Our modern world, the one that makes us say “I can’t remember a time before…” or “How did we ever live without…”, has its technological and business underpinnings built upon innovation, cooperation, and evolution. No less important are the historical stress points that punctuate normal progress and those include global pandemics such as the one we have been living through since 2019. The impact of COVID-19 on the medical industry is a topic that is still playing out and for the purposes of this article, I wanted to focus on three industry-wide issues that in my view are generating not just disruption but also immediate and practical economic opportunity with startups, established companies and their strategic collaborations. What’s particularly interesting is that each of the three trends discussed below did not simply emerge from the pandemic as something novel and unprecedented, but rather as latent and bursting technological solutions whose time had finally come.
1. Telemedicine and Virtual Health (Finally) Arrived
The COVID-19 pandemic was a crash-course in telemedicine for providers, patients, payers and regulators. While consumer video conferencing already penetrated a number of industries in the past decade, healthcare markets took their time, overcoming both privacy and reimbursement hurdles. Most healthcare providers have begun to offer televisits, which have gone from the only practical option during the height of regional lockdowns to valued workflow enhancements, optimizing time value of doctors, PAs, nurses and, yes, even patients. As lockdown restrictions are beginning to ease, the televisit option is not going away. In fact, much attention is now paid to identifying use cases that most benefit from continued doctor-patient interaction in the comfort of the patient’s home such as mental health, aging in place and off-hours consultations. Also there are opportunities to address unique experiences of specific patient populations and shed more light on exposed social disparities.
One of the reasons why this matters is that telemedicine is based on the digital capture and transmission of the patient-doctor interaction. It can effectively turn PCs and tablets into medical devices that capture data for transcription and utilize natural language processing (NLP) and artificial intelligence and machine learning (AI/ML) for medical comprehension, additionally capturing and classifying information for mining and prescriptive diagnoses. A medical comprehension system can track symptoms, identify pathologies, connect events, pick up visual and audible ques and flag couterindicated therapies.
Furthermore, telemedicine opens up the use of remote patient monitoring (RPM). Connected medical devices such as blood pressure monitors, weight scales, pulse oximeters, smart watches and other wearables at the patient’s location or on the patient’s person can monitor vital signs and help diagnose conditions, both enriching the telemedicine experience and providing pre- and post-appointment case monitoring. Most RPM use cases are now fully reimbursed.
All of this is starting to generate unprecedented volumes of streaming data and will heavily leverage storage, processing, encryption and analysis, much of it in the cloud. Numerous startups are building tools such as AI/ML for specific medical use cases, cloud security and data integration. For the right use cases and with suitable safeguards, telemedicine is not only becoming an acceptable norm in care delivery but is improving workflows in ways unavailable with the prior “brick-and-mortar” analogs of medicine.
2. Clinical Trials Are Going Virtual Too
We have all seen clinical trials take center stage in the context of COVID-19 vaccine approvals. But the pandemic had an even more pronounced effect on the global $45B clinical trials market. Traditional clinical trials are conducted with cohorts of patients spending a significant amount of time at the trial center which is not unlike a clinic. With travel and social distancing restrictions, decentralized or virtual clinical trials have moved from the innovative fringe prior to the pandemic into the mainstream. Nearly $7.5B of the 2020 clinical trials market was virtual, whereby patients are primarily kept at home and monitored remotely. In a decentralized trial, patient data are captured and transmitted using methods such as electronic patient reported outcomes (ePRO), electronic data capture (EDC) tools and, once again, remote patient monitoring (RPM) using a growing suite of connected medical devices. There are now even personalized devices for collecting patient samples for in-vitro analysis.
A decentralized trial is more than just a pandemic placeholder or a less costly alternative to the traditional variety. A clinical trial conducted with near real-time data capture provides at least two impactful enhancements to the industry. One is the ability to react to streaming data while the trial is in progress, enabling the investigator team to adjust trial parameters and protocols, affect compliance and even “fail fast”. The other is the opportunity to discover and track novel biomarkers, those combinations of physiological parameters that correlate the therapy under trial to specific patient populations, resulting in targeted indications for use of the therapy.
Because of these trends and opportunities, decentralized trials are not only more data driven but also lean more heavily on compute power than ever before. Discovery and use of digital biomarkers utilize machine learning and evolving algorithms. Real-time monitoring and capture of trials in progress make heavy use of predictive analytics. We have seen traditional companies such as providers of clinical trials management systems (CTMS), clinical trials data systems (CDMS), contract research organizations (CROs) and pharmaceutical companies make heavy investments in digital and virtual trials tools as well as partnerships with and acquisitions of startups that provide those tools. These investments are expected to continue to grow with COVID-19 to be remembered as the catalyst.
3. Fault Tolerant Supply Chain Needed (and Coming)
The pandemic has stressed the global medical supply chain with all-too familiar examples such as respirators, oxygen, COVID test kits and vaccines, not to mention items at the general store. Supply chain technology has been overdue for an overhaul, with the pandemic exposing shortages and slow response times along with the need for greater flexibility, visibility and redundancy.
The medical industry is complex, driven by variable demand and deep supply chains (suppliers of suppliers of suppliers.) It is also highly regulated with significant requirements around documentation control and traceability. For years prior to the pandemic the medical supply chain has been evolving technologically. Both inbound and outbound supply chains such as for a pharmaceutical company or a medical device manufacturer use technology to trace component location and flux, maintain temperature and other environmental control factors, and sustain vigilance over counterfeit and grey market exposure.
As a result of this evolution, and stimulated by the pandemic, there is growing utilization of the internet of things (IoT) with greater granularity throughout the chain. These tools provide local visibility, detection and tracking. For example, manufactured drugs are tracked for location confirmation and cold chain management (maintaining a certain temperature range throughout a shipment) to ensure the quality of the chain and the product. More deeply, these tools provide the necessary streams of data for fast feedback between supply and demand, fulfilment maintenance and price negotiation. Greater use of analytics via AI/ML tools is expected to grow. Once again, the tools are not new but certain technological solutions have come of age just in time. These include integrated circuits for low-power Bluetooth and low-cost cellular communication standards as well as growing availability of cloud computing services for aggregating data and for predictive analytics. Implementation of modern supply chains requires collaboration among several industries and often between established companies that own the chains and startups that either own a key piece of technology or are swift and agile at implementation.
Conclusion
The repercussions of the global COVID-19 pandemic are still being felt and are far from settled. The three trends noted above are highly visible to companies and analysts in the medical industry and their implementations (or lack thereof) will affect the larger downstream markets.
As with any complex system under stress, the medical industry is responding with solutions spurred on by a combination of self-reflection, evaluation of available options, and implementation within a regulated framework. While many solutions will come from established industry leaders, the demand for rapid timeframes will create opportunities for startups, both early and mid-growth. Highly successful leading market companies often see the broad entrepreneurial ecosystem as an extension of their own innovation process, offering opportunities to move quickly with an investment, acquisition or partnership and will take advantage of this innovation supply to cut down on response times demanded by the world in recovery.
Dr. Gene Dantsker
President & COO
EvoNexus
November 30, 2021