Technological Trends and Ecommerce-Healthcare

Palvannan

Business Development Advisor - Halodoc

“VIRTUAL”LY

NO MORE BUT REALITY

Fiction like Scientific Disruption is the New Game !

AI AI AI AI AI AI AI AI AI AI AI……..MACHINE LEARNING

• Artificial Intelligence – the sudden New Explosive Happening in different walks of life all around us … though it has been around for 30 years …

• We can dispense with the traditional personal secretary and replace with AI…personal digital assistant ☺….will it serve us coffee with a beautiful smile … especially when you are stressed ?

• The most exciting big event here is the driverless car …. A million neural inputs in different layers ….who would have thought ?

I would like to stay Positive….

Hopefully … Pal

Yes, It’s coming…

Infinity

Infinity

But We’ll talk about current Technological Trends with

IMMEDIATE IMPACT !

The Watson platform used in a number of disciplines within healthcare

➢ including with payers, oncology and patient risk assessment➢…while staying within current regulatory compliance

Healthcare is no exception

Four Areas where AI in Healthcare is gaining steam

1. Personal Virtual Health Assistant

• Combined with mobile phones, apps and robust AI like Cortana, Siri

• Medication alerts, patient education material and human like interactions

2. Advanced Analytics and Research

• In oncology to detect abnormalities and in X-Rays and MRIs

• In genomics to perform complex processing and in precision medicine

• Highly customised treatments – evidenced based

Four Areas where AI in Healthcare is gaining steam

3. Personal Life Coach

• Contacts with patients with chronic diseases outside of the examination room

• Life coaching at manageable cost – feedback from data on mobiles and wearables

• Adherence or simply a motivational voice encouraging healthy habits

4. Healthcare Bots• Scheduling appointments, medications and billing

Conversational Interface

- Diagnosis based on symptoms

- Extensive set of questions, each set linked to the previous answers - trained over 6 years with real world cases

- Extensive medical knowledge covering many thousands of conditions, symptoms and findings

- For the moment not replacing a dr, but creating a digital paper trail before consultation – saves time

- Has been shown to diagnose both common and quite rare condtions

Empowers patientsto make more informed

decisions about their health…

There are others :Your.MD, BabylonIn September 2017, Babylon responded to a critical letter in the British Medical Journal by claiming its AI symptom checker had "reduced same day GP consultations by 40 per cent by appropriately providing alternative care".

By 2020 sophisticated, machine learning and AI

algorithms will play a significant role in healthcare / life

sciences

Will Transform▪ patient pathways

▪ treatment plans

▪ physicians can take better informed decisions

➢ Better treatment outcomes

What is the one currently unthinkable AI disruption in Healthcare ?

…May be some would have thought about this …

A world without human doctors !

A ROBOT doctor - one of the first in the world - has passed its medical exams with flying colours.

Xiao Yi "mastered" all required medical skills, scoring 465 out of 600 points in China's National Medical Licencing Examination.

During the exam, the robo doc was forced to show a "reasoning process" when deciding how to treat symptoms, instead of regurgitating the information back.

Wu Ji, deputy boss of its electronic engineering department said: "Its score is 96 points above the acceptance line.

"This shows that it has indeed mastered the medical knowledge and clinical knowledge, and it has owned the basic ability to employ the knowledge to solve some problems."

Humans are not perfect, but AI could be worse▪ Computers are not always reliable and can fail on us from time to time.

➢ can lead to catastrophic consequences if AI prescribes the wrong medication or gives a patient the wrong diagnosis.

If its error margins are less than or equal to those of its human counterparts, could be ready to take on an active role in patient care.

Logical choices are not always the same as human choices▪ Physicians’ decisions based on gut feeling and intuition may never be replicated using

algorithms and super computers. ➢ These are the areas of patient care that would be hard to replace with a robot

Don’t worry – still a long way to go ….. ☺

Virtual Reality

5 Ways Virtual Reality is Improving Healthcare

1. Pain Management - Part of brain linked to pain less active when

immersed in VR- Can be used for procedures, to control phantom

pain in amputees2. Physical Therapy

- patients can use movements of therapy exercise as interaction in VR game.

- Increases motivation3. Fears and Phobias

- for e.g. Fear of heights 4. Cognitive Rehabilitation

- patients with brain injury like trauma or stroke can be helped to regain cognitive function

5. Training Doctors and Nurse- to learn anatomy, practice procedures

Telemedicine

Telehealth can change the current paradigm of care and allow for improved access and improved health

outcomes in cost effective ways.

Telehealth increases access to healthcare: Remote patients can more easily obtain clinical services.

Remote hospitals can provide emergency and intensive care services

In contrast, Telemedicine refers specifically to the use of medical information exchanged for the purpose

of improving a patient's health.

Telemedicine pertains to the use of electronic communications to provide clinical services without

requiring a patient to come in to a doctor's office.Nov 23, 2016

mhealth

• It is defined as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices.

•WHO Global Observatory for eHealth

Telehealth, Telemedicine and MHealth

The View of ATM

The second is that there is a real need for ways to overcome what we would call insufficient

workforce. There are just not enough clinicians to take care of everything that needs to be done. ...

We have shortages, insufficient workforce in a number of areas.

The ones that are really very compelling right now are what are seen in rural communities, as well as what

is seen with telemental health services, the fact that a significant percentage of counties in the United

States do not have access to psychiatrists.

If in USA : 27 Physicians per 10,000 is insufficient, then think of Developing Countries like Indonesia at 3 Physicians per 10,000 !

• What do Patients as the Digitalized Customers want ?

Telehealth Index : 2017 Consumer Survey - American Well

▪ More and more Consumers open to video visits➢ willing to switch doctors in order to get video visits

▪ Consumers believe Telehealth effective to manage ▪ Minor healthcare concerns▪ Manage complex chronic diseases too▪ Refilling prescriptions

IMPACT Of DELAYED CARE

3.3 times

But huge mindboggling opportunities – in an idealistic

situation - > 7 Bio people……and why not ?

▪ Rise of telemedicine influenced today by the growing mobile health field.

▪ Wide variety of mobile health apps and new mobile medical devices that are consumer-friendly drive patients to use technology to monitor and track their health.

▪ Simple home-use medical devices to take vitals and diagnose ear infections, monitor glucose levels, or measure blood pressure➢ patients can gather needed medical information for a doctor’s

diagnosis, without going into the doctor’s office. ▪ Patients get proactive about using technology to manage their health

▪ more open to alternative ways to get care – through telemedicine!

The Rise of Wearables

Access to Telemedicine is now a “right”

•Indeed, a growing number of patient and consumer groups expect access to remote services.

•In fact, several recent lawsuits were filed (and settled out of court) against hospitals for not providing telemedicine services.11

Excerpts from

The Telemedicine Providers in USA

Top 3 Online Doctor Consultation Services USA COMPANIES WHAT THEY DO COST REMARKS

Immediate access

to doctors &

therapists

24/7/365

Currently #2 in market share, MDLIVE is looking to surpass Teladoc

this year. Its investors include the Heritage Group – owned by 250 major

hospitals in the US.$45 per

consultation

or by

monthly

plan

Video or phone

consultations

Articles:

MDLIVE reviews (/blog/mdlive-reviews-telehealth-product/) from real

users11 minute

response time

Currently #1 in market share, Teladoc was late to providing video and

is likely to slip off its #1 position this year.

24/7 access to US

board doctors

$38 per

consultation

+ annual fee

($150 or

less)

phone and online

video

consultations

Articles:

Where does it hurt? Log on – The Doctor is in

(http://money.msn.com/saving-money-tips/post--where-does-it-hurt- log-on-

the-doctor-is-in) – MSN Money

16 minute avg

callback time

Faster, Easier Doctor

Visits

American Well started off building telemedicine portals for hospitals,

but their solution was expensive and complex (they licensed their video

platform from Vidyo (/vidyo)). They recently pivoted to providing their

own online doctor service, copying TelaDoc and MDLIVE.

24/7/365 on-

demand video

consultations

$49.95 per

10 min.

On web, mobile

(iOS, Android),

and kiosk

Example

Telemedicine in Europe

Issue Leader: Dr Stephan Schug - EHTEL Chief Medical Officer

11 Recommendations from EU eHealth Stakeholder Group to achieve Goal : Telemedicine for all by 2020 !

Europe - The Telemedicine Apps and Web

• United4Health ~ 12,000 patients.

• ELECTOR: Telemedicine solution for arthritis patients;

• THALEA: Telemedicine solution for intensive care units;

• MOMENTUM: A roadmap and support on how to put telemedicine into

daily practice.

Other Countries with Telehealth – Outside of USA, Europe

• Australia

• Singapore

• Malaysia

• India

Electronic Health Records (EHR)

• E Commerce Retail

Online Home Delivery of Medicines

Home Delivery of Medication Improves Adherence

There is Evidence

Leading Players in the Home Delivery Domain- increasing confidence

Online Retails – One of the Fastest Growing Segments

• Very convenient, saves cost and time

• Healthcare is no exception and is one of the biggest upcoming ecommerce markets

• A great boon - large promise for the future

• Age of rapid delivery – saves frustration of traffic jams

• Online home delivery – one of the fastest growing segments

• Healthcare industry expected to spend 32 B $ on ecommerce and web technology annually – Goldman Sachs

• 5 times more than the 6 billion retailers spend annually on all forms of e commerce and services

Amazon and start-up Xealth are planning a pilot where doctors would

'prescribe' products to be delivered after patients leave the hospital

The idea is to "prescribe" medical products and services to patients

before they're discharged. The products would be fulfilled by Amazon

or another e-commerce company, and Prime members could get

discounts.

That helps Amazon court a new demographic:

Those with complex medical conditions, new mothers, and people recovering from common procedures and surgeries.

AMAZON is HERE – PILL PACK is Just the Start !

E-prescribing is the use of health care technology...▪ to improve prescription accuracy, ▪ to increase patient safety

Physicians simply have to send prescriptions electronically into the pharmacy’s computer system

61

Simplifies Healthcare !

The Need for E Prescription

The Pain Point # 1 of Paper Based Prescription : Safety

The Pain Point # 2 of Paper Based Prescription : Prescription Non-Adherence

• The World Health Organization has estimated that there are 125,000 premature deaths and billions in preventable costs due to patients failing to adhere to medication treatments.

“Medication errors and adverse drug events contribute to approximately7,000 deaths a year, with an estimated cost for drug-related morbidity and mortality exceeding $77 billion a year”.

62

A Weill Cornell Medical College study found that physicians who are stillusing handwritten prescriptions had 88 legibility errors per every 100prescriptions.

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

1 2Paper Rx only Paper Rx + ERx

42.5%

6.6 %

Prescription Delivery Errors %

Start of Study

1 Yr later

E-prescribing is moving from futuristic notion, to nice-to-have, to expected norm.

- According to the results of a survey published by the American Health Information Management Assocn.

The Changing Expectations of Digitalized Customers

• Governments across the world are providing incentives for implementing e-prescriptions, and at the same time penalizing non-compliance leading to its growing popularity

• Several countries have enacted laws and implemented policies

• U.S.A and Europe constitute the two major markets for e-Prescription systems globally.

• Of the two, Europe represents the largest market for e-Prescriptionsystems.

Patrick Kierkegaard

E Rx - The Global Scene

In 20141.4 Bil +14%

Surescripts 2016 – National Progress Report

In 20159,7Bil

In 20151,06 Mil+21.5%

There are specific rules and compliancy hurdles that the healthcare industry must consider. •Security: Healthcare companies are tied to HIPAA compliance and must adhere to HIPAA regulations when it comes to patients. That means that companies need to make sure all of their patients’ medical information remains private, secure and encrypted at all times - even during delivery. •Time Sensitivity: In retail, if a delivery is missed it usually won’t be a life or death scenario. In healthcare, however, it very well could be. If a patient is depending on a vendor system that will deliver them time-sensitive medication or a much needed medical device, the system must always get these packages to him/her on time. For healthcare companies creating an e-commerce strategy, it is important to understand that consistency and reliability are among the top goals in regards to shipping and receiving medications and other healthcare supplies on time. •Compliance: It’s just as important for healthcare companies to ensure that they are compliant with the carriers they are utilizing for deliveries. Often times, medical devices and medications require a signature upon delivery, so navigating the carriers’ frequently changing requirements and associated protocols is a must. Maintaining compliance with FDA regulations related to shipping records is also a concern. •Hazmat/Dangerous Goods Compliance: Automating the complicated paperwork of hazardous and radioactive materials, and shipping them, is a headache for some companies in the healthcare industry. Improving productivity, lowering costs and keeping regulations up-to-date, all while avoiding fines and returned shipments is imperative for hazmat compliance. •Visibility and Reporting: In order to be successful in e-commerce, you need a good customer service strategy. Today’s customers, especially those ordering time-sensitive items, need updates on when their orders will be delivered. Not only that, but your own team is going to need visibility into the service quality of your carriers and notifications of delivery incidents/exceptions. •Heavy Business Rules: When it comes to shipping, many healthcare companies need to have custom business rules in place in order for their products to be shipped the right way. For instance, some products can only travel specific expeditedservices, or some are temperature-controlled shipments that need dry ice. Building, managing and updating these complex business rules can be an exhausting task

Telemedicine Market

• Total Market : US $ 112.5 Billion by 2025 with CAGR 18.3%

• Asia Pacific predicted to have lucrative growth over forecast period

• E Prescribing market expected to reach 1.403.2 Million by 2021 with 20.8%

Opportunities for all stakeholders

Indonesia -E Commerce

Healthcare E Commerce in Indonesia

• Even though still in its infancy beginning to make a strong presence

• Halodoc is an interesting example – complete eco system connecting patients to doctors, online market place for medicines delivering them at patients homes at speed ( 40 mins max ) and connecting patients to labs

• MOH has an ehealth Roadmap in place

• But huge challenges remain

Blockchain in healthcare ▪ Blockchain was a hot topic in 2016, even though the technology has been in use since

2009 and is one of the foundational pieces used for trading the digital currency Bitcoin. ▪ The technology is receiving a lot of attention in healthcare and support from the Office

of the National Coordinator of Health Information Technology due to its potential ability to solve several key challenges faced by healthcare.

▪ Security, interoperability, universal shared infrastructure and global standards would become available once blockchain technology is used to manage and transport electronic health data.

▪ While it is still in its infancy stage in healthcare, blockchain is one of the health IT trends executives will be watching in 2017.

Blockchain in Healthcare

The Future of Healthcare

Indisputably will be drivenby technology, devices, data

through out the globe

Unavoidable DISRUPTION andInspiringly Awesome !

Artificial Intelligence and Telemedicine – The Two Awesome Disruptors !

Thank you

For Listening