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Innovation: the force driving change in the health continuum

How an integrated approach to healthcare can link up the whole world

In my day-to-day work the focus is on the need to improve the global healthcare system, to make it more accessible and, above all, to ensure it remains affordable. Here at Philips we concentrate on the people in the health continuum – from the hospital manager, doctor and nurse to the patient and the health-conscious consumer. Our innovations are always geared to improving patient outcomes, to achieving efficiency and being more effective, and to controlling costs throughout the entire health continuum.

This can only be achieved if changes are made to the professional healthcare provision. Increasingly the emphasis is on prevention and promoting a healthy lifestyle, obtaining a more accurate 'definitive' diagnosis, choosing the most appropriate treatment, more accurate dosing and administration of medicines and treatments in order to prevent adverse side-effects, and providing good home care.

 

The patient and healthcare consumer and the healthcare professionals are being brought closer together. This shift is also being driven by the rise in the incidence of chronic disease, with which people often have to live for 10 to 20 years. The system has to become less paternalistic, giving more of a role to the patient, but at the same time, there is a huge opportunity for us to take a more industrial approach to healthcare as a whole; as more of a process, and with fewer inefficiencies.

 

In October 2015, I was invited to speak at the National Economic Forum on this important topic, and this was an invitation I was delighted to accept.

 

Prevention and a Healthy Lifestyle

When we look at innovations in the health continuum we look first at prevention and helping people to take care of their own health. We use our ‘Measure, Motivate and Monitor’ approach for this. This might mean, for example, wearing a watch that measures your heart rate and/or blood pressure almost unnoticed. This data then has to be translated into meaningful information so that consumers are able to understand and use it.

We then need to develop a coaching program to give continuous feedback and advice on healthy living. We don't expect prevention to develop into a real consumer industry, but think it will be more a case of hospitals and primary care facilities being connected with the people in their own homes.

 

Definitive Diagnosis

Secondly, and an extremely important topic when it comes to controlling the cost of healthcare, is diagnostics − in particular in relation to cancer care. As a result of major developments in the field of imaging, we are able to create increasingly sharp, more advanced images of patients. And we can also achieve a faster throughput speed, which will ultimately help to reduce costs. At the same time, we can still learn a lot about the location of a tumor and what stage it is in thanks to the invention of technologies like multiparametric MRI.

In order to make a definitive diagnosis it is then necessary to take a biopsy, following which a pathology test is carried out. It is not easy to take a good biopsy, and ‘false positive’ results are therefore not uncommon. One solution we have recently brought to market is a technology that uses existing MRI images in combination with ultrasound while the biopsy is in progress. This makes it possible to visualize the prostate and the tumor within it. A small electromagnet at the tip of the biopsy needle allows it to be guided with precision to the tumor tissue that can be seen in the merged MRI/ultrasound images.

 

Digital technologies have recently also made it possible to automate the way in which pathology tests are carried out – until today these tests have not been automated at all. Digital pathology makes it possible to record microscopic tissue images, to share them and even to obtain a digital second opinion.

 

If we look at genomics and the invention of targeted drugs, we can see that next-generation sequencing, or the unraveling of the entire DNA pattern or RNA pattern, for instance in cancerous tissue, is within reach. In combination with bio-informatics, we are already able to obtain some indication beforehand as to whether or not a therapy will work for a given patient because we are able to detect the activated biomolecular cancer mechanism.

 

In order to make a definitive diagnosis, it is essential that all the available information is brought together. Philips is currently developing software for an interdisciplinary tumor board, a kind of cockpit that can bring together MRI images, the images from digital pathology and genetic information, among other things, so that it becomes much easier to discuss, share and record outcomes. This kind of portal or app can be helpful for patients as well.

 

By providing specific and personal information about the diagnosis and the patients themselves – at their level of knowledge – it is possible for patients to read about the pros and cons of the various treatment options and to have them explained to them in their own time. This also gives them a chance to discuss the situation and the relevant information with their family and friends at a time that suits them. That is important because there is often a whole plethora of (surgical) treatment options and medicines from which the patient can choose. And in some cases it can even be better to do nothing at all for the time being; the ‘watchful waiting’ approach is sometimes adopted for mild forms of prostate cancer, for example.

 

Treatment: Less Invasive Forms of Therapy

New developments make it possible to use less invasive forms of treatment. One example is ablation. This involves using high-intensity focused ultrasound to heat the tumor tissue to such an extent that the proteins become denatured and die. MR images can be taken while this is being done, thus making it possible to very accurately target the area to be treated in the tumor tissue.

 

Another minimally invasive treatment method that has become available on the market is image-guided trans-arterial chemio-embolization. This method uses the existing catheter lab set-up that is commonly used for endovascular treatments. Tumors attach themselves to the regular blood flow with their own feeding vessels, in order to grow faster. Embolization is a technique where an image-guided catheter is inserted into these newly created blood vessels so that a highly concentrated chemo agent can be applied loco-regionally. The treated region is subsequently sealed via embolization to terminate the blood supply.

 

A very exciting new technology for treating tumors is image-guided radiation therapy. Philips is working together with Elekta and the University of Utrecht on the MR-LINAC – in which extremely precise MR imaging can be used to continuously adjust the radiation beam to compensate for any movement of, for instance, a tumor due to the patient breathing. It is hoped that this will ultimately help to reduce the damaging side effects of the treatment.

Personalized Care in the Home

One very clear example of personalized care in the home that has an impact on both the health continuum and the cost is the ability to measure the recovery of the patient's immune system after chemotherapy. Chemotherapy is still a fairly systemic process whereby the entire body is placed under attack in the expectation that the rapidly growing – and therefore metabolizing – tumor will die before the rest of the body does. A second or third dose of chemotherapy can only be given once the patient's immune system has recovered sufficiently.

 

The necessary tests to measure this recovery can be carried out at home using a clever device that measures the concentration of white blood cells in a drop of blood. Only when this shows that the immune system has recovered sufficiently will the patient be invited for the next treatment session.

 

Open Platforms and Innovative Eco-Systems: the Key to an Integrated Approach to Healthcare

It is important that we think carefully about how to reform the healthcare system itself, and that we determine what makes sense from a clinical point of view. The innovations in diagnostics and treatment, and the wealth of digital data being gathered − now and in the future − can contribute substantially to this.

 

This will, however, only bring about major changes if we all agree to adopt a more integrated approach to healthcare. A digital infrastructure in addition to the existing applications and systems will give us new and advanced insights into the entire health continuum. This will make it possible for us to link up the whole world, and to eliminate inefficiencies one by one.

 

For this it is essential that we create a digital platform where businesses and hospitals can work together on integrated solutions. This is not something that will happen overnight. More and more, we will find that innovations no longer take place behind the closed doors of research laboratories and that long-term partnerships are being created instead. That’s also why we started partnerships with Banner Health, Karolinska and Mackenzie Health in Canada, among others.

 

In short, digital technologies are enabling a host of innovations, including an almost industrial systems approach to the entire health continuum. It is only in this way that we will be able to bring about the necessary cost savings, with accountable care and the co-creation of solutions by industry and the healthcare providers serving as an important starting point.

 

Healthcare here implies an integrated approach from hospitals, primary care, healthcare insurance companies and the government. And the patient, of course. They all have to play a part in this.

Henk van Houten

CTO Royal Philips & General Manager Philips Research

 

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