Digital Health - Q3 2020

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DIGITAL HEALTH

Q3/ 2020

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“A silver lining around a very dark cloud that is COVID-19” Andrew Davies Digital Health Lead, ABHI

P2 “Patients take the lead and healthcare systems need to catch up” Lynsey Chediak Project Lead Shaping the Future of Health and Healthcare, WEF

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P6 “Digital technology has helped to minimise disruption” Julian David CEO, techUK

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IN THIS ISSUE

04

“Data has the power to save lives”

What are the digital health gains that have been made as a result of COVID-19?

Sarah Wilkinson

Chief Executive, NHS Digital

08 “The digital agenda should be a situation where everyone wins” Andrew Davies

Digital Health Lead, ABHI

11 “Technology has helped improve blood glucose control for those living with Diabetes” Liz Perraudin

Policy Officer, Diabetes UK

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In the battle against COVID-19, digital technologies have proved their worth, providing the virtual foundations for the next generation of healthcare delivery.

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n fact, Health Secretary, Matt Hancock, recently said: “The pandemic has been as close as you can get to fighting a war without actually fighting a war.”1 The way that all parties came together to tackle a common enemy was quite remarkable, and one we should all be proud of.

As well as being reinforced by a veritable army of volunteers, the NHS has been supported by technology.

In the history of war – be that armed conflicts, cold wars or space wars – these periods typically breed technological development. COVID-19 has been no different, and we have already seen significant changes in the way technology is used in the NHS: • Primary care was transformed from a walk-in service to a “dial-in or clickfirst service” in the space of weeks.

• Hundreds of thousands of people across the country are turning to digital services - such as the NHS App or 111’s online service — for help about their conditions. 2 • Electronic patient records and other essential technology services were installed within days at new field hospitals across the country. 3 • Remote health and social monitoring are a growing part of the armoury for hard pressed GP and outpatient clinics.

• Several new apps have been launched and adopted into the NHS, with the online status checker4 rolled out nationally.

The challenge, then, will be to hold on to these gains that have come out of necessity to “peacetime” use.

Technologies have kept the service running, but equally, they make that service more efficient, helping to ease the workload of those who are working on the COVID-19 frontline. It would be foolish to throw this away now.

Managing health online alleviates pressure on NHS Let’s not think about the NHS in isolation either, it’s part of a larger change in society. A digitally literate health service is, arguably, the natural direction of travel. For many reading this, homeworking is the new normal, with video conferencing facilities now critical to our everyday lives. The same is true for government, with cabinet meetings being held virtually. In a similar way to how we manage our finances online, we are now seeing that it is possible to manage our own health that way too.

There will always be a role for the hospital, but with the right use of technology, we can start to look at delivering care in alternative environments.

WRITTEN BY

Andrew Davies, Digital Health Lead, ABHI

Through monitoring and predictive algorithms, we are now better placed to manage our own health than ever before, with added focus on prevention and protection, thus alleviating pressures on the NHS, and allowing healthcare professionals to deliver care where it is most needed.

Digital health tracking can support lifestyle improvements The opportunity for population health management, with a focus on healthy living, is huge, and engaged citizens have the ability to make this work.

Through data collection, digital health solutions can improve our lifestyles and maintain good health for longer. As a result, fewer visits to the doctors are required, meaning a win for the patient, and a win for all of us as taxpayers.

I sense that there is a very real ‘want’ from both patients, and those within the health service, to keep digitisation on track. A silver lining around a very dark cloud that is COVID-19.

References

1. https://www.gov.uk/government/speeches/the-future-ofhealthcare 2. https://www.hsj.co.uk/technology-and-innovation/demandfor-nhs-tech-services-rockets-amid-covid-19-crisis/7027275. article 3. https://www.hsj.co.uk/technology-and-innovation/us-firm-toprovide-tech-for-first-nightingale-hospital/7027278.article 4. https://www.nhs.uk/conditions/coronavirus-covid-19/

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hen reflecting on 2020, our minds will of course first recall the challenges of COVID-19 – the pandemic that tragically impacted our society, our friends and our families. But in years to come, perhaps we might also acknowledge the sea-change COVID-19 brought to the way we live and work.

Which changes will “stick” is yet to be seen, but I take heart from how working through the pandemic together has strengthened communities, driving us to think differently and work collectively for a better future.

Creating capacity to treat COVID-19 forced rapid change to the way NHS care is delivered. With healthcare professionals (HCPs) stepping away from their usual roles to join frontline efforts, an immense strain was placed on primary and secondary care, disrupting much-needed services for people living with long-term conditions, such as cancer and diabetes.

and deliver effective care digitally.

Virtual appointments have become the ‘new normal’, with more than 99% of GP practices adopting remote consultation platforms and technology.

Delivering care for people with longterm conditions, without seeing them in person, is critical to protecting those most vulnerable to COVID-19.

The number one topic HCPs asked for was training on updated “sick day rules” – guidelines for people with diabetes who become unwell and how to manage their treatment and prevent hypoglycaemic (low blood sugar) events. Our webinars offered targeted, bite-size training, helping upskill more than 1,000 HCPs to deliver care remotely.

“As a commissioner, working in partnership with Lilly on this project has been beneficial in so many ways. Initially, it has provided us with an innovative idea and new approach for population health management not considered previously.

The PARM Diabetes tool has transformed diabetes care locally and has become an essential tool for improving diabetes treatment targets. Regardless of GP clinical system used and without the need for any external data extraction, it enables a real-time view of the T2DM population. The tool also supports clinician education by targeting and prioritising patients for review and intervention, which improves knowledge and confidence in diabetes management within primary care and reduces clinical inertia.” ~ Nicola Lant, Commissioning Support Manager, Devon CCG

We listened to doctors and nurses who specialise in treating the 4.7 million people living with diabetes in the UK, to understand the pressures they face and how we could help keep diabetes services on track. At Lilly, we accelerated plans to deliver digital education and tools to support diabetes services, co-created a predictive population health data tool to help improve outcomes for people living with diabetes, and are working to create a personalised diabetes management system that will integrate connected devices, software and analytics.

By 2030, it’s estimated one in four hospital beds in England will be occupied by someone with diabetes.

Working together to realise the potential of digital health solutions, we have the opportunity to change that.

Supporting diabetes services with online solutions Lilly’s medical education professionals created a series of online webinars and videos on how to optimise treatment

WRITTEN BY

Shannon Rush Lilly Diabetes Business Unit Leader, UK, Republic of Ireland and Nordic Countries

Creating capacity to treat COVID-19 forced rapid change to the way NHS care is delivered.

©IMAGE PROVIDED BY ELI LILLY

Accelerating digital evolution for better diabetes health management

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Population health solutions to improve diabetes outcomes Working together with a team of experts from NHS Devon CCG and supported

by Kernow CCG, we co-created PARM (ProActive Register Management) Diabetes, a population health management tool that has the potential to transform the way diabetes care is delivered.

The tool organises practice-level patient data to show how well patients are managing their condition, identify any potential issues as well as those who need critical or urgent attention, and can predict who may need input from a diabetes specialist in the future.

This helps ensure people with diabetes are going to receive optimal care and helps practices allocate their resources where they are most needed. We’ve also made this tool work alongside NHS systems to ensure patients’ data never leaves their GP’s practice.

Personalised technology to help people manage their diabetes For me, the most exciting digital health innovation is building technology that can help people manage their diabetes. That’s why we are working on developing a personalised diabetes management system that integrates connected devices, software and analytics. Our goal is to create one place where people with diabetes and their healthcare providers can access their personal data and actionable insights, to help enable better conversations and more personalised treatment plans.

Lilly has a 100-year history of leading the way in diabetes management.

As digital health changes the way healthcare is delivered, we’re embracing the change and it’s my hope that the solutions we are building today, will deliver better health outcomes for people living with diabetes tomorrow.

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The importance of data in fighting disease during the pandemic

Defining moment for digital health The digital health sector in the UK has matured rapidly during the COVID-19 outbreak as inperson services have been reduced to minimise transmission.

Time-consuming and costly processes for health SMEs Over the past five years, one of the most consistent challenges SMEs on the DigitalHealth.London Accelerator programme have experienced when trying to work with the NHS, is knowing how to best evidence their products and services.

It is right that the NHS sets the highest standards for digital health to ensure patients and staff get the best care and services; and that organisations do all they can to ensure innovations will work for their needs and challenges. However, given that the evidence required by NHS organisations can vary significantly, SMEs often complain that the process is time-consuming, costly and involves duplication.

Sara Nelson Programme Director, DigitalHealth.London Accelerator

Clinical data is acutely private and confidential, and patients rightly demand that it is handled with great care.

Previously, there was no national standard of expectations for reviewing, assessing and evaluating digital technologies. This led to some NHS commissioners and clinicians demanding that digital tools be evaluated in the same way as drugs and medical devices before they could be adopted.

However, many digital tools do not qualify as direct treatments and therefore carry considerably less risk to patients than new drugs and devices.

Even when digital tools do qualify as direct treatment, digital health SMEs often do not have the expertise or contacts in health economics or academic research to easily generate the required evidence quickly, or the necessary finances to fund it.

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Due to the complexity of diseases and variation in outcomes, each patient’s data is also extraordinarily valuable in gaining insights into the treatment of others. Medical research, as well as the work of optimising the planning and delivery of clinical services, depends on analysing rich, detailed data sets to identify variations and patterns in illness and treatment outcomes.

Increased interest in patient data During the pandemic there has been a significant increase in the number of parties seeking quick access to patient data, from the NHS, academia, and the private sector. NHS Digital usually receives around 60 applications per month, but in April this jumped to nearly 200.

When addressing a public health emergency, assessments as to the appropriateness, necessity, and proportionality of proposed new uses of data must be made quickly, but with no reduction in rigour.

In all circumstances, patients must be able to trust the way in which data usage decision are made, and the parties who make those decisions. Trust is tested more acutely when judgements are more complex.

The risks of inadvertently allowing misuse of clinical data are quite different to other technical risks we manage in crisis situations. Going live with a poorly designed or implemented digital service might result in frustrated users, occasional service failures, or fraught operations activities. All these situations are ultimately recoverable.

Confidential data, once shared, usually can’t be easily retracted.

Insights deduced from that data about individuals or communities can’t be ‘unlearned’.

Digital health has been a lifeline in 2020 This year has become a defining moment for digital health as it has been at the forefront of the NHS’ response to the pandemic. NHS organisations have been able to quickly and safely implement new products and services for the first time.

Many have already been effectively evaluated such as remote GP consultations, self-management apps and workforce digital solutions meaning they are ready to be scaled across the country. This is a welcome shift in culture for SMEs, NHS staff and patients alike.

At DigitalHealth.London we are proud to accelerate the best in digital health and support the evidence generation that requires.

Ensuring data is shared efficiently and safely During this pandemic NHS Digital has, again and again, achieved the nirvana of data disseminations, which are both fast and safe.

This acceleration has been facilitated by two key changes, in addition to the blood, sweat and tears of dedicated information governance staff across

WRITTEN BY

Sarah Wilkinson Chief Executive, NHS Digital

the health and care system. Firstly, the legislative frameworks that govern the processing of confidential patient information frameworks are more permissive when we are dealing with communicable diseases and other threats to public health. Second, there has been no tolerance for inefficient administrative processes and all parties have worked intensely hard to increase performance.

Data consumers have also upped their game: The urgency of the situation has encouraged much clearer articulation of need, of intended usage and of provisions for secure data management.

Conversations between parties about data dissemination and usage are more precise, more rigorous, and more efficient than ever before.

NHS data is internationally unique The impact of flowing health data faster for appropriate uses can be extraordinary. NHS data is internationally unique in its breadth and depth and, used responsibly, it can save lives.

Extraordinary research breakthroughs have been possible thanks to NHS data, such as the identification of the impact of dexamethasone in COVID-19 treatment.

This was a finding of the RECOVERY Trial, led by Oxford University, supported

by NHS Digital, and ultimately enabled by patients, families, clinicians and researchers across the country.

Supporting the planning and delivery of efficient health and care services through rich, high-quality, timely data insights is equally critical, particularly when the system is under great pressure.

As we look back on the last six months, there is much to learn.

We need clearer legislation and more efficient processes to enable appropriate data usage within the health and care system and for medical research.

Data that has the power to save lives must be put to greater use, with absolute diligence in the management of its use. Efficient and rigorous information governance, combined with transparency, earns us the trust of our citizens so that we can serve them better.

Extraordinary research breakthroughs have been possible thanks to NHS data.

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ntil recently, the requirements for proving digital innovation worked were unclear and the culture for implementing digital innovations had not matured.

The diversity and complexity of procurement procedures and processes across the NHS, means it can be a real challenge for digital health small and medium sized enterprises (SMEs) to navigate.

Thankfully, important steps by NICE and NHS England, in partnership with Public Health England, MedCity and DigitalHealth.London, were taken before COVID-19 to standardise how health technologies are reviewed and commissioned. Frameworks now exist for demonstrating evidence of effectiveness and economic impact, providing much needed standards for both commissioners and developers to adhere to.

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Self-care and digital health: how they help NHS From fitness trackers to symptom checkers, digital health is helping us all to take care of ourselves and shaping our future relationship with the NHS.

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A surge in digital fitness tracking since COVID-19 More people than ever are using fitness trackers and apps to monitor health. Smartphones with increasing computing power, and technologies such as AI and ML, are making giant strides in terms of interpreting all that data to deliver early disease detection and targeted results.”

“The COVID-19 crisis has given digital health an opportunity to prove what it is capable of,” said Fabio. “On-demand triage services have given people access to advice and diagnoses more quickly and efficiently than ever before.”

Digital health support for irritable bowel syndrome (IBS) and constipation Sanofi has been working on a number of digital health projects with the aim of supporting self-care for IBS and constipation – both undertreated conditions that have a significant impact on quality of life.

“In these areas, complementing digital services are very meaningful as they enable people who might not otherwise have accessed care, either because they were not aware of available treatment options or were struggling to receive appropriate and timely diagnosis.”

The COVID-19 crisis has given digital health an opportunity to prove what it is capable of.

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echnology has the power to help us all take care of our own health, better manage chronic disease, and relieve pressure on the NHS. “Self-care, which encompasses the responsible use of over-the-counter medications to the adoption of healthy lifestyles, not only empowers people to live better lives, but it also frees up precious NHS resource,” says Fabio Mazzotta, Head of North and South Europe Consumer Healthcare at medicines company Sanofi.

“Self-care empowers all of us to act in the interest of our own wellbeing. It activates a virtuous cycle of preventative healthcare, which decreases our dependency, hence relieving financial burden on the NHS and moving resources down the line to the care of more vulnerable patients,” he adds.

Improving access to health advice IBS is assumed to affect around 13 million people in UK, yet just three million take over the counter medicines to ease their symptoms. Only 30% of people with symptoms, which include cramps and abdominal pain, ever speak to a doctor, and just a fraction of those are diagnosed and treated.

Similarly, up to 12 million people in the UK might be affected by constipation, but just four million take proven, over the counter medications to relieve the problem.

“This translates into higher incidence of those conditions progressing in severity until they require hospital intervention later on,” says Fabio.

The company is running a “very fruitful collaboration” with UK-based digital health company, Babylon. More than 30,000 people have already been part of AI-powered symptom checker, triage, and video consultation service on the websites of Sanofi’s digestive health products.

“The objective is to offer people with IBS a way to selfdiagnose their symptoms and facilitate their access to a therapy. It takes on average four to five appointments for a patient to be diagnosed with IBS. By contrast, it takes only five minutes for a patient to complete the symptom checker. With two thirds of the users reporting a better understanding of their symptoms and showing intent for taking action on a treatment, you can appreciate the transformative impact for NHS and for individual sufferers of such a service,” adds Fabio.

Sanofi is also working with Cara Care, a digital therapies and diet management app, which helps people take a holistic approach to digestive health, assisting them with a personalised diet management programme.

High demand for easy access to straightforward advice “The encouraging results of many digital health solutions that we are testing plainly show the relevance and high demand for simplified health access for minor ailments and the synergy of science supported product offerings with added value services to provide better patient care.

“Based on our experience, we believe digital health innovation will shape the future of healthcare, and allow for a more holistic, interconnected and personalised consumer experience.”

INTERVIEW WITH

Fabio Mazzotta Head of North and South Europe Consumer Healthcare, Sanofi WRITTEN BY:

Amanda Barrell

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A global approach to data solves the mystery of rare diseases

visionable.com

Bringing clinicians to the patient at the touch of a button

A rare disease is not rare at a global scale. We must follow the lead of patients and collaborate globally to uncover more answers—our lives and livelihood depend on it.

Next-generation video conferencing and clinical imaging technology has transformed stroke care in NHS East of England.

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hen a suspected stroke patient is admitted to A&E, a portable, wireless-enabled “digital stroke cart” is rolled to their beside, with everything required for an immediate, full virtual consultation with a remote stroke specialist. Supported by immediate access to scans, as well input from the patient, their families and the local stroke teams, clinicians can make an immediate diagnosis, minimising critical door-to-needle (DTN) time and preventing unnecessary patient transfer to another hospital.

Former NHS service manager, Alan Lowe, saw the potential of system efficiencies from clinician-led digital transformation within the NHS. Lowe developed the new East of England (EoE) Stroke Telemedicine Stakeholder Partnership, Visionable technology.

Before implementing Visionable, in NHS East of England, fewer than 5% of patients eligible for thrombolysis in EoE were receiving the treatment within the critical three-hour time frame. Now, rates are 41%. Lowe says: “Patients receive faster, better treatment, because the stroke specialist comes directly to them. They are likely to spend less time in hospital, and their recoveries are often faster.”

WRITTEN BY

Lynsey Chediak Project Lead, Shaping the Future of Health and Healthcare, World Economic Forum

The internet and genomics are changing norms Patients are taking the lead, and healthcare systems need to catch up.

Merely by adding a hashtag with my disease name to my Twitter biography (#arthrogryposis), I receive dozens of messages a year from people thousands of miles away with my same disease.

What if we had a similar common platform for doctors to securely access de-identified health data?

Rare diseases take an average of five years1 to diagnosis and only 5% have a treatment2 approved by the US Food and Drug Administration. That is all changing, however, through DNA sequencing with genomic medicine3 and the ability to aggregate health data.

We are already collecting the data needed Understanding genetic rare disease at the level of the shared difference in DNA (variants in genomic data), linked to specific observable features (phenotypic data4), allows researchers and doctors to better-understand diseases; moreover, such discoveries

Connecting clinician and patient data, faster The key benefit of Visionable, he says, is that it is the only end-to-end system designed especially for healthcare, with features including high quality, real-time transfer of whatever still and moving images, data, and MDT clinical input are required.

He says: “What makes us different is that we are a manufacturer and so we have endto-end control of our system, so we can give clinicians what they want, rather than imposing a system on them.”

Success within the stroke treatment pathway has proved that Visionable can be applied to any clinical setting. Possible future development scenarios include ambulance crews delivering more care at the scene of an incident, and patients requiring a specialist referral being seen by their GP and consultant within one day.

As hospitals grapple with the winter challenges ahead, and the logistics of treating an ageing population, the NHS has started to think about how digital transformation can improve the ways patients receive care and Lowe sees Visionable as playing a key role in this.

“It’s about connecting every doctor with every patient in every location,” he says.

©ipopba

Alan Lowe CEO and co-founder, Visionable

Ailsa Colquhoun

reveal learnings about both rare and common diseases.5 In the last seven years, fourteen countries have invested over $4 billion USD6 to create national genomic initiatives, but these national genomic initiatives are not set up to share their data to achieve the scale and volume needed to accelerate discoveries in rare disease.

We need a global approach What is stopping national genomic initiatives from collaborating? It appears to be a people problem – predominantly, a lack of trust.

Partnerships are not created instantly, and national genomic initiatives need to invest the time required to work together and understand one another’s different processes.

The World Economic Forum recently released an eight-step guide outlining how to create a cross-border health data consortium7; six of the eight steps center on difficult conversations; only two steps involve technical components.

A rare disease is no longer rare on a global stage. We have the data and must follow the patient lead embracing digital platforms to provide more answers with a global approach to rare disease.

References 1. https://globalrarediseasecommission.com/Report/assets/static/documents/GlobalCommission-print-021919-a68c8ce2a5.pdf 2. https://rarediseases.org/wp-content/uploads/2019/01/RDD-FAQ-2019.pdf 3. https://www.genome.gov/health/Genomics-and-Medicine 4. https://rd-connect.eu/what-we-do/phenotypic-data/ 5. https://www.nih.gov/news-events/news-releases/nih-genome-sequencing-program-targets-genomic-bases-common-rare-disease 6. https://www.cell.com/ajhg/fulltext/S0002-9297(18)30422-1 7. https://www.weforum.org/reports/sharing-sensitive-health-data-in-afederated-data-consortium-model-an-eight-step-guide

We have the data and must follow the patient lead embracing digital platforms to provide more answers with a global approach to rare disease.

INTERVIEW WITH

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s a child living with a rare disease, I accepted an uncomfortable reality: my doctor had never seen someone with my disease before and could only make educated guesses about my condition. Yet what we classify as ‘rare’ diseases at a domestic level are not so limited in number at a global level. Genetic rare diseases do not discriminate by nationality. How can doctors learn from one another across country borders?

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How AI is offering hope to millions with rare diseases INTERVIEW WITH

Dr Bruce Bloom Chief Collaboration Officer, Healx

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rtificial intelligence could revolutionise treatments for rare diseases and offer hope where there once was none – now, with the help of human insight and expertise, this is becoming a reality.

Artificial intelligence (AI) offers a new model of drug development that could help the millions of people living with a rare disease get the treatments they desperately need more quickly, safely and cost-effectively than traditional methods allow.

That’s according to Dr Bruce Bloom, Chief Collaboration Officer at technology company Healx, whose mission is to discover and develop new treatments for rare disease patients at scale.

“There are at least 7,000 rare diseases across the globe, affecting over 400 million people, but 95% of those conditions don’t have an approved treatment. The standard pharmaceutical model of developing a drug from scratch over 10 – 14 years, and spending upwards of a billion dollars to get it to patients, simply doesn’t work for most rare diseases,” he says.

“It’s unattractive for traditional pharmaceutical companies to work on most rare diseases, as the small patient populations means the return on investment won’t match the R&D costs.

Furthermore, rare disease patients may not actually have the time to wait

over a decade for a treatment. So, we really have to rethink the model of rare disease drug discovery,” says Dr Bloom.

Faster, cheaper discoveries can be made thanks to AI That’s where AI comes in. It can reduce the time and money it takes to make discoveries, as well as increase the likelihood of clinical trial success by quickly identifying promising candidates. But the technology does not work alone.

“AI complements human intelligence,” says Dr Bloom. “It sorts through all the known medical and scientific information and looks for connections in a way, and on a scale, that would be impossible for humans.”

Case in point – testing AI success with rare disease patients Healx is currently preparing for a clinical trial of treatments for the rare neurological condition, fragile X syndrome – the leading genetic cause of autism which affects around 1 in 6000 people.

Healx worked closely with FRAXA Research Foundation to incorporate patient experience and insight into Healnet, an AI-driven drug discovery platform. Healnet analysed these insights, as well as scientific literature

and research, to produce a list of possible treatment candidates. Healx’s expert pharmacologists then selected several promising candidates that moved through preclinical validation in under 24 months and quickly onto clinical trial planning.

AI future must be entwined with human, patient experience “AI is central to the digital health revolution, not just in drug discovery, but in diagnostics, supporting medical decision-making, and helping to fight the COVID-19 pandemic,” says Dr Bloom.

“But AI is only one half of the solution. We also need human expertise, empathy and experience, which is why we work so closely with the patient and medical communities,” he concluded. This patient-centric focus has seen Healx collaborate with a number of patient groups in recent months, such as Muscular Dystrophy UK, the Children’s Tumor Foundation and the Foundation for Angelman Syndrome Research Therapeutics to understand the most urgent challenges patients face and identify new treatments to address their needs.

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How artificial intelligence is helping conquer cancer With its ability to spot patterns in huge datasets, artificial intelligence can unlock secrets in medical images – and help move the dial on cancer care.

I INTERVIEW WITH

Brandon Suh, MD, MPH, MBA CEO, Lunit WRITTEN BY

Amanda Barrell

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mmunotherapy may be the next step in cancer therapy but matching the right patient to the right treatment remains a challenge.

Brandon Suh, CEO of South Korean med tech company, Lunit, believes artificial intelligence (AI) in medical imaging will help advance precision diagnosis, personalised medicine, and, ultimately, conquer cancer.

“AI is the most advanced technology for pattern recognition. Because it is trained on a massive amount of data, its performance is extremely high and it can catch lesions that are hardly visible to the human eye,” he says, explaining that more effective, rapid diagnosis was crucial to cancer care.

“It’s not just about the treatment side of things,” he says. “We know that if cancer is diagnosed early, the patient does not need as extensive treatment and they have much better outcomes.”

Brandon believes that his company’s technology for mammography, which has been shown to be accurate in studies published in JAMA Oncology and Lancet Digital Health, still has many secrets to unlock, including ways to tailor screening methods based on individual risk of breast cancer.

Paradigm shift in treatment In recent years, next-generational immunological therapies that kill cancer by targeting immune cells have promised to transform the treatment landscape. But the current standard of care is reliant on a biomarker called PD-L1, which can be inaccurate in predicting responders, so there is still much to learn about who will respond.

“Cytotoxic chemotherapy and targeted therapy were about killing the cancer cells directly, so what we did before — sequencing of DNA and RNA — is no longer as important in immunotherapy,” says Brandon, explaining the focus was now on understanding which tissue structure and cells surround a cancer tumour.

“That’s really complicated because there are so many different types of cells, including immune cells, that surrounds the tumour and we don’t really know how that correlates to treatment response.”

By analysing digitalised versions of tissue slide images magnified down to the cell level, AI can “join the dots” in the data in a way that has not been possible until now.

“Before, we had pathologists reviewing

AI can “join the dots” in the data in a way that has not been possible until now. the images through the microscope.

Now, we can run software on this complex data and extract insights.”

“We are looking at a whole set of data that has not really been taken advantage of before, because it was so complicated for humans to look at.”

Through this work, Lunit is discovering a range of pathological features that are predictive of a person’s response to immunotherapy, and AI has been shown to be between 30 and 40% better at predicting outcome to treatment than PD-L1. The findings has been presented at AACR and ASCO, one of the largest conferences in oncology.

“Although our studies are still preliminary, we now have very robust data and are planning more ambitious prospective studies to clinically validate our product,” he says.

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How Britons have turned to health technology during the COVID-19 pandemic

How do we get patients to buy into digital technologies?

COVID-19 has put digital health technologies in the spotlight like never before, but what is critical to ensuring the benefits are realised, long-term, is a robust public dialogue on the subject of trust.

COVID-19 has brought unprecedented challenges and placed governments and citizens around the world under immense pressure to cope with the severe social, economic and health impacts resulting from the crisis.

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Digitalising healthcare could save billions for NHS Many of the digital technologies adopted prior to COVID-19 were focussed on back office or clinician use, rather than direct patients’ use.

Is this a reluctance by the patient to adopt new technology or a reluctance by healthcare professionals to cede power?

Of course, digital exclusion and exacerbation of health inequalities are very real issues and the NHS has a legislative duty to reduce health inequalities. It is estimated that up to 20% of the adult population lacks basic digital skills and of the 4.1 million people who are offline in the UK, 71% have no more than a secondary level education, nearly half are from low-income households, and 80% are aged 50+.1 However, the digital agenda should be a situation where everyone wins.

According to Ernst & Young, the NHS could get nearly £10bn a year through savings, improved outcomes and economic benefits, with patients enjoying better and earlier diagnosis from new, more accessible care settings.2 Patients must be assured they can trust new technology Also, vital to building trust is the reassurance of a modern, fit for purpose regulatory structure. The current regime, established for hardware-based devices and diagnostics, needs to also support digital innovation adoption, and must be sympathetic to how such technologies work, namely through continuous improvement and iteration as more data is fed into it. A modern regulatory framework that is swift and transparent, that helps maintain and enhance products across their lifecycle is therefore essential.

A

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o be trusted, technology needs to be effective and must be seen as a solution to a problem.

COVID-19 has, I would argue, accelerated this conversation to the next level.

Through remote consultations and programmes such as NHS Track and Trace, we have seen wide-spread adoption of digital technologies, and a willingness of the population to embrace these concepts. Admittedly, this has been brought on by necessity, but their success, and importantly, cost-effectiveness, surely means they are here to stay.

Up to 20% of the adult population lacks basic digital skills.

We have seen examples of data use during the COVID-19 crisis that would have been unthinkable in other circumstances, such as Government sharing data on vulnerable groups with supermarkets. Examples like this have delivered real benefit, in real life circumstances. The challenge now is maintaining the trust and permissive culture to deliver benefits for patients, families, peer groups, the NHS and wider society through use of data.

We need to move the conversation to a broader discussion on how data is used, rather than a focus on research and development. Meaningful engagement with the public will not only ensure better decision making, but it will also aid the design of digital technologies that are effective, and at their core, trustworthy.

References 1. https://www.hsj.co.uk/technology-and-innovation/ inclusion-crucial-for-a-digital-first-health-service/7027443.article 2. https://www.ey.com/en_gl/life-sciences/how-we-canplace-a-value-on-health-care-data

WRITTEN BY

Andrew Davies Digital Health Lead, ABHI

businessand industry.co.uk

WRITTEN BY

Julian David CEO, techUK

t techUK, our members have not been immune to these challenges, but their response has been marked by one word: collaboration. More than ever, COVID-19 has shown the power of working in partnership for the greater good, as individuals and organisations have stepped up to help our country and our health service in what has been described as the toughest health challenge in a generation.

But the crisis has also shown that digital health has never been more important. With health systems having to quickly adapt and reprioritise resources, digital technology has helped to minimise disruption and provide patients and citizens with access to vital services.

April, digital therapeutics startup, Big Health, announced a community access programme enabling organisations and their employees to receive free access to their products Sleepio, for poor sleep, and Daylight, for anxiety. The NHS is one of 50 employers that have signed up to this programme, with all 1.2 million employees now able to use these innovative tools.

Elsewhere, tech companies have been working with the NHS to boost access to primary services. One such firm is LIVI, which has been working in partnership with GP surgeries to ensure NHS patients can still access care remotely, with total video appointments increasing 534% between March 2019 and March 2020. The company has also been working with the government to share aggregated data received from their services across the continent, supporting the response to COVID-19.

Patients rapidly taking up apps to monitor health At the beginning of the outbreak, health app evaluation and distribution organisation, ORCHA, identified, reviewed and rated solutions that could provide the best support during the pandemic, adding them into their app libraries, including a dedicated one for COVID-19. In the past couple of months, ORCHA has seen a large increase in both the number of people using these libraries and the number of health and care professionals turning to them to distribute digital health to their patients.

As people living with pre-existing medical conditions are at higher risk of developing severe illness from the coronavirus, one of the conditions that citizens have sought most help for is diabetes. To help offer support, Roche Diabetes Care provided free access to the mySugr Pro diabetes management app. Roche also created a data dashboard to triage patients remotely, helping to reduce burden on the NHS.

Digital health is helping patients during COVID-19 The demand from patients is clear. iPLATO Healthcare, which provides a mobile patientfacing service, saw transaction volumes on their platform, called myGP, go up from 12 million in February to 27 million in March.

These are just a handful of examples of our members’ contribution to helping to combat the pandemic. But, as the benefits of these technologies become more evident than ever, we must ensure that the introduction of new tools and services does not leave anyone behind.

Giving citizens a choice about the services that they access and how they do so has never been more important.

To learn the right lessons from this crisis, we will need to evaluate what has worked well, what hasn’t and identify how we can improve. However, one thing is certain: it is vital that the collaboration between the NHS, industry and government continues.

The challenge that our members put to us is that there is much more that can be done. Let’s prove that can be delivered.

Digital technology has helped to minimise disruption and provide patients and citizens with access to vital services.

Sleep apps on the rise Another area that has seen an increase in demand is support for sleep. Back in

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Healthcare is about to get personal Following on from the rapid digitisation of healthcare in the past few months, are we ready for the next stage in personalised health?

W

INTERVIEW WITH Sarah Welton Chief Design Officer, Mindwave Ventures

INTERVIEW WITH Kumar Jacob Executive Director, Mindwave Ventures

WRITTEN BY Kate Sharma

hen it comes to gaming, it’s all about user experience.

This got computer game development executive Kumar Jacob, thinking: “What would happen if we looked at healthcare in the same way?”

The result was Mindwave Ventures, which Jacob set up in 2014 to harness digital tech within the health sector.

From digital track and trace systems to the use of artificial intelligence to detect cancer, tech is already part of our healthcare experience. However, Jacob and his team are developing applications that can be used much closer to home with patients’ needs at the heart.

Small innovations; big impact “The word ‘innovation’ can often be unhelpful, because we presume innovations have to be huge developments. But it’s often the small changes that can make the biggest impact,” explains Sarah Welton, Mindwave’s Chief Design Officer. A case in point is the introduction of online access to appointment details and clinic letters, which have helped to reduce missed appointments by a significant number.

Helping medical teams communicate through an app It’s easy to see the gaps in sharing patient information in the system. For example, a maternity team may not know that a patient they’re caring for has a condition such as bipolar disorder – even though this would impact the support they provide – because clinical information is often kept by separate teams.

Mindwave wants to help address issues like this by creating digital front doors to empower patients, carers and clinicians alike to access the information they need, when they need it, in one simple app. By integrating and streamlining complex healthcare pathways, multiple, small innovations will have a cumulative impact.

“We’ve undertaken discovery work with more than a thousand patients, clinicians, researchers and carers to find out what they really want,” confirms Welton.

Personal health records have applications across the board, particularly within multi-disciplinary care settings. Mindwave has already developed a tool to help patients with ADHD and their parents to track medication and behaviour, and coordinate care. They’ve also designed

Read more at businessandindustry.co.uk | 9

“We’ve undertaken discovery work with more than a thousand patients, clinicians, researchers and carers to find out what they really want,” confirms Welton. and built Citizen Portals, which act as a single point of contact for all health and wellbeing needs for patients in a number of regions.

In-app algorithms could potentially predict patients’ needs The power of the applications doesn’t end there though. The tech that gives computer games the knack of knowing what you’ll do next can also be harnessed to monitor patterns in a patient’s health and behaviour. This, in turn, can be used to help predict when intervention is needed.

“We’re looking at how we can analyse what people search for [online] and there’s also evidence that your language changes when you’re experiencing depression. These are all things that can be used to predict a crisis and avert it,” confirms Welton.

We’re already experiencing a digital transition in the way we interact with healthcare services and, as technology develops, this is only going to increase.

Within the post-COVID-19 era, our own smartphones could become key in our ongoing health and wellbeing.

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How the power of data is shaping the future of care Most care solutions are aimed at providing help to a patient once they are in need but, now, a new AI-led solution is helping professionals identify care support before an event might happen.

M INTERVIEW WITH Olivia Harker Managing Director, MySense UK

WRITTEN BY Gina Clarke

ySense is a wellbeing analytics platform where thousands of recorded personalised data points are providing health organisations, carers and families with more informed perspectives on the general wellbeing of an individual at home or in a care-based environment.

The company, created in 2016 by CEO, Lucie Glenday and backed by Ashley Head and Dame Ann Gloag, is improving health and care through its innovation around IoT, machine learning and data analytics.

A MySense wearable device and a number of sensors discreetly placed around the home are providing insight in an ethically sourced way leading to proactive care management, more personalised care packages and peace of mind for families.

Managing Director of MySense UK, Olivia Harker, says the technology is changing the conversation between carers and patients or loved ones by providing a more insightful and holistic picture of an individual’s wellbeing.

She says: “Currently, health and care is mainly reactive. MySense gets ahead of the problem. It doesn’t replace

professionals but facilitates better quality conversations and provides better care as the data helps to make decisions and validate hunches.”

Immediate and positive results South Warwickshire NHS Foundation Trust (SWFT) has been using MySense since May and has already seen some incredible results such as: a 58% reduction in GP appointments, 80% reduction in hospital appointments, 53% reduction in 999 calls, 100% reduction in 111 calls and 43% reduction in unnecessary visits from place based teams (PBT).

Glen Burley, Chief Executive at SWFT, says: “It is great that we are able to work with MySense and their deployment partner SCC to develop technology that will enhance the care our clinicians can provide.”

Elaine Martin, Dementia Clinical Practitioner at the Trust, adds: “These results are really promising. We can remotely monitor whether there are any indications of concern or changes in presentation, which helps inform our clinical decision making. We use the information from MySense to intervene early if there are any signs of

The technology is changing the conversation between carers and patients or loved ones by providing a more insightful and holistic picture of an individual’s wellbeing. deterioration and to ensure the right care and support is being offered at the right time.”

Deployment at scale Dan Cartter, Head of Innovation at SCC, an IT company and systems integrator and MySense partner says: “We bring at-scale access to customers, deployment and support capabilities through our national service. If this technology is deployed across the NHS and integrated care systems, we believe we have an opportunity to radically transform the way healthcare is delivered digitally.”

“Everyone who uses MySense owns and controls their own data” adds Olivia. “That is key to our business and our vision; by researching anonymised ethically obtained health data at an unprecedented scale, we will offer new insights into long term conditions and chronic ill health.”

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This is how to reset global healthcare: universal health coverage COVID-19 has demonstrated that health is a public priority: each individual’s health is dependent on, and impacts, others around the world. The debate over access and affordability to health services is in the spotlight, especially as new diagnostics, therapeutics and eventually vaccines are developed.

WRITTEN BY

Sofiat Akinola Project Lead, Shaping the Future of Health and Healthcare, World Economic Forum

Read more at businessand industry.co.uk

Public health challenges reverse global progress These numbers have increased with the coronavirus – and will continue to increase as people lose jobs and health insurance. An estimated 5.4 million Americans have already lost their health insurance coverage.

As health expenditures rise due to COVID-19 related testing, treatments and vaccines, the situation could get worse. Research shows that in the US, one in seven Americans wouldn’t seek coronavirus treatment because it costs too much.2 The response to the pandemic has also consumed global health resources, derailing the progress made in global public health3 in the past decade. The diversion of resources from other public health challenges is exacerbating inequities in access to care, quality of care and financial hardship.

Universal health coverage is advantageous during pandemic During the past months of the pandemic, we have seen that countries with universal coverage have had the advantage in responding to the virus – even though health systems everywhere were overwhelmed. As a baseline, these countries could offer access to testing or the ability to see a doctor when presenting symptoms without fear of out-of-pocket payment. This helped control the number of infections by enabling identification, isolation and appropriate treatment of people who were sick. It also helped with understanding of the reach of the virus.4 For many, COVID-19 is more than a matter of health. The costs of the test or hospitalisation will mean financial hardship and even bankruptcy long after the pandemic ends.

The virus has shown how a global health crisis is a threat to not only lives, but livelihoods. It’s time, therefore, to address both of these factors so that no one is left behind. The Great Health Reset must sharpen the tools available in the healthcare kit and guarantee that global healthcare is comprehensive, consistent and universal.

References 1. https://apps.who.int/iris/bitstream/handle/10665/174536/9789241564977_eng.pdf;jsessionid=BD73B9406391267B951164FE981DDD82?sequence=1 2. https://www.marketwatch.com/story/1-in-7-americanswouldnt-seek-coronavirus-treatment-because-it-probably-costs-too-much-2020-04-28 3. https://www.nytimes.com/2020/08/03/health/coronavirus-tuberculosis-aids-malaria.html 4. https://www.vox.com/policy-and-politics/2020/3/16/21173766/coronavirus-covid-19-us-caseshealth-care-system

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or the first time in recent history, governments and the private sector are convinced of the need for investment into global public health as countries seek to deal with the immediate health crisis and prepare for the next one.

Within the current dialogue on how best to reset, there is much debate on “universal health coverage” – including accessible care, quality care and affordable care. An estimated 400 million people around the world lack access to basic health services. Each year, close to 100 million people are pushed into extreme poverty because they pay their own health costs.1

An estimated 400 million people around the world lack access to basic health services.

Digital health solutio

Find out more

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Over the decades, technology has rapidly evolved to become an integral part of our day to day lives. Work, social lives, entertainment etc – there is no area that technology hasn’t touched, and this includes our health and wellbeing.

Technology has transformed the lives of people living with diabetes

T

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echnology has transformed the lives of people living with diabetes. 40 years ago, blood sugar testing was done using a urine dip-stick test that told you what your blood sugar had been a few hours ago. Today, Flash and continuous glucose monitors (CGM) not only tell you what your blood sugar is doing now, but what it was doing overnight and the direction of travel it is heading in.

Indeed, closed-loop, artificial pancreas technology is developing in a way that means we may soon see a world where blood sugar testing and insulin delivery are completely integrated, requiring limited input from the person with diabetes. Some people describe this type of technology as a ‘practical cure’ for diabetes.

Living with diabetes can be an emotional burden The need for diabetes technology is very much apparent in that the management of diabetes is relentless, making it much more than just a physical condition.

Living with the condition can be tough and keeping on top of it can be a struggle. Surveys we’ve carried out show that seven in ten people living with different types of diabetes feel overwhelmed by the demands it puts on them. It can also affect the emotional and psychological wellbeing of those close to them.

In diabetes, psychological wellbeing and physical health have a two-way relationship. While the demands of living with the condition can affect how people feel; struggling emotionally can make it even more difficult to keep on top of self-management. And when diabetes cannot be well managed, the risk of dangerous complications increases.

We know that diabetes technology can help. In fact, our recent survey found that 67% of people who had used diabetes tech, like insulin pumps, Flash

and CGM said they felt more confident managing their diabetes as a result.

A recent audit of Flash glucose monitor users in the UK found the technology has helped improve blood glucose control, increase awareness of low blood glucose levels and reduce hospital admissions, which in the long term can potentially save the NHS a significant amount of money.

Location, affluence and ethnicity can all impact access to tech There is no doubt that diabetes technology has the potential to significantly improve the lives and clinical outcomes of people living with diabetes. However, there is a big problem with access. In the UK, there is significant variation in access depending on where a person lives, their level of deprivation and their ethnicity – sometimes referred to as ‘postcode lotteries’.

Sadly, despite our successful campaign to make Flash glucose monitoring available on prescription across the UK to everyone who meets the NHS criteria – no matter where they live – some people are still denied access. With insulin pumps, data shows that, while in some areas, over 40% of people with type 1 diabetes are using one, in others it is under 5%.

Diabetes UK is working to ensure people living with all types of diabetes have access to the technologies they could most benefit from. This work is more important than ever, as the pandemic has left people with diabetes unable to access their diabetes healthcare team and health checks, causing further stress as they try to manage their condition. Diabetes technology can help and as we continue to navigate these difficult times, it is vital that people are given the tools they need to handle it.

WRITTEN BY

Liz Perraudin Policy Officer, Diabetes UK

Read more at businessand industry.co.uk

ons for seamless diabetes management.

• Share glucose data from your phone to your healthcare team.Δ

AGP Report

December 7, 2019 - December 20, 2019 (14 days) GLUCOSE STATISTICS AND TARGETS

TIME IN RANGES

14 days 97%

December 7, 2019 – December 20, 2019 % Time CGM is Active Ranges And Targets For

Very High

Type 1 or Type 2 Diabetes Targets % of Readings (Time/Day) Greater than 70% (16h 48min)

Glucose Ranges Target Range 3.9–10.0 mmol/L Below 3.9 mmol/L

Less than 4% (58min)

Above 10.0 mmol/L

Less than 25% (6h)

Below 3.0 mmol/L

10.0

Less than 1% (14min)

Above 13.9 mmol/L

1% (14min)

>13.9 mmol/L

13.9

High 10.1 - 13.9 mmol/L

18% (4h 19min)

Target Range 3.9 - 10.0 mmol/L

78% (18h 43min)

Less than 5% (1h 12min)

Each 5% increase in time in range (3.9-10.0 mmol/L) is clinically beneficial.

Average Glucose Glucose Management Indicator (GMI) Glucose Variability

Defined as percent coefficient of variation (%CV); target <36%

7.8 mmol/L 6.7% 31.6%

Low

3.9 3.0

3% (43min)

3.0 - 3.8 mmol/L

Very Low

0% (0min)

<3.0 mmol/L

AMBULATORY GLUCOSE PROFILE (AGP) AGP is a summary of glucose values from the report period, with median (50%) and other percentiles shown as if occurring in a single day.

21

mmol/L

13.9

95%

10.0

75%

Target Range

50% 25%

• Healthcare teams can manage their patient population remotely.₼

5%

3.9 3.0

at FreeStyleLibre.co.uk

• Review glucose reports with your healthcare team during virtual consultations.₼

0 12am

3am

6am

9am

12pm

3pm

6pm

12am

9pm

DAILY GLUCOSE PROFILES Each daily profile represents a midnight to midnight period with the date displayed in the upper left corner.

Saturday

7

Sunday

8

Monday

9

Tuesday

10

Wednesday

11

Thursday

12

Friday

13

10.0

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16

12pm

12am

17

12pm

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18

12pm

12am

19

12pm

12am

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10.0 3.9 Source: Battelino, Tadej, et al. ‘Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range’ Diabetes Care, American Association, 7 June 2019, https://doi.org/10.2337/dci19-0028

18/09/2020 13:43

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Digital health at the heart of accomplishing universal health coverage during COVID-19 and beyond

This same time last year, we had no idea of the unprecedented global health challenge waiting for us around the corner. When COVID-19 struck, it shook the foundations of our health, political, social, and economic systems. In doing so, it exposed a crucial vulnerability – that, without a resilient global health system, the social and economic foundations of societal security is at risk.

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he pandemic has shown that, when safe and affordable healthcare is not accessible, the repercussions transcend political, social, and economic borders – impacting lives across the globe, particularly the poor and most vulnerable.

According to the World Bank forecast, the global economy will shrink by 5.2% this year,1 representing the deepest recession since the Second World War. The new report by the UN’s Food and Agriculture Organization (FAO) and World Food Programme (WFP) identifies 27 countries2 heading for COVID-19-driven food crises. No country or region is immune; but emerging markets and developing economies are particularly vulnerable.

In the wake of this pandemic, universal health coverage, founded on principles of equity and social justice, has never been more relevant. With that, a unique window of opportunity has opened. Now, we have the opportunity to build resilient post-COVID-19 health and disease surveillance systems that meet the 2030 Sustainable Development Agenda and fulfil the overarching priority of universal health coverage.

Encouragingly, 71%3 of countries that moved to universal health coverage did so shortly after episodes of state fragility.

It proves that with political commitment, and the efficient and equitable allocation of resources, UHC is achievable for all countries, rich and poor.

Digital health can help accomplish universal health coverage. It has the potential to transform public health systems by improving its reach, impact, and efficiency.

WRITTEN BY

Bernardo Mariano Junior Director of Digital Health and Chief Information Officer World Health Organization

With expanded access to available health services, more marginalised and underserved populations will be included.

Digital health can accelerate the achievement of the new normal for4 UHC driven by the COVID-19 demands. The new normal puts greater emphasis on common goods for health, which includes public health functions – such as comprehensive surveillance, data and information systems, regulation, communication, and information campaigns.

To move toward this, WHO is developing the Global Digital Health Strategy5. It proposes a framework for regulating, benchmarking, and certifying artificial intelligence and digital medical devices for countries to implement. It also proposes a regulatory framework for health data to protect the safety and privacy of personal health data. It calls for all digital health stakeholders, both private and public, to take action to align with principles that govern health data and safeguard data providers’ anonymity and safety.

We must remember that, to reap the benefits of digital health, countries must address the governance gap, the public trust gap, and the many ethical considerations.

Without proper regulation, the divide will grow within and between countries, and with existing social and ethnic disparities.

Governments cannot work in isolation because digital health, unlike the traditional health sector, operates in a multi-sector ecosystem. We need all stakeholders, including health sector entities, multilateral organisations, governments, academia and the private sector, to preserve the safety, privacy, and ethical use of digital health tools.

Public-private partnerships are a fundamental component in this international solidarity, but the actions must be motivated by equity, solidarity, and social justice.

Engagement with the private sector must explore ethical ways to structure collaboration and commercial model.

It is also the time for sustained political interventions and agreements. The establishment of the Digital Health Taskforce by the Saudi Secretariat for the G20 adds momentum to this vision. WHO is establishing a multisectoral network to help countries to conceptualize, develop, finance, and implement a sustainable digital health ecosystem.

COVID-19 is teaching the world many things, and one of those lessons is that isolating our sectoral efforts has little potential to affect great change, especially in the role of digital health in advancing health sector reform. Collective action and borderless solidarity is always the best answer.

References: 1. Pandemic, Recession: The Global Economy in Crisis https://www.worldbank.org/en/publication/ global-economic-prospects 2. FAO-WFP early warning analysis of acute food insecurity hotspots http://www.fao.org/3/cb0258en/ CB0258EN.pdf 3. Reaching universal health coverage: a political economy review of trends across 49 countries- ODI https://www.odi.org/sites/odi.org.uk/files/resource-documents/200623_uhc_paper_final.pdf 4. Living with COVID-19: Time to get our act together on health emergencies and UHC- https://www. uhc2030.org/fileadmin/uploads/uhc2030/Documents/Key_Issues/Health_emergencies_and_UHC/ UHC2030_discussion_paper_on_health_emergencies_and_UHC_-_May_2020.pdf 5. The global strategy on digital health 2020-2025, World Health https://www. who.int/docs/default-source/documents/gs4dhdaa2a9f352b0445bafbc79ca799dce4d. pdf?sfvrsn=f112ede5_50 Disclaimer- The opinions expressed in the article belong solely to the author and not necessarily to the author’s employer, or any other organization

When safe and affordable healthcare is not accessible, the repercussions transcend political, social, and economic borders.