Q&A: The year healthcare came into the home

In the wake of the COVID-19 pandemic, many doctors needed to find new ways to care for their patients. As health systems were overwhelmed in many parts of the world and people became wary of entering health facilities for anything other than urgent care, telemedicine and telehealth emerged as opportunities for patients to still receive healthcare access without leaving home. To find out more about how health providers are thinking about digital care options today and in the future, we spoke with Katherine Ward, Chief Commercial Officer of Healthy.io and veteran of the U.K. National Health Service and United Health Group.

Could you tell us a little bit about yourself and your background?

Sure. My name is Katherine Ward, I am the chief commercial officer for Healthy.io and I'm also the managing director for the U.K. and Europe.

I'm a veteran of healthcare, so this is my 30th year inside the healthcare space. For the first 15, I was actually inside the U.K. National Health Service as a government employee. I then spent 11 years with United Health Group in a commercial U.S. global health care company... and three and a half years ago, I joined Healthy.io as employee #23. So I've worked for the U.K. government, an American commercial enterprise, and now an Israeli tech startup.

What is Healthy.io and what does the company do?

Healthy.io is the first company in the world to get to CE mark and then an FDA approval for using the smartphone camera as a clinical-grade diagnostic device.

A big inspiration was becoming aware that the biggest investment in tech is the smartphone camera and that if you could actually take the investment in the smartphone camera into healthcare, you could get a more rapid transformation and get it at a lower cost to a government-sponsored healthcare system.

That’s because the tech companies are paying for the hardware and the software, the consumers are buying the device, and it should be something that you could rapidly deploy at a good value to enable healthcare to modernize and become sustainable.

You've personally worked in both the public and private healthcare system, so I'm curious what you've seen in terms of different incentives and how those systems think about innovation, particularly in an increasingly digital or online world.

As you're probably aware, government systems are not necessarily set up to be driven to innovate and certainly, the regulatory environment and the need for patient safety and quality really does make people somewhat risk-averse.

What I think though offsets that is a need both in the public and the private sector to actually handle and ensure that healthcare becomes something sustainable financially for the longer term. We all know the costs of drugs, the costs of the demographic challenges that are leading to add more demand on the system. Generally speaking, technology costs actually extend the costs of healthcare, as drugs become more sophisticated and equipment becomes more sophisticated.

So trying to find levers that actually drive value where you can see that you're making healthcare more accessible and more available, but also reducing costs are a huge opportunity. It's innovation in digital technology and bringing with it that mindset that where the hardware and software has already been invested in.

As an example, we have a kidney test that we work on with people with diabetes and hypertension. There are nationally agreed-upon guidelines for the U.K. and the U.S., so for people with diabetes, everyone should be having their urine tested once a year.

If you pick up protein, it's an early sign of kidney degradation. Related diseases are extremely debilitating in terms of an individual's health, but also have extremely expensive catastrophic costs for the payer of healthcare.

You can actually use the smartphone camera and a simple kit to enable someone to test at home, rather than having to pick up a pot, take it to the lab or take it to the primary care physician, then have that sample sent off to a lab, and have come back in again if it's positive.

All of that to-ing and fro-ing, if you can just cut that out and enable someone to test in the comfort of their own home, have the result go straight to the electronic medical record you've saved so much time on admin from the physician's practice or the lab. You've saved so much time for the person and you've got more people to do the tests that otherwise would have done it.

And a health economic analysis in the UK shows that if we only reached 30 percent of the people who haven't done their test in the last 12 months, people with diabetes, it's about 1.4 million people if we just reached 30 percent of them and we can drive 209 million pounds of savings for the NHS in five years.

So it's that sort of lever that will then drive innovation to be adopted in a way that has that regulatory underpinning and that safety at heart because actually, you're driving more uptake of a recognized protocol than you were otherwise getting.

From a high level, just taking a step back, what would you say was the state of telehealth or telemedicine prior to 2020? Obviously a lot has changed out of necessity, but how far along were we in the wake of the COVID-19 pandemic? How has that maybe accelerated adoption in the short term?

So I would say in the U.S., they're further ahead in this world than the U.K. in my experience. In the most established companies in the U.S., a lot of work has been done over the last 20 years in managed care to engage at least in telephonic interaction -- less so on the video consultation side. But actually, even in that market, telehealth hadn't reached its full potential and there were a lot of regulatory barriers to actually enabling it to become scaled across states, for example, with different regulatory requirements in every state for a company to take account of.

In the U.K., I would say there was a lot of interest in shiny new products that could potentially have applicability, but there was very little appetite for actually taking them on, funding them, and scaling them.

The biggest difference I've seen in the last nine months would be that a year ago I would meet a group of nephrologists and show them digital urine testing. They would say, "That's really cool. Oh, I really like that. That could be great for my patients."

And then they would say, "But the patients have to come into the hospital anyway, and they don't mind bringing their sample with them." And you think to yourself, "I'm not sure if you've thought about if they actually mind carrying their urine in their handbag." But on the other hand, I accepted their mindset. I'd say, nine months later, that imagination gap has already closed.

Now they're thinking we really don't want vulnerable patients like post-transplant kidney patients to come into the hospital at all. We are already doing a video or telephonic interaction with them, but there is no diagnostic depending on that. So actually, if I can have that digital diagnostic that's coming straight into my system, that means I can see their urine test results 10 parameters before I speak to them, and then I can actually see that trend over time because I can see the results from last week’s and the week before.

Then you've got a very different proposition, and suddenly that imagination gap is closed. I think the level of risk I described earlier sometimes prevents government systems, particularly in a regulated environment, from taking a leap has just disappeared because of that urgency and that need to move quickly.

We actually saw a tripling of our uptake rates in the last six months in terms of the number of scans and tests that were being done remotely on the back of that, but what's been interesting is I think some of the imposition of regulatory environments and the post-first-wave shift had led to some companies seeing a stabilizing or a reduction in that growth.

We've actually seen it retained because we're very much also in the world of chronic disease where we're now dealing with nine months of people who not only have had challenges in accessing urgent care -- they've actually not had anybody do their annual check for diabetes.

So we're now seeing a big catch-up with people that have missed some of those more routine interactions and we're actually seeing the benefit of people moving forward. I think for patients, the lid has come off the box. So if you now know that you don't have to carry your sample in your briefcase with you all day and you know you don't have to travel to the hospital every time you need an appointment, it's quite hard to persuade you that you have to go back to that way of approaching.

How much of that do you think was built out of the necessity of getting that care and how much of it is from the opening up of the imagination of both the healthcare provider versus the patient?

I think that the necessity came first. That sudden two-week moment where I think everybody was almost caught in the headlights for a couple of weeks realizing that this world was changing very rapidly... that just put everybody's barrier to change down because of that necessity, that urgency, that sense that we were all in this together and that we actually had to do something different.

That then led to the imagination gap closing, I would say. So I think the crisis came first, but somebody who coined the phrase that you should never waste a good emergency would be proven right, I think, in this instance.

Based on your perspective of the market, what were some of the unseen challenges? The industry was thrown into this crisis point and had to very quickly adapt, to rethink the way that they were delivering healthcare. What were some of the things that people maybe hadn't thought about as they entered this environment?

I think one good example in response to that question is I think that the desire for people to really not leave their houses and access any form of care was unprecedented.

An unforeseen example of that for us is that we've had a very successful partnership with Walgreens Boots Alliance for the last two and a half years, where we've been operating. You pick up your kit in the pharmacy, you take your test, and then you return to the pharmacy and they can actually dispense an antibiotic if appropriate for a urinary tract infection.

We suddenly realized in March that people were not even prepared to go to the pharmacy. We understood and predicted that they wouldn't go to the hospital and they wouldn't want to go to the doctor's office, but actually, the fact that they also didn't want to even go to their High Street pharmacy was surprising.

We actually then pivoted to create a direct-to-consumer offer where you could buy a kit online, and you could have it delivered within four hours. It had a primary care physician backend, so the online doctor would turn around the script if necessary and you'd have that antibiotic, your medication was then delivered to the home again and that was how we adapted there.

I think this would also then be true of the general hospital situation. People have not anticipated that all the regular outpatients would just stop, that all the regular annual checks and other pieces would actually also be impacted.

Everyone anticipated a great swathe of demand from the emergency and COVID cohort and certainly in the UK, that was planned for with huge hospitals being built and extra ventilation, but nobody I think anticipated that nobody would turn up for any of their routine and regular appointments, and we've got now a very big backlog to try and address in that space.

What about opportunities that you've seen? We talked about the imagination gap closing earlier, but where does this leave us as we look forward to how we provide care in a post-pandemic world?

I think the understanding now is that care doesn't always have to be face-to-face and that the telephone -- which has been with us for 150 years -- probably was underutilized in our environment in the U.K. healthcare system.

That there isn't a necessity always for everybody to be traveling in and out face-to-face for their healthcare is actually a huge paradigm shift that will stay with us. What that has to be underpinned by is a level of diagnostics and other data and insights that enable it to be sustainable and maintain quality. It won't be appropriate for everybody or for every type of intervention, but I do think that transitioning to that model for a good percentage of what happens is actually then going to free up that face-to-face time and resources so diagnostics actually get a more efficient throughput for the longer term and hopefully a lower cost base for healthcare as a whole.

So I hope that we'll be able to actually benefit from that mindset change from clinicians and a mindset change from patients to actually create a more sustainable digitally enabled system for the longer term.

What other aspects do you think will carry over? Are there particular examples we haven't talked about that you think have been adopted during this time and will be a part of this new normal as people get vaccinated and feel that they can go about their regular lives again?

I think the piece we haven't talked about very much yet is the change in people's own perception of their responsibility in handling and managing their healthcare. So I think part of that is the sense that the focus of healthcare moves to your own home, the fact that you now have an ability to measure and monitor what's happening, whether it's through having your own pulse-oximeter or temperature checking, or whether it's more complex sort of ways to manage and measure your own health.

Part of what we do is explain to people why their kidney health is important and enable them to take a test that they see the result of. So whilst it's going in real-time to the doctor as well, it's very different from turning up to a healthcare facility and then being told that everything's fine and not really seeing and understanding that for yourself.

I think that's the very first start on a journey that I would hope would become ever stronger of people actually understanding, taking more responsibility, driving their own health care, and taking ownership of their healthcare in a different way.

We talk about how in health care, I think the voice of the consumer and the power of the patient is often not particularly strong. The doctor's mindset hasn't necessarily caught up with how people really feel about that.

So I think we're in the very early stages of a path where the patient could become more and more powerful as a voice. That could be something that actually does transform healthcare quite significantly when people start to be much more bullish about what they think is the right way to do it.

I think again, in the U.S. there is much more sophistication around that. There's been a lot of work on quality metrics and the voice of the consumer is stronger because people shop around for healthcare in a way they don't so much in other government systems. But nonetheless, I think it's an important development for healthcare more generally.

What might make patients feel more empowered and what tools might become available to them that will move that along a little bit over the long term?

I think it's interesting that healthcare is such a personal and hugely impactful part of your life... and that you have so much more control of it over so many other facets of your life that you wouldn't dream of being as ignorant about as you might be.

If you take the surge of interest that there is in physical fitness and everyone comparing their results on Strava and everybody measuring every day, "What are all these different elements that I'm kind of looking at?" So why should it then be any different then to be thinking about, "Where is my blood pressure at?"

That is already sitting on a smartwatch more or less. And then you've got your echocardiogram also on there and then you start to see that you can bundle increasing amounts of data and information... And then to your point, if you are somebody who has diabetes or you're somebody who has hypertension, being able to do your own evaluation of when you want to raise your hand and see that there's an issue that the physician needs to handle, rather than them treating you like a passive recipient who has to be told when to go through a series of tests.

To have more insight, education, and impact just in your pocket, I think is huge. So I do think that we'll see that changing over time and that's probably another thing that's slightly been kick-started in this crisis.