The digital revolution is changing the way doctors work. Within the next few years, doctors’ workloads will be reduced, healthcare costs will be slashed, and diagnoses will be faster as the digital healthcare innovation reinvents the way medicine is practiced. Billions of rand will be saved as advances in technology are embraced by the medical fraternity. The new technology will empower patients to take responsibility for their health. This is not science fiction; it’s a growing reality. People are already able to wear a device that monitors their activity, checking how much exercise or sleep they’re getting. They can swallow tiny devices that monitor the gut biome, stress levels, insulin levels and transmit valuable data to their doctors who can make early diagnoses of potential health risks. More than a decade ago, Google was a search engine and Amazon was an online book store. Now they are at the forefront of the revolution in digital healthcare with their data-rich innovations that enable doctors to discover patterns and causes of diseases. In South Africa, Discovery Health has embraced the changes in technology and uses its own Vitality member data to advance this new approach to medicine. David O’Sullivan spoke to Deputy CEO Ryan Noach about Discovery Health’s initiatives.
Ryan, what are we talking about when we speak about digital healthcare, what’s that all about?
Much like many other industries around the world, David, the world of healthcare is being completely revamped by some of the innovation in the digital sector. Right across the healthcare chain we’re seeing majorly exciting developments that are just changing the way we diagnose and treat disease, the way patients interact with doctors, and the way medical records are stored. To be honest, my view is that healthcare has been too slow to embrace some of these trends, but I’m quite sure that in years to come the way healthcare is going to be delivered will look different and be practiced differently than it is today.
My initial assumption was, if we’re talking about digital healthcare, it meant going onto the internet and diagnosing myself with whatever illness might prevail. I thought that might be dangerous, but it’s not doing that is it, it’s using technology to empower patients. Flesh it out for me Ryan, what is it that patients use, how does the technology work to give doctors the correct data to help them with an accurate diagnosis?
Well, the consumer element that you’re talking about is very popular and becoming more and more popular, and there are a large number of online sources of medical information that consumers use every day. I’ve heard doctors talking to each other saying to patients, “Don’t confuse your Google search with my medical degree”, which is said in jest, but actually there is this consumerism happening around the world where consumers (and we believe strongly at Discovery), should become much more proactive about their healthcare. Healthcare is unfortunately a situation where there’s a real asymmetry of information. The patients are generally not well-informed; it’s a complex situation and they frequently are scared.
The doctors are typically very well-informed and so digital healthcare is crossing some of this divide and ensuring that there is much better symmetry of information, and that patients have reliable information at their fingertips. One of the things we’re seeing is the evolution of artificial intelligence which is already changing doctors’ jobs. Today, patients search online for answers, but artificial intelligence that uses very smart cognitive engines that have ingested huge volumes of data in the background can provide you with an accurate answer with very high confidence intervals. At Discovery we’re investing in one such service, which we will provide to Discovery members later this year.
This artificial intelligence engine is supported by many thousands of doctors around the world and we hope by many thousands of doctors in South Africa, which is able to answer a range of questions with a very high confidence interval. So certainly that is one part of it, but the other part of it that you were asking about is how does it help doctors make diagnoses? At the most simple level we see that central to a good diagnosis is having all the information at your fingertips. Electronic health records which have centralised the recording of all clinical data in one place and given the doctors via their smartphones, their tablets or web access, immediate comprehensive clinical history for the patient they’re treating, is extremely powerful in and of itself. We see anecdotes. Discovery Health ID is an application that does this for doctors.
We have 2,200 of our doctors using it every day in their practices and we see anecdotes every day of how this changes doctors’ practices. I’ll give you some concrete examples just to make it real. A dermatologist told us recently that a rash that he had been unable to diagnose, when he looked at the electronic health record on Health ID, he recognised that in fact, the timing of the rash was related to a medicine, a drug prescribed by a doctor which the patient had forgotten to tell him about. He was able to immediately link the rash to the medicine, and attributed it to an adverse drug interaction and resolved that situation. Sometimes there are far more serious circumstances.
We heard of an anaesthetist recently who was about to put a child to sleep for a simple anaesthetic and looked at the Health ID record on the Discovery Health ID platform and found that there was a critical cardiac defect that this child had that the mother had in her anxiety about the procedure completely forgotten to tell the anaesthetist about. It changed the way he delivered the anaesthetic. So from the relatively minor to the seriously important interventions, this centralisation of records is critical.
We’ve seen three waves of digital innovation in healthcare. The first starting in the early 2000’s was driven by the availability of 3G and devices becoming much more portable. This enabled telemedicine, where one was able to get a consultation remotely which has certainly changed the way doctors have delivered care and consultations in remote places. The second wave, which started around 2010 or just before, really related to the electronic health records that I have been talking about. We’re right in the teeth of the third wave of digitisation now, which is much more about empowering the consumer. It’s about using Big Data to find disease inflection points, where diseases are going to get worse, where patients are at risk on a personalised basis. It is about combining health risk factors with genetic information to understand an individual’s risk profile and using artificial intelligence to support diagnostics, and then connecting the doctor and the patient to each other in a very seamless and portable way.
I’m also impressed with the technology that’ll empower patients to take responsibility. The wearable or even ingestible automatic devices that monitor and transmit relevant information, tell me a bit more about that.
This term has been coined, ‘the quantified self’ and patients are really able these days (I shouldn’t say patients), people are really able these days to measure everything about themselves. I wear a wearable device every day, I measure how many steps I take, I look at my heart rate through the day, I measure the intensity of my exercise and these wearables are advancing to be able to measure stress, to track your sleep, to track all aspects of your behaviour and we really are able to quantify everything around ourselves through these sophisticated sensors.
As you say, they have advanced to the point where now there are ingestible sensors too. You swallow a pill, it’s a smart pill and it’s able to make all sorts of measurements and readings inside your intestines and transmit that through Bluetooth or another mechanism to a device externally and so you can make diagnosis from the inside out. Ultimately, our view is that this quantified self-environment, all these different measures will be combined with genetic measures or precision medicine to really personalise healthcare. It’ll mean that for a particular individual, your own personal physiology which is being measured, your own personal diagnostics in the context of your genetic makeup will really mean that you can get a personal healthcare tailored solution to your particular risks and needs.
In South Africa, do the medical aid schemes keep pace with the technology; do they understand that, does the council for medical schemes understand what is happening with increased digitisation around the world?
I think everybody in the healthcare sector is feeling this digitisation and it’s impossible to hold it back. It’s being thrust upon us and consumers are adopting it broadly everywhere. I can only speak for Discovery and at Discovery we’ve really embraced these technology trends in a large way. We’ve delivered Discovery Health ID for four years now. Over the four years it’s been a hard process of changing the way doctors consult with patients to get them to use a digital interface as part of the consultation process. But as I said earlier we’re now seeing doctors very engaged and more than 2,000 of them are using it every single day and a large number are using it intermittently. It really means results at their fingertips. So in terms of that second wave we’ve been successful.
From the quantified-self perspective, our Vitality Active Rewards Benefit, which uses the Apple watch as the wearable device (which you can get for free on a fully funded basis if you’re continually active), has meant that we’ve seen a huge number of people, 300,000 of our members in a very short space of time actively measuring and tracking their physical activity, and being incentivised through weekly rewards that we offer to meet targets. We’ve seen a precipitous improvement, (way beyond what we actually ever expected, to be frank), in the activity levels of these members. We’ve seen on average, a 24 percent increase in the activity levels of all Active Rewards members and for those wearing the wearable device, the Apple watch in our context, their activity has increased by almost 80 percent.
Tell me about the investment in DNA sequencing. I see that in the United States it received R55bn in funding last year alone, that’s a phenomenal amount of money. It seems that people can send saliva samples for analysis to quantify their genetic susceptibility to a wide range of diseases. Is that something that is encouraged here in South Africa?
Yes, it’s a rapidly evolving side of medicine and I think if I were back at medical school today that would probably be the field I would want to choose as the explosive growth field. Just over two years ago we were nowhere near as advanced as we are today. There are two things happening. Firstly they’re recognising more and more of the important sites within the genetic DNA. Within the DNA makeup that are relevant sites in respective diseases and risk factors, and so this is a big mapping exercise of millions and millions of data streams to try and find exactly which part of your genome, your genes are responsible for a risk or a health issue. The second part of it is that because it’s becoming so commoditised it’s becoming much more affordable. Therefore, we have more information that’s more accessible and you can imagine what that means for diagnostics and for interventions.
In many parts of the world now it’s routinely screened. In South Africa, that’s not the case yet – it’s certainly not routine. There are very few sites (two that I know of in South Africa), that are able to sequence the full genome (in other words, the mapped out portion of the DNA) and they are still for research purposes. They are not being used commercially yet, so most of the sequencing in South Africa is actually being done overseas where a full exome sequence is required. In oncology medicine the treatment of certain tumours is now very closely linked to the genetic makeup of those tumours and so it has become routine, including in South Africa to do genetic analysis of many of the tumours for cancer treatment plans.
So for somebody who wants to embrace the technology, is the Apple watch one of the fundamental starting points?
Well, it doesn’t have to be the Apple watch. We’ve partnered Apple as a leading technology supplier, but we do partner with other wearable suppliers too.. Our data demonstrates a material improvement in physical activity and engagement in physical activity, or understanding of what your body is doing and needing through the use of a wearable device. So I would say, get on the train and join this quantified-self world, get a wearable and track your behaviour day-to-day.
Where’s the best place to get information, the Discovery website?
The Discovery website certainly – the Active Rewards Page has a lot of information about this and if you go to a reliable Google site and you Google wearable devices, there’s a fortune of information there.