Eugene Canavan’s father is 83 years old. He has multiple underlying health conditions, and prefers, when possible, to receive healthcare from the comfort and safety of his own home rather than venture out into a crowded hospital.

Canavan is the medical design director at Design Partners, a Wicklow-based product design agency with a division focused on telehealth technology, allowing people like his father to receive care from home. The company is over 35 years old, but only in the past year has Canavan seen the market for his technology become mainstream.

“We have been working to provide digital health solutions to patients like my dad for a long time, and Covid has absolutely accelerated the development of this technology and the market for it,” Canavan said. 

Spurred by the pandemic, healthcare providers around Ireland and the world have made the rapid pivot to online care, which has thrown the healthcare industry into a long-awaited digital revolution.

“Healthcare is probably 20 years behind other industries in terms of technology, and in the past year, the industry has finally come around to realise that,” said Martin Kelly, chief executive and founder of HealthXL. 

HealthXL is a Dublin-based health consultant platform that has built a global community of investors, entrepreneurs, and healthcare professionals with the goal of making digital health, a phrase that describes the integration of digital and online technology with healthcare, more mainstream. 

Kelly founded the company in 2014 “out of frustration” after seeing several technology entrepreneurs try and fail to push technology into the healthcare sector. Now, he says, the market is finally shifting in the right direction.

“Anyone who has used healthcare in the past year can notice the difference. The healthcare world has evolved around the central model of big hospitals and people going to big hospitals. They still use fax machines, write letters, and hand prescriptions to patients on a piece of paper. These are practices that were phased out of other industries decades ago. The pandemic has finally accelerated the large-scale adaptation of technology into the healthcare space.”

Fewer than 1,000 Irish people used video-enabled care in March 2020, according to an HSE spokesperson. In January 2021, over 24,000 people took part in online health sessions. Very few Irish health service staff had any experience or training with video-enabled care prior to the pandemic as well, meaning the HSE’s growth in the telehealth space over the part-year has been “from a low base,” the spokesperson said. 

“There were only small examples of telehealth working before the pandemic,” Kelly said, but with online care becoming the new normal, the explosion of demand has fallen mainly on outlets like MyClinic, which was one of the few companies already practising telehealth successfully. 

“We’ve seen our telemedicine usage increase five-fold over the course of the pandemic,” said the company’s consultant psychiatrist and managing director Daniel Clear. Founded in 2015, MyClinic is a virtual healthcare provider that offers doctor-patient consultations, as well as online ordering for prescriptions and blood tests. 

“We’ve scaled up our general practitioner (GP) recruitment significantly over the past year in an ongoing process to continue to invite GPs to explore the benefits of digital healthcare provision,” Clear said. 

“The entire healthcare system is one big bottleneck, and there is a huge benefit to unlocking this by means of digital health.”

Daniel Clear

Not only has MyClinic seen more customers, but they are also presenting with a wider variety of conditions, which Clear says is a good sign. “We’ve seen an increased level of complexity of cases now than before the pandemic. We’re getting more mental health [conditions], more chronic conditions – this is contributing to a more distributed, decentralised version of healthcare that we are striving for.”

Clear explained that the “big hospital” model is built for acute health issues, like broken bones or severe illnesses. These issues only make up a fraction of health conditions that people experience, he said, adding that most people need medical care for long-term, chronic health issues like arthritis, asthma, and even depression. 

“The entire healthcare system is one big bottleneck, and there is a huge benefit to unlocking this by means of digital health,” he said. “We know from our own research that telemedicine reduces the burden placed on hospitals, ensures better continuity of care and in these times obviously reduces the risk of viral transmission.”

To Clear, digital health’s worldwide debut in 2020 may be the healthcare industry’s silver lining from the pandemic. 

One reason is digital triage, a vital telehealth service that has emerged in the past year, allowing people with novel health issues to first consult with healthcare professionals via telehealth to determine whether or not they need to seek in-person care. 

This digital triage is a long-awaited solution in the healthcare sector, and a welcome one, according to S3 Connected Health’s marketing director William Lyons.

“We’ve seen gaps emerge in the healthcare system as a result of the pandemic, especially around the capacity of hospitals,” he said. “They have been overwhelmed with Covid patients, which has interrupted the care given to people with existing treatments. Most of the time, these patients with existing treatment don’t even need to go into a hospital, they can be dealt with over the phone.”

Based in Dublin, S3 Connected Health produces digital health technology that enables telehealth to function effectively and efficiently. Its flagship product, a cloud-based, digital health platform called Affinial, gives patients access to a range of resources to manage their own health better. These include the patient’s medical history, data and analytics that apply to their health issues, and specialised medical services. Patients can access the service from an app on their phone, which has seen a “huge increase in focus” since the pandemic, according to S3 president Jim O’Donoghue. 

O’Donoghue also touched on how digital health lends itself better to more specialised treatment, which has been invaluable during the pandemic. “If you have a patient with asthma, they want to know ‘how does Covid affect me, what do I need to be aware of, how does it affect my conditions’,” he said.

“These are questions that not every GP will have an answer for, and if you go in to ask them, they might direct you to someone else, but you have already spent the time and money for an in-person consultation that didn’t answer your question, not to mention that it wasted the time of the GP. We can avoid all that with online care.”

Despite S3’s market seeing an unprecedented growth spurt in the past year, Lyons said the digital health revolution has been a long time coming. “The underlying motivators of digital health have been there for years, we saw factors that said digital health was going to happen, and it’s been a slow process, but Covid has been a catalyst to get it moving.”

The cost challenge

The healthcare industry’s digital transformation hasn’t come without its challenges, though.  One of these has to do with how much telehealth services should cost. 

“There is still room to improve the [telehealth] system. With us, for example, we are trying to figure out how to reimburse patients for virtual consultation versus in-person,” said HealthXL’s Kelly. 

Most healthcare providers agree that virtual care should cost less than in-person care, but it isn’t that black and white, especially with the industry’s shift towards value-based vs volume-based care. 

“We are always working towards value-based care, we want to incentivise away from x number of hours and x number of prescriptions equals x amount of money,” said S3’s Lyons. “What were the patient’s treatment outcomes? Did the patient take the medication? Did they achieve the results they wanted? That’s what doctors should be paid for.”

S3’s president O’Donoghue explained that telehealth operates best on a value-based charging system, where doctors make more based on how much they can help the patient, rather than just how much time they spent with them. On the contrary, in-person care is traditionally a volume-based charging system, where doctors make more based on the more hours they put in. 

In order for telehealth to be sustainable, he said, doctors still need to find it financially worth their while to engage in it. 

“When it becomes more lucrative [for a GP] to see people in person, that is a strong driver to go back to the old days,” Lyons said. The solution, he added, will probably mean a combination of a value-based and volume-based charging system for online services. 

“The reimbursement system is still something the entire industry is working towards finding a standard for, it’s something we just started to look at now that online consultations have become a major part of medicine,” Lyons said.

ECG-enabled T-shirts

The pandemic hasn’t just spurred growth for online consultation and medical apps, though. With more healthcare professionals looking for ways to provide high-level care from afar, medtech companies around Ireland are developing technology that brings the hospital to the home. 

Design Partners has created a T-shirt with a built-in electrocardiogram (ECG) monitor, which can measure a person’s internal diagnostics like heart rate and rhythm, and upload them to the cloud for both the patient and the doctor to view at all times. 

The shirt will be especially useful for patients with chronic conditions, which Canavan said is the best use of telehealth technology.

“If you think you have a cardiac problem, and you come to the hospital, the doctor will try to get to the bottom of it by hooking you up to an ECG monitor in the hospital,” Canavan said. “This has been described to me as a fool’s errand by many cardiologists because it’s just a snapshot of time; trying to find the issue with the system in that very moment is like trying to find a needle in a haystack. If you have something like arrhythmia, the problem will only present itself over a couple of days.” 

With the ECG-enabled T-shirt, a doctor will be able to effectively monitor the patient’s heart rhythms over time, which will give them a clear picture of the patient’s condition and health that would be unattainable from just one hospital visit. 

The product is one of several Design Partners’ prototype projects in the works that Canavan hopes will create a world of “homespitals,” or at-home hospitals. 

Canavan said a significant benefit of not just Design Partners’ products, but the recent emergence of telehealth technology in general is that it contributes to what he calls the therapeutic alliance. 

“It’s a care point of view where healthcare professionals and patients enter into an alliance where they work together to solve [medical issues],” he said. “The healthcare professional is the expert on the disease, but the patient is the expert on how the disease is affecting them and what it is like to live with it. One party can’t have a fully textured understanding of the problem without the other, which is why it requires doctors working with the patient to achieve a tailored solution.”

Digital health is the bridge to that, Canavan said, because it allows for more communication between doctors and patients beyond just a scheduled appointment. 

One Irish company is even using digital health technology to tackle the Covid-19 virus itself. 

Dublin-based medtech company BlueBridge Technologies has developed a hand-held device, similar to an asthma inhaler, that will measure a Covid-19 patient’s lung function, breath temperature, and saturated oxygen levels to monitor the effect that the virus has on the body both in the short and long term. 

Dubbed “Respr,” BlueBridge developed the device as part of a partnership with the European Space Agency (ESA), which will see the data from the device shared via both mobile-phone networks and the EU’s Galileo satellite network to allow doctors to monitor the patient’s health in real-time. 

Data from the device will also be recorded for use by medical researchers to study the long-term effects of the disease on the human body.

The technology is expected to begin commercial production in early 2022, and BlueBridge has partnered with American firm Actuate Technologies to help commercialise the device when it becomes available. 

Consumers would likely not have been comfortable with using a product like Respr before the pandemic, but the nation’s shift to digital health in the past year has made people more open-minded to digital health solutions, according to S3’s Lyons.

In 2017, 17 per cent of people said they were willing to use digital health technology, like at-home monitoring systems, to assist their health. In 2020, that number increased to 71 per cent, according to a study by S3, which surveyed 4,000 people across the US and UK.

“People have seen how effective the technology can be, and how it makes things easier and cheaper on them, and it has completely changed their attitude towards it,” Lyons said. “Digital health means more power to the patient, which is good news for everybody.”

Companies like S3, BlueBridge, and Design Partners have been pushing for a more digital approach to healthcare for over a decade, but the strained relationship between tech companies and the medical industry has held them back until now. 

“Part of the tech company methodology is being agile and adaptive. It’s about testing and failing and seeing what eventually works out,” said Ciara Finnegan, BlueBridge Technologies’ marketing director.  “In pharma, you don’t fail, you can’t fail, you cross every t and dot every i. If something doesn’t work, it’s the patient who suffers, not the company. [The medical industry] is heavily regulated, so it’s been incredibly hard for technology companies to penetrate that.”

Now, Finnegan says, the two sides are being forced to work together. 

“With what has been going on with the pandemic, everybody has had the realisation of just how many blockers you’re coming up against with regulatory bodies when you have a piece of technology that can do a lot of good,” she said.

Finnegan pointed to the vaccine rollout as an example of how quickly a brand-new product can be introduced on a global scale if the industry really pushes for it. Still, the medical field hasn’t been in any hurry to be on the cutting edge of technology in the past. 

“[Covid] has put a looking glass on the whole industry; they need to transform,” Finnegan said. “In every conference now we have the same conversation: How can we do this quicker, how can we get a faster time to market. We need automation and speed.”

Countries around Europe are reacting the same way. Germany’s Federal Institute for Drugs and Medical Devices, or BfArM under the German acronym, has adapted its digital health regulatory process to allow new technology to hit the market sooner and with less redundant testing. BfArM has provided the condition, though, that people who are in any way medically disadvantaged by the technology, or who missed out on proper treatment due to the technology not performing as it should, are eligible to be reimbursed by the government. 

Finnegan said that regulation still needs to play a significant role in medicine, but a hybrid approach between ensured safety and technological adaptiveness is possible and should be the way forward. 

The recent ransomware attack on the HSE also acted as a reminder of the importance of the security component in deploying new digital health technologies. In a recent column for The Currency, Eoin Goulding, the founder of Ireland’s leading cybersecurity firm Integrity360, wrote: “Unfortunately, healthcare is one of the top industries of choice for Conti, having already had multiple hits on healthcare in 2020 and 2021 so far.”

Yet healthcare providers and medtech companies around Ireland agree that the digital health wave over the past year isn’t going anywhere. 

“The traditional healthcare system has been criticised for being fragmented with care, and tech offers the opportunity to join all that up.”

Tim McKeown, VHI

“I think some form of the hybrid model is here to stay,” said Tim McKeown, head of business development at VHI Healthcare. 

VHI is Ireland’s largest health insurance provider. The company also operates several clinics throughout the country.

McKeown said 75 per cent of VHI’s doctors did teleconsultations for the first time in 2020, and he saw a six-fold increase in patients making use of their online care.

“The traditional healthcare system has been criticised for being fragmented with care, and tech offers the opportunity to join all that up. That’s certainly the opportunity that we have and are trying to take advantage of going forward now that Covid has paved the way.” McKeown said. 

Design Partners’ Canavan echoed McKeown’s goals for the industry, saying the ECG-enabled T-shirt his company designed was “not in direct response to Covid, but in response to how Covid might change the world forevermore from this point forward”.

Ireland’s venture capital firms are coming around to the idea too.

“Health tech is a space we are very interested in investing in,” said Gerry Maguire, partner at Atlantic Bridge. Medtech companies make up about 30 per cent of the venture capital firm’s portfolio. 

“We’ve generally seen a lot of innovation there recently in areas like sensors and software that allows you to monitor your health from home,” Maguire said. He also acknowledged the trend that patients want to take more control of their own health and are becoming more comfortable with technology helping them do that, which will only lead to more opportunities for telehealth. 

HealthXL’s CEO Kelly welcomes the investment in the telehealth technology boom, saying it is a sign of where the sector is heading in light of the past year.

“There was a track record of venture money going into digital health that was growing steadily over the past 10 years, but we were struggling to see any meaningful adaptation,” he said. “There has been a fairly fundamental shift with that in the last 12 months that I have no reason to believe it won’t continue.”

Despite the heavy workload that telehealth services have carried since the pandemic began, many providers agreed that Ireland’s hospitals are in no danger of being replaced by websites. 

“Telehealth will never, and should never replace on-the-ground primary care,” said MyClinic’s Clear. “What’s clear is that digital health can support primary care, and it should be used for just that: support.”

HealthXL’s Kelly agreed. “A web doctor is not a replacement for a GP, but there are things that you can do without going to see a GP like medication refills or small diagnosis that you can do online,” he said.

S3’s Lyons added: “We have taken a giant step forward, but we won’t see a giant transformation of healthcare.”

“The pandemic has demonstrated to the world the need for care beyond the hospital doors, but more importantly, it has demonstrated that care beyond the hospital doors really does work.”