Episode 6: Dr Leonid Shapiro on the Internet of Things

Candesic Managing Partner Dr Leonid Shapiro explores how the Internet of Things is reshaping healthcare, from real-time patient monitoring and remote consultations to streamlined hospital workflows and data-driven decisions, ultimately driving better outcomes and more proactive care.

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Transcript

SPEAKER_01 0:06

Welcome to Candesic in Conversation, a podcast series exploring the big innovations, opportunities, and challenges in health and social care, life sciences, and medtech. Today Candesic is in conversation again with Lena Shapiro, managing partner at Candesic, and we are talking about the Internet of Things. Welcome back to Candesic in Conversation. Thank you. Now I guess we ought to say really, and most people will know, what the Internet of Things is because it's got a massive remit. So we are talking about the physical devices that are connected to the Internet, allowing them to collect, to exchange, and to share data. Specifically in the case of healthcare, we're looking at everything from smart watches to continuous glucose monitors for diabetics, fall detection systems, smart hospitals, tracking assets, beds, and patients in real time, et cetera. And I'm interested to start off with a couple of questions. Why there is an appeal to investors, and then we'll go on to why it matters to patients, possibly the wrong order. But let's look at it from an investor perspective. Where is IoT currently delivering the most immediate operational return on investment?

SPEAKER_00 1:18

So IoT, uh again, very uh exciting, potentially overhyped uh area in the past, really bringing some wins for operators. Uh it's a very broad space. For example, in hospitals, it's being used to uh look at patient flow and and throughput and beds in a real-time way. So it's about getting real-time information about when's a bed free, uh, when's it been turned around, where the patient is at the at the at that this moment in time, what where is the uh specific piece of equipment that you need at this moment in time? Has it been clean? Has it has it been is it broken? Is there an issue? All of that stuff historically is done on paper. Uh it led to you know very long turnaround times for beds, lots of equipment being lost or not available when needed, so the hospital needed to buy more of the equipment in order to make sure that it was available than it actually needed. Um and uh and nowadays uh with real-time tracking, and this is everything from barcodes to you know uh uh RFIDs and and and just Bluetooth-based location uh base inside the hospital, uh it it the beds beds can be turned around faster, so more patients can be put into them. Um there the hospital needs fewer assets, like you know pumps and things like that that go by the patient bedside. So they can save on on uh capital expenditure um because they need fewer devices for to deliver the same care. Um and they know where everything is at any one time with dashboards so they can identify issues and deal with them uh before they become bigger problems. Um another area is around uh uh the workforce uh and also remote monitoring. So uh workforce nurses historically, in for example, in care so care homes, uh even in hospitals, had to go in and take vitals of patients on a regular basis, check up on people and so on. Nowadays, with the with the Internet of Things uh and re and remote monitoring, those things can be done automatically. Uh and they can be done uh constantly or continuously rather than every two hours or every four hours or every you know, whatever. That does two things. One is reduces the amount of time that uh nurses and and carers need to spend, but it also improves the frequency of updates so that you can identify issues earlier and improve quality. And the other thing is it's also um moving care further away. So again, in the past you you have to have nurses and carers come to you, so you have to be in a care home or in a hospital. Now you can have these remote devices in your home, for example, monitoring the same way as they would if you were in a hospital.

SPEAKER_01 3:54

Sure. And from a patient perspective, why does IoT matter to the patient? In what ways is it meaningfully improving the patient's lot?

SPEAKER_00 4:03

Well, patients find it much more convenient. Uh you know, they don't necessarily want to be disturbed if a nurse has to come and check their vitals every two hours throughout the night. Uh they'd rather rather sleep and have an automated system do that uh automatically. It's more convenient for them if they can be cared for at home. So virtual wards or just remote monitoring in the home enables patients to be uh let out of hospital sooner uh and and get better care, higher quality care while they're at home.

SPEAKER_01 4:35

And what about things like um medication adherence? Presumably there are uh there are systems in place for IoT to do that as well?

SPEAKER_00 4:42

Aaron Powell Yeah, so adherence to uh treatment protocols is a big issue, uh particularly when a patient goes home, because you know they don't have the nurse coming in saying, you know, it's time to take your medication. They have to take the medication themselves when they need to. Uh so you can have uh Internet of Things type devices that track uh when you've taken your medication. They can even nudge you to uh remind you that you need to take this medication, uh, and play do a little bit of kind of like uh gamification to uh get you to you know walk that extra mile or whatever it is that you need to do that the doctor prescribed. Um and that does two things. One, of course, it improves adherence, so you get better outcomes, but it it also gives the clinician looking after you more information. Uh because they can see if if something's not working, they can actually see is it is it really because you know it's the wrong drug, or is it just because the patient hasn't been taking it?

SPEAKER_01 5:34

Sure. And you you mentioned the data though. I mean, data analytics is obviously huge here. We are gathering vast swathes of hopefully usable information. How do you get the most out of that data? What do you do with that kind of volume of clinical and operational data? How can you turn that into measurable outcomes?

SPEAKER_00 5:55

Aaron Powell Well, you have to data mine it. Uh the amount of data that's created when you have something autonomously collect information is huge. And of course, again, we've we're shifting away from episodic collection of data to continuous collection of data, which means the data just explodes. Uh the benefit of that is you have so much data that you can then do a lot of machine learning and AI and all that good stuff uh to mine that data to identify patterns that perhaps are not obvious to the naked eye or to an individual looking at the data. Uh and that will lead to uh interventions that perhaps in the past were never done or never thought could be done. Preventions as well.

SPEAKER_01 6:33

I mean interventions, but preventions because you can see these things coming before they happen.

SPEAKER_00 6:37

Yeah. So the continuous nature of data collection from these remote sensors is that you could identify problems earlier in their life cycle and therefore intervene earlier to perhaps reduce the chance that that patient may need to be admitted to an emergency room. And uh uh that's one area. Uh but in general, you're the more data you collect, the more information that the clinicians have to make some kind of interventions. And yes, the they can make them earlier if they have the data earlier.

SPEAKER_01 7:06

But that, of course, will raise its own questions in relation to governance, uh in relation to trust, in relation to interoperability, because there are all these devices speaking a different language. How do you see the the future going forward in that area?

SPEAKER_00 7:25

So this um uh leads to a good discussion about which companies are going to be successful. Uh we see a lot of point solutions out there. A lot of companies coming up with I've got the better mousetrap, I've got a device that does this, or I've got a device that does that. Uh unfortunately, these devices don't necessarily talk to each other, and they're not based or built on the same governance and cybersecurity protocols uh that perhaps other systems um demand or that the Trevor Burrus, and that suggests there may be winners and losers then? Aaron Powell Yes, of course. So uh the question is you have you have a number of players in the space, and they're all adopting Internet of Things solutions. So you have some players that are coming from a hospital uh EHR perspective. Uh so these are the the systems that run hospital uh health records and uh patient management, the health clinical side of patient management, not the like the financial. They historically have collected data, but only in the hospital setting. But it's very easy for them to integrate with devices out there that uh collect data from the community or or or continue or continuous data from the hospital as well. So the companies that are making point devices or point solution devices need to interoperate with the hospital systems, for example, um to in order for the benefit to come through. Uh you also have uh service providers now that are outside of hospital that are delivering care through the use of Internet of Things. Uh and these typically uh are more outsourced service providers that, for example, home care provider or where someone could look after you in your home with some remote monitoring, uh, that's not related to a hospital. Again, interoperability isn't is key. You need to, whatever technology is deployed, it needs to talk to other systems and it needs to uh do it in a way that's safe, secure, and governed. So in those whatever you invest in has to have those basic principles. Um but someone's got to tie it all together into a service offer that's useful. It's uh i I don't think that that the companies that have a again a point solution, even if it's a best point solution, are gonna be uh as successful as the ones that offer a generalized service, perhaps integrating the point solutions, but offering a broader uh service that creates value for everyone.

SPEAKER_01 9:44

Aaron Powell Well, one way to integrate things, of course, is MA, consolidation. Yeah. Is this a consolidating market? And if so, who will the winners be?

SPEAKER_00 9:53

It is increasingly a consolidating market. Um so you have some uh broader providers like Apple, you know, with the healthkits and the every every uh you know, Amazon's like doing uh their own thing. And there's all the large providers are trying to create a an ecosystem um uh and own the patient. Uh but I think we'll see probably kind of two scenarios. One is the large integrated uh service providers, data providers. So it could be hospital EHR systems, um, it could be players like Apple that pull together lots of different sensors and try to create value from that. Uh but it also might be a couple of uh point solution providers that just do something very, very well in an area like cardiology, for example, um, uh, or other another subspecialty. But increasingly they're gonna have to go much broader than just offering one solution to be successful. And perhaps you know the ones that are the best are that do a bit of both, that have a uh offer a generalized uh relationship with the patient or the pair uh and a broader service, but have a really, really you know excellent sensor or device for a particular function uh that they use as a spearhead to get in, and then they offer the broader service by integrating perhaps competitor solutions into a solution for the patient or the or the pair.

SPEAKER_01 11:16

And if I ask you to look into your crystal ball five years, ten years hence, how do you see the market developing? How do you see IoT reshaping if it's going to the healthcare landscape over that kind of period?

SPEAKER_00 11:32

So I think the the real opportunity comes from being able to shift care from being episodic to being continuous. Um this means that it's not just when you're sick, but when you're not sick, you can monitor your health uh and identify uh areas where you know you can intervene or your clinic your doctor can intervene earlier in the process. And that's that's vital for these devices, these Internet of Things devices, to integrate with the clinical systems that monitor your health, either if you're at a hospital or if you're not, if you're under the care of your, say, GP over, you know, basically a long period of time to see how things are going and see and and see how those those those data and those the insights coming from those data can be turned into actions. Um data, just for the sake of data, is isn't useful. It needs to be integrated into the clinical pathway in a way that the the clinicians are accepting uh of it to be helpful. So it can't be just I've got a wearable, um, I'm gonna connect it to my doctor, and the doctor is is you know gonna suddenly use it. It it doesn't work that way. Uh the the doctor needs to believe that the data is is is that collected in a secure and governed way. The doctor needs to know that that the data is actually uh insightful so that it actually adds uh value to his clinical, his or her clinical decision making uh and uh um is able to create value. Uh it's important for payers as well. So payers don't want to people to get more sick uh because they'll cost more in the long run. So if they intervene early, they can reduce the spend uh that they would normally have to spend if the patient was more sick. So using these devices to do things like risk stratification and uh avoiding unnecessary A and E visits, for example, uh by identifying things early and enabling the GP to deal with it rather than A and E doctors to deal with it, is a big thing for payers. And I and I think another really big area that we haven't touched upon uh where this can be used is in clinical trials in actual uh drug development. So things like decentralized clinical trials, uh, where patients don't come into the hospital, they're they stay at home, but all the data is collected effectively in their home and in the community. Um that's now possible with Internet of Things. Uh and this serves to reduce the cost of trials and it speeds how quickly trials can be done, how quickly patients can be recruited, uh, and eventually gets us our miracle drug to the market faster.

SPEAKER_01 14:08

What are the biggest barriers then to adoption of this? Are we looking at technical, regulatory, cultural even uh issues here? What do healthcare operators, et cetera, face when adopting IoT solutions?

SPEAKER_00 14:21

Well, interestingly enough, uh the technology isn't really the stumbling block. Uh technology isn't rocket science. I mean, true, there are more and cooler sensors out there that can do things at a distance that normally would need injections and things like that, but uh they're all always coming up. Um but a lot of the basic technology has been around for years, uh, is just being implemented in healthcare now. Uh integration, as I mentioned, is key. The data has to flow to the right people in your care looking after you, that look after your care, to be able to use it properly. Otherwise, you're just collecting data for data's sake. It's the same thing as like like I've got my my my watch here, I've got my or a ring here as well. Uh and it collects data all the time and it's all sitting on my phone. If I never check my phone to make any decisions about what I do with that data, what's the point of collecting the data? It's just there. So it needs to be integrated in the in the care pathway. And doctors, your GP, for example, needs to start using that and believe believe that that data is useful to their decision making.

SPEAKER_01 15:27

Aaron Powell How would you personally feel about that data being streamed not just to you, but to your doctor?

SPEAKER_00 15:34

Well, I I I wouldn't mind, but obviously uh trust is very important. So uh who else has access to the data, under what circumstances? Um who owns it? Well, uh I mean don't get me started with who owns the data thing uh with the NHS. That's that's a big one. But um trust is important. It's just being able to know that look you you trust already with if you have Apple or Google or whatever, because it'll go to your phone, it goes to the cloud. In theory, someone in the can look at it from the cloud, but people trust their that Google and Apple are not gonna somehow sell their data, but it's it's it's always possible. But uh trust is important. Um the other area is around regulatory uh and and reimbursement. So what's allowed and not allowed, of course, um that's getting easier, uh, but it differs by country, so it's not as easy to develop something in one country and then spread it to another. Uh but reimbursement is perhaps the strongest uh issue because a lot of in many countries doctors get incentivized to do some things, but not others. So they may get um from a clinical perspective, they may see that that uh IoT device brings a lot of value to their decision-making for for you as a patient. But if they don't get paid for it, uh particularly in America, they're not going to necessarily adopt it or interpret it. Trevor Burrus, Jr.

SPEAKER_01 16:49

They may not want to have great swathes of data. They might not want that message to ping up that gives them the data that they then have to look at, because that's another round of work for them to do as well.

SPEAKER_00 16:59

Trevor Burrus, Jr.: It's it's I I think doctors from a clinical perspective will take whatever data they can get if it helps care for the patient. But the reimbursement is an issue because sometimes doctors get paid, for example, for doing a procedure uh because they're doing something. If that procedure was replaced with some data that came from an IoT device that they don't get paid for, they're less incentivized to adopt that. And again, this is particularly a problem in America uh than in Europe because of the difference in the way the healthcare systems are run, are funded. But uh but it is it's definitely a barrier to adoption.

SPEAKER_01 17:31

Aaron Powell And from uh an investor perspective, what does the company need to show here?

SPEAKER_00 17:34

Aaron Powell So if you're an investor in investing in an IoT company, you know, there's a number of things that you know generally you want to see. One is you want to see the company actually have data that they have some kind of return on investment. So there's a there's a benefit from their device. The the doctors are using it to to make a clinical decision that either saves money or improves quality. If you if you don't have that, it's very hard to convince uh payers to pay for it. Uh you have to have integration and you have to have trust and kind of data governance. That's kind of like that's almost like uh right to play. You have to have those two. Um you have to have some type of reimbursement uh mechanism. So direct or indirect, sometimes you get a code for that using of that device or uh that approach. Other times you don't get a code, but you kind of save money elsewhere. But there's got to be some benefit, financial benefit for the system or the clinician to use it. And then the last, of course, is you know, evidence of adoption. Uh pilots are not enough. You know, you need to actually see real adoption by clinicians uh uh in a broad sense, that not prompted through a pilot, but broad adoption uh to know that there's a uh a runway for growth.

SPEAKER_01 18:51

Sure. And let's talk about innovation hotspots or or the exciting elements to this. Which new developments are you most excited about? Which thematic areas within IoT healthcare, it could be hospital robots or smart beds or the medication uh adherence devices we talked about, continuous monitoring. What are the ones to watch?

SPEAKER_00 19:13

So the hospital at home uh scenario is quite an interesting one. Uh you know, we know in the UK, for example, the Labour government is is really pushing for to take care out of hospital. IoT has a big role to play there. Being able to monitor patients in their home uh in a safe way uh will serve to reduce costs, improve quality, and actually improve uh convenience and uh satisfaction uh by the patient. Uh so we'll see a lot more of technology being deployed in in in patients' homes. Um the ability to continuously monitor and collect huge amounts of data, that's gonna be uh that's gonna benefit not only in making uh decisions earlier in the disease cycle uh to intervene earlier, but also create so much data that it can be analyzed through machine learning to bring insights that historically have never been able to be developed or brought out. Um you mentioned medical adherence, so uh devices that help you make sure you take your drugs, very important. Um and I think for hospitals, you know, this concept of a smart hospital. So I mentioned about knowing exactly where your assets are at any one time, um, what state they're in, have they been turned around, cleaned, repaired? Those assets could be beds, they could be devices. Uh just having that kind of real-time dashboard allows the hospital to be run much more efficiently uh and in a smart way.

SPEAKER_01 20:47

Aaron Powell You're creating capacity out of nothing, out of what you already have. Exactly. Simply deploying it smarter.

SPEAKER_00 20:53

Yes, you're using your existing infrastructure more effectively. Uh and we could really do that now because uh I mean the NHS is you know promising to build all these new hospitals because it needs to, but it's it's doing that very slowly. So anything we can do to make the existing hospitals more uh efficient uh is definitely welcome. Um and then you know you mentioned robotics. Uh I mean there's there's two types of robotics in hospitals. There's the the surgical robots, like the Da Vinci. Uh they're great, and you know, there's a lot of opportunity for AI to potentially um make a lot of the the um surgery almost automated, so to speak. Um but there's also the other type of robotics, which is moving things around the hospital. Uh and a lot of American hospitals, uh like I I w when I visited Cleveland Clinic um uh uh a while back, uh I saw in their basement they have the entire basement is full of these automated robots, basically factory robots that autonomously move uh materials around the hospital.

SPEAKER_01 21:55

Sure, you've got automated robotic um pharmacy dispensers in some countries now as well.

SPEAKER_00 21:59

As well, yeah. Yeah, yeah, for sure. So you know that's gonna just increase as as time goes on.

SPEAKER_01 22:04

And I I think you've touched on this already, but who are the winners going to be here? So there are specialized players, remote cardiac monitoring, uh chronic care asset tracking, and there are broader platforms that are trying to bring these threads together and integrate multiple device types and data streams. Um you may not be able to pick a a winner, but which of these is the horse to back?

SPEAKER_00 22:28

So I mentioned that there are the generous providers that try to more develop a relationship with the patient or the pair, uh, but don't necessarily have a better mousetrap. And there are these point solution providers that uh have a really great tool, but it's it's very narrow in what it does and how it's it works. Um so those are kind of the two angles. And um and perhaps we'll see you know development a bit of a bit of both, but but it's the ones that, as I said, combine the two where they have a very good point solution that they use as a spearhead to get in and to win, but they're offering uh a more broader um uh relationship or value to the pay the pay patient or the payer. Uh so for example, you know, let's take Apple App Store, for example, and common example. But you know, obviously they're not making all of the apps, but they're making a few apps that are very good, right? And of course, they have the whole phone and ecosystem to be able to deliver that technology to users. So that's the generalist approach. Um but then of course they're pulling in best of breed solutions from everywhere else. Um so it's important to We're back to your spearhead argument again, kind of, aren't we? Yes, yes, yeah. It's important to have to have both, uh, if if you can. Um and you know, also you you think about hospitals and health systems, they don't want to have dozens of dashboards or dozens of implementations, some with different you know, technology stacks and so on. They want to have one solution that's integrated, that's safe, you know, that that they buy once, uh one-stop shop, uh, it all integrated together. Um, and that's where things are going to go. Unfortunately, a lot of the EHR providers historically aren't that good at innovating new stuff. You know, they they, in fact, if anything, they try not to integrate. They try to do these wall gardens, um, you know, uh keep to keep other people out. Uh so you know, it may not be them that are necessarily the winners, uh, but I think the innovative ones of those are or and organizations that bring a lot of things together and integrate them are the ones that are gonna win.

SPEAKER_01 24:31

I can see that the clock is ticking down as we bring this podcast to an end. If people want to get in touch with you, if they want to get in touch with Candesics specifically, I will be leaving a link at the uh usual blurb. But um what's the best way to get in touch with you?

SPEAKER_00 24:45

Please feel free to call me or email me. Uh we've done a lot of work in in this area, both in hospital and out-of hospital care and technology and AI. Uh, very happy, uh always happy to talk uh about this with investors, providers, startups. Um it's an exciting space.

SPEAKER_01 25:03

Fantastic. Thank you for your time. And thank you to everyone who listened all the way to the end of this podcast. My name is David Fabrather, and I am director of content and communications at Candesic. We are a London based consultancy. Feel free to link in with me or drop me an email. I would love to hear from you. New podcasts in this series are available regularly on YouTube, Amazon Music, Apple Podcasts, and Spotify.