Part 2: Working together for change: The future of BC’s health is in our hands

I never thought I would be in the business of making other people’s health better. But that changed when I met Dr Eric Topol,[1] a cardiologist, geneticist, and digital health researcher at the Scripps Translational Science Institute in San Diego. His keynote address at the CTIA Wireless Convention in April 2009 persuaded me that technology can transform health care. 

Although I am a technology entrepreneur and not a doctor, I care deeply about the future of health. Technology is already making a difference to health in British Columbia and beyond. But we can accomplish much more if entrepreneurs, doctors, and patients learn to work together. In the entrepreneurial world, we call this building BC’s digital health ecosystem. So what exactly does building such an ecosystem mean? What are the challenges and opportunities? And what support is available to those who want to engage in transforming our health care system? 

For doctors in BC to continue delivering high-quality care and achieve maximum professional satisfaction, I believe we need to answer the following questions: 

• Are we focusing our creative, intellectual, and social efforts on the right objectives?
• Are we delivering care of the highest standards to meet new patient demands and expectations?
• Are individual doctors ready to welcome patients as partners in the transformation of health care? 

We also need to consider the kinds of change already occurring, the opportunities technology presents, and the current state of BC’s digital health ecosystem. 

The face of change 
Taking a broad view, medicine helps people live longer, healthier, and happier lives. In doing this, medicine has relied on a long tradition of innovation. There are more than 7 billion people on the planet, over 3 million doctors, and tens of thousands of hospitals. And with a global move to preventive, precise, and personalized medicine, innovation has never been more important. “Do no harm” does not mean “Do not change.”

Change is happening, and it is happening faster than ever before. Ray Kurzweil, futurist, innovator, and special advisor to Google, calls it exponential acceleration and notes that the law of accelerating returns affects every industry.[2] We are now seeing entire operating systems and industries being replaced almost overnight. You may not always see it, but rapid change is also happening in health care, something Dr Topol calls “the creative destruction of medicine.”[3] 

Relationships between patients and doctors are changing because a large number of social, economic, and technology forces are converging to empower patients, help doctors, and democratize medicine. Change is being driven by: 

• Smart phones, smart cars, and smart homes.
• Artificial intelligence such as IBM’s Watson supercomputer, the Alexa operating system from Amazon, and the next generation of quantum computers.
• Advanced wearable or ingestible biosensors such as the Proteus Discover, which can send real-time data to doctors and patients alike and serve as a medication carrier.
• Virtual and augmented reality technology.
• RNA and DNA sequencing kits such as those by Illumina that enable gene expression profiling.
• New approaches to modifying foods to actively promote good health and longevity.
• 3D printing by ventures such as Aspect Biosystems, a UBC spinoff that specializes in bioprinting and tissue engineering.
• Social networks for patients such as smartpatients.com or patientslikeme.com.

Expanding on two of the examples above is instructive. For instance, virtual reality (VR) is being used now to treat mental health problems, pain, and PTSD, a condition affecting 32% of Vancouver police officers.[4] VR is being used in clinical practice by Dr Brennan Spiegel at Cedars-Sinai Medical Center in Los Angeles and by Drs Brenda and Mark Wiederhold at the Virtual Reality Medical Center in La Jolla, where they have been treating phobias such as fear of flying and PTSD with VR for years. Toronto hospitals are starting to use VR to ease presurgery anxiety. In Vancouver, two new VR technologies have been developed in the last 2 years—PeriopSim, a medical simulation app used to train perioperative nurses about tools and procedures, and Osso VR, an award-winning surgical training platform. Regarding nutrition-related innovations, Nestlé, the world’s largest food manufacturer, is pursuing research that will allow them to design individual diet plans. Former chairman Peter Brabeck-Letmathe believes that future consumers “will undergo health testing . . . to learn more about the genetic material of the microbes—the bacteria, fungi, protozoa, and viruses—living inside their bodies” in order to “analyze genetics, caloric levels, predisposed illnesses, and more. Such information would allow Nestlé to create products that essentially act as medicine to alleviate known health issues.”[5]

Technology-related opportunities 
The digitization of genomic information will open up new opportunities to change curricula in medical schools and health science programs. The exponential power of technology in the life sciences and biotech will accelerate discovery and produce revolutionary breakthroughs in research in cancer, mental health, and rare diseases. Patients and doctors will both benefit tremendously from all these changes, as will the governments who have to respond to people’s demands for better care and improved value. 

The next generation of family doctors, specialists, and medical students will practise in a decentralized digital world and rely on machines to serve the needs of smart patients and smart communities, delivering health services and compassionate care anytime, anywhere. Patients and doctors will use smart digital health tools and real-time information to focus on prevention, precision, and personalized medicine. 

Business innovators will create new high-paying jobs along with new revenue streams for doctors and health-related professions. Governments will face pressure in their ability to pay for social services. They will look at impact investing, social impact bonds programs, and pay-for-success to reduce the risk and improve the outcomes and accelerate social progress. 

There will be winners and losers. The way for health care systems to emerge as winners is to understand there is no one big idea or magic bullet to deliver better outcomes. Instead, meaningful collaboration between all participants will improve health care delivery through seamless knowledge transfer, and by connecting the dots between the most promising approaches to health care in research, industry, and government. As Dr Jeffrey Flier, former dean of medicine at Harvard University, says, “We need approaches to solutions that aren’t just arithmetic and additive, but are in some sense logarithmic. This will require us to reach across historic boundaries and unlock the potential of collaboration across the usual disciplines.”[6]

As well as increasing efficiency, digital health technology can improve health care delivery and support relationships. Doctors who adopt digital health technologies will be able to serve more patients in a more precise and personalized way, and will enjoy greater professional satisfaction, less stress, and potentially higher incomes. Doctors of tomorrow will need to learn to work with their patients as partners because patients will be empowered with digital health products and services and they will demand that their doctors be equally familiar with digital health. 

BC’s fast-growing digital health ecosystem
The College of Physicians and Surgeons of BC says 11 574 doctors were practising in the province as of February 2015.[7] That is 1 doctor for every 400 of our 4.6 million residents. Some suggest that our health care system is the perfect size for change—the sort of change that has transformed health systems in Singapore and Denmark, two countries with similar-sized populations.

In BC as elsewhere, health care is late to the world of digital innovation, and that may be a good thing. In the last 25 years the tech industry has learned a lot about how to serve consumers with products and services they need and want—and can afford. Technology has brought us the Internet, smart phones, Google, Amazon, Facebook, Twitter, Airbnb, Uber, virtual and augmented reality, bitcoin, and blockchain technology. Blockchain in particular is important to health care because it may provide a way of securely and anonymously sharing big data, a crucial step to creating new models for population health while protecting the privacy of British Columbians. 

The global digital media and wireless industries have already transformed financial services, commerce, consumer electronics, publishing, music, and travel. Now is the time to bring everything the tech industry has learned in the last quarter century to serve the needs of patients and doctors, and to do it faster and more efficiently than ever before. 

Fortunately, innovation is a team sport, so doctors in BC will not be alone in their efforts to change health care. Innovation is everywhere in our provincial economy and we are fortunate to have a large and talented group of innovators in the life sciences, health IT, digital health, the creative industries, and technology. 

In 2015, Vancouver was ranked in the top 20 of global start-up ecosystems by the benchmarking company Compass.[8] We have a robust environment supported by world-class institutions such as UBC, SFU, UVic, Emily Carr University of Art and Design, BCIT, and others. Genome BC, the Michael Smith Foundation for Health Research, the UBC Centre for Molecular Medicine and Therapeutics, the Providence Health Care Research Institute, and many other centres of excellence inside various health care authorities promote and support health innovation. Numerous venture accelerator programs are available to help doctor-entrepreneurs take a product to market, including entrepreneurship@UBC, the BC Tech Association’s HyperGrowth: Life program, the Coast Capital Savings Venture Connection and Digital Health Hub at SFU, the Health Design Lab at Emily Carr University for Art and Design, Innovation Boulevard, the Health and Technology District, and Interface Health (https://interfacehealth.com).[9] (This last example is the community and platform for innovators that I founded and now serve as CEO.) Various government programs also help entrepreneurs connect with researchers or build new companies, including the National Research Council’s Industrial Research Assistance Program (NRC IRAP), the Natural Sciences Research and Education Council, and the Western Diversification Program. In fact, reports from the NRC IRAP show growth from barely 20 start-ups in 2009 to more than 150 today.[10] 

In 2017, digital health was recognized as “a dynamic and fast-growing sector in British Columbia”[11] by the Ready to Rocket business recognition program, which since 2003 has been considering companies with the greatest potential for revenue growth in different sectors, including information and communications technologies, clean tech, and life sciences. Of the 150 companies that made the final lists this year, 31 digital health companies were recognized.  

The Information Communication and Technology Council predicts that 32 000 new jobs will be created by digital health in Canada by 2020.[12] Some of those jobs will be at BC digital health start-ups such as Ayogo, Claris Healthcare, Curatio, Equicare Health, GenXys Health Care Systems, InputHealth, NZ Technologies, PHEMI, QxMD, and SHIFT Health, all members of Interface Health. The demand for health-related technology is increasing as well. According to the 2016 Telus Health Digital Life survey, “89% of Canadians believe digital health technology will lead to better care; at least 85% report missing out on tech that would let them take more control over their personal health.”[13] 

So, why do 9 out of 10 Canadians want to use digital health products and services but cannot? The short answer is because there is no marketplace where private citizens and health care providers such as hospitals, labs, specialty clinics, health insurance companies, retail pharmacies, and employers can actually buy digital health products and services. Interface Health examined this problem and is testing a possible solution called the Interface Digital Health Showcase. This initiative launched on 1 June 2017 to help consumers and health care providers find some of the most innovative products and services in the world. For this first showcase, an Interface Health panel considered over 100 Canadian digital health products before selecting 12 to profile (9 from BC and 3 from Ontario):

• Brain Power Score, an app for promoting optimum brain vitality.
• CareTeam, a care-coordination app that reduces hospital visits.
• Claris Reflex, a wearable sensor that speeds recovery from knee surgery.
• Curatio, an app that offers access to a support community for those with rare or difficult chronic health problems.
• HeadCheck, an app for assessing sports concussions right on the sidelines.
• Health Storylines, a self-management tool that helps users make better health decisions.
• MemoText Sentinel, an app that empowers users to achieve their health care goals.
• Muse, a brain-sensing headband that trains users to meditate and focus.
• NourishedBabe, an app that provid-es nutrition guidance for mothers-to-be.
• TickIt, an easy way to collect health data that is otherwise difficult to obtain.
• Tipso, an interface that lets surgeons review medical images without leaving the patient’s side.
• TreatGxPlus, a system that uses genetic information to personalize medical treatments and medications.

These and other innovations demonstrate that patients and doctors have much to gain from digital health care. As Dr Topol states, “the path forward will be complicated: the medical establishment will resist these changes, and digitized medicine inevitably raises questions surrounding privacy. Nevertheless, the result—better, cheaper, and more humane health care—will be worth it.”[14] 

One final thought: By making health care about more than just the delivery of medicines and treatments and considering the use of social impact investing in BC to develop technologies, we will truly be leaders in the global transformation of health and health care.

Competing interests
Mr Bidu received honoraria from BCIT for a keynote presentation he gave at the 2017 convocation as CEO of Interface Health. He also received fees from several digital health companies named in this article: Ayogo, Claris Healthcare, Curatio, Equicare Health, GenXys Health Care Systems, InputHealth, NZ Technologies, and SHIFT Health for business development consulting. Mr Bidu also received financial support from public and private organizations for organizing events such as the Interface Health Summit and the Interface Health Challenge X. 

This article has been peer reviewed.

Mr Bidu is an entrepreneur responsible for eight technology start-ups and is the founder and CEO of Interface Health, a not-for-profit organization dedicated to helping entrepreneurs build, market, and grow successful companies in the digital health field. He also sits on the board of the Centre for Molecular Medicine and Therapeutics at the University of British Columbia and is a sought-after speaker and key influencer in digital health innovation in Canada and around the world.