Shields, Spears, Digital Tattoos and Bionics: 6 Healthcare Disruptions for 2020

Christopher Surdak, JD, global subject matter expert for analytics, information governance and eDiscovery, Hewlett Packard Enterprise

As 2014 draws to a close, we can see that it was a year of rapid, accelerating change. The relentless advance of technology is impacting nearly every aspect of our society in ways that are frequently unexpected. This is true even in markets which have historically been slow to adapt to change, such as the market for healthcare.

The healthcare market in the United States (valued at between $2.7 and $3 trillion, depending upon the source) has not historically been a hotbed of innovation. While there have been some tremendous advances in medicine over the last fifty years, operationally, the healthcare industry is largely stuck in the mid-1900s. Many of the advances brought on by the information age have yet to be applied to this industry. But, as this article will discuss, this situation may change rather dramatically over the next five years.

In attempting to forecast the future of healthcare one must reconcile our ever-growing expectations of innovation, high quality and affordability with institutional controls, beliefs, and traditions which tend to stifle such changes. As consumers we may wish for constant progress and advancement in everything that we consume, including healthcare. However, structures such as regulatory bodies, professional associations and licensure schemas frequently work to maintain the status quo; sometimes with surprising vigor.

The shield and spear paradox

Most of us are familiar with the shield and spear paradox. Simply stated, this paradox asks, What happens when an irresistible force meets an immovable object? As with all paradoxes, there is no right answer per se, but one can be sure that the outcome of such a meeting will be messy, noisy, and the source of a great deal of chaos and change. The healthcare market represents such a paradox, and the future of this market will be similarly filled with noise, chaos and change.

The spear in this instance represents an aging population, rapidly advancing technologies and unsustainable consumption trends. These forces are joining to create an irresistible force of change in how healthcare is consumed and delivered, particularly in the U.S. The shield, or immovable object, represents the institutions underlying how healthcare is defined, delivered and managed in our society. These institutions, represented by care and coverage providers, "big pharma," professional associations and regulatory bureaucracies, are largely focused upon maintaining things as they are; or at least ensuring that changes occur with a minimum of risk and disruption.

In making prognostications about healthcare in 2020, we must balance the changing needs, desires and expectations of consumers with the needs, desires and interests of those who benefit most from the status quo. For example, while vast quantities of data and advances in mathematics might enable us to discover a wide range of new therapeutic drugs in the coming five years, the regulatory structures that review and approve such new drugs will prevent their rapid introduction into the marketplace. Indeed, most regulatory schemes are designed around the principles of prudence and caution, rather than risk-taking and speed-to-market. As a result, it is doubtful that any discoveries in pharmacology, genetics or medical devices not yet made in 2014 will make it to market use before 2020.

So from where will change and disruption come in the healthcare marketplace? It will come from paths of lesser resistance. It will come from other societal mega-trends suchas appification, thingification and socialfication as they leech into the nooks and crannies of the institutional controls maintained by the healthcare industry, and begin to break down those controls just as water breaks down the largest, strongest stones. This process of change will happen in healthcare just as relentlessly as water erodes entire mountain ranges. However, these changes won't come at a geologic pace; they will come at the blistering speed of the Internet.

The six major disruptions that will drive the most change in healthcare by 2020 are:

1. Consumerization
2. Telemedicine
3. Diagnostics
4. Smart Devices
5. Bionics
6. Predictive Analytics

Let's look at each of these disruptive trends in turn, and take a peek at what healthcare might look like five years hence.

Disruption #1: consumerization

First and foremost, the Affordable Care Act (AKA: Obamacare) is going to drive the development and growth of premium healthcare services. These services will be bought with discretionary funds, will be provided to the highest bidder in competitive marketplaces, and will be held in extremely high regard by consumers. If the ACA sets a floor of care for all Americans, consumerization of healthcare will create an enormous demand for something better than that floor.

That the forced-marketization of healthcare is occurring at precisely the same time that the buying public is expecting more and more from vendors is a happy coincidence for healthcare startups. Unshackled by preconceived notions of how care should be delivered or how things "have always been done," these fast-moving companies are setting up to do to healthcare what Uber has done to transportation and Airbnb has done to hospitality.

And just like these two companies, many healthcare startups view the regulatory protocols governing their competitors as quaint, rather than authoritative. Regardless of the political future of Obamacare, the consumerization of healthcare will cause massive disruption over the next five years, awarding innovators and rendering established players irrelevant in the only market segments likely to remain commercially viable.

Disruption #2: telemedicine

The second significant disruption coming to healthcare is telemedicine. As the cost of in-patient care continues to skyrocket, and as we become more and more addicted to the instant gratification afforded to us by our smartphones and apps, the idea of going to a hospital or doctor's office to receive care will seem as outdated as using a phone booth to place a call. (Remember those? If you remember, you've dated yourself!)

Telemedicine, where the patient and his or her care provider can each be anywhere in the world, will completely change how healthcare is delivered. Technologies such as FaceTime and Skype aren't just mainstream; they're integral to modern connected living. They allow us to interact immediately, without delay, and with a high degree of interactivity. Issues such as location and schedule no longer matter, and we'll expect the same from our care providers. By 2020, going to "visit" a doctor likely will seem abnormal, while "seeing" our doctors will occur with much greater frequency and brevity.

Disruption from telemedicine will be even greater as consumerization takes hold. As I spend more discretionary funds on my own healthcare, I'll want to spend those funds obtaining the very best care I can possibly receive. With telemedicine, it won't matter where I live, or where my provider practices; we will simply log into a consultation session online. As a result, I will seek out the very best providers wherever they are in the world, and they in turn will work to market directly to me through online exchanges not unlike Angies List or eBay. This transformation is already taking place, and doctors who do not join such exchanges immediately will, again, find themselves providing commodity services to the least-common denominators in the market.

Forced-marketization of healthcare is occurring at precisely the same time that the buyingpublic is expecting more and more from vendors. This is a happy coincidence for healthcare startups. Unshackled by preconceived notions of how care should be delivered, or how things "have always been done," these new companies are creating entirely new business models, specifically targeting the regulatory mine fields and cognitive barriers that existing providers avoid at all costs.

Disruption #3: advanced diagnostics

Fans of the science fiction hit Star Trek are no doubt familiar with the handheld medical scanner predicted by the show's creators. Such devices, called "tricorders" allowed medical staff to simply wave the device over a patient's body and instantaneously obtain an accurate diagnosis of the patient's condition. What may not be known to many people is that this magical "tricorder" is no longer science fiction; it is becoming medical fact.

In 2012, Qualcomm Inc. sponsored a Google X-Prize for a medical tricorder. Under this contest, dozens of companies have been attempting to create an actual handheld medical diagnostic device. Each device must diagnose at least a dozen conditions, weigh less than 5 pounds, and perform the diagnosis non-invasively (without penetrating the patient's body). Google will announce a winner in Spring 2015, and from that point on medical diagnosis will never be the same again.

While only the top three contenders will win any money from this X-Prize, the result is that hundreds of ailments will be diagnosable, accurately, immediately and with little or no need for invasive testing. It might take a few years for these devices to deliver high degrees of accuracy and reliability, but the result of this innovation will be nothing less than the disruption of the front-half of the healthcare value chain. Presently, misdiagnosis and other human errors are the third leading cause of death in America, killing over 400,000 people every year. As automated diagnosis gets better and better, such errors will become increasingly rare and increasingly unacceptable.

By 2020, when you or I feel a bit sick it will be completely normal for us to stop by a vending machine at the mall, buy a disposable, $5 plastic cube (like today's Square credit card reader), lick it, and then get an accurate diagnosis of our ailment in 10 seconds or less. We'll then get a coupon for the best treatment for that ailment and an invitation to consult with a five-star specialist in that condition, who practices medicine on a different continent. This will all be normal to us by 2020.

Disruption #4: smart devices

As 2014 draws to a close it seems not a day goes by without some mention of the Internet of Things, or IoT for short. From toothbrushes to refrigerators to cars, the things in our lives are all becoming connected, self-aware and "smart." Within the next couple of years we will consider it to be "normal" when we friend our new microwave oven on Facebook, our fridge reminds us to pick up a gallon of milk on the way home from work, or our car negotiates for the best price on our next tank of gas on our behalf. These sorts of interactions with the objects in our world will not only be normal, we will expect it.

Inevitably, the Internet of Things will infiltrate healthcare in a range of novel ways. Our prescriptions will come in smart bottles that know when we haven't taken our scripts on time and texts a reminder to us (and our loved ones and our insurance carriers and doctors). Medical devices will monitor how they are being used by practitioners, and will intervene if they are about to be misused. Such smart monitoring and intervention will be expected, and practitioners will have to be prepared to defend their actions to their insurance carriers when they choose to disagree with the instrument in their (likely telerobotic) hands.

As with all IoT devices, objects throughout the healthcare value chain will plug in, measure and monitor everything we do in real time. They will produce vast quantities of information regarding our health, treatment, habits and behavior, and will make fact-based health care a reality. Our care will be controlled with mathematical precision, and our satisfaction with our care will be constantly quantified. Again, this will feed back into our expectations of consumerization, and will accelerate the changes that it brings to the market.

Disruption #5: bionics

As its name implies, the Internet of Things is often thought to include only "things" or physical objects in our world. However, the field of bionics, or the merging of machines with living tissues, is advancing at an alarming pace. In the very near future, we might not only "friend" our fridge on Facebook, we might even get a "friend" request from our heart, kidneys or lungs. Indeed, our livers may be posting a complaint about how much we had to drink at last night's dinner party!

A simple internet search on "digital tattoos" quickly demonstrates just how far this field has come. Presently, we are able to connect digital devices directly to the human body and interact with each of the body's primary systems (nervous, circulatory, sensory, respiratory, etc.). Right now, most of this interaction is passive monitoring, merely watching what the body is doing. However, researchers are already finding mechanisms for actually controlling the body digitally, and blurring any line that might still exist between our technologies and ourselves.

As this capability advances, and as it merges with our ever-growing expectation of instant gratification, prediction and prevention, more and more products and services will be created to take advantage of this technology. People who today have concerns over personal privacy may be overwhelmed at the notion of our vital signs being posted to the internet in real time; rightfully so. But if the last seven years of smartphones and apps has taught us anything, it is that our signing up for such services is very likely when the perceived benefits clearly outweigh the hard-to-articulate risks. By 2020, the bionic man or woman might not cost $6 million to create, but the data that they publish to the web might be worth something like that much to advertisers attempting to mine it!

Disruption #6: predictive analytics

Finally, of the six disruptive forces that will drive healthcare in the near term, predictive analytics may generate the greatest gains, and the most discomfort. Today, whenever a disaster, catastrophe or other surprising event occurs in the world, the media and public begin the hue and cry, "Why didn't we predict and prevent this from happening?" Our constant generation of data about ourselves and our lives gives society the ability topredict our behaviors with ever-growing accuracy and precision, and this ability is driving our collective expectations in our lives.

In healthcare, as digitization of our health records merges with the five other forces listed above, disruptors of the industry will have an ever-growing ability to predict our futures. Presently, we usually seek healthcare services once something has gone wrong. We have an accident or injury, feel ill, or are at disease in some other way, and we go to our doctors to get better. As healthcare gets more and more expensive, and our access to actionable data becomes better and better, there will be an increasing focus upon intervention and prevention. Bionics and the IoT will allow issues to be identified before they become severe or chronic. Better diagnostics will lead to more accurate treatment. Telemedicine and apps will allow us to consult with our doctors in real time, for mere minutes, while we are on our way to work or the store. Our growing expectations of prediction and prevention will be met, and they will be expected by 2020. It will all be part of our "new normal."

Predictive analytics will also support fact-based, quantitative care. While there is a great deal of focus upon quality in healthcare, the vast majority of it is qualitatively based. How the patient feels about their treatment is the measure of quality, rather than measurable, quantifiable results. This is largely due to the absence of relevant data, but this is rapidly changing.

Going forward, doctors may in fact refuse to administer treatment when they know, predictively, that the treatment won't provide good results. As long as quality is defined qualitatively, this process will remain fairly broken. As predictive models become better and better so too will the quality of care and results that they can generate for patients. We will expect this. We will be comfortable with it. We will come to rely on the results that we receive from these technologies. And, by 2020, we would be hard pressed to return to a state where our every need was met in this manner.

Conclusion: hold on tight

Many people in the healthcare field may find these disruptions highly unlikely. Indeed, many feel that this sort of thing, "just doesn't apply to healthcare," or, "healthcare is just different." There are plenty of executives from the retail, transportation, lodging, banking and even the yogurt industry who thought the same way five years ago. Ask them today whether they were somehow "protected" from disruption and they will likely tell a very different story, or somehow remain unaware of the changes taking place around them.

Yes, healthcare has a range of constraints that retard significant disruption to the present business model. Licensing schemes and certifications restrict access to the profession, regulatory structures protect patients by enforcing byzantine testing protocols that tend to reinforce the hypothesis in question. All of these forces tend to slow down the rate of adoption of new therapeutics, be they devices or chemical in nature, as we try to ensure their efficacy in human trials.

What is being proposed here is that much of the coming disruption will come not from the basic research performed by big pharma companies. Rather, most of the innovation in healthcare will result in how the application of these tools will change, how they'll be marketed, how they will be measured and their efficacy determined, in a world where more and more patients are taking an educated interest in their healthcare, and wish to manage their health as they would any other important project in their lives.

These changes are fundamental and will affect every aspect of how healthcare will be delivered in the U.S. in the coming decade. Those companies which seek to remain relevant five years hence would be well served to study these six forces of disruption, understand how each will impact their current business model, and strive to be the first player to incorporate these changes into their own operating strategy. Short of this, existing players in healthcare will have their work cut out for them if they wish to remain relevant. And many of these executive will reach the year 2020 wondering how so much of what they believed about their chosen industry could have been made so wrong, so quickly.

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