Two faces of the digital revolution

Two tech experts offer their vision for how digital will shape healthcare going forward. In the first interview, Shafi Ahmed, Chief Medical Officer at Medical Realities, talks virtual reality and its impact on medical education and pharma. In the second piece, John Nosta, Founder of NostaLab (pictured right), explains how digital will enable us to mine data to unearth previously unreachable insights.

1: Using VR to benefit patients and physicians

As a consultant laparoscopic colorectal surgeon working in London, Professor Shafi Ahmed is both a medic and an educator. The Associate Dean of Bart’s Medical School is also a tech enthusiast, futurist, innovator, and runs a small portfolio of companies focusing on digital health. Known as the “Virtual Surgeon”, Professor Ahmed is interested in the concept of augmented reality and virtual reality. Indeed, one of the companies he founded, Medical Realities is an award-winning AR/VR pioneer which has just released the world’s first VR Interactive Surgical Training Module.


He explains that VR was given a new lease of life around three or four years ago. “I guess, it’s not a new concept; it’s an old concept but, because the computing power is now powerful enough to drive the kind of technology and innovation involved in VR, we’re in a good time for VR. Before it was driven by hardware; big devices are expensive, tethered to computers, and now we’re seeing a plethora of smaller devices not attached to computers. The price of devices has come down enormously.


“What’s also changed are the applications. You can’t really drive change with just hardware; you have to have compelling content – and what we’ve seen for the first time in the last 12 months is lots of clinical data showing the efficacy of what’s called VR therapy and VR medicine. So now patients can be prescribed virtual reality for anything from anxiety and phobias to post-stress disorders, to behavioral change, for physiotherapy, mental illness, and so on. We’re also seeing lots of clinical trials with our patients showing improvement with this new kind of therapy. So that’s going to be the game changer in future. At the same time, we’re seeing education being driven hard, and now we’re seeing lots of content out there.

Use cases

“People are looking at things like depression and phobias, for example, and we’re seeing it in dementia a little bit as well. Granted, these are small studies at the moment; they’ll gradually increase in size.” Professor Ahmed points to a lot of activity around areas such as cognitive behavior, adding that cognitive behavior therapy (CBT) could be delivered quite easily via VR. Normally that would involve somebody meeting the patient regularly, but this is inevitably expensive, time inefficient, and resource-intensive. Instead, there is the potential to do this virtually, making the whole process more efficient and less costly, and ultimately democratizing the availability of such therapies.

“I think the cognitive behavioral therapy component would be an amazing addition in VR, and really accessible. If you look at primary care, for example, very few practices access CBT therapy and the waiting list is quite long. We should be using more of these therapies to keep people out of hospital, for example, and off medication.”

Benefits for pharma

In a pharma context, Professor Ahmed sees plenty of potential for efficiencies and cost reduction in the field. Pharma companies are thinking about VR, especially as a tool for learning and education. “If you think about it, pharma relies on a lot of face-to-face interaction with employees who might be out on the circuit seeing people: primary-care physicians, for example. This is quite an intensive process in terms of re-educating people about therapies, new drugs, how to take them, and so on. Lots of our patient education is how to take a medication – they can inhale it, for example – and all of that can be transformed by VR. In fact, we’ve done quite a lot of work with pharma companies already, and we’re about to do more in the New Year.”

The same applies to education internally, for instance by providing MSLs and their physicians with immersive therapeutic training online, which allows them to ramp up their medical teams more quickly. Professor Ahmed cites parallels in the airline industry, where carriers use VR for training cabin staff.

He sees VR and other new technologies as a key component in the struggle to bring down healthcare costs by reducing the burden of healthcare resourcing. “Where we are at the moment around the world is no one’s got enough money to sustain healthcare as it is, so we’ve got to figure out how we use existing resources in a different way.” Moreover, new technologies should facilitate a switch in emphasis to preventative healthcare and more of a focus on well-being.

Making it happen

Nevertheless, to make progress with some technologies, we are going to have to see some social re-engineering, according to Professor Ahmed, with less reliance on face-to-face contact and a change in the doctor-patient relationship. However, this will depend on government and society being prepared to accept rapid change. At the same time, it implies a significant level of collaboration both between organizations externally and within the organization.

“Companies can’t do it all themselves and they’ve got to educate their workforce and scale it up and make sure they’re more agile in their minds, understand where tech is going – that’s one element of it. And they’ve got to find the right people and companies they can work with. The whole of technology is about collaboration, no one can do it all; that’s impossible. You have to open your access to doors, see what’s going on,” he concludes.

2: Connecting the dots to reveal insights that are hiding in plain sight

Founder of NostaLab, John Nosta has a background in both science and marketing, and is a specialist in helping life science companies, NGOs and governments navigate exponential change and innovation.

“For me, the health tech marketplace is very broad because many of the innovations and opportunities intersect and evolve together. I cast the net very broadly: for me, digital health includes fundamental aspects of consumer engagement (such as social media) but it also extends out to advanced aspects of diagnosis and imaging – for example, the utility of nanoparticle-mediated early-cancer detection in the establishment of Stage 0 disease detection.” Add to this the use of artificial intelligence (AI) to read mammograms or as a powerful tool for the recruitment of patients in clinical trials and the scope for digital gets yet wider.

“I think that, ultimately, it is inevitable that pharma will integrate technology into virtually all aspects of what they do, including drug development. And there are a couple of fundamental issues around this. For me, I think that the evolution or the emergence of data analytics and AI will become an absolute necessity because the ability for humans to assimilate the process and assimilate data is going to become too difficult. The datasets are becoming extraordinary and it’s going to require the technological implementation – so for me, I think that this is an inevitability.”

At the same time he emphasizes the pace at which the use of technology in the life science industry is expanding, with new use cases emerging almost on a daily basis. “So, today, we really don’t have a full understanding of the emergence of many technical aspects of this.” In short, digital is only just coming of age – it’s a vast opportunity but also one of the industry’s most significant challenges.

Change is scary

So, what are the barriers to full adoption in terms of pharma really getting involved in digital health and embedding it into the business models? “I think one of the key problems – one of the key impediments – is not technology but the human side of the equation, and that’s the idea around culture squashing innovation. We all speak to innovation, managers talk about it, people in the C-suite embrace it and consider it a fundamental initiative for companies to embrace and adopt, but the reality is that the culture of the company, the rank-and-file employees need to embrace technology and make it part of their mission. I see this to be oftentimes not the case.

“I’ll give you one, simple example. When I speak to companies around the world I often discuss how telemedicine is an extraordinary opportunity, whether it be teleconsultation to a physician, or telereferrals for advanced care, follow-up care, or even something as simple as acute care for a cold or ear infection. Heads nod as people recognise that dynamic – but, in fact, that dynamic is not about innovation, it’s about implementation. That technology is readily available; it’s just that we have to implement it in the context of clinical benefit in society. Now, here’s the interesting part. When I ask people in the audience how many have used telemedicine or have even tried a single telemedicine visit, the vast majority say they haven’t – I would think maybe 5% have done it, have tried it. So for me that is an ‘aha moment’ and that reflects how people are reluctant to change because it frightens them – it’s human nature, it puts them out of the context of the safety of their job, of their profession, of their income.

Data is the future

Nosta see data as the key to the future. “I believe that the creation, collection and interpretation of data will actually transform humanity; it’s that big. I often speak of big data in terms of it being the third fundamental window into humanity. The first was the telescope and the second window the microscope – it showed us a world that was vastly smaller than ours but equally important. I believe that big data will show us profound connections that address aspects of humanity, of society, but also around medicine and clinical care.


Asked whether pharma needs to use data in order to connect the dots to derive new insights, Nosta has an interesting new perspective. “Connecting the dots implies you can see the dots, connecting what’s hiding in plain sight means that there are points of observation that, when combined with others, yield new prognostic significance. And I think that is where big data and analytics – particularly AI – will be extraordinarily revealing. We are seeing this with the emergence of genomic-mediated cancer therapy. I think that’s a beginning. After that we will begin to look at broader datasets and re-evaluate how we think about care.”

Collaboration

In conclusion, Nosta highlights the opportunity for collaboration between pharma and tech. “I believe in the final analysis that collaboration is the new competitive advantage. Just imagine the cognitive power, if we can take the intellectual resource that we call the life-science industry and augment that with technology, with machine learning, with analytics and artificial intelligence – the opportunities are amazing - earth-shattering even. This is the fundamental reality that I want people to understand about the business we are in. We are at the right spot. We are at the spot that will help change the world; it will change humanity. And it’s really coordinated efforts between individuals and technology that will make this happen.”