In living memory, this experience has been nothing other than unprecedented.
That's the one word we've heard consistently to describe the societal shift that resulted from the COVID-19 pandemic. The pandemic provoked unique and unexpected increased demand for some medical devices. However, it also brought significant disruptions to medical device manufacturing and supply chain operations for others.
COVID-19 has dramatically impacted the world and the medical industry in particular, whether for prevention, diagnosis, or therapy. It has led to interesting changes in trends in medical devices and services that could not have been predicted before the pandemic and will likely have long-lasting repercussions.
As a global company that works with manufacturers of medical devices, we support healthcare organisations and the patients they serve. This article discusses our observations of the impact COVID-19 has had on the medical and public health industries as a whole and the new ways of thinking and living that have come from it. In it, we present different trends that must be recognised and considered by manufacturers in order to better meet healthcare needs in the near future.
Overburdening of the Healthcare System and Emerging Solutions
Healthcare systems have at times been overwhelmed as a result of the pandemic and the effective handling of medical care has become a challenge. Hospitals and healthcare facilities have at times been overcrowded and healthcare professionals have struggled to keep up with the surges of demand.
During the pandemic, we have seen the ever-growing needs of healthcare providers for special equipment, while many elective procedures and therapies have been postponed, sometimes indefinitely, with deleterious effects on those parts of the medical industry. During the first months of the pandemic, many companies that were otherwise paralyzed or severely impacted by the quarantines across the country stepped forward to try to help.
The need for more protective, therapeutic and diagnostic equipment as in ventilators, ICU beds, PPE, etc. resulted in redoubled efforts from existing medical device companies, streamlined regulations to facilitate design-to-market of relevant technology, inventive contributions from the non-traditional industry, and the repurposing of existing technology.
Medical products needed to combat COVID-19 range from high-technology ventilators, monitors, and test kits, to lower-tech protective garments, masks, hand sanitizers and soap.
The pandemic shortages have illustrated the limits of our resources despite existing medical companies maximising their efforts. Given the capacity constraints, the medical device regulatory environment is adapting to meet the challenges by becoming more agile to reduce time to market while attempting to keep quality and safety at the forefront.
Because the pandemic has impacted the global economy as a whole, companies from other sectors started manufacturing the necessary equipment to address shortages, both to assist in this humanitarian crisis as well as to seize the opportunity to pivot into a resilient industry during an unpredictable economy.
As a result, medical industry outsiders have pivoted to contribute with the repurposing of existing technology for tertiary care equipment or the creation of PPE. Alcohol companies, facing a drop in demand because of lockdowns across the world, realised their equipment could be used to create essential ingredients in sorely needed hand sanitiser. Defence industry contractors reconfigured their equipment to produce face shields, to meet health care providers increased need.
In response to the shortage of ventilators, therapeutic devices that have been a primary treatment for advanced cases of infection, automotive companies used the HVAC parts they had available to assemble reasonable substitutes. In collaboration with medical device companies, defence companies were able to contribute similarly. [source]
In another example of existing technology repurposed for the specific needs of treating coronavirus, Teknic developed a machine to automate the normally manual ventilation device used by EMTs and other first responders.
"It isn’t designed to replace an ICU ventilator, but rather to provide health care institutions a life-saving option when standard ventilators are needed but no longer available." [source]
Below is a video of the prototype in action:
source: Teknic, Prototype Ventilator: First Trial, via YouTube
Of these unconventional innovations, not many are likely to stand the test of time. When the urgency passes, stricter medical device regulation will resume, and ad hoc solutions are likely to be set aside. Companies will return to their original industries, but with perhaps a greater awareness of their ability to pivot and take advantage of major disruptions.
The Role of Automation
In an alternative solution to the shortages in PPE (Personal Protective Equipment), Johns Hopkins developed a robotic assistant to adjust ventilator parameters remotely.
Johns Hopkins is testing a small robot attached to a touchscreen ventilator, to limit the need to wear protective equipment or risk infection by entering an intensive care unit room.
source: Johns Hopkins Medicine, Robots Joining the Front Lines to Battle COVID-19, via YouTube August 14, 2020
The ability to control the ventilator outside the room is invaluable. Hospitals can save on PPE and reduce the risk of exposure to their employees.
Economic Impact on Business - Fear of Public/Shared Spaces
The immediate impact of the pandemic on the medical industry was the slowdown of elective procedures/care, and even procedures conventionally considered non-elective. Besides the lockdowns themselves, the public’s fear of becoming infected in a healthcare setting and uncertainty about available medical services has created reluctance to seek medical attention that has been slow to recover. This has created the need for virtual and remote care, the most significant being telehealth. As COVID-19 began to spread, healthcare providers were leveraging remote care and telehealth to protect their patients and medical personnel.
Impact on Hospitals
The fear of infection has shut down more than elective procedures. Surprisingly there have been patients choosing to stay at home even with urgent care needs, such as heart attacks and cancer treatment. As they come back in for treatment, they will be sicker and in need for more dramatic care, but the volume of patients will slowly resume.
In general, larger companies will be less impacted than smaller companies as they weather the economic downturn. This will shift the dynamics of certain industries, such as spine neuro-stimulation, which has had sizable portions of the market controlled by smaller companies.
Certain sub-segments of the health industry that can ship drugs and equipment to the patient at home should be well situated. This includes homecare by self-injections by immunocompromised patients, easy to use portable monitoring equipment, diabetes medication providers, and companies like Invisalign. Non-invasive or less-invasive treatments and outpatient care will likely recover more quickly as they will allow patients to spend minimal time in the at-risk spaces of hospitals.
Despite the increase in urgent and intensive care caused by the pandemic, the economic hit taken by the hospitals regarding the elective and “semi-elective” segments mean that the industry will be forced to rethink their strategies if a similar pandemic occurs again in the future (as experts believe is likely). Hospitals are likely to develop special, isolated facilities for the treatment of highly infectious disease, away from other care centers.
Additionally, some care, including minor forms of surgery will begin to be performed at satellite facilities rather than central locations, for the same goal of isolated risk of exposure. Finally, hospitals will seek to invest more in the type of health conditions, such as pregnancy, that cannot be deferred in the case of another pandemic. [source]
Emerging Solutions from Technology
Remote care through telehealth, home monitoring, and self-administered care have been utilised to address the problems of the pandemic and are not likely to disappear when the threat finally subsides.
Telehealth and remote monitoring use digital information and communication technologies to access healthcare services remotely and to manage your healthcare. For example, video can be an option for a doctor's appointment before, after or instead of a face-to-face appointment.
According to an article by McKinsey & Company,
"The use of telehealth has accelerated, with providers seeing between 50 and 175 times the number of patients via telehealth as before the pandemic."
Telemedicine tools are commonly used for remote treatment, particularly in the U.S. where 63% of healthcare providers have used it during the COVID-19 outbreak.
source: MedCity News, Survey: More than 90% of physicians are treating patients remotely
According to a survey by Sermo, the types of tools physicians are using also showed some variation between countries.
- In the U.S., more providers reported using telemedicine for a consultation (63%) than physicians in other countries.
- Video conferencing was widespread across all countries.
- Remote monitoring tools such as wearables or sensors were more widely used in Asia and Europe.
The goals of telehealth are to create a safe environment, improve the quality of healthcare, and to make it more accessible to people who live in rural or isolated communities.
Healthcare facilities can take advantage of technology to provide better care for their patients and share information with other specialists regarding diagnosis or treatment. Digital technology's capability to keep people connected despite physical distance, has been one of the main themes in response to the COVID-19 outbreak and has facilitated the development of remote monitoring devices that can connect through an IoT.
Another impact of COVID-19 is the program under the coronavirus response bill, which will support healthcare providers responding to the pandemic by helping patients in need acquire telecommunications services and devices for receiving connected care at home.
This year brings new trends and change in the industry. Healthcare facilities are starting to drive innovative programs. Here are five hospitals engaged in piloting digital transformation summarised from Becker's Hospital Review.
- Department of Veteran's Affair (VA) will expand in tele-critical care technology to remotely monitor patients.
- New York-Presbyterian hospital is connecting patients with COVID-19 and their families with walkie-talkie devices.
- The University of Michigan rolled out a home pilot program that will give patients a digital tablet and electronic devices kit to monitor their vital signs and transmit data to nurses.
- Yale University gets behind a telehealth program for seniors to get connected to their physician.
- Cedars-Sinai rolled out a virtual reality training program for residents, as many are unable to be present in face-to-face training.
All of the efforts and increased programs are geared toward avoiding infection risk for patients but also have drawbacks. One glaring one is the fact that telehealth is fundamentally reliant on connectivity. Millions of Americans, for example, still do not have broadband access while also living in areas with limited physical access to care. Telehealth cannot be an option for them until their access is addressed.
Additionally, the use of cyber-solutions through telehealth and remote monitoring increase the risk to cybersecurity.
Other Forms of Security
Last year, before the pandemic, the healthcare industry saw a 49% increase in hacking, impacting 41.4 million patient records. [source]
As remote healthcare services are trending well-beyond the pandemic, providers must take all necessary precautions to secure sensitive health data. Privacy and security risks have increased as doctors are quickly adapting to telemedicine. They are swiftly moving onto digital platforms which increases vulnerability to hacking and a threat to doctor-patient confidentiality. The healthcare industry should define cybersecurity duties and establish procedures for upgrading software and handling data breaches in order to manage new risks and vulnerabilities.
As these trends continue through 2020, cybersecurity leaders can take a prioritised approach to protect and defend patient care, securing protected health information, and meeting HIPAA Security Rule requirements.
CI Security's CISO Mike Hamilton and Executive Healthcare Strategist Drex DeFord look ahead to 2020 and share the trends and priorities in healthcare cybersecurity.
source: CI Security, 2020 Outlook for Healthcare Cybersecurity, via YouTube
Encryption, threat monitoring, risk assessment, user training, informed consent and formalised and documented security practices are all vital to ensuring the protection of healthcare technology and the confidentiality of patient information from unauthorised access.
While it is a time for growth, the medical field faces the challenges of integration, service quality, and internet-connected medical device security. Big data allows physicians to build better patient profiles and predictive models. However, all the data sharing can be compromised if precautions are not in place.
Businesses who learn to harness the data created by the Internet of Things and have precautions in place are the ones who will survive and thrive in the future. If used correctly, the volume of information generated from smart devices will help companies learn where they need improvement and innovation.
Impact on Public Life - Lockdowns and Caution/Caution Fatigue
Building public confidence requires reducing the spread of the Coronavirus and building out public-health measures.
Testing capacity has generally improved, and researchers are developing technologies for screening and diagnostic testing. Quick point of test results will be essential in encouraging faith in public spaces in a responsible way.
"One card-based antigen test can generate results for just $5 in about 15 minutes with a high level of specificity, though with a shorter detection window than the gold standard. Recent data suggest that saliva-based testing is as effective as nasal swabs. To improve speed and scalability, companies are also exploring a large number of gene-editing and membrane-protein treatments across CRISPR and LAMP platforms.
Screening tests relying on breathalyzer technologies are being evaluated to screen people quickly before they enter public areas such as schools and airports.” [source]
Other public health efforts to make safe public and shared commercial spaces, such as workplaces, sports arenas, airports, and music venues, to restore the public's confidence have resulted in a variety of innovations or rapid developments of cutting-edge technology.
Virus detection technology, sterilisation/anti-bacterial robotics for cleaning environments, the temporary closing of non-essential industries, and the normalisation of working from home are just a few efforts to ease the public's safety concerns.
The public health fears created by the threat of the pandemic are not likely to ever go away completely, much less very quickly. The impact of dramatic events, like the quarantines, can be felt in industries for decades just as the commercial aviation industry has experienced in the wake of the 9/11 attacks. The pandemic brings the same need for public reassurance that security efforts are in place. Various industries are rising to the challenge to build our confidence again.
High foot traffic areas, e.g. airports, have been recognised as a potentially dangerous environment for infection. This means the industry needs to explore ways to protect against community spread of COVID-19 as we begin to resume our "new normal" lives.
One of those ways is screening people for typical symptoms of infection, such as high temperatures, with the help of thermal imaging.
Thermal imaging cameras were initially used for military purposes, such as night vision. The cameras have also been improved to be used by firefighters, law enforcement, and rescue teams in disaster zones. There has even been speculation regarding mounting these cameras on drones to patrol public spaces.
The application to detect high body temperatures in high traffic areas could identify those people for safety precautions to be taken until further testing could be done.
By having body-temperature sensing security cameras available, the hope is that it will help protect against the virus spread by rapidly screening individuals before they enter a facility. However, it has limited usefulness in the face of asymptomatic infection and the general variety of symptoms that can occur in any infection.
Other tests that monitor specifically for the virus through nasal or saliva swabs are being developed that may be able to provide relatively quick, point-of-testing results. Some technology is being explored to test for the presence of the virus with breathalysers or even virus-detecting dogs, to allow faster entrance of the public to shared spaces such as schools and airports.
Sterilization/Anti-bacterial Robotics for Cleaning Environments
As the world begins to re-open and the public goes back to work after months of quarantines and lockdowns, however inconsistently implemented, employers are currently dealing with the challenge of easing the concerns of their customers, suppliers, and employees, while meeting new safety regulations.
Although recent research has shown that is aerated droplets that are the more significant danger in COVID-19 transmission rather than a failure to keep surfaces clean, environment sterilisation is an area where reassuring efforts to create a safe environment can be made visible to the public. This can be difficult to implement.
While chemical cleaning products are useful in this case, using them to disinfect surfaces in larger spaces like a warehouse or manufacturing facility is a daunting task because workers have to ensure that all surfaces are cleaned multiple times throughout the day, which can be time-consuming.
Not to mention, the risk to workers of being exposed to the virus and possibly contracting it themselves.
New technology, such as disinfecting robot systems, are already being introduced to combat the virus and prevent vulnerable workers from getting the virus.
An example of this technology is presented by a team at MIT who collaborated with the Greater Boston Food Bank and Ava Robotics to create a mobile robot that can disinfect surfaces using a UVC light that's built into the robot’s base.
According to initial tests, the results look promising and suggest technology like this robot system can be used to disinfect and sterilize a wide range of work environments from supermarkets to factories, and anything in-between.
Source: MITCSAIL, Disinfecting Spaces Using Robots, via YouTube
According to the team at MIT, tests at the food bank showed:
“The robot was able to cover around 4,000 square feet of the warehouse in around 30 minutes, with the team claiming that roughly 90% of the coronaviruses on surfaces would be neutralised during this time.”
Another example is the Avidbots Neo robot which patrols Cincinnati’s CVG airport to clean and disinfect the terminals.
“20 of these bots are already in use in one of the world’s busiest airports—Changi in Singapore—the model at CVG is the first in a U.S. airport,” according to Christopher Mims, an author at The Wall Street Journal.
In terms of autonomous vehicles, these robots aren't very complicated, but they can avoid people and move through spaces like hospitals and airport terminals to clean easily and continually, reducing risk to the public as well as employees.
Robotic technology has also been useful by allowing hospitals as well as other high traffic facilities like warehouses, prisons, and offices to disinfect and sterilise more frequently than they would with humans doing the work (thus keeping us safer, or at least building our perception of safety, as a result).
Other Automation in the Workplace
A repercussion of the coronavirus crisis is a scrutiny of how we work, even outside of the medical and public health industries. The shutdowns and quarantine periods caused a lot of companies to lose business or go bankrupt through lack of manpower. Automation, believed to be on track to replace a lot of this labor even before the pandemic, is now being seriously considered as a way to provide a cushion against the potentially devastating impact of future pandemics situations.
"In an effort to keep businesses functioning, companies are increasingly turning to automation in order to manage supply chains and production processes. Industry experts believe that automated machines, AI, industrial robots and other technologies will take jobs which require lesser human skills." [source]
One example is Honeywell's use of AI and machine learning to creating new models to help device operators with increased tools for decision-making.
Companies are looking to keep their businesses operating successfully while keeping their employees safe.
"Robots could potentially reduce contact between humans, performing several automated tasks that boost safety and keep people out of danger." [source]
Improved Prevention Through Technology and Behaviour Change
This section is drawn from the "Three W's to ward off COVID-19":
- Wearing a mask
- Washing your hands
- Watching your distance
Three W's to Ward off COVID-19 With the Help of Technology
A new world of medicine is upon us, and it's starting with new behaviour - wearing a mask, hand washing, and safe distancing.
Overwhelming evidence shows the efficacy of masks. The global pandemic has made face masks an essential item in combating the virus.
As we continue to struggle to control the spread of COVID-19 and prepare for the inevitable future incidents of mass future infectious disease crises, PPE of some sort is here to stay.
In Asia, SARS and other previous infectious disease events have introduced a casual culture of wearing face masks, and the West is likely to adopt similar fashion to some degree. But the conventional cloth filter mask may evolve into something more sophisticated, and even high-tech.
Although clearly speculative if not fantastical, the next generation of face masks could be see-through, capable of zapping germs, self-cleaning, and even translating languages.
A Japanese technology company called Donut Labs is speculating as to where masks could be going next. It’s developing the C-Face smart mask, which has a lot more in common with Fitbit than a typical cloth mask.
The idea of augmented reality COVID-19 mask sounds slightly bizarre and far-fetched, but these unprecedented times seemed to be characterised by those features.
Spacing technology is another prime example of the influence COVID-19 has on new digital technology.
"Wearable-device providers have developed solutions that can help employees social distance … as well as provide analytical data, like contact tracing," said J.P. Gownder, Vice President and Principal Analyst with Forrester Research in Cambridge, Mass. [source]
Companies are looking into wireless devices that hang around employees' necks and vibrate if they get too close to each other. And another prompts physical distancing by the use of a vibrating wrist band when people come within a 6-foot perimeter.
The COVID-19 crisis has disrupted societies around the world and will have lasting impact on our economies and the development of technology. Our new awareness of the threat of pandemic level disease has altered the direction of healthcare for the long term. This experience is now driving new technology and digital disruption in many industries, but most directly in healthcare.
The pandemic has highlighted the limitations of the MedTech industry in ways we cannot ignore. Strategies to avoid overwhelming demands for essential medical supplies and to avoid shortages and overwhelmed care centers will be essential moving forward.
With the changes that have already occurred, we see creative collaboration between medical technology and other industries at levels that, like the pandemic experience itself, are also unprecedented. Affected industries are resetting for long-term recovery and growth, now as well as after the coronavirus crisis.
As the medical and public health industries accept the new (and for the foreseeable future) reality of potential pandemic level health crises, they must adapt to models that allow improved access to care while limiting risk by limiting exposure, in order to improve the care patients receive and create efficiencies in the health care system.
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