Around the world, healthcare systems are struggling in the face of rising demand and spiraling costs. And the reasons are complex and varied. Partly, it's because healthcare providers have so much more to do. The populations of rich countries are aging inexorably. That means millions of older patients, who tend to have more frequent and more complex healthcare needs. Partly, it's because providers can do so much more. The life sciences sector continues to make strides in its ability to treat and manage a broad range of diseases and conditions, but many of those new treatments are extremely expensive to deliver. Partly, it's because people expect much more from their healthcare providers. In emerging economies, millions of people are demanding better access to healthcare provision. And as people from the wealthy baby boom generation enter old age, they aren't willing to sacrifice the convenience and high levels of service they have come to expect in other parts of their lives.

TAKING THE TABLETS: Digital pills allow the safe delivery of precisely controlled doses of medicine.

These pressures are raising difficult economic and ethical questions for the sector, and for society as a whole. How should healthcare resources be allocated? Who is going to pay the bills? They are also forcing the sector to explore entirely new approaches to healthcare delivery.

And when it comes to problems that combine scale, complexity and tight cost constraints, there's one obvious place to look for solutions. Digitalization has already shown that it can disrupt industries and define new service paradigms, offering people cheaper, more compelling and more personalized services in sectors from transportation to entertainment.

"The potential for digital technologies to help reduce the cost of healthcare services, while also improving outcomes for patients, is phenomenal," says Scott Allison, President, Life Sciences & Healthcare, DHL. In particular, he highlights four major trends that show how digital or digitally enabled processes have the potential to transform healthcare delivery.

The internet of things

First, there's the internet of things (IoT). Robust, accurate, low-cost sensors and secure communication technologies allow people to collect and store unprecedented amounts of health-related data.

These technologies are already common in consumer products. Accelerometers in smartphones track activity throughout the day. Watches measure heart rate, body temperature and sleep patterns. More specialized devices can measure and record a host of other attributes, from glucose to blood oxygen levels.

The availability of this data, collected non-invasively and in real time, is transforming the management of long-term medical conditions. It is also rewriting the traditional contract between doctor and patient. IoT technologies can reduce the need for patients to visit their doctors for tests, while also providing new insights into symptoms that vary over time. Continual monitoring can help to pick up potentially dangerous changes in the patient's condition faster, allowing timely intervention. And perhaps most significantly, monitoring helps patients to help themselves, giving them the data they need to manage their own health more easily and more effectively.

In November 2017, the U.S. Food and Drug Administration granted approval for the first drug that uses an ingestible tracking system. Abilify MyCite tablets, a treatment for schizophrenia and bipolar disorder, each contain a tiny sensor that is activated by contact with digestive juices in the stomach. A patch on the patient's skin picks up signals from the sensor and communicates with a smartphone app. The system helps patients track their own use of the medication, and they can also allow care providers to monitor their use through a web-based portal.

"This sort of technology could eventually have a big impact on treatment outcomes," says Allison. "Even the best drugs only work if patients use them, and non-compliance with treatment plans, especially for long-term conditions, can be a major contributor to poor outcomes."

Combining 3D printing with smart monitoring, advanced analytics and AI could create an entirely new paradigm.
Andrew Mitchell, Vice President Life Sciences and Healthcare EMEA at DHL

Big data and AI

The second major area of digital opportunity is big data. Modern medicine has always been data-driven. Doctors make clinical decisions informed by the results of large-scale studies and trials. And recent advances in the study of the human genome are revealing how genetic differences affect both an individual's susceptibility to particular diseases and their response to different treatments.

When it comes to picking the right treatment options for each patient, however, medical professionals need to know they are basing their decisions on the most relevant research. As medical databases contain millions of separate references, that can be a formidable task.

This is where artificial intelligence (AI) can help. Advanced AI technologies are accelerating the process of searching medical literature and matching the symptoms and attributes of individuals with previously documented cases, treatments and outcomes.

In a 2015 proof-of-concept study, researchers at the New York Genome Center sequenced the DNA of a tumor in one patient, along with the DNA of normal healthy cells. Then they used a beta version of IBM's Watson for Genomics AI system to search for information on the specific mutations identified in the tumor, while their own team of experienced oncologists did the same thing manually.

The machine won the race with ease. After searching its database of more than 27 million citations, the IBM system produced a report of "potential clinically actionable insights" in less than 10 minutes. The human researchers took 160 hours to reach a similar set of conclusions.

Elsewhere, drug manufacturers and researchers are using an array of new data sources, from climate models to internet search results, to improve their ability to predict disease outbreaks and spikes in demand. As these approaches become more sophisticated, and their results more accurate, they are helping companies and healthcare providers to take a more proactive approach, for example by ramping up production of specific products or shifting inventories to affected regions.

Digitally enabled manufacturing

Digital technologies are reshaping the drug manufacturing process too. In 2016, U.S.-based Aprecia Pharmaceuticals was the first company to gain regulator approval for tablets manufactured using 3D printing technology. The company's ZipDose system uses a proprietary printing technique to create pills with a porous structure that dissolve rapidly in the mouth. The technology is designed to allow the safe delivery of precisely controlled doses of medicine to patients who have difficulty swallowing a normal solid-dose tablet.

SCREENING PROCESS: Big data is a major area of opportunity for the healthcare sector.

Research teams across the world have other ambitions for 3D printing technologies, however. They hope such technologies will allow the creation of highly personalized medicines, with doses and release characteristics tuned to the needs of individual patients or multiple products combined into a single pill. And 3D printing technologies that allow drug ingredients to be transported separately and combined only when the final tablet is manufactured may help to simplify the distribution of sensitive pharmaceutical products. FabRX, a spinoff from University College London, for example, is using a range of 3D printing technologies, including fused deposition modeling, selective laser sintering and stereolithography, to create "Printlets": pills or chewable formulations containing various drugs. Other researchers are exploring the use of 3D printing techniques to create custom medical devices, tissue for transplantation and even complete replacement organs. According to a recent report by Grand View Research, the global 3D bioprinting market will reach $2.6 billion by 2024.

"Combining 3D printing with smart monitoring, advanced analytics and AI could create an entirely new paradigm," says Andrew Mitchell, Vice President Life Sciences and Healthcare EMEA, DHL. "Today, getting the medication right for somebody with a long-term health condition is often a matter of trial and error. "That involves significant time, effort and expense, not to mention the impact on the patient's quality of life. In the future, we will be able to use data from the patient's genome to identify the combination of drugs that is going to work for them, and then we will be able to manufacture a personalized medication that contains the right products in precisely the right dosages."

GOOD MEDICINE: The manufacture of pharmaceutical products is set to become a much more decentralized activity.

Going directly to the patient

The fourth big opportunity is in the supply chain. In the retail world, e-commerce technology has driven a large-scale switch to self-service, direct-to-consumer delivery. The healthcare sector, by contrast, remains largely a bricks-and-mortar operation. It's an unusually labor-intensive one too. Even for straightforward conditions, patients may have to visit their doctor to pick up a prescription, then go to a pharmacy, which could be several miles away, hand over the script and wait in line for their medication to be prepared.

The disadvantages of this approach are obvious, especially for patients for whom travel is difficult or expensive, such as the elderly and people in remote rural areas. It's no wonder that interest in internet-enabled ordering and direct fulfillment of drugs and other healthcare products is rising rapidly.

The U.K.'s National Health Service (NHS) introduced its Electronic Prescription Service in 2013. The system is designed to streamline a number of stages in the prescription supply chain, allowing doctors to send prescription information to pharmacies electronically, and patients to manage repeat prescriptions for long-term conditions online. The system also allows patients to order their medicines online from approved pharmacies and have them delivered directly to their home.

The NHS says the new approach has cut the costs associated with prescription management and fulfillment by £130 million ($176 million) a year since its introduction, and that the reduction in paperwork saves pharmacies around an hour and a half every day. In March this year, the NHS announced that it was extending the use of electronic prescriptions to urgent care settings, such as hospital minor injuries units and out-of-hours medical services. Healthcare providers are embracing other forms of internet-enabled service delivery too, allowing patients to consult their doctor via video link, for example.

Scaling up the digital transformation

These digital innovations clearly have the potential to transform the individual patient's experience. It is now possible to envisage healthcare systems where every doctor has access to artificial intelligence systems to aid diagnoses and recommend treatment options. The chosen treatment might be completely personalized, manufactured using 3D printing technologies and delivered direct to the patient in their home. And once treatment begins, its effectiveness will be monitored by internet-connected devices, with doses and drug combinations continually adjusted depending on the patient's response.

OFF THE SHELF: Warehouse automation will improve the productivity of pharma operations in future.

The transition to such a world will have implications for the entire healthcare value chain, however. The manufacture of pharmaceutical products may become a much more decentralized, distributed activity, for example, with pharmacies taking on new roles as miniature drug factories. Other services may be more distributed too, with patients receiving consultation, diagnostic tests and treatment at their homes and workplaces.

That shift will challenge the industry. Regulatory barriers to the direct distribution of drugs and other medical products will have to come down. The industry will need to find new ways to ensure product quality, safety and data security. Supply chains and logistics processes will need new structures, new processes and new management approaches.

"The life sciences and healthcare sector has always been bold in its application of cutting-edge science to meet the needs of its patients," concludes Allison. "But now the sector needs to be bold in other ways too. Digitalization is going to transform the way healthcare products and services are designed and delivered. The successful application of these approaches at scale will depend on the availability of the right infrastructure to support them. Companies need to start experimenting now with new technologies and new approaches in their supply chains and logistics processes, as well as in their products." — Jonathan Ward

Published: June 2018

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