By STEPHANIE KUKU, MD and HUGH HARVEY, MBBS

The ability to predict in healthcare is the utopia promised by every artificial intelligence for healthcare built, funded and tested in the last decade. Yet very few doctors, technologists, or investors would have imagined they would live to witness a pandemic of the scale we are currently experiencing. We are still getting our heads round the lives lost, the lives of the frontline workers at risk, the disruption and self-isolation, the less fortunate who will suffer the most, the companies in survival mode, and a battered global economy. It is a good time to reflect on what the future of health will look like after we recover. We need to get better at acting on the predictions that truly matter. In a booming health-tech market saturated with promises of predictions and diagnostic insights, it’s a shame we didn’t listen to the scientists who predicted this violent wave of viral disruption. 

The future of healthcare investing needs to change

With the first case of the virus last December, everything changed, and there is so much more change to come, in healthcare, technology and in the way we all work.  Like with policy and public health, the majority of players on the healthcare stage remain so far removed from the frontline. The perceived ‘market’ rarely truly represents the real one, and true intelligence is lacking the collective intelligence that should prioritise the needs of the healthcare systems and the populations they serve. Our values, motives and how we create the pitch-perfect melting pot of skills, expertise, and mindset needs readjustment. Somewhere between evidence- based decision making and patience; clinical impact aligned with economic impact should be the goal. More focus is needed on validation and less on valuations that are largely built on assumptions and unproven hypotheses. Given the amount of investment that has drowned the healthtech/biotech domains in the last decade, we must praise the advancements that have been made. We must also examine the failures, the wasted resources, and whether technology really is moving healthcare forward at a pace that matches the investment.

The forces that determine what startups and spin-outs are funded and what innovations make it to the lab or hospitals regardless of their eventual clinical impact is an intricate, complex web of sometimes distorted priorities. Amidst competing incentives of donors, investors, developers, scientists, clinicians and governments, the harsh reality is that only a handful of R&D and companies that receive funding will both create something of impact in healthcare and a healthy return on investment. The pandemic has in effect created its own mini-Gartner hype cycle, and investors would do well to pay attention to the rise and fall of promised technology during these uncertain times.

Domain expertise, hedging bets or FOMO-driven?

There are numerous healthcare analogies to the hype and investor fan-girling that resulted in the rise and subsequent crash of Wework, not to forget the billions wasted on Theranos. For whilst Elizabeth Holmes might have been held accountable, in these very extraordinary, uncertain times, it is painful now to think of what good that money could have been put to. Vaccines, immunotherapy drugs, diagnostics for early detection of cancer and autoimmune disease, mental health therapeutics, clinical decision support for the brave and exhausted healthcare workforce. The list goes on. 

Healthtech investors and venture capitalists at large have a distinct skill set and usually have previously had some experience in the healthcare sector. It is likely that some make better bets with experience. Others make predictions by analysing the markets and trends. Surprisingly few rely on experts for deeper insights. 

More diligence is due

Just like with any effective cancer team, a true Multi-Disciplinary Team (MDT) skill set should be required for due diligence, steering validation and scalability of proposed products in healthcare. True due diligence requires a team effort. The silos of expertise needed to make decisions on what companies to fund, scale and support need to be converged. Deep due diligence should involve a team of experts who can:

• assess a management team and their ability ‘to manage’ in the healthcare sector, as well as detect any complex divides in mindset between the scientific, product, regulatory and business leads 
• guide operating executives to honestly and reliably evaluate the robustness of the underlying technology or product 
• understand  the clinical research required and clinical impact within the intended setting and/or workflow
• comprehensively assess the regulatory pathways and requirements needed for a specific novel technology 
• evaluate the ‘marketplace’ with depth, collaborating with relevant clinicians, scientists, and health care economists  
• evaluate the true and hidden costs of ‘customer’ acquisition in healthcare

In healthcare, one cannot rely on fast iteration and user churn to help find product-market fit. It needs to be found first, before going to the market to shop for ‘customers’. Tech companies frequently appear to not understand the difference in behaviours between patients and customers.  

Evaluating the competitive landscape is also important. Founders will usually underestimate this to raise funds, and in doing so underestimate the time from development to implementation and procurement, as well as the resources needed to get there. If ‘competition shows the market’ then telemedicine truly is here to stay post-pandemic.  

Hope for the future of digital health

Whilst COVID has revealed staggering flaws in our healthcare systems, it has also shown the potential for massive improvements in access to care and resources to support this. It has confirmed to the skeptics out there that technology in healthcare does have the ability to improve workflow, communication and free up doctors and nurses for essential patient-facing care. We have to be prepared for the next healthcare crisis. In the future, our healthcare systems will be stronger and more valued. Technological innovation will accelerate equitable healthcare access and quality, instead of sitting eagerly on the sidelines waiting for acceptance. We must reassess our healthcare priorities as we no longer have a choice.

It is impossible not to expect that in some existential way all our priorities will have to change. What won’t is the need for deep expertise and experience. In fact, we need it now, more than ever.

Dr Harvey is a board-certified radiologist and clinical academic, trained in the NHS and Europe’s leading cancer research institute, the ICR, where he was twice awarded Science Writer of the Year. 

Dr Stephanie Kuku is a health technology advisor who has worked in the NHS/HCA as a surgical oncologist specialising in women’s cancers and is an advisor and consultant in Clinical AI at the WHO.

This article originally appeared on the Hardian Health blog here.