I spoke to Dr Jonathan Andrews, chief medical officer of Certific, on what he is seeing at the cutting edge of digital health. Certific is an early-stage pan-European health-tech startup founded by Taavet Hinrikus, founder of foreign exchange platform Wise, alongside health-tech entrepreneur and physician Dr Jack Kreindler and Estonian entrepreneur Liis Narusk. It is focused on transforming the workflow and patient interface of GPs.
Andrews is still a practicing physician in the UK’s National Health System (NHS), but moved into the health technology world after getting frustrated by the outdated technology and lack of infrastructure in the NHS pre-COVID. He says UK-based medical technology companies and entrepreneurs have been going from strength to strength since 2017, with doctors moving from clinical practice into the sector.
One of the early entrants in the field was teleconsultancy Babylon Health, which launched in 2013 in the UK, before expanding to the US and beyond. Sadly, Babylon’s initial public offering on the New York Stock Exchange resulted in significant financial issues, against a worsening macroeconomic backdrop, leading to the announcement in May that the company will be taken private again.
Yet the potential for technology to transform medicine is undeniable. In the UK, work continues within the confines of a creaking NHS to create better outcomes for both patients and staff, in a context of an ageing population and severe shortage of medical personnel.
The COVID effect
The COVID pandemic suddenly shut down face-to-face interactions for clinicians. As a result, there was a push into teleconsulting companies with Babylon Health, Kry (known as Livi in the UK) and Doctor Care Anywhere leading the way. There have since been numerous other outfits. “Clinicians suddenly overnight had to come on board and accept it. GP practices that had been previously hesitant could see it was the only route,” says Andrews.
He adds that it was a lightbulb moment for many traditional career clinicians. But these were legacy software applications that were inefficient, not that useful, and did not interact with patients. Over the past three years, Andrews has seen several waves of innovation.
“I think the sector that will grow possibly the most in the next decade will be age-related tech”
Jonathan Andrews
The first wave was the push to teleconsulting, whereas the next one was focused on allowing hospital patients to be treated in their own homes, where recovery is generally better. This set in motion the development of ‘virtual wards’ and an uptake in remote patient monitoring, which has been at the forefront of health-tech conferences across Europe. A physician can create a virtual ward by using software and, in some cases, with the help of remote wearable devices. Combined with questionnaires, a clinician in the hospital is empowered with a lot of data to evaluate the patient’s progress.
When the next pandemic arrives, the experience of COVID indicates that it may not be possible to give everyone a bed. However, it would be possible to give all patients affordable tools to enable monitoring of vital signs and alert clinicians if readings go beyond pre-determined safety levels, or even trigger an ambulance call.
Devices such as Apple Vision Pro may find clinical use cases for virtual wards. Virtual reality (VR) and augmented reality (AR) are already used for medical education and telesurgery. Wearable technologies like Fitbit and the Apple watch are continuously improving their health-monitoring capabilities, and are moving towards the realm of being medical devices, which would require approval in the UK by the Medicines and Healthcare products Regulatory Agency (MHRA). These can give some insights to help clinicians make decisions.
“Where wearable tech gets really exciting is use cases beyond the nerds who are interested in biohacking and tech,” says Andrews. The prime example is remote monitoring for the elderly. “I think the sector that will grow possibly the most in the next decade will be age-related tech.” In a care home, for example, it is not possible to have one-to-one care and those with cognitive issues like dementia might not necessarily be aware of problems. These can be quite basic – such as reminders to get up and move, as inactivity can lead to blood clots, or to drink water since dehydration can cause kidney disease, and medication alerts with digital pill boxes. Andrews points out that drug trials show much better results than in real life because patients often do not take their medication regularly and on time.
AI steps in
AI holds the promise of transforming medical practice, research and training. Just like Alexa, which continuously listens into sounds in a room, medical device software exists that analyses audio biomarkers to diagnose respiratory conditions by listening to people coughing, or detect depression from the tone of people’s voices. The prospects for the development of such technologies in other areas of medicine are immense.
AI also has the potential to transform healthcare providers. Andrews points out that up to 40% of a clinician’s day might be spent on routine administration and documentation. While electronic or digital records and dictaphones save time, they still need manual input. New AI tools would be able to dramatically reduce the time spent on documentation. In the past few months, Andrews has come across six companies that are focused on listening to clinical consultations. They are producing tools that can accurately and quickly summarise patient notes from the consultation and generate a high-quality letter. Where it may potentially transform diagnosis is the ability of the AI to add value to discussions on complex medical problems involving cross-disciplinary teams. AI can potentially assess the issues from each specialist’s perspective and also incorporate information from the latest scientific research.
Medical training has yet to fully exploit the potential of new technologies. For example, while students used to practise by acting out procedures on a mannequin or colleague, a VR headset plus haptic sensors allow them to simulate different conditions and try out potential treatments in a virtual setting. For managers in hospitals, tools to reduce the admin for workers to book shifts and allow better HR scheduling are also topical. For patients, tools that can assist with communications and long waiting lists are an obvious advantage.
For investors, getting closer to the souces of innovation in healthcare and the medical technology specialists driving them may be not only a rewarding but also a socially valuable manoeuvre.
Joseph Mariathasan is a contributing editor to IPE and a director of GIST Advisory
