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In October 2021, orthopedic surgeons at the Hospital for Special Surgery in New York performed the first ever knee replacement with a smart implant. Called the Persona IQ, this device includes smart sensors that collect and wirelessly transmit patient data such as steps taken, walking speed, stride length, and knee range of motion. This information enables doctors to remotely monitor a patient’s recovery with the new implant, and change therapy plans as soon as necessary, rather than having to wait weeks for a patient’s follow-up visit.
The Persona IQ is one of the examples of medical innovation pointing the way to a healthcare future radically different from the current status quo. However, while a large number of healthcare initiatives have been launched in recent years, many of these have subsequently failed to make much impression on clinical practice. “In healthcare, we see things come and go,” says Pamela Spence, global health sciences and wellness industry leader at EY. “You read press releases about pilots and then things disappear. We wanted to see which projects people are really seriously investing in and planning to scale up.”
In Spence’s analysis, products such as the Persona IQ can be classified as “digitized” innovations. These initiatives essentially represent “digitized versions of existing analogue products and services.” Other innovations point beyond digitized technologies to a more ambitious approach, which Spence terms “connected care”. “These are connected and integrated operations of many digitized devices,” she says. “At this stage we start to see a degree of personalized and predictive healthcare with AI-driven insights.” One example of this connected approach is the Sheba Medical Center, a virtual hospital in Israel which treats over 1 million patients every year.
Ultimately, digitized and connected care are only milestones on the path to what Spence sees as the true model for future healthcare: the “smart health system”. Spence describes this system as built on “hyperconnected and intelligent devices that utilize the explosion of health data that exist in the ambient world around us.” Whereas the digitized and connected categories essentially represent incremental improvements on analog care, the smart category represents a radical technological disruption. “This final stage of technology evolution is truly smart,” Spence says. “A smart, intelligent ecosystem that makes use of sensors in our living rooms and workplaces to help us live more productive, healthier lives. That’s the vision.”
For instance, in a smart healthcare system, an implant like the PersonaIQ wouldn’t just be a standalone device. “It would become a node in a digital ecosystem that would deliver post-operative care,” Spence says. Currently, patients who receive a knee implant are discharged home to manage their own recovery. “They are given a booklet of exercises, but while that’s easy to follow initially, most people struggle with it after two weeks. Being smarter would mean that patients would be given an interactive physio session with a chatbot nudging them to do tailored exercises, with a digital twin on a device that reacts depending on how their bodies are recovering.”
For now, while digitized and connected care initiatives continue to emerge, the smart health system remains an unrealized vision. “It’s quite disappointing,” Spence says. “We seem to be playing around with great innovations at the pilot project stage, but then we’re not really deploying them and we’re not really scaling them fast enough.”
Spence believes that what’s holding back this sort of medical innovation is not technology but people. Recently she attended a workshop about value-based healthcare—a model proposed by Harvard researchers Michael Porter and Elizabeth Teisberg based around improving patient outcomes at a lower cost. “They were different stakeholders there—patient advocacy groups, payers, providers, life science companies—and what became really clear is that although they believed in value-based care, they couldn’t agree on what they meant,” she says. Each group, Spence realized, had very distinctive goals: Patients valued access to the right treatment, providers prioritized the most effective treatment, payers focused on the most effective solutions, and biopharma companies wanted faster clinical approval of drugs. “All these goals are connected—but they’re not the same,” Spence says. “That is the crux of the conundrum: the different stakeholders—be it payors, providers, life sciences companies, regulators or patients—fundamentally value and thus prioritize investments to achieve different things, and that’s stopping us from scaling.”
Spence believes that this lack of agreement about what constitutes the value in healthcare is preventing the different stakeholders from sharing and accessing each other’s datasets and devices, which is a crucial step in making the full transition from an analog to a smart healthcare system. “We have the opportunity to progress to smart systems only when we start to share data and combine insights across different stakeholders. But the different stakeholders need to agree on what those mutual shared values actually are,” Spence says. “Today, we are living in a world of seamless experiences—just think of Amazon, Netflix, and Airbnb. Their success boils down to factors like convenience, predictive and personalized service, vast consumer choice and transparency. It should be no different in healthcare.”
This article was originally published by WIRED UK
