The Digital Health Outlook for 2050 and Beyond
Colleagues at MedTech Europe recently asked for input into a survey response that was issued by the European Medicines Agency. The study was looking into the future of digital health, with a view to helping facilitate the EMA’s understanding of the potential evolution of digital health by 2050, and therefore, to help identify any consequential impacts for regulators and other key stakeholders.
I very much enjoyed ruminating over the possibilities of what we can expect to see over the next few decades, and so, with some quick reworking, I thought my response would make for an interesting membership blog to stimulate a discussion.
Two well-known quotes guided my thinking in writing this piece, firstly “the future is already here – it's just not evenly distributed”, this gave me my starting point and the confidence to extrapolate from where we are today, both within health and other sectors that have digitised. Secondly “We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run”…I tried to temper my wilder musings, yet go beyond where logic would take me…a balancing act!
By 2050, digital health will not even be a widely used term. The pervasiveness of digital technologies in our everyday life will have extended into health in the same way it already has in areas such as retail and financial services. It will be another, probably preferred (by both patient and system), access point into the health and care ecosystem. This will have broken down barriers between fitness, wellness, care and health. Some key characteristics of this will be:
- Greater ‘self-service’ with personalised information supporting public and patients.
- Automation of routine tasks within the health system, such as booking, scheduling, follow-up information…and possibly even prescribing.
- The use of AI to provide health ‘nudges’ via real time/real world data. This will be used preventively for the ‘well’ in addition to those with longer term conditions.
- Targeted preventative cohort interventions based on data and genomics.
One area that I do not see changing that much is the importance of the clinical priorities of chronic disease and mental health. Indeed, the demand to address these areas will grow further over time. I would also add cancer and cardiovascular, given the significant burden of disease in these areas, but their trajectory seems positive and hopefully a burden that will decrease as we diagnose earlier and have more effective and personalised interventions.
In addition to that, however, we should also consider how lifestyle driven disease - obesity and diabetes being key ones - will trend. Prevention is going to be a key mantra, we cannot go on being a ‘sick service’. We have to be a ‘wellness service’, and we may see an increasing role of third sector with self-help organisations and communities enabled through digital platforms to support this.
While some diseases will become inevitable as our population continues to age, we need acute services to be able to focus on those, and manage other issues by prevention, early diagnosis and rapid intervention. Those that need acute intervention will be increasingly aided by a combination of robotics (both surgical systems and nanorobots), AI, augmented reality and new materials including biologics.
Currently, digital health technologies are often focused on point solutions, such as diagnosis of a particular disease or the monitoring of certain chronic disease markers. This is unsustainable and we will see a shift to integrating platforms…this may be an evolution of current electronic patient records (EPRs), or maybe a disruptive tech player...but will look a lot different than the current cumbersome EPR systems! These platforms will potentially yield significant influence in the ecosystem and provide a bridge between consumer and professional sectors. The governance of data will become a bigger and more complex issue given its ubiquity. Alongside the necessary technical security and privacy measures, stakeholders who deal in the critical matter of trust will be needed, to ensure appropriate governance that protects individuals, but enabling the system to be run efficiently and effectively. I foresee a different range of solutions in different markets, ranging from government, arms-length bodies, health systems, and the third sector, to consumer led data trusts. This will be driven by trust levels in differing organisations and the structural system in a given jurisdiction. In my mind the ideal owner for UK is the health system, control of the data will be control of the system and will be a fundamental enabler of everything the health and care system is trying to achieve.
Funding and reimbursement will become both bigger and fading issues. As we see a shift to prevention, budgets will move to bodies outside of the health system and/or we will see greater integration between health and social care (a trend already started). Data will be used to democratise the funding process, enabling citizens through representative bodies to have greater say, and great transparency, of where money is being spent and what outcomes are being achieved.
The flow of real world and real time data will also influence the regulatory regime. We will see regulators increasingly using data and predictive analytics to address product issues, and we will also see increasing co-working or changing responsibilities across regulators as digital, data and devices merge. The regulators will, by now, have accepted that regulation cannot keep up with the pace of change in technology and rather than focus on legislation, will be looking at creating agile processes. Early warning systems, guidelines, standards and regulatory sandboxes will play an important role in the development and deployment stage, with data driven systems taking care of post market.
However, digitisation may well also have impacted on health inequalities, with a digital divide opening-up between the well off and digitally literate, compared to underserved communities. However, I would hope that between now and 2050 that these structural barriers would have been removed given that a huge range of government services will generally be delivered through digital tools and therefore central initiatives will address the obstacles currently hampering adoption and/or availability of some technologies.
There is also a possibility that with the increasing health workforce shortages globally, and pressure on services through aging populations, and therefore less access to services, that those with the financial means may increasingly opt to pay for primary care through digital platforms, with social health systems becoming a default provider of critical/trauma and last resort services. This may be accelerated and exacerbated by employers playing an increasing role to ensure they maintain a productive workforce. This may, however, differ in insurance-based markets.
I would love to predict the end of the hospitals, but in all honesty, I cannot. There are many views on this area. Myself, I favour a model where hospitals are central to the system, a sort of digital command centre pulling levers that extend throughout local communities. The virtual wards and remote consultations of today will be the default model, with greater use of AI to identify, manage and intervene at an individual patient level. 25 years out, will we have AI autonomy? No, not in health, but it will be a critical tool for managers, clinicians and patients alike. Wearables will have given way to ambient sensors on the home environment, looking at not just health data, but an array of environmental data as well.
This is not a prediction, merely a possibility, one of many that will be shaped by happenings within and outside of the health system. In writing this I have assumed a nice straight line from where we are today into the future, all contained within a nice little healthcare bubble. But of course we know that external shocks can have significant impacts on heath, be that a banking crisis, a global pandemic or conflicts. Any of these could derail the trajectory, and I do not even want to think about the consequences of conflict over Taiwan, with 2027 the year it is forecast that China will be ready to do so.
Is this a reasonable scenario? Have I over, or underestimated the impact of technology? I would be really interested to hear your views. I have focused on digital, but what about drugs, biologics, material science? What about wider technological changes 5G, 6G, 7G..whatever number we get up to? Neurotech? Genetic engineering?
There are just so many elements that will interact.
I would love to hear your views, either privately, or if you wish to pen a response for publication, that would be really appreciated.
