The World Economic Forum began in the early 1970s as a meeting of economics professors from around Europe in the sleepy Swiss ski village of Davos. In the four decades since, it has grown to be the pre-eminent global conference where 3000 thought leaders from industry, government and civil society come to discuss the key global priorities for the year ahead. This year’s attendees featured over 50 heads of state (including Ji Xinping and Theresa May), 10 Nobel Laureates (including 2 Australians), the CEOs of major global corporations from General Motors to Pfizer, and the heads of international organisations such as the UN, World Bank and IMF.

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Although the dialogue at Davos has traditionally centred on economic and geopolitical issues, the program has had an expanding healthcare focus over recent years. One of the flagship sessions of 2016, featuring the former US Vice President Joe Biden and Australian Nobel Laureate Elizabeth Blackburn, was “The Cancer Moonshot: a call to action” about the United States’ concerted national strategy for cancer research.

Continuing this trend, this year’s annual meeting included sessions such as “The Hospital of the Future” featuring the President of Brigham and Women’s Hospital together with the CEOs of Omada Health, Telehealth Robotics and Welltower. The Australian National University convened a workshop on “Precision Public Health”, Atul Gawande hosted “A conversation on the future of medicine”, while the CEOs of Medtronic, Novartis and Quest diagnostics discussed the notion of “Feel better or your money back” – new models of healthcare financing based on clinical outcomes. Although the smaller workshops operate under Chatham House rules, most of the keynote presentations were publicly streamed and are still available online at www.weforum.org.

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So, coming away from the amazing confluence of ideas that is Davos, what does the future of healthcare look like? Here are four emerging trends in healthcare that resonated throughout the conference program:

1.  Tech-enabled self-care

There is a paradigm shift away from hospital-based care towards patient-driven self-care, especially in the management of chronic disease. It was fascinating to see the CEO of Brigham and Women’s Hospital say that a key priority for her large academic medical centre involves moving beyond the hospital’s walls and bringing care into patients’ homes. Health systems worldwide are interested in how technology can help to facilitate this shift by providing patients with education, guidance, and a means of communicating with their care team?

Many private sector organisations have begun to tackle this problem, with notable examples such as Omada Health and Healthloop. These are digital patient engagement platforms, offering an online health coach, an education program, targeted recommendations about behaviour change, and connected hardware such as blood pressure and blood sugar monitors. One trial with 220 participants demonstrated reduced progression from pre-diabetes to diabetes over a 2-year follow-up window using the Omada platform. An interesting spin-off from this concept of self-care is the idea of “social medicine” – using technology to bolster social networks around a patient. This can involve networks of similar patients (c.f. Patients Like Me) or simply engaging family and friends more deeply in a patient’s medical journey (c.f. Weal Life).

How can the Australian health system leverage some of these technologies to empower self management of chronic disease in the community?

2. Artificial intelligence

From Microsoft to Toyota, almost every major corporation represented at Davos saw AI as a significant part of their future strategy. The vast implications of AI in healthcare are beginning to be explored from bench to bedside. At the bench end of the spectrum, Palantir recently forged a partnership with the large pharmaceutical company Merck to apply machine-learning in the drug discovery pathway, so as to better predict which molecules may be suitable drug candidates.

At the bedside, the objective is to create a “learning health system” – one that leverages all the data built up about a given patient (and other patients like them) to improve clinical decision-making and personalise care. Can clinical AI help to improve diagnostic power, provide more tailored care plans with better outcomes, predict complications, or reduce unnecessary investigations? In cancer diagnosis for example, IBM Watson is able to outperform a human oncologist for lung cancer diagnoses based on pre-biopsy clinical data. Based on 2013 processing power that has now been far superseded, Ian Steadman of Wired writes: “Watson’s ingestion of more than 600,000 pieces of medical evidence, more than two million pages from medical journals and the further ability to search through up to 1.5 million patient records for further information gives it a breadth of knowledge no human doctor can match.”

This will not remove the need for clinicians at all – but it may well change the role we have.

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3. Data convergence

There is growing interest in linking large volumes of health data across traditional divides, for example bridging national and industry borders. What happens when clinical data becomes linked across countries, or linked to wearables data, or (not inconceivably) to credit card spending patterns or location data or employment data?

Data convergence amplifies issues around privacy and security. Current data governance structures may not be appropriate for these highly convergent datasets. There are also issues around interoperability: how do we coalesce data from different sources gathered in non-standardised formats, or how do we deal with data clashes in the clinical record?

One technological advance that may play a growing role in data management is blockchain. Although blockchain is most renowned for its applications to cryptocurrency like bitcoin, at its core it is a distributed public ledger made up of append-only transactions which can be applied to a much wider range of contexts. In health, the MIT-based startup MedRec uses blockchain to manage prescription records – each new prescription is treated like a financial transaction and added to the blockchain. The blockchain provides a unified (and encrypted) “source of truth” for what medications a patient is on, and, critically, the patient is in control of this data. The patient may grant viewing rights for a defined period of time to family, friends or healthcare providers, and strict audit logs are kept for all access events.

4. Virtual reality and sensory augmentation

Augmented and virtual reality (AR & VR) featured prominently in Davos, notably in a live demonstration of interactive anatomy education using VR headsets. Is this a new platform for teaching medical sciences in a 3-dimensional, interactive environment? VR has already been used for surgical simulation in conjunction with haptic feedback. It has even been used to simulate clinical situations such as aggressive patients or breaking bad news. Stepping beyond education, what are the impacts of VR in delivering care – for example, can it be used to enrich telemedicine or telesurgery?

There were also several sessions, run by Stanford and Carnegie Mellon University, about using technology not just to provide a virtual experience, but to augment our sensory capacities themselves. Consider the impact of brain-computer interfaces, retinal implants or haptic technology on the lives of people living with disabilities. What if these technologies are then made available to the general population? How does human thinking adapt in the presence of a brain-computer interface? How can our neural plasticity make use of altogether new sensory inputs e.g. the ability to “see” infrared radiation from a retinal implant? Ultimately, what are the sociological impacts of a divided society of sensory “have’s and have nots”?

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Conclusions

These four trends only capture a glimpse of the tectonic shifts that stand to reshape healthcare in years to come. We have not mentioned the critical developments in genomics, automated radiology/pathology, or robotics. Suffice to say, all of the leaders at Davos felt that the healthcare sector was on the verge of significant disruption. The common language was one of digitisation, automation and patient empowerment through technology. How can we be not just prepared, but proactive in adapting to these new trends?