Patient 2050: Transformation axis and associated challenges

Predicting what the world of healthcare will look like in 2050 is a major challenge, yet the key trends in innovation combined with certain weaker signals suggest that the patient’s condition is likely to change over the next 30 years. In order to decipher the opportunities and challenges that will come along with the transformation of the patient experience in 2050, ALCIMED, a consulting company specialising in innovation and the development of new markets, organised a conference in Paris which brought together six complementary players from the healthcare sector: Jonathan Ardouin, General Manager for France at LIVI, Vincent Galand, E-Health Expert and Operations Manager at EMBLEEMA, Raymond Gérard, President of the French Diabetes Federation and France Assos Santé, Jessica Leygues, Head of Patient Associations and Institutional Patient Programs at CELGENE, Denise Silber, Digital Health Opinion Leader, founder of Basil Strategies and Doctors 2.0 & You and Benjamin D’hont, Great Digital Health Explorer at ALCIMED.

Between patient-centred preventive medicine and optimised care

The reinforcement of preventive or even predictive medicine is expected to be a major axis of transformation in the patient’s lives by 2050. In fact, the application of artificial intelligence to real life data continuously generated by the connected medical devices of the future could allow for an even earlier diagnosis and targeted prevention for high-risk behaviours, while predicting the occurrence of pathologies according to lifestyle and physiological parameters of each person. Some digital players, such as Apple, which plans to integrate a glucometer into the Apple Watch^[1], or AliveCor, which has launched wireless sensors to perform an ECG measurement with a smartphone^[2], have already laid the foundations for this scenario.

Moreover, care as we know it will undoubtedly be optimized by new technologies, enhancing patient comfort, access to care and its quality. According to Jonathan Ardouin, teleconsultation already improves patients’ daily lives by saving them from having to travel to the practitioner and reducing the risk of contamination during a hospital visit. The widespread deployment of this technology, the arrival of self-diagnostic devices on the market and the robotization of certain types of care will thus support the development of ambulatory medicine and home care. Benjamin D’hont estimates that within ten years, patients may for example be able to use a 3D printer to custom design their splint (a Latvian startup CastPrint already offers the first solutions of this type^[3]).

With the implementation of the SMP (Shared Medical Record), the quality of patient management will also improve thanks to its greater personalization. In fact, the centralization of the patient’s previous illnesses, allergies and medical background in a digital file accessible to all those involved in the care process would, in the medium term, make it possible to personalize and therefore optimize therapeutic decision making.

In addition, health authorities are increasingly relying on real life data to track patient care pathways and to have a more accurate measure of the effectiveness of health products. Companies can also use it to develop new solutions in different therapeutic areas, such as Janssen, which has set up a “Datathon” made up of data generation and processing specialists. EMBLEEMA’s project, led in part by Vincent Galand, is part of this perspective: aiming to give patients a stronger voice within the secure and transparent framework of Blockchain technology, so that they can access and exchange their health data, especially in real life, for research purposes.

The increasing digitalisation of care also makes it possible to simplify the patient journey. According to Benjamin D’hont, drugs may no longer be dispensed at the pharmacy in the future but delivered by drones, while data flows to healthcare insurers will be accelerated through the implementation of the SMR.

Finally, according to Denise Silber, the optimization of care will undoubtedly involve an initial disruption due to the impact of virtual reality therapy which will replace certain chemical treatments. New therapies will also make it possible to, for example, eliminate genetic diseases, overcome physical handicaps, develop selective senses or improve human physical and intellectual capacities. In line with all this, each treatment must not only be effective but also adapted to the patient’s lifestyle, according to Raymond Gérard. We are already seeing the development of new innovative therapeutic solutions such as virtual reality modules to relieve pain^[4] or brain implants to treat Parkinson’s disease^[5]. For Benjamin D’hont, we can even imagine in the longer term that the use of the latter will go beyond medical problems for example to increase human cognitive abilities. According to Vincent Galand, cryogenics, or even immortality more generally, is a major topic for many health futurists, in the same way as biomimicry or regenerative medicine.

With the transformation of the health system come technological, ethical and societal challenges

While these future changes in the patient’s condition represent development opportunities for major players in the healthcare sector, they also raise concerns and many technical, legal, organizational and ethical issues.

In order to fully enter this new era of patient care, manufacturers and healthcare institutions will have to extend their activities to include the storage, management and analysis of a massive amount of personal health data. This evolution will imply a new distribution of roles within the healthcare system. According to Benjamin D’hont, hospitals will move towards a model of patient data processing centres, where the provision of care will be limited to state-of-the-art medical procedures. Physicians and carers will therefore see their professions evolve, which will also raise the question of the division of responsibility between the doctor and the data analysis system in the event of a medical error. Alongside healthcare professionals, the pharmaceutical industry is also changing, and we can already see the challenge of setting up ultra-powerful information systems. For example, Sanofi’s Darwin platform already gathers anonymized data from more than 300 million individuals and could make it possible, among other things, to create modules to support therapeutic decision-making^[6].

This modernization effort is also accompanied by a major challenge: cyber security in view of the sensitivity of health data. The major players in the sector will therefore have to ensure the impenetrability of systems managing shared medical records, connected medical devices or biometric and neural implants. Hacking such systems by for example taking control of an implantable medical device, such as a pacemaker or an insulin pump, could become a new type of crime according to Benjamin D’hont.

Another concern raised by these developments, and in particular by the massive generation of personal health data, is related to the issue of individual freedom and equity of the healthcare system. According to Denise Silber, the implementation of a series of connected medical devices permanently generating biological data associated with behavioural data implies a permanent monitoring of individuals by their doctors or insurers. This raises major ethical and societal questions: Who will own the health data? How can we prevent patients from being discriminated based on their state of health in the name of prevention and personalisation of care? To what extent could the prevention of risky behaviours limit patients’ freedom of choice regarding their lifestyle? One could indeed imagine the implementation of different health insurance plans depending on the daily behaviour of individuals, as reflected in their alcohol consumption, blood sugar levels or smoking habits. In order to avoid these pitfalls and the risk of a total rejection of this progress, the authorities will have to put in place a number of laws to serve as safeguards. As initiators and beneficiaries of the development of these new technologies, major industrial players and health professionals have a strong interest in supporting the authorities in order to reflect on this new health system.

All future technological innovations will only be able to reach their full potential if they are centralized around the patient and make it possible to decipher people’s individual feelings.  The ability of authorities and manufacturers to consider patients’ experience to its fullest extent is therefore a major challenge for ensuring that a truly “personalized” medicine emerges within the next thirty years. This is what the “Ma Santé 2022” reform advocates through tools designed to collect patients’ experiences – tools which have been designed by patients and are adapted to the healthcare system, emphasizes Jessica Leygues.

Predictive medicine, the optimization of paths and processes, and the refocusing of the health system on patients are already part of the reality in 2019, allowing the pioneers to imagine the patient of 2050. Faced with the doubts, questions but also fantasies or utopias that these ideas reveal for the future, many technological, ethical and cultural challenges await authorities, health professionals and major industry players. It is in their best interest to explore these unknown lands now in order to ensure their leadership in the care of the patient of the future.

[1] https://www.wareable.com/apple/apple-watch-diabetes-glucose-monitoring-guide-2018
[2] https://www.alivecor.com/
[3] https://www.forbes.com/sites/rebeccabanovic/2019/04/14/these-3d-printed-casts-from-latvia-could-be-the-future-of-healthcare/
[4] https://www.sciencesetavenir.fr/sante/e-sante/la-realite-virtuelle-le-nouvel-antidouleur_124813
[5] https://www.lexpress.fr/actualite/un-implant-cerebral-pour-guerir-de-parkinson_2040479.html
[6] https://www.sanofi.fr/fr/Actualites/communiques-et-dossiers-de-presse/Conseil-strategique