The year 2020 inaugurates the decade that will finally make a reality of the ‘patient-centered approach’ so many healthcare professionals (as well as citizens-patients) have been calling and working for over the past years or even decades. We’ll witness the rise of personalized diagnostics and medicine, data-driven care, targeted prevention, virtual and remote health assistance and – last but not least – we’ll finally get to have more (complete?) agency and control over our personal health data.

As all of the tech giants have entered or are about to enter the eHealth market (just to name a few, Apple with its ever-expanding Health service, Amazon launching its own healthcare service Amazon Care for employees, Google partnering up with US healthcare provider Ascension to ‘improve healthcare experience and outcomes’ through AI), let’s break down the most common buzzwords and outline the most likely protagonists of the European healthcare IT and digital health scene for 2020, in light of the most recent EU legislation and of what’s going on in Member States and in other regions of the world.

Digital Transformation

We know that European EHRs (Electronic Health Records) and cross-border medical databases (think of the “1 Million Genomes by 2022” initiative) ‘are coming’, but what is actually coming in 2020?

On a EU-wide level, 22 countries have committed to fully implementing, by 2021, cross-border ePrescriptions and Patient Summaries, while on a national scale, several European countries (such as Germany and Italy) have recently passed legislations, to be enforced in 2020 and subsequent years, to boost dematerialization of healthcare services, incentivizing HCPs to use interoperable EHRs, telemedicine services and other secure (certified) online tools to improve quality of care and efficiency of healthcare systems – catching up with other Member States like Estonia or Finland that have already successfully achieved healthcare digitalization.

Ultimately, what EU citizens-patients can expect in 2020 is easier access and transfer of their medical information (such as drug prescriptions while traveling), fewer trips to the doctor (thanks to online healthcare services), safer healthcare systems (through targeted cyber-security and cyber-hygiene initiatives), better care for patients (thanks to local as well as cross-border networks and registries) and – hopefully – less overworked HCPs.

Digital Therapeutics (MDR)

Wellness and fitness apps have been flourishing for years, and the boundary between them and certified SaMDs (Software Medical Devices) is more blurred than ever, sometimes with dangerous effects for citizens-patients. This is why the EU has decided to step in to ensure eHealth applications and devices are carefully checked for safety and effectiveness before reaching the public: in May 2020, the new MDR (Medical Device Regulation) will come into force, requiring all new medical apps (i.e. apps aimed at ‘diagnosis, prevention, monitoring, prediction, prognosis, treatment or alleviation of disease’) to receive CE marking in order to enter the EU market.

With the EU setting the standard for medical apps, several European countries have decided to give DTx (digital therapeutics) a try – most recently Germany, whose 2019 Digital Care Act officially incorporates ‘DiGAs’ (digital health applications) into prescribable therapies reimbursed by public insurance.

As, thanks to the MDR, European doctors will be increasingly provided with clear, evidence-based information about medical apps, we can definitely expect more ‘app prescriptions’ in 2020, especially in the fields of psychiatry, rehabilitation and secondary prevention, as well as for conception support.

Telemedicine

Tele-medicine is definitely not news (having been around for decades in various forms – from tele-monitoring to tele-training to remote surgery and first aid), but 2020 may well be the year it becomes mainstream.

Across the world, tele-medicine services are booming, as apps and tracking devices allow HCPs to monitor, diagnose and treat patient remotely. In the EU, several cross-border projects have been successfully carried out over the years, primarily focusing on chronic and elderly patients in rural areas. Europe has now collected enough evidence to start rolling out big-scale tele-medicine initiatives, and Member States are committed to not falling behind: once again, we have countries (e.g. Estonia, Denmark, Finland, Croatia, Spain) that have already made of tele-health one of the fundamental pillars of their healthcare system, while others have come on board more recently (e.g. France and Germany, which made telemedicine services reimbursable respectively in 2018 and 2019).

The bottom line is that we’re at a time when citizen and doctor requests, technological availability, private interests, HCP shortages and healthcare systems’ digitalization efforts all converge, creating the perfect storm for tele-medicine’s boom in 2020 and upcoming years.

Decision support tools

The year 2020 was inaugurated by news that a team of UK and US researchers, supported by Google, developed an AI model that can detect breast cancer in mammograms more accurately than radiologists.

As extraordinary as this story may have sounded just a few years ago, we are now nearly accustomed (in a good way!) to reading about healthcare organizations partnering with tech companies to realize tools that support diagnostic and clinical decision-making. Nearly every lab and diagnostic test (or panel) is now getting the AI make-over, with machines often outperforming experienced doctors in making diagnoses, choosing optimum treatment plans and predicting outcomes.

While Europe may have fallen somewhat behind the US and China in terms of AI due to the strict limitations on data collection and processing imposed by the GDPR, this may well be the year we make our mark in the field: the second semester of 2020 will see Germany host the rotating presidency of the EU Council, and the German health minister Jens Spahn along with President of the European Commission Ursula von der Leyen have already made it clear that they want to use this period to work on healthcare digitalization projects like the European Health Data Space (with the aim of promoting exchange of health data and ultimately develop ‘new, successful screening, treatment or diagnostic procedures’), while still ensuring EU citizens maintain control of their data.

AR & VR

As clearly shown by the worldwide success of Pokémon GO, AR has a transformative potential to engage in physical activity people who would typically have a mostly sedentary lifestyle. The medical world has clearly taken notice, as gamification through AR and VR has become part of many programs for weight loss and prevention of cardiovascular disease as well as for physical therapy and rehabilitation. 

In the last few years, the EU has seen its fair share of partnerships between healthcare institutions and AR/VR companies, mainly focusing on patient empowerment, HCP training and work optimization, and development of new treatment options (such as AR-enhanced surgery or VR / AR environments for treatment of neurological and mental disorders). European VR / AR companies are also developing solutions directly for citizens-patients, pharmaceutical companies, lab workers and life science students, ultimately encompassing all aspects of the healthcare world.

Over the next years, the EU has committed to invest over € 9 billions on key digital challenges, and the European Commission has made it very clear that citizen-patient empowerment through digital tools like VR and AR is one of the top priorities.

Cloud computing & Blockchain

While cloud computing is of more immediate understanding, blockchain technology is still somewhat of a mystery for many people. In short, it involves storing (distributing) an online database (e.g. patients’ medical records) on multiple ‘nodes’ of a decentralized infrastructure, eliminating the need for a trustworthy central mediator.

Both technologies have recently gained popularity in the healthcare sector, responding to the need for secure, affordable and efficient storage of large amounts of information that must be easily accessible and sharable in real time. Though the privacy concern has yet to be completely addressed, it is clear that cloud computing and blockchain will dominate the healthcare IT ecosystem over the next decade, supporting and improving existing processes (e.g. EHR management, remote consultations, delivery of diagnostic imaging reports) as well as solving many of cyber-security problems that have been plaguing the healthcare sector.

The EU has been exploring the potential of blockchain technology for a few years now, instituting in 2018 a Blockchain Observatory and Forum (which, in September 2019, discussed the possibility and ways to implement blockchain in large-scale European healthcare telematics infrastructures) and the European Blockchain Partnership (tasked with the creation or the European Blockchain Services Infrastructure, or EBSI, to deliver cross-border public services using blockchain technology).

The next step is to combine the two technologies together, using blockchain to protect healthcare data hosted within the cloud (as pioneered by IBM and Microsoft). This disruptive duo could also offer the solution to the growing security concerns surrounding the expansion of the IoMT (Internet of Medical Things, a collective term for all medical devices and apps that can connect and exchange information with healthcare IT systems).

Chatbot

As Samsung just unveiled its ‘artificial humans’ (realistic video chatbots that can respond to questions in milliseconds), it is increasingly clear that chatbots are bound to become the first-line support system in a variety of fields, and healthcare is no exception.

Around the world, different projects are evaluating the possibility of using chatbots and digital assistants – supported by carefully designed AI systems – to ease doctors’ workload by acting both as ‘triage systems’ (e.g. taking care of patients with easily diagnosed problems, recurrent / chronic needs and basic physical therapy questions, as well as directing patients to the right specialist based on their symptoms and signs) and as true ‘physician assistants’ (e.g. helping doctors recognize drug interactions, choose appropriate drugs for pregnant and breastfeeding women, suggesting possible patient diagnoses).

Although the EU hasn’t expressed any specific opinion or intention about the use of chatbots in healthcare, national and local experiences are flourishing across Europe (again, through synergy between public healthcare institutions and private tech companies), and the cost- and time-saving potential of this technology are bound to place it on the EU’s radar when it comes to healthcare optimization through innovative digital tools.