers, with exchange of practices and technical assistance. • Mobilise more efficiently public funding for innovative digital-based solutions for health, including EU funding. Digital tools and data for citizen empowerment and person-centred healthcare
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  23 Source: Digital HealthInnovation Action Plan, US FDA (July 2017) Health system goals – developed countries In the US, a conducive regulatory environment is being created to foster innovation in digital health • The US FDA is recalibrating its approach to digital health to assure safe and fast access for its people. • One of its key initiatives is the launch of its ‘Pre-Cert Program’ under which certified manufacturers of digital health software will qualify to be able to market their lower-risk devices without additional FDA review or with a more streamlined premarket review. • Pre-Cert firms could also collect real-world data postmarket that might be used, for example, to affirm the regulatory status of the product, as well as to support new and evolving product functions. ― Pre-Cert 1.0, the first version of the program will be available in 2019 Digital Health Innovation Action Plan
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  24 Source: Healthy China2030 Program Health system goals – developing countries Focus is on improving health access and overcoming regional fragmentation Objectives Initiatives and Emerging Models • Improving key indicators of healthcare delivery • Streamline investments in healthcare • Improving healthcare resource utilization • Increasing access to healthcare insurance • Healthy China 2030 Program, announced by President Xi Jinping in October 2016 • Medium to long-term plan is being executed currently (2017-2025) and is executed by State Council • Tiered healthcare services including transformation of primary care • Using healthcare IT to transform healthcare delivery in China • Integrate healthcare services • Healthcare modernization, optimize resource utilisation, innovative services, improve efficiency, reduce costs and meet the increasing demand on healthcare • China’s national planning guideline for the healthcare service system - establishing digital health information database network which will integrate patient health profiles and medical records in electronic form by 2020 • Rise of several digital and E-commerce companies • Online hospitals and virtual care • State guidance on developing Internet plus Healthcare
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  25 Back to Contents 1.3.CONSUMER / PATIENT CENTRIC CHALLENGES THAT NEED ADDRESSING
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  26 Source: WHO, FAO,World Bank Consumer / patient centric challenges – discussion Attitudes of consumers/patients has resulted in serious global challenges including rising obesity and low adherence to medication The term “patient engagement” is increasingly used to convey the idea of consumerism or patient-directed healthcare. The Center for Advancing Health defines patient engagement as “actions individuals must take to obtain the greatest benefit from the healthcare services available to them.” For patients, these actions involve taking on more personal responsibility to learn about how to care for themselves beyond what happens within the four walls of the hospital or doctor’s office, including managing a chronic condition or preparing for a medical procedure or hospitalization. Studies have shown that patients who are involved in their health decisions are more likely to cooperate and understand their disease process. In addition, educated, engaged consumers tend to have better outcomes at lower resource utilization. The patient engagement movement is real, but barriers continue to exist as many consumers still lack the interest and motivation needed to take a more proactive role in their health. This is leading to serious issues such as rising obesity due to poor diets and limited exercise and lower medical adherence.
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  27 Consumer/ Patient CentricRoadblocks High consumption of unhealthy food escalating obesity Source: WHO, FAO, World Bank DataBank 650 million (2016) >1 billion (2025) Total Number of Obese Adults (>18 years) - Global 11.7% (2011) 13.2% (2016) Percentage of Obese Adults (>18 years) - Global 20.0% (2025) • Swayed by marketing and advertisement and other factors such as ease of access and low cost, people are consuming unhealthy, fast junk food items which are rich in fat, calories and salt, but lack essential nutrients. • Such unhealthy diet is linked with obesity which in turn leads to high blood pressure, cardiovascular disorders and diabetes. • Globally, the US, the UK, Ireland, Australia, Canada and New Zealand lead, have almost a fifth of world’s obese adults. By 2025, the UK will become the most obese nation in Europe, with about 38% of its adults seen as obese. “Fast and junk food is cheaper, and easier to access and prepare than fresh food, particularly for poor people in urban areas. The consumption of these cheap foods comes however, at a high cost to society with obesity a risk factor for many non-communicable diseases such as heart disease, stroke, diabetes and some cancers. If we do not adopt urgent actions to halt the increasing obesity rates, we soon may have more obese people than undernourished people in the world.“ — José Graziano da Silva, Director- General, FAO
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  28 Consumer/ Patient CentricRoadblocks Sedentary lifestyles with limited exercises increasing unfit population Source: ‘Lack of exercise puts one in four people at risk, WHO says’, BBC News (September 2018) As per the World Health Organization (WHO), nearly 1.4 billion people in the world are not doing physical exercises Inactivity raises the risk of numerous chronic conditions, including cardiovascular disorders, type-2 diabetes and cancer
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  29 Consumer/ Patient CentricRoadblocks Low adherence to medication makes treatment ineffective, wasting expenditure Source: Medication adherence: helping patients take their medicines as directed. Public Health Rep. 2012;127(1):2-3. Pagès-Puigdemont N, Mangues MA, Masip M, et al. Patients' Perspective of Medication Adherence in Chronic Conditions: A Qualitative Study. Adv Ther. 2016;33(10):1740-1754. Cardinal Health, Catalyst Healthcare, WHO 51% of people aged 65 years and above take at least five prescription drugs regularly — 63% forget to take their medications 50% of patients suffering from chronic diseases, do not adhere to their prescribed medication schedule In the US, low adherence to medication accounts for 10% to 25% of hospital and nursing home admissions, $300 billion expenditure, and 125,000 deaths annually
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  30 Back to Contents 1.4.WELLNESS MANAGEMENT – PRESCRIPTIVE OR OWNERSHIP BASED
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  31 • Providers continueto encourage patient engagement and ensure that efforts are sustainable to positively impact health outcomes. Fortunately, a variety of new strategies have been developed that encourage and motivate patients to take ownership and become more involved in decisions about their care. • These strategies include increased deployment of a range of consumer- facing digital solutions, including digital educational content, wearable sensors, mobile apps, and other tools. • The future healthcare expenditure spend will evolve to focus less on treating diseases and more on prevention, diagnosis, and monitoring. Prevention Diagnosis Treatment Monitoring $$$$ CARECONTINUUM *Not to Scale Healthcare Market: Shifting Healthcare Spend* Across Care Continuum, Global, 2017 Source: Frost & Sullivan Wellness management – prescriptive or ownership based Healthcare industry shifting ownership on patients - focusing on prevention and wellness
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  32 Source: US PatientEngagement Solutions Market, Landscape Assessment, Frost & Sullivan Wellness management – prescriptive or ownership based Gaps encountered in a typical patient engagement workflow and their impact on national health expenditure
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  33 Source: US PatientEngagement Solutions Market, Landscape Assessment, Frost & Sullivan Wellness management – prescriptive or ownership based Patient engagement strategy for a value-based healthcare ecosystem based on three key objectives
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  34 Source: Technology Innovationsfor Patient Engagement, Frost & Sullivan Wellness management – prescriptive or ownership based Patient engagement enabling patient centric care
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  35 Source: Technology Innovationsfor Patient Engagement, Frost & Sullivan Wellness management – prescriptive or ownership based Technology advances improving patient engagement solutions
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  36 Source: Technology Innovationsfor Patient Engagement, Frost & Sullivan Wellness management – prescriptive or ownership based Technology advances and convergence for patient engagement
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  37 Source: Technology Innovationsfor Patient Engagement, Frost & Sullivan Wellness management – prescriptive or ownership based Patient engagement solution enabling treatment adherence, disease management, and overall population health management
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  38 Back to Contents 1.5.ALTERNATE CARE LOCATIONS
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  39 Source: Vision 2025– Healthcare in the Smart Home, Frost & Sullivan, HealthCatalyst Alternate care locations – discussion Care delivery moving to the home environment • The industry is gradually evolving to acknowledge the ‘anytime, anywhere care’ model, and the result is the remodeling of healthcare services to suit this trend. Technological developments and the Internet of Things (IoT) enable a home to evolve into a connected home. We believe that the convergence of these trends—focus on prevention and wellness, care delivery moving in to the home and endless home automation possibilities—is imminent. • According to a report on the Clinically Appropriate & Cost-Effective Placement Project (CACEP) from the Alliance for Home Health Care Quality and Innovation, Medicare could reduce its spending by $34.7 billion over a 10-year period by shifting patient care settings from facility-based care to home and community-based care. Additional $100 billion could be saved if care delivery were restructured to be less wasteful and more effective. Pharmacy Patient Visits Path lab Clinic Health & wellness stores Telemedicine Home testing/collection Online stores [nutrition, wellness, medical devices] House call Products and Services Visit Patient. ePharmacy/third-party delivery Past Present Healthcare Market: State of Care Delivery, Global, Past, Present & Future In future, integration of digital solutions will be more concrete and visible
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  40 Source: Vision 2025– Healthcare in the Smart Home, Frost & Sullivan Alternate care locations Smart home provides multiple healthcare services Analytics/ Informatics Storage Machine Learning Cybersecurity Interoperability Decision Support Common Healthcare Services in a Smart Home Diet & Nutrition Monitoring Activity, Exercise, Rest & Sleep Monitoring Vaccination and Medication Management Telehealth Services Wearables/Contactless Vitals Monitoring Smart Toilets for Waste Monitoring Virtual Home Assistants Diagnostic Devices
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  41 Source: Vision 2025– Healthcare in the Smart Home, Frost & Sullivan Alternate care locations Smart home caters to care needs of all resident profiles General Wellness & Prevention Tracking health and wellness vitals (such as, weight, temperature, blood pressure); prevent development of chronic conditions Aging-In-Place Ensuring senior safety remotely, while enabling them to live independently Physically/Intellectu ally Disabled Enabling independent living or vitals tracking to ensure wellbeing Sleep Tracking sleep, supporting better quality of life Chronic Disease Management Medication reminders, coaching and education Post-acute Care Monitoring Monitoring for faster recovery and preventing readmissions Children Tracking vitals and taking doctor advice at home (telehealth) as part of after- hour diagnosis of seasonal flu Smart Home Services for Entire Age Spectrum Key: Health, Safety & Wellness Medical Support D Infant and Maternal Health Monitoring of infant needs and supporting maternal care D Teenagers Preventing mental health issues and substance abuse Smart Home Healthcare Market: Healthcare Services for Smart Home Users, Global, 2017
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  42 Source: Vision 2025– Healthcare in the Smart Home, Frost & Sullivan Alternate care locations Aspects of aging in smart home Safety & Security • Alarms and notifications for residents to be aware of any open doors, windows • Reminders for appliances not switched off after use • Warnings for potentially dangerous leaks (water, gas) • Automatic notifications for loved ones to check on residents Isolation & Loneliness • Virtual companions or social robotic companions • Video communication for staying in touch with friends and family • Mixed reality for virtually attending family events and get-togethers • Mixed or virtual reality devices to relive past memories Health & Wellbeing • All aspects of senior lives and body monitored unobtrusively—vitals, weight, diet, excreta, gait, memory and moods—and updated in patient records and made available to doctors • Review of information and real-time alerts (by doctors), if any, and connect via telehealth with patients weekly to provide medical advice • Use of mixed reality devices (by doctors) to connect with patients, to explain complex health conditions visually
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  43 Source: Vision 2025– Healthcare in the Smart Home, Frost & Sullivan Alternate care locations Aspects of aging in smart home On-Body Wearables  Smart implants  Vitals/activity tracking devices and apparel • PERS • Fall detection • Smart hearing aids Bathroom  Smart pill dispensers  Diagnostic devices  Smart mirrors  Smart weighing scale  Smart toilets Entire Home  Contactless monitoring sensors and devices for vitals monitoring  Motion sensors for detecting activity, turning lights on/off  Carbon monoxide, smoke and water leakage sensors for preventing mishaps • Smart plugs or sockets, tags and sensors for monitoring activities of daily living (ADL), keep caregivers and family members informed • Flashing tags to remind performing ADLs for dementia sufferers • Smart tags to detect location of keys, wallets, reading glasses and other items • Assistance robots to help with tasks and for lifting residents from bed to wheelchair Smartphone Apps  Medication adherence  Activity tracking • Location tracking/geofencing Living Room  Telehealth visits Kitchen  Connect with nutritionist for diet and meal suggestions • Smart bin to track & reorder groceries • Smart cups, spoons and plates for countering tremors Bedroom Sleep Quality Monitoring  spO2 monitoring  Ambient environment Social Engagement Tools • Companion robots • Virtual companions with digital avatars that have human caregivers in the background • Video communication devices or screens for virtually visiting friends and family • Mixed/virtual reality headsets for virtual presence/reliving memories Voice Interactive Diagnosis & Control Tools Artificial Intelligence + Data Analytics Insights Legend  Active Care |  Monitoring |  Support
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  44 Alternate care locations Chronicdisease management in the smart home Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan Seniors Prone to Expensive Chronic Diseases 80% 77% One Chronic Disease Two Chronic Diseases Proportion of Elderly Suffering from Chronic Diseases, US, 2017 $317 billion Cardiovascular Disease $245 billion Diabetes Annual Cost of Chronic Diseases, US, 2017 Proportion of Deaths Attributed to Non- communicable Diseases, Global, 2015 and 2030 2015 2030 68.4% 73.9% Lack of Information Between doctor visits, on • Symptoms: normal, abnormal • Diet and nutrition • Activity • Side-effects of medication • Actual health progress Mental Health Detecting and managing mental health issues arising out of managing chronic conditions for a lifetime • Anxiety • Depression Treatment and Medication Adherence Chronic Condition Patient Challenges Reminders and ‘nudges’ to stay on track with provided medical advice, and treatment regimen Engagement Engagement, support and motivation for managing condition, in terms of diet and exercise
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  45 Alternate care locations Requirementsfor chronic disease management in the smart home Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan Analytics, Artificial Intelligence Education and Engagement Monitoring and Intervention Medication Adherence and Treatment Compliance Care Coordination and Management Caregivers, providers, and family members are updated on condition and progress and empowered to take necessary corrective action. • Education • Feedback • Motivation—challenges, peer support, etc. • Smartphone apps & logs • Connected medical devices • Smart vitals devices • Connected activity and fitness trackers • Smart pill dispensers • Smart devices (such as inhalers) • Smartphone apps for accessing medical instructions • Weight • Vitals • Biomarkers • Diet • Activity IntheSmartHome What How • Medication reminders • Appropriate dosage consumption • Dietary restrictions • Activity and exercise instructions • Other medical advice • Voice interactive devices • Web portals • Smartphone apps • Text or calls Who can support • Care providers • Care givers • Family members • Nutritionists • Health coaches EHR Integration
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  46 Alternate care locations Requirementsfor chronic disease management in the smart home Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan On-Body Wearables  Smart biomarker monitoring devices  Vitals measurement devices and apparel  Chronic pain management Bathroom  Smart pill dispensers  Diagnostic devices  Smart mirrors  Smart weighing scale  Smart toilets Entire Home  Voice assistants to  Answer basic questions on managing disease or to connect with care providers to seek answers from experts  Remind taking medicines  Motivate users to exercise and follow prescribed regimen of diet and activity  Contactless monitoring sensors and devices for vitals monitoring • Prepare analytics-based reports on overall progress, share (if consented) with family and friends, and with care providers Smartphone Apps  Medication adherence tools  Personal disease management diaries or logs • Disease management information tools Living Room  Telehealth visits  Peer support forums (video) Bedroom  Sleep apnea support for diagnosis & therapy  Sleep quality monitoring Kitchen  Connect with nutritionist for diet and meal suggestions  Smart bin to track used food and check compliance with treatment regimen • Smart refrigerator that keeps track of expired items and suggests recipes on the basis of available ingredients and diet recommendations Voice Interactive Diagnosis & Control Tools Artificial Intelligence + Data Analytics Insights Legend  Active Care |  Monitoring |  Support
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  47 Alternate care locations Theimportance of post-acute care Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan • Clinical comorbidities to be managed • Complications—current and potential • Functional status/cognitive ability • Necessary post-acute care Patient Discharge Home Shorter length of stay = higher profits* 30-day readmission penalties Hospital Patient Discharge Decision *Fixed reimbursement per episode of care • If hospitals can ensure patient wellbeing after discharge and prevent readmissions within 30 days, they stand to benefit, as the profit is higher. • Care beyond hospital walls is critical also for hospital’s reputation in the era of healthcare consumerism and healthcare reviews. • Patients are more comfortable recovering in their own homes, also lowering the chances of hospital-acquired infections complicating their recovery process. Important Consideration Factors • Family support • Home environment • Patient preferences The growing importance of post- acute care Hospital
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  48 Alternate care locations Requirementsfor post-acute care in the smart home Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan Support System for Recovery Understanding and Remembering Discharge Care Plans Compliance to Medical Advice IntheSmartHome Analytics, Artificial Intelligence Care Coordination and Management Caregivers, providers, and family members are updated on condition and progress and empowered to take necessary corrective action. EHR Integration • Medical monitoring and advice • Information support for recovery • Assistance for daily tasks • Regular vitals monitoring • Telehealth support • Automated home tasks • Primary care provider • Caregiver • Family • Recording discharge care plans, making them accessible to primary care provider and care givers • Integrating medical advice in daily care of the patient • Via smartphone apps (hospital/third-party vendor) • Accessible via voice/screen interface, which also provides reminders and advice, on the basis of the care plan • Hospital • Primary care provider • Caregiver • Ensuring adherence to medication and other recovery advice • Tracking recovery progress • Medication adherence tools and devices • Vitals data and telehealth check ups, in-person follow- up appointments to assess recovery progress • Specialist care professional • Primary care provider • Caregiver What How Who
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  49 Alternate care locations Requirementsfor post-acute care in the smart home Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan On-Body Wearables  Smart implants  Counter nausea/vomiting (post- chemotherapy)  Vitals/activity tracking devices  Smart clothes Bathroom  Smart pill dispensers  Diagnostic devices  Smart mirrors  Smart weighing scale  Smart toilets Entire Home  Contactless monitoring sensors and devices for vitals monitoring  Motion sensors for detecting activity, turning lights on/off  Collection of data on patient activity and progress, and sharing with care team and family members • Voice interactive tools for asking queries related to post- discharge care plan • Reminders via voice or screen interfaces to adhere to care plan • in view of temporary disabilities, support for carrying out daily tasks in the recovery phase, that is, tech-enabled or tool-based caregiver support Smartphone Apps  Medication adherence  Activity tracking Living Room  Telehealth visits in lieu of physical visits when possible Kitchen  Connect with nutritionist for diet and meal suggestions • Recipe support in accordance to dietary requirements and restrictions Bedroom  Sleep quality monitoring  spO2 monitoring  Ambient environment Social Engagement Tools  Post-discharge care plan discussions and queries, tracking progress, with care providers via telehealth solutions • Video communication screens for virtually visiting friends and family • Mixed-reality-based entertainment solutions for the recovery phase which curtails outings or activities Voice Interactive Diagnosis & Control Tools Artificial Intelligence + Data Analytics Insights Legend  Active Care |  Monitoring |  Support
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  50 Alternate care locations Challengesin maternal and infant health management Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan Tracking fertility cycles for conception Monitoring fetal wellbeing Tracking contractions Tracking and recording fetal heartbeats and movements Track and log contractions automatically, especially in case of high-risk pregnancies Maternal Health Infant & Toddler Health Keeping track of details Feeding, naps, diaper changes, doctor appointments, vaccination schedules, medication dosage, milestones Finding reliable information all parenting queries; peer support Monitoring health Measurement of vitals, motion, sleep Remote monitoring ensuring child wellbeing when away Access to care providers preferably at home, before and after childbirth to ensure wellbeing
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  51 Alternate care locations Requirementsfor maternal and infant health management in the smart home Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan Preconception Prenatal care Delivery Postnatal care Tracking sleep cycles, feeding patterns and growth Vaccinations, growth checkups Weaning, supplements General health monitoring Learning, wellbeing and safety Tracking periods, fertility, family planning support Monitoring maternal and fetal health and wellbeing Normally occurs in traditional care delivery sites Ensuring mother’s recovery Allergies, deficiencies Ensuring appropriate growth Ensuring a growth-conducive environment and support Minor ailments diagnosis and treatment Preventing injuries and appropriate learning Smart Support—From Preconception to Infant Management
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  52 Alternate care locations Smarthome features for maternal and infant health management Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan On-Body Wearables  Counter nausea, vomiting, morning sickness  Fetal activity monitoring  Contractions monitoring  Infant vitals monitoring Bathroom  Diagnostic devices  Smart mirrors  Smart weighing scale  Smart fertility trackers/toilets  Smart toothbrush (children) with augmented reality Smartphone Apps • Infant activity, allergies, milestones and vaccination record or log Living Room  Telehealth visits (mother and child) Kitchen  Connect with care provider, pediatrician or nutritionist for diet and meal suggestions Bedroom/Nursery  Baby monitors  Sleep quality monitoring  spO2 monitoring  Ambient environment  Lullaby/calm soothing music played to help put the baby to sleep; automated if required to be played at night if baby’s cries detected  Smart breast pumps Entire Home • Disabling of electric sockets accessible to children • Two-way baby monitors to monitor activity • Remotely communicate (audio-visually) with baby in the nursery from other rooms (while working in kitchen, for example) or outside home to support baby-sitter • Voice assistants to provide information on parenting questions, access and input app data Voice Interactive Diagnosis & Control Tools Artificial Intelligence + Data Analytics Insights Legend  Active care  Monitoring • Support
• 53.
  53 Alternate care locations Smarthome requirements for the physically and intellectually disabled Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan Tasks or Functions that are a Challenge for Patients with Disabilities Vision Hearing Thinking Learning Movement Mental health Remembering Communicating Social relationships Daily Tasks • Opening doors to rooms and of cabinets • Switching on/switch off lights, drawing blinds/curtains • Controlling thermostats, environments • Bathing and toileting challenges • Accessing cabinets, kitchen counters, sinks and cook-tops • Watching television, changing channels • Answering doorbell, opening door • Locating items (such as smartphone) • Understanding voicemails • Dispensing medication • Self-evaluating vitals • Maintaining home security • Housekeeping activities • Support after falls/emergencies • Guidance and reminders for daily activities • Communicating, socializing with others • Writing/typing, reading, math
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  54 Alternate care locations Smarthome requirements for the physically and intellectually disabled Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan • Each type of disability poses a unique set of challenges, with an additional need for ‘personalization’ of solutions designed for the smart home resident, depending on their level of disability. • Smart home tools are a necessity more than a novelty, allowing disabled residents to increase their capabilities and maintain independence, while maintaining their dignity. Visually Impaired Hearing Impaired Physically Disabled Intellectually Disabled Heavy reliance on interaction with voice-enabled devices: • Warning for obstacles, open doors • Finding objects like smartphones, medications or other devices • Helping identify objects or people at the door. • Ascertaining status of environment: curtains, cooktops, thermostats. • Reliance on visual feedback, depending on level of hearing loss: o Send notifications for door bell ring, innovative wake up ‘alarms.’ o Transcribe incoming voice mails. o Hearing aids that connect directly with smart devices and phones • Tracking ear health and ability, and impact on overall health • High need for customization, depending on the level of disability • Environmental control via remote interfaces: blinds, lights, thermostat, internal doors, countertops, cabinets, etc. • Activities of daily living (e.g., prepared baths at desired temperature, and smart door locks or door bells) • Reminders for daily exercises to hone mental skills (e.g., math) • Monitoring vitals and activity without contact, especially for those who cannot detect/express symptoms for ailments • Tracking moods, emotions and developmental progress or deterioration on the basis of activities, movements, and behavior
• 55.
  55 Alternate care locations Smarthome features for the disabled Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan On-Body Wearables  Smart implants (including future brain implants)  Vitals/activity tracking devices  Smart clothes Bathroom  Specialized medication dispensing devices  Diagnostic devices  Smart mirrors, bath  Smart toilets Smartphone Apps  Tracking development and emotions (intellectual disability) Living Room  Telehealth visits • Voice-controlled smart TVs, projectors Kitchen • Movable countertops, cooktops • Fast-cooling cooktops to prevent burn injuries Bedroom/Nursery  Sleep Quality Monitoring: spO2 monitoring, ambient environment  Height adjustable beds, cribs  Soothing lights, sound therapy for intellectually disabled  Light-based, vibration-based notifications/alarms for the hearing impaired Entire Home • Motion sensing and/or voice-controlled and/or display controlled lights, thermostats, blinds • Automatic doors and windows, smart locks • Robots for home assistance – transporting residents between beds, bathrooms, wheelchairs • Therapeutic and teaching robots for the intellectually disabled. Voice Interactive Diagnosis & Control Tools Artificial Intelligence + Data Analytics Insights Legend  Active care  Monitoring • Support
• 56.
  56 Alternate care locations Exploringhealth and wellness areas Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan Physical Intellectual Spiritual Occupational Emotional Social Environmental Types of Wellness in the Smart Homes Context, Global, 2017 Complete, balanced wellness also leads to better health. • Diet • Exercise • Sleep • Sharp memories • Active brains • Thinking skills Living a purposeful life Being able to balance work and personal lives • Decreasing stress • Improving mental wellbeing and happiness Staying engaged with friends and family, ensuring positive and meaningful relationships Protection from environmental toxins, sharing a harmonious relationship with nature and environment
• 57.
  57 Alternate care locations Smarthome features for health and wellness Bedroom Sleep Quality Monitoring  spO2 monitoring  Ambient environment • Sleep support—aroma, sound or light therapy, other tools for insomnia Bathroom  Smart pill dispensers  Diagnostic devices  Smart mirrors  Smart weighing scale  Smart toilets On-Body Wearables  Smart implants  Neuromodulation for pain management, mood enhancement or goal achievements  Vitals/activity tracking devices and apparel Entire Home  Contactless monitoring sensors and devices for monitoring of vitals  Motion sensors for detecting activity, turning lights on/off  Carbon monoxide, carbon di- oxide, smoke and water leakage sensors for preventing mishaps and tracking exposure • Air and water quality testing for environmental toxins • Music, light, aromatic ambience to create environments relevant to residents’ moods • Smart furniture to help improve posture and health, and to promote activity Smartphone Apps  Medication adherence  Activity tracking • Daily health/diet logs • Brain exercises Living Room  Telehealth visits  Smart exercise equipment Kitchen  Diet and meal monitoring, suggestions for appropriate recipes Social Engagement Tools • Companion robots • Pets with smart trackers and other smart pet devices • Video communication devices or screens for virtually visiting friends and family • Mixed/virtual reality headsets for virtual presence/reliving memories Voice Interactive Diagnosis & Control Tools Artificial Intelligence + Data Analytics Insights Legend  Active Care |  Monitoring |  Support Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan
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  58 Source: Vision 2025– Healthcare in the Smart Home, Frost & Sullivan Alternate care locations A smart home will gradually evolve into a more sophisticated and interactive healthcare monitoring environment PERS Diet & Nutritional Monitoring Chronic Disease Management Siloed Implementations Platform-based Implementations Remote Patient Monitoring Digital Coaching Smart Wellness Activity Monitoring Medication Management Evolution of Healthcare Services in the Smart Home Independent Devices Voice Tablets Smartphone Apps Mixed Reality Past Present Future Increasing use of data integration, analytics and artificial intelligence Smart Toilet Monitoring Environmental Monitoring Smartwatch Chatbots InterfacesLegend Services
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  59 Source: Internet ofMedical Things, Forecast to 2021, Frost & Sullivan Alternate care locations There are many potential smart home applications with in home IoT
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  60 Source: Internet ofMedical Things, Forecast to 2021, Frost & Sullivan Alternate care locations In home health virtual assistants can provide a holistic health view
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  61 Source: Internet ofMedical Things, Forecast to 2021, Frost & Sullivan Alternate care locations In home health virtual assistants can provide a holistic health view
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  62 Source: Vision 2025– Healthcare in the Smart Home, Frost & Sullivan Alternate care locations Tech savvy consumers are very interested in living in an integrated home health monitoring environment. Yes 32% No 33% Already Have One 4% Don't Know 31% 35% 41% 31% 22% 12% 9% 0% 20% 40% 60% 18–24 25–34 35–44 45–54 55–64 65 or older Have or Wish to Have There is sufficient interest in an integrated connected home environment (grown over previous year’s results). Interest in a home health monitoring network is definitely high, especially amongst the 25-to-34 year age group which is tech savvy and tends to be the ‘tech decision maker’ of the house. A connected home environment includes a home network; a multi-room video experience; voice, video and data services; home security monitoring; and wireless smartphone access to home systems. A home health network service can include services that track vitals or overall health conditions via wearables, sensors and devices, or telehealth. (n=1,505 North American adult consumers) 2018 Frost & Sullivan North American Consumers Survey for Connected Home Preferences Question: If a communication carrier offered a connected home package that included setting up a home network; providing a multi-room video experience; voice, video and data services; home security monitoring; and wireless smartphone access to home systems, would you/your household consider buying it? Do you have a home health-monitoring network (tracking vitals, sleep quality, health conditions, etc.)? Would you be interested in such home health-monitoring network (tracking vitals, sleep quality, health conditions, etc.) if a digital health company designed it and installed it for you? Willingness to Buy Connected Home Environment Solutions, North America, 2018 Interest in Home Health Network by Age Group, North America, 2018
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  63 Source: Vision 2025– Healthcare in the Smart Home, Frost & Sullivan Alternate care locations North America and Europe are most likely to pick up on alternate care trend and adopt smart homes for monitoring health and wellbeing Middle East and Africa When compared for overall smart homes readiness, the regions show an unsurprising trend. Given that healthcare delivery in smart homes will also depend on the development of the overall smart home ecosystem, this assessment is reflective of the care delivery trends in smart homes, as well as of the prevalent healthcare industry trends. North America Europe Asia-Pacific Infrastructure Technology Government Push (Energy Efficiency) Consumer Awareness Affordability & Willingness to Invest Low High Legend Latin America Rank 1 2 3 4 5 Smart Home Healthcare Market: Regional Readiness Assessment, Global, 2017
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  64 Alternate care locations SmartHome Healthcare Market: Impact of Top 10 Trends, Global Source: Vision 2025 – Healthcare in the Smart Home, Frost & Sullivan Higher impact Projected Impact on the Smart Homes for Healthcare Market Lower impact Certainty Low High Rising healthcare costs; demand for solutions to control itLower Growth Impact Medium Growth Impact Higher Growth Impact Positive Impact Negative Impact Increasing incidence of chronic diseases, ageing population Increasing interest of non- healthcare tech companies in the industry, convergence with technology Growing interest in connected home products; first buy leads to subsequent purchases of other automation devices Adoption and installation challenges (cost, expertize, implementation) Privacy concerns and regulations, especially with healthcare data Cybersecurity risk Lack of sufficient, strong healthcare in smart home success stories Consumers becoming aware of importance of health and wellness; rise of quantified- self and similar movements Traditional healthcare companies going digital; digital health industry growing
• 65.
  65 Back to Contents 1.6.PATIENT MANAGEMENT – USE OF WEARABLES
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  66 Source: Frost &Sullivan Patient management – discussion Digital technologies are helping in more efficient monitoring of health. A confluence of cultural and societal changes is motivating individuals to become more empowered as consumers. For individuals, becoming empowered pertains to gaining a stronger sense of control over one’s circumstances as well as a greater sense of well-being and satisfaction. Cultural attitudes are evolving from conceptualizing the patient as a mostly passive recipient of whatever treatment the doctor decides (the provider-centric model) to recognition of a more active, engaged patient/consumer that works in conjunction with caregivers to realize the best possible health outcome (the patient-centric model). Empowered consumers and patients want to be—and need to be—a full member of the healthcare team. Access to accurate information promotes a stronger connection between the patient and the healthcare team, providing the nexus for patient- centric models that drive high levels of engagement and activation. Digital technologies serve an important role in helping people connect with both peers and advice givers/seekers to share information. Use of wearables is picking up and aiding this trend. Care systems are shifting away from traditional fee-for-service (FFS) toward fee-for-value reimbursement that rewards providers based on the quality of care rather than the quantity of care. Value-based care comes with increased financial risk. Therefore, care delivery must be re- engineered to ensure economic viability under this new business model. Consequently, providers are developing new digital strategies for better alignment of care processes to ensure collaboration with key stakeholders, including patients and their families, to ensure optimal health outcomes and maximum reimbursement. Smart hospitals and telemedicine are key enablers in this regard.
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  67 Source: Frost &Sullivan Patient management Wearables are poised to play a critical role in broader transformations in healthcare delivery. Technology-Driven Paradigm Shift in Future Healthcare System Factors Transforming Healthcare From Today As-is-State (2015) Future To-be-State (2025) Focus Process/provider centric Patient-centric and participatory Objective Symptomatic, curative Predictive and preventive Access/ Location Limited in-hospital care (centralized) Any time, any place- homecare (decentralized) Technology Isolated systems Integrated systems (digital medicine) Treatment Methods Episodic care (invasive) Holistic care (minimum/non-invasive) Medication Blockbuster medication Personalized medication Technology Innovation Digitization of HealthCare Decentralized + Miniaturized + Personalized Shift Role of Wearables in Transforming the Future of Health and Wellness Customer Centric Care (Data Driven – Engaging, Social, Outcome-based Care) Cost Containment (Promoting ACO and value-based care) Preventive & Wellness Focused (Personalized Medication/Care) Decentralization of Care Delivery Model (Home & Virtual Care; eVisits)
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  68 Source: Frost &Sullivan, AJM Patient management Wearables can enable anytime/anywhere access through enhanced mobility, both for the caregiver and patient to optimize the outcomes and cost of care. Hospital Reduces readmission, patient process time, and test duplication Physician Can access comprehensive patient data and history for improved decision making and diagnosis Patient Can stay more informed about personal health and wellness, and benefit from reduced treatment time Benefits to Different Stakeholders Payer Reduced treatment cost, hospital length of stay, and overall process efficiency Wellness Program Home Monitoring Medication Adjustments Service While Travelling PoC Labs and Diagnostic Health Awareness & Training Patient Physician Insurance Self Monitoring Regular feedback Reinforcement Appropriate level of intervention Analytics Report Population health benchmarking Reimbursement Wearables Care Modules Wearable-enabled Decentralized Care Model by 2025
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  69 Source: Frost &Sullivan Patient management Advancement in sensor and wireless platform technologies is driving the evolving need of consumers for smart wearables. • Emerging paradigm for wearables in the consumer space • Hardware with multiple applications and platform integration • Emerging market with competing platforms and advanced user interface • For example, smart watches, smart bands, smart glasses • Created from the point of view of being a special-purpose device • Limited functionality and does not run on third-party apps • Product cycle has reached the peak and the market is mature • For example, Basic activity trackers and bands Overview Always-On Interconnected Flash ROM SRAM Apps CPU Interconnected ROM SRAM DMC Always- On GPU Display Processor Video Processor Architecture Fitbit, Xiaomi, Nike, Jawbone, Microsoft, Garmin, Samsung, Sony Apple Watch, Samsung, Microsoft, Google, Sony, LG, Pebble, Motorola Passive Tracking Smart WearablesWired Devices Past Current Future First Generation Second Generation
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  70 Source: Frost &Sullivan Patient management Six key attributes around design, technology, and function for future success of smart wearables 6 Key Attributes of Smart Wearables • Wireless charging • Low power consumption • Multiple charging options • Minimum charging time • Multi-parameter tracking • Augment special features • Third-party apps • API partners • Accessories • Customized and modular functionalities • Voice/gesture recognition • Augmented reality • Remote sensing • Wi-Fi • Cellular Bluetooth • NFC, 3F/4G • Less distracting UI • Quick response time • Automated user feedback • Plug-and-play mode Inter- Operability Always- On Multi- Functional Ease of Use Hands- Free Always Connected 4 Design Technology Function API: Application program interface
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  71 Source: Frost &Sullivan Patient management Consumer electronics and non-traditional participants entering the clinical wearables space • Apple Inc. CEO Tim Cook in his recent public appearance testified that Apple’s strategy is to branch out and create actual medical devices without force fitting clinical aspects into existing consumer wearable segments . • Moreover, Apple’s open-source frameworks such as HealthKit and ResearchKit are to complement building services around wearable technology. • Recently-formed Google Life Sciences has multiple on-going med tech R&D initiatives. Google’s clinical-grade wearables are expected to target non-invasive diagnostic tests. • Examples: Google X team is building a clinical-grade wearable health sensor for cardiac and activity tracking and investigational use. • Speaking at Mobile News “Wearables and Accessories” (Nov. 2015) Leila Martine, Microsoft’s product marketing director said, “Microsoft intends to become the leader in advanced wearable technology for healthcare and medicine.” Microsoft’s future wearable technology on cloud and mobile apps aim to cater to digital therapeutics to address unmet health problems such as mental healthcare. • Wearable technology remains an integral part of Intel's future innovation roadmap with other complementing technologies such as voice, gesture, 3D, holography, robotics, and the virtual piano. • In the recent past, Intel has partnered with Parkinson's disease researchers and been helping them use wearable devices, IoT, and Big Data technologies to collect and analyze patient data. • Samsung is expected to move into clinical-grade wearables and applications in clinical trials with its upcoming wristband Simband. It has partnered with Medtronic to enable patients implanted with neuromodulation therapies to use consumer electronics such as smartphones, wearables, or tablets to securely and wirelessly transmit real- time data from their device to their physicians—aiding them to make informed, data-driven treatment decisions.
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  72 Source: Frost &Sullivan Patient management Companies need to find the optimum marketing trade-off between mass and niche healthcare wearables. Activity Tracker Single- Purpose Clinical Wearable Multi- purpose Health Wearables Strategic Approach: • Improve software/insights • Add more biosensors • High acuity health features Strategic Approach: • Create wearables for family of health segments • Feature extension by improving interoperability and Integration Degree of Clinical Relevance/ Product Novelty AddressableMarket Low High HighLow Fail to gain widespread adoption due to lack of usefulness/ROI Highly valued but limited to niche segments Fear of regulations Companies that fail to embrace regulatory requirements (FDA, HIPPA, CE, and so on), and avoid making their devices truly medical-grade may get to market faster, but will eventually restrict their long-term potential in the saturated consumer-grade wearable market. Too Niche, Fail to Gain Widespread Adoption Wearable devices that address a very niche use case often fail to achieve widespread adoption. Companies that fail to achieve customer-centric integrations often over-estimated the value and expectation for adoption and market size.
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  73 Source: Frost &Sullivan Patient management Companies should assess the future attractiveness rating by segment for clinical and medical-grade wearables Low HighKey : PayerPatient Physician Respiratory & COPD Low High 1 52 3 4 Low High 1 52 3 4 Low High 51 432 Heart & CVD Low High 1 52 3 4 Low High 1 52 3 4 Low High 51 432 Multi-Parameter RPM Low High 1 52 3 4 Low High 1 52 3 4 Low High 51 432 Aging in Place Low High 1 52 3 4 Low High 1 52 3 4 Low High 51 432 Diabetes and Obesity Low High 1 52 3 4 Low High 1 52 3 4 Low High 51 432 Pediatric Health Low High 1 52 3 4 Low High 1 52 3 4 Low High 51 432 Women‘s Health Low High 1 52 3 4 Low High 1 52 3 4 Low High 51 432 Neurological & Mental Health Low High 1 52 3 4 Low High 1 52 3 4 Low High 51 432 Attractiveness to Sleep Disorders Low High 1 52 3 4 Low High 1 52 3 4 Low High 51 432 Chronic Pain Management Low High 1 52 3 4 Low High 1 52 3 4 Low High 51 432
• 74.
  74 Back to Contents 1.6.PATIENT MANAGEMENT – SMART HOSPITALS
• 75.
  75 Patient management –Smart hospitals The popular notion of Digital = Smart is incorrect; going digital is only the first step. Source: Future of Smart Hospitals, Frost & Sullivan Optimize / Redesign / Build New Smart Hospitals Smart hospitals are those that optimize, redesign, or build new clinical processes, management systems and potentially even infrastructure, enabled by underlying digitized networking infrastructure of interconnected assets, to provide a valuable service or insight, which was not possible or available earlier, to achieve better patient care, experience, and operational efficiency. Clinical Processes Management Systems Infrastructure Digitized, networking infrastructure of interconnected assets Achieve better patient care, experience and operational efficiency Frost & Sullivan Defines Smart Hospitals as: Smart Hospital implementations involve strategy, not a to-do list For providing a valuable service or insight, not possible or available earlier The ‘Smart Component’
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  76 Patient management –Smart hospitals Healthcare transformation impact on hospitals Source: Future of Smart Hospitals, Frost & Sullivan Market Forces Emerging Trends Rising care delivery costs, reimbursement pressures Aging population, increasing incidence of non- communicable diseases Healthcare consumerization Improve productivity and efficiency, reduce operational costs Employ multi-disciplinary approaches, improve care coordination Cater to needs of empowered patients who are active participants in care decision making HOSPITALS
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  77 Patient management –Smart hospitals Hospitals Facing Increasing Pressure to Adapt or Close. Source: Future of Smart Hospitals, Frost & Sullivan PRESSURE • Evolving Re-imbursement Landscape • Changes in Healthcare Delivery Models CHANGE Next level of supply chain savings • Implement data standards • Change contracting process • End-to-end supply chain costs • Expand scope of products in distribution CHANGE Moving beyond the acute care setting • Enable home care setting • New front-line care models • Leverage non-acute data CHANGE Supporting outcomes • Link products and outcomes • Data for actionable insights • Share risk • Standardization CHANGE Restructuring for consolidation • Transparency on product-service costs • Strip away supply chain costs • New capabilities to enhance care outcomes HOSPITAL
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  78 Patient management –Smart hospitals Smart hospital impact on healthcare industry. Source: Future of Smart Hospitals, Frost & Sullivan, Image Source: Flaticon (Smashicons), Thinkstock PRESENT FUTURE • Healthcare consumerization is a growing trend, affecting hospitals’ ability to attract patients as well as reimbursements in some countries. • Smart hospitals, with a patient-centric approach, ensure patient experience is optimal, allowing for better revenue generation. • In line with the cost reduction targets, patient outcomes will also need to be improved to reduce or even eliminate preventable, expensive hospitalizations. • Smart hospitals will enable better quality of care with personalized approaches and reduced medical errors to achieve better patient outcomes. • Hospital expenditures account for the largest share of healthcare expenditures. • As global economies struggle to reduce the overall expenditures on health, smart hospitals will prove to be an effective tool to achieve that target. Healthcare Industry Outcomes Cost Experience Smart Hospitals
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  79 Patient management –Smart hospitals Smart hospitals are utilizing a myriad of digital technologies to deliver on patient-centric care. Source: Future of Smart Hospitals, Frost & Sullivan Wearables H O S P I T A L S Representative list, not exhaustive Robots Augmented/ Virtual Reality mHealth Artificial Intelligence Community Enhancement Telehealth Currently implemented as singular efforts Technologies lie in disparate systems Unplanned applications lead to significant manual coordination efforts Reduced workflow efficiency: opposite of what is actually expected Current State of Implementation Patient Management Tablets Patient Monitoring Sensors RFID Tags Internet of Things Blockchain Open API Analytics Big Data Tools Security & Identity Management Population Health Management Chronic Disease Management Financial Support Wellness Plans Support Smart Hospitals: Digital Technologies and Services Landscape
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  80 Patient management –Smart hospitals Digital health has long-term healthcare implications. Source: Frost & Sullivan, Intel Health Innovation Barometer, McKinsey Survey Patients want to use digital health services in the future More than 75% 39.7 M Healthcare smartphone apps in use 150+ exabytes Amount of healthcare data that exists today 24 months Rate at which healthcare data doubles 20-30 B Internet of Medical Things Devices by 2020 Increasing digitization complexity in healthcare Are hospitals prepared for a digital future? 57% People who believe traditional hospitals will be obsolete in future Healthcare Industry: Increasing Digitization Complexity, Global, 2016
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  81 Present Future Patients Patients canview their medical records, lab test results and learn more about their health conditions on tablets in their rooms Patients’ educated about their health conditions, diet and activity requirements via smart in-room devices, with content progressing in-line with patient recovery as tracked by the Electronic Health Record data Physicians Patients’ vitals tracked using wearable /in-room devices and automatically recorded in EHR; physicians can access data on tablets while on rounds Integrated, live patient data from various body, room sensors and lab results visible to doctors, allowing for ‘virtual’ rounds, in addition to alarms when patient health deteriorates Nursing Staff All of patient’s condition and medication history stored in EHR on hospital servers, accessible from any computer/tablet after authorization Nurses have access to information on wearable/mobile devices allowing them to perform clinical duties without excusing themselves from patient room to access their EHR data Administrator Administrators can view all housekeeping and facilities management details online to identify incomplete tasks or equipment faults in real-time and fix them immediately Administrators for areas such as housekeeping and facilities management have access to basic patient information to speak to them and clinical staff to get feedback about expectations being met Patient management – Smart hospitals Digital health has long-term healthcare implications Source: Future of Smart Hospitals, Frost & Sullivan, Image Source: Flaticon Beyond digitization, hospitals must align processes and workflows, eliminate technology implementation silos, and ‘connect’ all technologies to ‘talk’ to one another, with an objective to enhance patient experience and to improve care, to harness the true potential of a smart hospital. Smart Hospitals: Present and Future Utilities
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  82 Patient management –Smart hospitals What smart hospitals do different than digital ones Source: Future of Smart Hospitals, Frost & Sullivan, Image Source: Flaticon (Freepik) • Digital hospitals are ‘connected’, but just because they are networked, does not make them ‘smart’! • Truly smart hospitals derive insight and value from the networked services in a digital hospital Reduce operational costs, improve margins Help patients recover faster Reduce staff burden, make jobs easier Improve patient satisfaction and experience Smart Hospital: Areas for Development Operational Efficiency1 Clinical Excellence2 Patient Centricity3 Advantages
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  83 Patient management –Smart hospitals The smart hospital concept overview Source: Future of Smart Hospitals, Frost & Sullivan, Image Source: Flaticon (Freepik) Facilities Building Automation Systems Network Infrastructure Asset Maintenance and Management Mobile Asset Tracking Logistics Inventory Control Other Logistics People Flow Personnel Nurses Patient Rooms OPERATIONAL EFFICIENCY CLINICAL EXCELLENCE PATIENT CENTRICITY Doctors Departments Patient Outcomes Emergency Surgery Radiology Hospital-Wide Patient Monitoring Referrals Patient Engagement Hospital Services Technology Initiatives Hospital Design
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  84 Patient management –Smart hospitals The smart hospital framework Source: Future of Smart Hospitals, Frost & Sullivan DATALAYER SMARTINSIGHT LAYER ACCESSLAYER FACILITY SYSTEMS CLINICAL DEVICES OPERATIONS DEVICES OTHER DEVICES Sensors Systems Interconnected Networks INFORMATION DATA DATA DATA DATA Connectivity ANALYTICS MACHINE LEARNING DEEP LEARNING ARTIFICIAL INTELLIGENCE CLOUD (Optional) Enable devices and machines to become smart; automate some tasks to make human job easier /faster AND INSIGHT MobileDesktop Tablet Appropriate level of insight customized to every potential user (clinical staff, operations staff, support staff) to enable them to perform their job faster and efficiently. Also, appropriate information provided to the patient, on demand. User inputs and instructions can also enable smart, automated operations, reducing workload for staff Ability to provide commands/instructions to take action
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  85 Patient management –Smart hospitals Clinical areas in a smart hospital Source: Future of Smart Hospitals, Frost & Sullivan Ear, Nose, Throat Geriatrics Gastroenterology Hematology Obstetrics/Gy- necology Maternity Neonatal Nephrology Neurology Oncology Ophthalmology Orthopedics Rheumatology Urology Emergency Operating Room General Surgery Anesthetics Critical/Intens- ive Care Psychiatry Outpatient* Inpatient Radiology Pathology Pharmacy* Physiotherapy Sterilization Unit Nutrition/Dieteti- cs Services Administration Human Resources Finance Information Technology Facilities Management Food Services/Caterin g Non-clinical areas not considered in this analysis Least Impact Medium Impact Maximum ImpactLEGEND: Cardiology Supporting Areas
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  86 Patient management –Smart hospitals Departments—Emergency Source: Future of Smart Hospitals, Frost & Sullivan, Image Source: Flaticon (Smashicons) • Patients can register pre-arrival using app/Web site • This allows them to view approximate wait times, as well as helps the ED better plan for patient flow • Paramedics can transmit patient vitals and other clinical information from ambulance to the ED, for better preparedness • Interoperability between emergency services and hospital medical records can also help for better patient outcomes I N F L O W The Emergency Department Patient Information Screen(s) Helps manage patient flow, communication and care coordination within the ED Feed information to central information screen Digital whiteboards in every exam room/next to bed Provides information on: • Care team members – names and pictures • Status of lab tests • Diet information • Discharge information • Staff member responding to alert Eliminates: • Back-and-forth phone calls • Communication by hand-written notes • Delays in decision-making due to unavailability of latest test results
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  87 Patient management –Smart hospitals Departments—Surgery and Operating Room Source: Future of Smart Hospitals, Frost & Sullivan, Image Source: Flaticon Smartphone app/Web-based interactive tools, checklists, and reminders for patients to adhere to pre-surgery instructions • Smartphone app/Web-based tools for customized aftercare plans • These aim to educate and guide the patients on recovery, as well assess their progress • These also provide the relevant contact information of hospital staff/physicians for follow-up questions Training • Virtual reality-based training and simulation tools Planning • Virtual/Augmented reality- based surgery planning and rehearsal • 3D printed anatomical models for planning • Robotic surgery (with potential for autonomous surgery) • Augmented reality-based surgical navigation tools • 3D printed tools and implants • Surgery optimization tools • Accurate orthopedic implant positioning tools • Other tools, such as blood loss measurement tools PATIENTS SURGEONS • Tools for assessing patient recovery • Tools for gauging implant performance (for example, orthopedic implants with sensors) Pre-surgery During Surgery Post-surgery
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  88 Patient management –Smart hospitals Departments—Radiology Source: Future of Smart Hospitals, Frost & Sullivan, Image Source: Flaticon (Dinosoft Labs, Freepik, Nikita Golubev Using inputs from traditional 2D images to construct 3D models of anatomies to better understand maladies – as a personalized tool to help patients comprehend their conditions and also for doctors and surgeons to design therapies tailored to each unique patient condition Deep learning algorithms to • Help radiologists process images and diagnose faster, addressing personnel shortages • Improve diagnosis of rare conditions • Design precision radiation treatments for oncology patients Patients’ images available within and across health systems, helping construct a complete picture of patients’ health history and disease progression • Advanced, state-of-the art imaging equipment • Portable device solutions for imaging in patient rooms/outpatient point of care, to help patients with limited mobility and for streamlining bottleneck issues in the department EQUIPMENT TECHNOLOGIESIMAGE ANALYSIS Cloud Machine Learning / Artificial Intelligence 3D Modeling Higher application of interventional radiology procedures to help replace other costlier and invasive procedures
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  89 Patient management –Smart hospitals Departments—Intensive Care Source: Future of Smart Hospitals, Frost & Sullivan, Image Source: Image Source: Thinkstock Continuous Monitoring Remote Care Tele-Care Use of algorithms to process data generated by patient- monitoring devices to • Minimize need for periodic checks by nursing staff • Reduce alarm fatigue • Raise pertinent alarms for deteriorating patient condition • Serve as pre-requisite for remote care • Single location control room to remotely monitor patients spread across different health systems locations’ intensive and special care patients who do not have specialists during the night shift • Data from monitoring devices flows into this control room for monitoring patients and alerting ground staff for appropriate interventions when necessary • Some intensive care patients can be discharged to their homes earlier than usual, leveraging the same technology as for remote care • Under constant monitoring at home, patients can video call any doctor or nurse at any point of the day • This concept was run by Banner Health in the US as a pilot for its 28 hospitals, and it estimates saving 33% costs
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  90 Patient management –Smart hospitals Regional readiness for smart hospital adoption Source: Future of Smart Hospitals, Frost & Sullivan 4.5 4.0 2.5 4.8 4.3 3.5 4.0 3.7 3.03.0 3.0 2.5 End-user Readiness Consumer interest in health and wellness and in movements like Quantified Self is important. However, more important is clinician comfort with and education in medical technologies to help them navigate their day-to-day tasks. Spending Power Health systems with clear incentives for providers and vendors to collaborate and enter into risk-sharing agreements are better positioned for smart hospital development. Sources of funds could be public or private, as long as they are transparent and accountable. Technological Sophistication High levels of Electronic Medical Records and Health Information Systems (>70%) adoption in hospitals and increasing adoption in primary care are foundational infrastructure that contribute to smart hospital success. While the technologies may be easily available in all regions, uniform ICT penetration is a challenge. Regulatory Landscape Regulations that support payments for quality are limited to the US. Other regions have invested in the concept but do not have advanced regulations yet. Compliance is building up across regions and emerging as a key driver for smart hospital investment. North America Europe APAC Score(1–5) Smart Hospitals Market: Regional Readiness Assessment for Smart Hospitals Adoption, Global, 2016 For each of these Assessment Domains, Frost & Sullivan rated the largest geographic regions, North America, Europe, and APAC, on a five-point scale.
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  91 Patient management –Smart hospitals 3 Big Predictions Source: Future of Smart Hospitals, Frost & Sullivan 2 Cybersecurity will continue to be a major concern; guidelines, standards, and best practices are still being developed and shared. By 2025, a major cyberattack targeting a smart solution vulnerability in hospitals will underscore the need for stronger security strategies and measures. 3 An explosive growth for smart hospital augmentation solutions is expected by 2020, when hospitals with implemented solutions report extensive benefits and substantial return on investments. Greenfield ventures (especially hospital building replacements) are likely to take-off gradually due to a minimal need for new hospitals. 1 By 2025, 10% of hospitals across the globe will become or will have started implementations to become smart hospitals, located likely in Canada, the Nordic regions, Australia, and the medical tourism focused regions of Singapore and Dubai. Beyond 2030, today’s traditional hospitals without any smart elements will simply cease to exist.
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  92 INNOVATION ACTIVITIES MIKA SIEVI-KORTE mika.sievi-korte(at) businessfinland.fi +358 50 342 3268 INTERNATIONALIZATION MERIA HEIKELÄ meria.heikela (at) businessfinland.fi +44 778 715 3014 HANNA RANTALA, DIRECTOR HEALTH AND WELLBEING PROGRAMS hanna.rantala (at) businessfinland.fi +358 50 557 7797 SMART LIFE FINLAND PROGRAM https://www.businessfinland.fi/en/smartlifefinland