The challenges facing healthcare in 2020 are as vast as they are complex. How can healthcare providers and organizations care for growing numbers of patients, increase efficiencies, improve quality and safety, retain and nurture a skilled workforce, and predict and respond to evolving crises like the coronavirus pandemic?
As healthcare transforms to meet these challenges, technology will play a critical role. Technology helps eliminate barriers to effective collaboration—factors like distance, knowledge, and access—resulting in improved operations, enhanced communication across silos, and a broad framework for data-driven decision-making. By enabling providers to capture, analyze, and integrate data across different geographic regions, practice specialties, and modalities of care, technology promises to improve outcomes for both organizations and patients.
Tools like artificial intelligence and machine learning are helping organizations manage and use growing piles of patient data, while drone delivery, machine vision, 5G, and 3D printing are making healthcare faster, more accessible, and more effective. Here’s how these six tech trends in particular are shaping the ongoing revolution.
More people than ever are visiting healthcare providers in 2020. General medical-care visits are expected to reach 200 million this year, up from original forecasts of just 36 million visits. But here’s the catch: all these people aren’t visiting in person.
As providers and patients adapt to COVID-19 and social-distancing recommendations, more and more of those visits will take place remotely. Prior to COVID-19, telemedicine was already projected to grow 16.5 percent by 2023, according to a report by Market Research Future consultants. The global pandemic has accelerated this growth: in March 2020, telehealth visits surged by 50 percent, according to research from consultants with Frost and Sullivan.
All this remote care and monitoring can put a strain on the networks of healthcare organizations, increasing congestion and slowing speeds. When jammed networks are hampered by lags and delays, communication suffers, care is less efficient, and capacity is limited.
Large files generated by PET scans, MRIs, and other types of imaging technology may not send successfully;videos used during telesurgeries are bound to be less precise; and fewer patients will be able to use cost-saving technology like remote monitoring. Without adequate bandwidth, providers will have limited access to data on mobile devices, and AI and predictive analytics capabilities will be stunted.
High-speed connectivity has become so central to effective patient care, advocates now argue that connectivity is a public-health concern. Lack of access to high-speed internet has hampered access to care in rural areas, prompting the American Medical Association to adopt a policy advocating for expanded broadband and wireless internet access across underserved parts of the U.S.
Ultra-reliable, high-bandwidth networks are required to enable healthcare to use technology to improve patient outcomes, and 5G networks are providing the answer. By providing near-instantaneous access to data and lightning-fast transmission of large files, 5G networks improve quality, efficiency, and outcomes.
Earlier this year, the Veterans Administration launched one of the nation’s first 5G hospitals in California, joining Chicago’s Rush University Medical Center and Barcelona’s San Raffaele hospital in ushering in an era of blazing-fast connectivity that will improve patient experience and reduce the cost of care.
AI AND MACHINE LEARNING
Medical data doubles in volume every 73 days—and technology experts say that’s good news for healthcare organizations. According to business and economics-research engine the McKinsey Global Institute, pairing this big data with the AI and machine learning tools needed to analyze it could result in $100 billion in annual savings for healthcare organizations.
By facilitating decision support, information exchange, and improved workflow for surgeons and surgical teams, AI holds enormous promise for healthcare, particularly in the operating room. Using motion tracking to gather data on how surgeons carry out complex procedures can inform robust algorithms that allow surgeons to share best practices across specialty teams, ultimately creating cost savings in operating rooms, says Carla Pugh, MD, Ph.D., professor of surgery at Stanford University School of Medicine and the director of its Technology Enabled Clinical Improvement (T.E.C.I.) Center.
Motion-tracking data is gathered by evaluating the location, speed, and movements of surgical instruments during a procedure, and has been shown to be an effective means of evaluating surgical skill. Compared to video data alone, motion-tracking data combined with video data provides a more comprehensive data set for training and evaluation. Using this data to create more effective algorithms for training and decision support represents an exciting application for AI, Pugh says.
“Motion-tracking technology adds a three-dimensional layer of data that enhances our ability to understand the video data,” she says. “It has the potential to streamline the AI analysis process, because video and motion data combined are easier to work with than the video data alone.We get real data on how surgeons adapt to the variety of
ways disease presents itself.”
Using AI, healthcare organizations can more easily share this data, putting data-driven decision support at surgeons’ fingertips anywhere in the world. Even with AI-augmented decision support, Pugh notes, a trained surgeon is still the decision-maker. But if a surgeon can quickly and easily access data about how others have navigated complicated presentations in the operating room, it can improve outcomes and save time.
One barrier to implementation of AI,Pugh says, is a fear of data-driven performance metrics for providers. “When we talk about AI in medicine, the huge elephant in the room is that when you mention tracking workflow and motion, providers fear that this data will be used against them, either in performance evaluation or in the courtroom,” she says. “The irony is that, with respect to video and its discoverability from a legal and malpractice standpoint, many studies show that when this type of information is used in a courtroom it ends up helping the physician.” (See “Virtual Risk: How to Manage Risk and Professional Liability When Adopting New Technology,” page 12.)
The potential for AI in healthcare is limited by the data informing its algorithms: widespread buy-in allows for more robust algorithms that yield more actionable decision support. Ultimately, Pugh says, this will be a symbiotic relationship. “The more we can integrate AI into our workflow, the better it will get at calculating,benchmarking, and providing the information we need,” she says.
COMPUTER AND MACHINE VISION
The same technology that allows an iPhone to recognize the face of its owner and self-driving cars to navigate roadways can also augment the skills of surgeons and improve patient care. Machine vision, a global market expected to reach $14.7 billion by 2025, involves the use of specialized cameras and algorithms to gather and interpret visual information in real time. During surgery, machine vision allows surgeons to see through a patient’s anatomy and orient their tools in space.
Machine vision represents the next stage of advancement for digital surgery, according to a news release from Anthony Fernando, CEO of TransEnterix, a company that added a machine vision feature to its robotic-surgery system earlier this year. The technology enhances the sensing capabilities of computer-assisted surgery, automatically moving the camera during a procedure and even responding to commands within the surgical field. Like other recent advancements in surgery, including the growth of robotic and digital surgeries, machine vision has the potential to improve patient care. But its adoption may exacerbate existing disparities in the technological
skillsets of surgeons and decrease the already dwindling number of providers who excel at open surgery. Already, many newly graduated surgeons may not be confident in performing the open version of some surgeries, while their more seasoned counterparts may have little to no experience with robotic surgeries, says Jordana Gaumond, MD, FACS, general surgeon at The Oregon Clinic.
Surgical groups should also consider what share of their procedures require digital augmentation before investing in any new technology, including this one. “For some procedures—like prostate surgery, deep pelvic surgery, or complex hernia repair—robotics allows surgeons to do things that are unimaginably awesome,” says Dr. Gaumond. “For others, we don’t need to add that level of technical difficulty. Whatever procedure is being performed, ultimately it’s the surgeon who needs to have the skill and judgment to choose the best approach.”
DRONE DELIVERY OF TRANSPLANT TISSUE
Modern drones—unmanned robotic aircraft that fly autonomously using onboard sensors and GPS-informed flight plans embedded in their systems—have been buzzing through the air since 2001, when they were first used for military missions. Soon drones may be deployed for a new mission: helping lifesaving organs reach their recipients quickly and safely. Each of the more than 30,000 organs transplanted each year must reach its recipient swiftly to remain viable. Per the United Network for Organ Sharing, hundreds of donated organs don’t make it to their intended destinations each year, and thousands are delayed by two or more hours. Compared to commercial flights, drones could deliver organs in a fraction of the time, at a much lower cost, and without unpredictable delays that could result
in the loss of a viable organ.
In 2018, the Federal Aviation Administration began changing its strict regulations on commercial drone usage, paving the way for more widespread medical use of drone technology. The following year, the first drone-delivered kidney was successfully transplanted into a patient at the University of Maryland Medical Center, the culmination of years of UMMC research on drone organ delivery. The drone flight between hospitals delivered the organ in under 10 minutes.
Drone delivery of viable organs has been proven successful, but challenges remain. Federal, state, and local governments need to change regulations to allow medical-delivery drones to fly more than a few miles.To broaden the lifesaving impact of drone organ delivery, more medical drones will need to be produced, and trained technicians capable of “piloting” them will need to be integrated into the organ delivery process at more hospitals and medical centers.
The expansion of 3D printing is rapidly impacting industries like aerospace, manufacturing, and education. Although 3D printing is already widely used in healthcare, experts say the impact of this emerging technology on medicaland surgical care is just beginning. The journal Radiographics reports that the field of radiology in particular will see exponential growth in the number of 3D models used for planning medical interventions and creating implants.
The field of surgery is also being shaped by 3D printing. By using well known, widely available bioprinting hardware, practitioners can create custom implants, surgical guides, and anatomical models on demand for surgeries in nearly every domain, from orthopedics to spinal, maxillofacial, and cranial surgery.
The benefits of 3D printing are well supported by research, per a study in Biomedical Engineering Online. Their systematic review of literature found that 3D-printed parts can improve surgical outcomes for patients by increasing efficiencies, reducing surgical time, and decreasing radiation exposure.
Adopting 3D printing presents challenges, particularly for small group practices that must balance the cost of a 3D-printing laboratory with its clinical benefits, according to Radiographics.Startup costs are significant, and the costs of printing and additional scans can increase the overall cost of the procedure, according to the journal Biomedical Engineering Online.
To effectively use bioprinting technology, organizations must invest in training, management, materials, and equipment. Another challenge is managing the security and privacy of Digital Imaging and Communications in Medicine (DICOM) files used in bioprinting. Exchanging and storing DICOM files requires establishing protocols for the safe, secure transmission of patient data.
Over the last three decades, breakthroughs in genotyping and gene-expression profiling have transformed the field of genomics, allowing researchers to investigate more of the human genome while dramatically driving down costs. In 2003, the first human genome was sequenced at a cost of $3 billion.Today, next-generation sequencing (NGS) has brought the cost down to below $1,000 per human genome.
In 2020 and beyond, NGS will continue to shape genomics with further cost reductions, per health sciences consulting firm L.E.K. Innovations in instruments, sample preparation, and bioinformatics—healthcare-computing applications and tools—will streamline workflow and make genomics more cost-effective for organizations large and small.
Most genomics research involves analysis of DNA across different populations in a sample. Now, advancements in technology that allow researchers to study individual cells are creating more individualized applications for genomics research. This “single-cell biology” enables researchers to compare genetic expression and study cellular heterogeneity between cell populations, providing new insights for oncology, reproductive health, and genetics. Advancements in the field of RNA biology, or the study and sequencing of ribonucleic acid, and the development of “molecular stethoscope” applications, providing less-invasive testing for cancer, pathogens, and chromosomal abnormalities, are also expanding the potential for genomics.
Emerging challenges in the field include increasingly narrow candidate pools for clinical trials of ever-more specialized gene therapies and the need for integration of siloed genomic data to inform large-scale projects like the 1000 Genomes Project and the Cancer Genome Atlas. More robust datasets will help further unlock genetic diversity and uncover more biomarkers for disease, paving the way for future breakthroughs.
Carla Pugh, MD, PhD, is Professor of Surgery at Stanford University School of Medicine
and director of the Technology Enabled Clinical Improvement (T.E.C.I.) Center. She is the first surgeon in the United States to obtain a PhD in education. Her research involves the use of simulation and advanced engineering technologies to develop new approaches for assessing and defining competency in clinical procedural skills.
Jordana Gaumond, MD, FACS, is a general surgeon at The Oregon Clinic, where she specializes in acute care surgery, the treatment of breast disease, and minimally invasive gastrointestinal procedures. She is a Fellow of the American College of Surgeons, board-certified by the American Board of Surgery, certified by the American Society of Transplant Surgeons, and a member of the Physicians Insurance Board of Directors.