Last month, Mary Meeker presented the 2019 edition of her annual Internet Trends report.
As usual, this landmark digital trends report covered a wide swathe of topics, from ecommerce and advertising to data growth, the changing nature of work to the latest developments in China.
This year, as she last did in 2017, Meeker dedicated a section of her report to trends in US healthcare, examining how technology and the internet are changing patient interactions with healthcare providers, improving access to health services, and improving the user experience of healthcare.
Here are the most prominent trends highlighted in Meeker’s report.
Digitisation of healthcare is being driven by consumers
Healthcare as an industry is notorious for being slow to adapt and resistant to change. But statistics cited in Meeker’s report from the Rock Health Digital Health Consumer Adoption Survey, 2018, show that the appetite for digitised healthcare is there.
Between 2015 and 2018, consumer adoption of digital health tools has risen across the board. Of the 4,000 Americans aged 18+ surveyed in 2018, 80% use online health information – up from 71% in 2015. Close to two thirds of Americans – 64% – use online provider reviews in 2018, a 14 percentage point increase from 2015. The adoption of mobile tracking tools in healthcare has also increased from less than a fifth (18%) in 2015 to more than a quarter (28%) in 2018.
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Two digital health tools that have seen particularly significant increases are wearables and live video telemedicine. Use of wearables for healthcare has increased from 13% in 2015 to 33% in 2018; and live video telemedicine has increased from just 7% in 2015 to 34% in 2018 – an increase of 27 percentage points.
Older patients are more engaged in decision-making
The increasing use of the internet for healthcare decision-making is empowering older patients in particular to become more involved in their care.
This insight comes from an analysis of the National Health & Aging Trends Study, carried out by Cajita, Whitehouse, et al. By analysing cross-sectional data from the study’s 1,945 participants, the analysts found that internet use is associated with active decision-making preference in older adults – and that health-related internet use in older adults is positively associated with decision-making involvement.
As Meeker concludes, “Patient engagement in decision-making [is] associated with increased patient satisfaction and improved health outcomes.”
Electronic Health Records (EHR): rising adoption, but development is needed
The use of electronic health records (EHR) in healthcare allows hospitals, doctors and other healthcare institutions to quickly and securely access patient information, update, search and share it, enabling them to more effectively spot patterns and proceed to a diagnosis. They are an essential component of a modern health environment (though their adoption has seen some level of difficulty).
Meeker’s report reveals that adoption of electronic health records in the United States is “nearing 100%”. According to data from the Office for National Coordination of Health Information Technology, adoption of EHR systems by physician’s offices has increased from around 20% in 2004 to more than 80% in 2014. Data on the adoption of EHR systems by hospitals only goes back to 2011, but statistics cited by Meeker show that hospital use of EHR has increased from around 70% to 95% over the course of five years, from 2011 to 2016.
However, doctors would still like to see their EHR systems develop further in certain areas – particularly interoperability. Different systems often have issues with sharing data from electronic health records, leading to treatment delays, duplicative tests, and other issues with co-ordination. According to a Stanford/Harris poll conducted in September 2018, 67% of physicians cited interoperability as a top ‘want’ for future EHR development.
Other top ‘wants’ cited by respondents included predictive analytics (43%) and financial/cost data integration (32%).
New digital healthcare tools and systems are emerging to plug gaps
In the healthcare section of her report, Meeker highlights a number of new digital tools and systems that have emerged to address problems inherent in US healthcare, plug gaps in healthcare institutions, and improve the treatments that are available to patients.
Some of the innovations cited by Meeker include:
Collective Medical: Aligning care teams
Collective Medical Technologies is a software-as-a-service collaborative health network that operates in real-time to help care providers such as physicians, hospitals, medical groups and clinics co-ordinate care and collaborate on case management.
In practical terms, this can mean notifying care providers of repeated visits to the emergency department, which might indicate a problem; redirecting patients to a specialised care venue to prevent them from being readmitted to hospital unnecessarily; and identifying historical security incidents with a patient so that care providers can plan accordingly before they engage.
Meeker quotes Chris Klomp, CEO of Collective Medical, as saying that, “You can either throw a tremendous number of expensive, scarce bodies at the problem [of distributed healthcare] – which isn’t scalable – or you can use technology.”
The more the network grows, the more providers are able to take action to optimise patient care. In 2019, Collective Medical estimates that there will be close to 60 million acute patient-provider interactions, and nearly 1.4 million unique provider-provider actions taken to optimise care.
Zocdoc & Solv: Improving availability of care
Zocdoc and Solv are two tools created to solve the perpetual problem of long wait times to see a physician: on average in the United States, patients can wait 24 days before getting an appointment, which is extremely difficult for patients who need care much sooner.
Zocdoc partners with healthcare providers to fill their unused appointment inventory, which can be as many as 20-30% of appointments, dramatically accelerating access to care for patients. Patients can use Zocdoc’s online tool or app to quickly obtain an appointment with local healthcare professionals – including OBGYNs, dentists, dermatologists, psychiatrists, eye doctors and gastroenterologists.
Similarly, Solv is a tool that enables patients to book same-day or next-day urgent care appointments. One of its key features is simplifying health insurance: patients can take a picture of their insurance card and upload it ahead of time; Solv will explain the benefits, track a patient’s deductible, and send it on to the physician’s office prior to a visit.
Solv’s CEO, Heather Fernandez, estimates that Solv has collectively saved patients more than 20 years of wasted time spent booking appointments and getting an issue resolved. Solv also estimates that it has saved users of its service more than $150 million worth of medical bills between 2017 and 2019.
Nurx: Providing on-demand medication
In the United States, prescription drug expenditures are rising rapidly. Meeker cites figures from the Centers for Medicare and Medicaid Services (CMS) which show that more than $360 billion was spent on prescription drugs in the United States in 2018, up from $136 billion in 2000.
Services like Nurx aim to address this issue, by allowing patients to order sexual health medication and testing kits quickly and discreetly online and have it delivered to their door, with automatic refills and renewals. Patients can also send messages to the Nurx team through the app to get advice about things like side-effects or insurance.
Major internet companies are increasingly trusted with healthcare data
Would you trust a non-medical, for-profit technology company with the most intimate details about your health? According to data in Meeker’s report, the answer for a large number of people is ‘Yes’ – though it can depend on the company.
When asked with which tech company people would be willing to share their health data, respondents to the Rock Digital Health Consumer Adoption Survey were most willing to trust Google, with 60% of respondents willing to share their health data with the search and advertising giant. Amazon was the next-most trusted, with 53% of respondents prepared to share health data with Amazon, followed by Microsoft at 51%. These three companies were the only companies trusted by a majority of respondents – Apple just fell below the line, trusted by only 49% of respondents despite its strong stance on privacy.
At the lower end of the scale, respondents were least willing to trust IBM with their health data, with just 34% saying that they would share health data with IBM. Facebook was second least trusted, with 40%.
Big tech is developing its own healthcare solutions
The question of whether consumers trust companies like Google, Microsoft and Apple with their healthcare data is not just a theoretical one. Big tech companies are increasingly developing their own healthcare solutions and throwing their weight behind research and funding for healthcare technology.
Tim Cook, CEO of Apple, said in January 2019 that Apple’s “greatest contribution to mankind will be about health. Because our business has always been about enriching people’s lives.”
He added that the company is “democratising” healthcare with innovations like ResearchKit and CareKit, open source frameworks that allow medical researchers to gather data for studies, and developers to create apps that help individuals manage their health, respectively. Apple Watch apps created with these frameworks have been used for everything from monitoring depression to collecting data about Parkinson’s Disease symptoms.
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Google parent company Alphabet, meanwhile, is aiming to shape healthcare through AI and apply technologies like machine learning to solving health problems. Through DeepMind Technologies, Alphabet has applied AI to the issue of detecting early signs of eye disease, detecting cancerous tissue in the head and neck, predicting the onset of acute kidney injury in patients, and more.
However, despite Google apparently commanding the most trust out of the major technology companies, DeepMind has been implicated in some data-sharing controversies, such as the 2018 announcement that its health division and the Streams app (which sends alerts to doctors about patients at risk of acute injury) would be absorbed into Google Health – despite previous statements that patient data would be kept separate from Google projects and services.
Microsoft is also devoting itself to AI solutions with Microsoft Healthcare. Peter Lee, CVP of Microsoft Healthcare, said in April that Microsoft can “make a big contribution” to turning digital healthcare assets into better health insights, experiences and outcomes, adding that “Cloud, AI and research capabilities will play a fundamental role towards the future.”
To this end, Microsoft has already launched a chatbot called the Clinical Trials Bot that aims to tackle the problem of matching suitable patients with ongoing clinical trials, providing patients with access to vital treatments, and researchers with subjects for vital studies.
Finally, Amazon has recently made inroads into healthcare with its acquisition of PillPack, an online pharmacy that delivers prescription medication to consumers, offers automatic refills, and provides 24/7 customer support.
Amazon has notably been mostly silent about this acquisition – except for a statement by Jeff Wilke, CEO of Amazon Worldwide Consumer, about how PillPack will enable people to “save time, simplify their lives, and feel healthier” – but it is significant that Amazon has acquired a company that already posed to a threat to many pharmacy businesses, particularly pharmacy benefit managers (PBMs), the middlemen who negotiate prices for retail drugs.
Meeker notes that prescription medicine usage in the United States is “increasingly common”, with 62% of Americans taking one or more prescription drugs, according to the 2019 Kaiser Family Foundation Health Tracking Poll. 24% take four or more.