Diagnostics and Triage
Diagnostics and triage are often the first points in a patient’s journey through the healthcare system. In simple terms, diagnostics is the process of identifying a particular illness using a combination of signs, symptoms, tests etc. Triage, on the other hand, is the process of assessing patient needs/symptoms to direct them to the right specialist/institution, to improve patient health outcomes and reduce costs. Inefficiencies in these fundamental processes have long created unnecessary costs for healthcare systems and have kept millions of people from getting quality healthcare. Technology promises to bring revolutionary changes to how people get directed to the relevant specialist, get diagnosed and ultimately treated. To better understand how these gains can be harnessed, we dive into some of the most pressing problems with how diagnostics and triage are currently carried out.
Inefficiencies in current diagnostics and triage processes are creating huge financial and human costs for healthcare systems:
- Diagnostic errors
- Most people will experience at least one diagnostic error in their lifetime
- Diagnostic errors are more common and costly than treatment mistakes with an estimated $750 billion or 30% of U.S. annual healthcare spending wasted on diagnostic errors and other inefficiencies
- The human cost of misdiagnosis is just as significant with an estimated 40,000 to 80,000 patient deaths annually in the US alone
- Unnecessary tests and treatment
- Unnecessary tests and treatment are a big part of why healthcare costs so much
- In a study on the efficiency of ICU utilisation at Harbor-UCLA Medical Center, researchers found that around half of the patients who received care in the hospital’s resource-strained Intensive Care Unit did not benefit from the treatment
- Slow diagnosis limits opportunities for preventative care
- The rising costs of diagnostics make it less likely that patients will get early diagnosis and will subsequently avoid developing chronic illnesses.
- Globally, more than 70% of deaths can be attributed to chronic illnesses which are significantly more costly to treat. In fact, treatment of chronic conditions accounts for around 75% of U.S. annual healthcare spending.
In our forthcoming model of the impact of digital health on healthcare costs, taking into account accelerated uptake in 2020, we forecast that digital health applications in diagnostics and triage could save nearly US$200bn in costs globally by 2030.
Another major issue with how diagnostics and triage are carried out is that, in most traditional settings, patients need to travel to the doctor to get the first appointment, before being redirected to a different specialist/institution. This map developed by Nature Medicine visualises the various travel times to access healthcare services globally. The bottom line is that for many people across the globe, the time to reach a health provider may be too long and too costly. In addition to the physical barriers to access healthcare facilities, for many people in low- and middle-income countries, there just aren’t enough doctors. In fact, according to the UN, “about 44% of WHO member states have less than one doctor per 1,000 population” and more than half of the global population still doesn’t have access to essential health services.
On the backdrop of these problems, technological breakthroughs significantly enhance access to and quality of diagnostics and triage services globally. Innovations such as artificial intelligence (AI), virtual health bots, online triage systems and others address some of the critical challenges highlighted above. There are various opportunities for telcos to play part in helping partner companies apply these innovations:
- Many telcos have already launched virtual care and/or remote monitoring solutions. From either of these starting points, diagnostics & triage is the next logical steps for an operator seeking to build scope and support the wider patient journey.
- According to STL Partners’ latest modeling, diagnostics & triage is the second largest value bucket globally in adoption of digital health after remote monitoring. Hence, it should be on the radar for telcos in health, especially as all the application areas are likely to merge into a holistic patient journey over the long term.
- For telcos seeking to expand their digital health propositions to include diagnostics and triage, the key to success will be forging partnerships with leading technology players in this field and supporting them to bring industry leading solutions into local healthcare systems.
Below are a few companies which are at the forefront of using technology to improve diagnostics and triage.
The first group of companies we profile is focused on improving access to healthcare services.
Mendelian is a UK-based company that helps doctors find undiagnosed patients early. The company “focuses on rare and hard to diagnose diseases which affect 1 in 17 people worldwide” and on average take five years to diagnose.
Its solution, MendelScan, is a machine learning tool that captures disease features from electronic health records across a patient population and matches the patients to published diagnostic criteria for hundreds of rare diseases. A MendelScan report with a list of suspected rare diseases is then sent to the healthcare provider for further action.
In 2020, the company announced a partnership with Modality NHS Partnership to roll out the program throughout Modality’s extensive GP practice network, supporting more than 450,000 people across 45 GP practices.
China has 1.8 practising doctors per 1,000 citizens, compared to 2.6 for the United States and 4.3 for Sweden. One company that is trying to address the doctor shortage problem in China is PingAn Good Doctor- a leading online healthcare service platform in the country. As of the end of June 2020, the number of active users had surpassed 67 million, making it the largest mobile medical application in China based on user coverage. The company has developed an AI system that can diagnose around 3000 common diseases and treatment methods. Moreover, they claim to have achieved 99.6% accuracy rate for the company’s smart triage online consultation system.
Pneumonia is the number one cause of death for children under the age of five globally. Feebris has taken up the challenge of saving around a million children each year who die of pneumonia because they are either undiagnosed or diagnosed too late. The company was set up “to develop ethical AI that improves access to early diagnosis” for children across the globe.
The Feebris platform connects to tools like a digital stethoscope to identify pathological sounds in the lungs using machine learning algorithms. Combining these with other essential symptoms, Feebris identifies pneumonia and determines severity.
The second group of companies we profile is focused on cutting unnecessary healthcare costs.
Healthy.io’s mission is to “transform the smartphone camera into a medical device to deliver healthcare at the speed of life”. The company offers Standardised Digital Wound Management Services that help clinicians make better care decisions using the smartphone camera to accurately capture wounds and analyse their progress. The camera captures the wound size and tracks healing over time from a centralised portal. The wound data can then be shared with the care team and used for reimbursement purposes.
Qure.ai uses AI algorithms for medical imaging to identify and localise abnormalities on X-rays, MRI and CT scans. qXR, one of the company’s products aimed at automatic chest XR interpretation, was trained with over a million curated X-rays and radiology reports, making it hardware-agnostic and robust to variations in X-ray quality. For suspected Covid-19 cases, the tool also interprets X-rays to help doctors classify patients as high-, medium- or low-risk and prioritise testing accordingly. Qure.ai has recently partnered with AstraZeneca to improve early-stage diagnosis of lung cancer and reduce mortality rate in Latin America, Asia and Middle East & Africa regions. Hence, qure.ai is not only set to decrease healthcare costs by introducing efficient ways of diagnosis but to also democratise healthcare by bringing quality diagnostics to underserved populations.
Odin Vision is an award-winning AI company founded by a team of eminent clinicians and AI experts with the mission to create the next generation of AI-enabled applications for endoscopy. Detecting and diagnosing polyps during colonoscopy procedures is challenging for doctors and studies have shown up to 25% of polyps can be missed. Increasing the detection/diagnosis performance can lead to improved patient outcomes, as a 1% increase in Adenoma Detection Rate (ADR) leads to a 3% reduction in cancer incidents. The technology developed by Odin Vision enables doctors to better detect and characterize diseases during colonoscopy procedures. In a partnership with the NHS, the company’s AI technology will be installed into selected hospitals across the UK to evaluate its impact on patient outcomes and the cost benefits to the NHS.
Doctorlink is the leading provider of online triage to the NHS & insurers. The online triage system enables health providers to efficiently manage demand by directing people to the most appropriate care pathway, including self-help, pharmacy and urgent care. It transforms how doctors manage resources, saving money in workforce efficiencies and reducing administrative burden. Doctorlink assesses the patients’ symptoms online by asking a series of medical questions based on an algorithm built by doctors and tech innovators. According to Doctorlink, the company’s algorithms cover 95% of conditions and provide the most accurate symptom assessment on the market. The company estimates that the tool has the potential to free up 99 million GP appointments and save approximately 3 billion pounds for the NHS.
Whether it’s through helping doctors better diagnose various conditions through the application of AI, machine learning, visual imaging and others, technology promises to significantly enhance diagnostics as we know it. Online triage systems promise to free up much needed healthcare resources and achieve greater efficiency in how they are allocated. Overall, new technologies promise to enhance access to healthcare globally by delivering out-of-the-box solutions wherever they are needed. The cost savings that can be achieved through these improvements are truly massive. And while much more innovation and widespread adoption of new technologies is still needed to address the larger problems discussed in this article, there is much hope for a better future ahead.
Author: Ani Keshishyan, Consultant and member of the Digital Health Practice
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