Contact

Menu

Article

How relevant are sensors for Digital Health?

In the last couple of years, world politics seem to be on a path where nations are increasingly growing apart. At the age of connectivity, where the six degrees of separation1 theory looks more true than ever, this is quite a direction shift. Despite this multipolar scenario, there are various common global challenges to take on.

March 22, 2019

M. Bruno Azevedo

Analyst, Credit Suisse Asset Management

How relevant are sensors for Digital Health?

Global challenges and Digital Health

Two of the most prevalent are the increasing costs of healthcare and the demographic trend of an ageing population. To show how relevant these trends are, let us use these simple data points/projections: according to the United Nations2, the potential support ratio (PSR)3 is predicted to fall to 3.5 in 2050, from 7.0 in 2015, i.e., not only enlarging the elderly population, but also drastically reducing the caregivers population. Already today EU member states alone spend €4 billion every day providing healthcare4.

The two challenges are closely related, as an ageing population is set to amplify the healthcare cost issue. As such, in order to maintain high quality standards and the affordability of the healthcare system, significant innovation will be needed. In this Thematic Insight, we explore how Digital Health may cause positive disruption. Specifically, we illustrate how sensors will play a crucial role that is expected to drive a paradigm shift of the current healthcare system.

"It takes the average American four years of doctors' visits to spend as much time with their physician as they spend with their phone in a single day. " Emmanuel Fombu, MD, MBA⁵

Paradigm shift – sensor’s key role

In order to get a sense of the roadmap ahead of us, let us first define our goal. Ideally, an effective healthcare system delivers a high quality service, is accessible and affordable, is patient-centric, and has a focus on prevention rather than just disease treatment. Given these characteristics, and the current healthcare systems’ architecture, it is clear that such an equation cannot be solved. However, a fundamental change in our assumptions, i.e. a paradigm shift, might solve the puzzle. That fundamental change may be the time compression that healthcare sensors can offer.

Consider that in the US, on average, each person visits their doctor 4 times per year6, thus totalling 1.3 billion visits per year. Essentially, a visit to your doctor is simply a bilateral exchange of information: at a specific point in time, your doctor observes a set of parameters and, based on those, gives you advice. In some cases, following your doctor’s advice, follow on visits are needed to monitor the reaction to therapy.

Thematic Investments

Our investment teams identify and aim to invest in exciting and attractively valued companies that are on the cutting edge of innovation. Join us and invest in tomorrow’s winners.

Now, suppose that the parameters your doctor evaluates can be monitored by wearable sensors at a much higher frequency, and your doctor can access that data remotely. There are a number of advantages to this process: first benefit for both parties, is a richer dataset upon which the counselling is based; second, as the information is readily available, the physical displacement can be (in some cases) avoided; third, your doctor would be able to monitor the evolution of your organism reaction remotely. In other words, the use of sensors may be a game changer for healthcare systems.

The evolution of sensors

As we did for the ideal healthcare system, let’s start by drawing the roadmap for sensor systems. Quoting Marschollek et all7,

“the ideal sensor-system for health related parameters would be deployed at one point in time and continuously measure and wirelessly report all health-related information thereafter. It would not constrain or affect its user in any way and it would need no maintenance”.

This is a challenging goal, however, the gap between current technology and this goal is continuously narrowing.

Figure 1: Adapted from „Wearable Sensors in Healthcare and Sensor-Enhanced Health Information Systems: All of our Tomorrows?”, Marschollek M. et al., 2012

The simplified framework in Figure 1, gives a simplified overview of the sensor space. Consider that at its origin, wearable sensor technologies focused largely on cardiovascular diseases, simply because the technology to record electric signals has been available since the 1960’s8. Today however, sensors span several disease areas and the potential applications greatly benefit from the rise of the Internet of Things (IoT). As in any other IoT related topic, the challenge will lie in extracting value from the large amount of data available On this matter, the “IT Future of Medicine”9 project, puts forward interesting proposals; for example, one possibility is to create a digital twin that contains information based on an individual’s –omics (genomics, proteomics, metabolomics) analyses, imaging techniques, and information from sensors of various forms. This digital twin profile would be updated continuously by sensors and intermittently otherwise, and would essentially be based on modelling every individual biology in order to generate the best prediction possible from a complex data set. Even though this makes a compelling case of a preventive healthcare system, we are still some steps away from this reality.

Use cases

The use cases for sensor-systems span a wide spectrum. Depending on the type of sensor, the use cases can span from classic medical uses such as Constant Glucose Monitoring (biosensors), to surgical fluid management systems (pressure sensors) or electro-surgery (flow sensors); outside the pure medical spectrum, wearable sensors designed to measure oxygen levels in the muscles, i.e., performance optimization are a good example.

Currently, many of the existing digital health sensors that have been broadly adopted are perceived mainly as lifestyle products or lifestyle wearables. Flagship examples are FitBit® with its reported 25 million users10 by the end of 2017or the use of Microsoft Kinect in physiotherapy rehabilitation for stroke patients11.

Marschollek et al12 assert that sensor applications should focus on neuropsychiatric conditions based on a report13 of the World Economic Forum indicating that mental illnesses are expected to generate higher costs than cardiovascular diseases.

Conclusion

As we have shown throughout this Thematic Insight, sensors are a cornerstone element for the success of Digital Health. The health sensor technology has significantly evolved since the early 1960’s, and the IoT revolution is the tipping point that may enable the transformation of healthcare systems. We are already at a stage where we can envision a future where implantable biosensors for blood glucose coupled to an insulin release system, can regulate the release of the drug fully autonomously.

The driving forces behind the healthcare systems reform, i.e., the financial burden of healthcare and ageing societies, are long term global trends that will generate significant investment opportunities. As such, we see the exposure to the Digital Health topic as an essential part of a portfolio.

Issues and risks

The main issues or risks stem from three main areas: data security, regulation, and technical development.

On the security issue, the common IoT data security issues also apply. This is further amplified by two factors: first, the nature of healthcare data is by definition sensitive (i.e., confidential); second, the use of mobile operating systems to collect and transmit information is prone to data exfiltration and malware. The health sensor industry will have to draw on the cybersecurity industry expertise in order to tackle data security.

On the regulation side, the integration of these devices into reimbursement schemes and all the regulation regarding data storage and usage will be critical for the mass adoption of the sensors.

Last but not least, technical advances can significantly enhance the value of sensors. For example, advances in energy harvesting have the potential to significantly increase the energy autonomy of sensors, thus reducing the maintenance burden and improving user experience.

1 in “Everything is Different” (1929) Frigyes Karinthy advances the idea that all living things and everything else in the world are six or fewer steps away from each other so that a chain of a “friend-of-a-friend” statements can be made to connect any two people in a maximum of six steps
2 World ageing population 1950-2050, pp.87. Available at: http://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf
3 Number of persons aged 15 to 64 years divided by the number of persons aged 65 years and above
4 The Future of Health Care: deep data, smart sensors, virtual patients and the Internet-of-Humans, pp.2
5 Source: “The Future of Healthcare: Humans and Machines Partnering for Better Outcomes”, Fombu E. (2018)
6 https://www.forbes.com/sites/niallmccarthy/2014/09/04/americans-visit-their-doctor-4-times-a-year-people-in-japan-visit-13-times-a-year-infographic/#367ddfa9e347
7 “Wearable Sensors in Healthcare and Sensor-Enhanced Health Information Systems: All Our Tomorrows?”, Marschollek, M. et al (2012), Healthcare Informatics Research
8 “New Method for Heart Studies”, Holter NJ (1961), Science; 134:1214-20
9 http://www.itfom.eu
10 https://investor.fitbit.com
11 https://www.physio-pedia.com
12 “Wearable Sensors in Healthcare and Sensor-Enhanced Health Information Systems: All Our Tomorrows?”, Marschollek, M. et al (2012), Healthcare Informatics Research
13 “The Global Economic Burden of Non-Communicable Diseases”, Bloom et al (2011); World Economic Forum;

IMPORTANT INFORMATION
Fee Disclosure
Where permitted by law, we may receive fees, commissions or other monetary benefits in connection with this product from third parties. For details please refer to your Fee Schedule or contact your Relationship Manager.
If you are not a client of Credit Suisse UK Ltd
If you are not a client of Credit Suisse, please note that this document has been provided to you for information purposes only as an example of the type of products we are able to offer to you should you become a client of Credit Suisse. The provision to you of this document does not constitute an invitation or inducement to buy or sell any security or other financial investment, nor does it constitute an advice or personal recommendation. Should you wish to invest in any products, you will have to go through our account opening process which involves providing us with details of your personal and financial circumstances, risk appetite and investment objectives as well as selecting the most appropriate portfolio mandate for you. We can thereafter work with you to determine which investments are suitable or appropriate for you.
Marketing Disclaimer
This document is provided to you for your information and discussion only. It is not a solicitation or an offer to buy or sell any security or other financial instrument. Any information including facts, opinions or quotations, may be condensed or summarised and is expressed as of the date of writing. The information may change without notice and Credit Suisse (UK) Limited (“Credit Suisse”) is under no obligation to ensure that such updates are brought to your attention.
The price and value of investments mentioned and any income that might accrue could fall or rise or fluctuate. Past performance is not a guide to future performance. If an investment is denominated in a currency other than your base currency consult with such advisor(s) as you consider necessary to assist you in making these determinations. Nothing in this document constitutes legal, accounting or tax advice. Credit Suisse does not advise on the tax consequences of investments and you are advised to contact a tax advisor should you have any questions in this regard. Thek levels and basis of taxation are dependent on individual circumstances and are subject to change.
This document has been prepared from sources Credit Suisse believes to be reliable but we do not guarantee its accuracy or completeness and do not accept liability for any loss arising from its use. Credit Suisse reserves the right to remedy any errors that may be present in this document.
Credit Suisse its affiliates and/or their employees may have a position or holding, or other material interest or effect transactions in any securities mentioned or options thereon, or other investments related thereto and from time to time may add to or dispose of such investments. Credit Suisse may be providing, or have provided within the previous 12 months, significant advice or investment services in relation to the investment concerned or a related investment to any company or issuer mentioned. Some investments referred to in this document will be offered by a single entity or an associate of Credit Suisse or Credit Suisse may be the only market maker in such investments. This document is intended only for the person to whom it is issued by Credit Suisse. It may not be reproduced either in whole, or in part, without our written permission. The distribution of this document and the offer and sale of the investment in certain jurisdictions may be forbidden or restricted by law or regulation.
Investments may have no public market or only a restricted secondary market. Where a secondary market exists, it is not possible to predict the price at which investments will trade in the market or whether such market will be liquid or illiquid. Where such investments will not be listed or traded on any exchange, pricing information may be more difficult to obtain and the liquidity of the investments may be adversely affected. A holder may be able to realise value prior to an investment’s maturity date only at a price in an available secondary market. The Issuer of the investment may have entered into contracts with third parties to create the indicated returns and/or any applicable capital protection (in part or in full). The investment instrument's retention of value is dependent not only on the development of the value of the underlying asset, but also on the creditworthiness of the Issuer and/or Guarantor (as applicable), which may change over the term of the investment instrument. In the event of default by the Issuer and/or Guarantor of the investment and/or any third party, the investment or any income derived from such contracts is not guaranteed and you may get back none of, or less than, what was originally invested. Parties other than the Issuer or Guarantor (as appropriate) mentioned in this document (for instance the Lead Manager, Co-structurer, Calculation Agent or Paying Agent) do neither guarantee repayment of the invested capital nor financial return on the investment product, if nothing is indicated to the contrary.
You may have to accept smaller returns on an investment relative to a direct investment in the underlying index, basket, etc. because of the costs involved in providing the capital protection. Such capital protection normally only applies if the investment is held until maturity. The amount of initial capital to be repaid may be geared, which means that a fall in the underlying index or securities may result in a larger reduction in the amount repaid to investors. Where this document relates to packaged products (such as regulated collective investment schemes), any advice offered to retail clients is based on a selection of products from the whole of the market. Where this document relates to emerging markets you should refer to the Risk Disclosures section of the Credit Suisse Terms of Business. Additional information is, subject to duties of confidentiality, available from Credit Suisse upon request.
Hedge Fund strategies may include the use of leverage (borrowing) and derivative instruments resulting in certain risks, some of which are as follows: leveraged investments, by their nature, increase the potential loss to investors resulting from any depreciation in the value of such investments. Consequently, a relatively small price movement in a leveraged instrument may result in a substantially greater loss to the Hedge Fund. The market in some of the investments made as part of a Fund’s strategy may be relatively illiquid, giving rise to potential difficulties in valuing and disposing of such investments.
Information for determining the value of investments held by a Fund may not be readily available which has corresponding implications for the overall valuation of a Fund. Accurate risk profiling of the Fundholdings may also not be readily available. Always refer to the Fund’s Prospectus and/or the Key Investor Information Document before making an investment.
Your personal data will be processed in accordance with the Credit Suisse Privacy Policy published at https://www.credit-suisse.com/uk/en/private-banking/important-disclaimer.html.
Credit Suisse (UK) Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority for the conduct of investment business in the United Kingdom. The registered address of Credit Suisse (UK) Limited is Five Cabot Square, London, E14 4QR.
If you have any questions regarding the document, please contact your Relationship Manager.
© Credit Suisse (UK) Limited 2019.