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  • Up to ~5% of American and British citizens grapple with narcissism, which is characterised by self-centeredness and a lack of empathy
  • Narcissists disrupt organisations and relationships through hindering collaboration, discouraging teamwork, exploiting others, and displaying an exaggerated sense of self-worth, all while lacking empathy
  • Narcissists are drawn to healthcare for admiration, control and validation, which can pose a threat to the delivery of quality care
  • Narcissism's impact on efficiency and productivity often goes unnoticed by many healthcare leaders, despite the underlying harm it causes
  • Vigilance in identifying and effectively managing narcissistic traits within healthcare settings is necessary to preserve the integrity of patient-centred care and collaboration among healthcare professionals
 
Narcissism: Impeding Healthcare Quality and Organisational Effectiveness
 
 
Abstract

In the landscape of 2024, where the healthcare sector is strained by the aftermath of the Covid-19 pandemic, the challenges faced by healthcare executives are multifaceted. The surge in demand for care, driven by aging and chronically ill populations, collides with a diminishing supply of health professionals, creating a significant imbalance. Amidst this, many healthcare organisations grapple with declining workplace productivity and escalating gross margins. Such issues are further complicated by the struggle of human resource executives to foster collaboration, enhance teamwork, and improve employee satisfaction in the face of weak corporate cultures. A critical and often overlooked aspect contributing to the complexity of healthcare delivery is narcissism: a silent force that permeates the industry. The warning from Rob Behrens, the UK's Parliamentary and NHS ombudsman, sheds light on the impact of narcissistic tendencies among health professionals. The revelation of daily failings linked to narcissism raises concerns, supported by data indicating ~11,000 avoidable deaths in NHS England annually. An investigation conducted by the UK's Times Health Commission in 2023 emphasises the urgency of addressing narcissism within the healthcare system. As the Commission examined the future of health and social care, it uncovered a landscape fraught with challenges such as the aftermath of the Covid-19 pandemic, budget constraints, an A&E crisis, mounting waiting lists, health inequalities, obesity, and the challenges posed by an aging population. The extensive evidence sessions with diverse stakeholders, including senior doctors, nurses, midwives, hospital managers, scientists, business leaders, politicians, and health experts, provided a comprehensive understanding of the issues at play. Narcissists are attracted to healthcare, and narcissism, is identified as a rising concern with suggestions of a potential "narcissism epidemic" in Western economies. The prevalence of narcissistic personality disorder (NPD) in up to ~5% of the US and UK populations is alarming, with important implications for healthcare providers and the delivery of care. Early recognition and mitigation of narcissistic tendencies are critical to safeguard both care providers and patients. In the face of unprecedented challenges within the healthcare sector, recognising and actively addressing narcissism becomes necessary to strengthen the resilience of healthcare delivery. Unveiling the subtle yet impactful consequences of narcissistic tendencies and integrating targeted mitigation strategies into healthcare management are central to our suggestions. This proactive approach not only ensures a more robust operational framework but also paves the way for a patient-centric future, where the wellbeing of individuals takes centre stage in the evolving landscape of healthcare.
 
In this Commentary

This Commentary has three sections. Part 1: Decoding Narcissism, describes the condition, highlights some early warning signs, points to its incidence rates in the US and UK, and draws attention to the impact of narcissism on individuals and relationships. Part 2: Narcissism in Healthcare, discusses the prevalence and challenges of narcissism in healthcare settings, examining its impact on team dynamics, and patient-provider relationships. Part 3: Mitigating the Negative Effects of Narcissism, describes early warning signs and suggests key human resource strategies to alleviate the adverse effects of the disorder and considers some ethical implications of NPD for healthcare delivery. Takeaways emphasise: (i) early recognition of NPD and a proactive approach to its mitigation, (ii) professional help, and (iii) continuous learning and empathy development.  
 
Part 1
Decoding Narcissism
 
In recent years, the spotlight on narcissism has intensified, prompting discussions within the healthcare community. Narcissistic Personality Disorder (NPD) is a mental health condition characterised by a pervasive pattern of self-importance, a constant need for admiration, and a lack of empathy for others. More specifically, characteristics of the condition include: (i) a grandiose sense of self-importance and an exaggeration of one's talents and achievements, (ii) a preoccupation with fantasies of success, power, brilliance, beauty, or ideal love, (iii) an excessive need for admiration and a constant seeking of validation from others, (iv) a lack of empathy, (v) a sense of entitlement, (vi) a tendency to take advantage of others to achieve personal goals, often without regard for their wellbeing, (vii) a pervasive sense of envy toward others and a belief that others are envious of oneself, and (viii) arrogance.
 
People with the condition often engage in a behaviour referred to as gaslighting. This is a manipulative tactic that makes others doubt their own perceptions, memories, or sanity. Narcissists subtly or overtly distort facts, deny events, or present alternative narratives to undermine the confidence and reality of their victims. This can lead the person being gaslit to question their own judgment and feel confused, ultimately reinforcing the narcissist's control over them. Gaslighting is a harmful behaviour that undermines trust and can have enduring effects on the mental wellbeing of the individual experiencing it. The term gaslighting comes from a 1944 American movie, Gaslight, which is based on a 1938 play by Patrick Hamilton and stars Ingrid Bergman. The movie tells the story of a narcissist that drives his wife insane.
 
It is important to note that while everyone may exhibit some narcissistic traits at times, which are characterised by expressions of pride, egotism, and vanity, it does not mean that a person is a narcissist.  Individuals with the disorder display these traits consistently and to a degree that manifests as antisocial behaviour expressing callousness, remorselessness, and selfishness, with little empathy, and the condition impairs their functioning in various professional and personal aspects of life.

Narcissism casts a significant shadow over the psychological landscape. The condition affects up to ~5% of the American (~17m) and British (~3.4m) populations. The overwhelming majority of people with the disorder are males (~75%). Despite a prevalence among Afro-Americans (~12.5%) and Hispanics (~7.5%), ~87% of diagnosed Americans are Caucasian. However, such disparities could reflect access to therapy and treatment. A demographic breakdown reveals a higher incidence of the condition among young adults aged 20 to 34, with declining rates in those aged ≥50. Challenges in relationships are evidenced in the US statistics, with ~9.6% of narcissists being single, ~7.3% divorced or separated, and ~4.9% married. A higher percentage of narcissism is observed among mental health patients (~6%), forensic analysts (~6%), military personnel (~20%), and first-year medical students (~17%). These trends invite reflection on the socio-cultural factors contributing to the manifestation of narcissistic traits and emphasises the importance of tailored interventions across diverse demographics.

The causes of the disorder are rooted in a complex interplay of inherited traits, distinct personality characteristics, neurobiological influences, and environmental factors, all of which remain elusive. Notably, parent-child relationships marked by excessive adoration or criticism are believed to be contributory factors. The contemporary shift towards individualism, amplified by the omnipresence of social media, is also implicated in the increase of the disorder. A study published in the May 2021 edition of Personality Neuroscience suggests a connection between narcissism and heightened sensitivity to ego threats and emphasises social and emotional processing challenges and alterations in the brain's salience network as factors influencing the interpersonal dynamics of individuals with the condition. As society, organisations, families, and individuals grapple with these shifts, comprehending the ramifications of NPD's rise and impact becomes important. Here we discuss the negative influence of the condition on healthcare.

 
Part 2
Narcissism in Healthcare

In healthcare, the interplay between narcissism and health professionals is a complex and much debated subject. While quantifying the prevalence of narcissistic traits within healthcare institutions is challenging, studies suggest an affinity between narcissists and professions offering authority, recognition, and control: qualities inherent in certain healthcare roles. This proclivity can manifest in behaviours with potential repercussions on workplace dynamics and the delivery of care. John Banja's 2005 publication, Medical Errors and Medical Narcissism, illustrates how healthcare professionals, driven by a need to preserve their self-esteem, might hesitate to acknowledge and disclose medical errors.
 
The manifestation of narcissistic traits in healthcare professionals can divert their focus towards personal recognition, hindering collaboration with colleagues and impeding empathetic connections with patients. Identifying and addressing narcissistic traits in healthcare settings becomes imperative to cultivate a positive and collaborative environment. The inclination of narcissists to prioritise self-promotion over collaboration adds complexity to patient care, where emotional understanding and connection are necessary.
 
NPD casts a shadow on the dynamics between healthcare providers and their patients or collaborators, leaving an indelible mark on the relationships within the healthcare landscape, be it the collaboration and innovation-driven realm of MedTechs or the intricate doctor-patient connections. Healthcare professionals navigating narcissistic traits may find it challenging to comprehend and empathise with the emotions and experiences of colleagues and patients. This difficulty can create a perceived lack of compassion, posing a threat to trustworthy collaborative relationships within healthcare teams and compromising the balance in patient-provider connections.

 
The influence of narcissism on healthcare delivery is multifaceted, creating various disruptions. Providers swayed by narcissistic tendencies may prioritise personal validation over patient-centred care, challenging the importance of focusing on the patient's wellbeing in decision-making processes. Effective communication and empathy, critical elements in healthcare, may become casualties of narcissistic traits, impacting the informed consent process, and necessitating heightened ethical considerations to ensure respectful and informed patient consent. Maintaining appropriate boundaries becomes a struggle, giving rise to ethical concerns related to potential exploitation or invasion of patient privacy.
 
Beyond individual interactions, narcissism can also permeate collaborative efforts and teamwork, with ethical dilemmas emerging when personal interests overshadow collective goals. This compromises patient care and safety as collaboration and synergy take a back seat to self-centred motives. A culture of openness and accountability, vital for addressing concerns and errors in healthcare, faces hindrance, impacting care quality and the ability to rectify issues. Additionally, the prioritisation of personal recognition over equitable resource distribution raises ethical concerns regarding the fair and just use of healthcare resources. Thus, the ripple effect of narcissistic traits extends across a wide range of healthcare relationships and collaborations, demanding a nuanced approach to ensure the wellbeing of both providers and patients.

 
Part 3
Mitigating the Negative Effects of Narcissism

Early intervention plays an important role in addressing NPD and preventing its potentially harmful behaviours. Identifying early signs within oneself requires careful attention to behavioural patterns and interpersonal dynamics. Key indicators include feelings of grandeur, an inflated sense of achievements, and an incessant need for admiration. Additionally, individuals should assess their ability to understand and connect with the emotions and experiences of others, scrutinise their excessive need for praise and validation, and be cognisant of defensiveness or emotional reactions to feedback.
 
Similarly, recognising early signs in colleagues involves observing their interactions with others, noting potential signs such as a lack of genuine connection, self-promotion, and difficulties collaborating. Communication styles, domination in conversations, and reluctance to listen are red flags. Assessing their teamwork, prioritisation of personal goals over team goals, and conflicts with colleagues can provide further insights. Observing consistent patterns over time is important due to the enduring nature of the disorder's traits.
 
It is essential to emphasise that occasional narcissistic traits do not equate to NPD. However, if concerns persist, seeking professional help early enhances the likelihood of positive outcomes. Professional intervention fosters self-awareness and serves as a foundation for positive change. Therapy guides individuals through self-exploration, offering tools to navigate challenges, manage stress, and improve relationships. Early intervention is critical in mitigating the potential harm narcissistic traits can inflict on relationships.
 
Creating a positive work environment involves open communication, clear goals, and team-building activities. Acknowledging and appreciating team efforts, empowering members, embracing diversity, and establishing effective conflict resolution mechanisms contribute to a positive workplace. Leaders play a crucial role by exemplifying positive behaviour and encouraging constructive feedback, promoting collaboration, employee satisfaction, and increased productivity.
  
Addressing NPD in healthcare delivery raises ethical concerns, requiring a focus on patient-centred care, effective communication, professional boundaries, and a collaborative, ethical healthcare culture. Healthcare professionals and organisations must embrace these challenges, guided by ethical principles to ensure quality patient care. Human resources play a crucial role in fostering psychological safety: a culture where team members freely express ideas, admit mistakes, and contribute without fear. This openness supports innovation, risk reduction, and inclusivity, serving as a game-changer for team dynamics and performance. Properly managed, psychological safety leads to fewer mistakes, increased creativity, enhanced team performance, improved diversity, and greater organisational resilience. It is not a luxury but a necessity for thriving teams, encouraging open communication, building trust, and emphasising team dynamics over individual skills.
 
Takeaways

Successfully addressing the challenges posed by NPD requires a comprehensive and proactive strategy. Recognising the early signs and intervening promptly is essential to mitigate the negative impacts on personal relationships, work environments, and healthcare delivery. Seeking professional help, fostering self-awareness, and developing effective coping mechanisms serve as foundational pillars for cultivating healthier interpersonal dynamics. Building resilience against narcissistic challenges necessitates a commitment to continuous learning, empathy development, and the establishment of robust boundaries. Organisations, too, can benefit by promoting awareness, education, and proactive management of narcissism, thereby reducing associated stigma, and fostering open conversations about mental health. Education is a key component, targeting healthcare professionals to recognise early signs of the disorder and understand its impact on individuals, relationships, and healthcare delivery. Proactive management involves creating supportive environments, implementing interventions, and cultivating a culture of empathy and collaboration. Prioritising mental health, advocating for accessible resources, and adopting a compassionate and informed approach can collectively address the challenges associated with NPD, contributing to a more empathetic and understanding society.
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The HealthPad Team would like to extend our thanks for your continued support. As we celebrate another year together, we sincerely hope you've found our Commentaries interesting and helpful and we look forward sharing more thought-provoking content with you in 2024.

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MedTechs Battle with AI for Sustainable Growth and Enhanced Value
 
Preface
 
The medical technology industry has experienced significant growth, consistently surpassing the S&P index by ~15 percentage points. This success is rooted in the early 1990s, a time when capital was costly, with interest rates ~10%. However, as we moved closer to 1998, interest rates began to recede, settling just below 7%. This early era of growth was not devoid of challenges. The US was still grappling with the aftermath of the oil embargo imposed in 1973 by the Organization of the Petroleum Exporting Countries (OPEC), which was a response to the American government's support for Israel during the Yom Kippur War and had lasting consequences. The oil crisis triggered hyperinflation, leading to a rapid escalation in the prices of goods and services. In response, the US Federal Reserve (Fed) raised interest rates to a historic high of 17% in 1981, which was aimed at curbing inflation but came at the price of increasing the cost of borrowing. As we entered the 1990s, the landscape shifted. The Fed’s monetary policies began to work, inflation started to decline, and interest rates fell to ~10%, eventually dipping below 7% in 1998. This created conditions for increased investments in research and development (R&D) and the American economy blossomed and benefitted from the internet becoming mainstream. It was during this period that many medical technology companies developed innovative medical devices, which were not only disruptive but also found a receptive global market characterized by significant unmet needs and substantial entry barriers. In the ensuing years, the industry thrived and matured. Fast-forward to the present (2023), and we find ourselves in a different scenario. Over the past five years, numerous large, diversified MedTechs have struggled to deliver value. One explanation for this is that growth of these enterprises over the past three decades, except for the early years, was primarily driven by mergers and acquisitions (M&A), often at the expense of prioritizing R&D. Consequently, many large MedTechs did not leverage evolving technologies to update and renew their offerings and are now heavily reliant on slow-growth markets and aging product portfolios. Navigating a successful path forward would be helped by a comprehensive embrace of artificial intelligence (AI) and machine learning (ML) strategies, since these technologies possess the potential to transform how MedTechs operate, innovate, and serve their stakeholders.
 
In this Commentary

This Commentary explores the role of artificial intelligence (AI) in reshaping the future landscape of the MedTech industry in pursuit of sustainable growth and added value. We focus on the impact AI can have on transforming operational methodologies, fostering innovation, and enhancing stakeholder services. Our aim is to address five key areas: (i) Defining Artificial Intelligence (AI): Describes how AI differs from any other technology in history and sheds light on its relevance within the MedTech sector. (ii) Highlighting AI-Driven MedTech Success: In this section, we preview three leading corporations that have utilized AI to gain access to new revenue streams. (iii) Showcasing a Disruptive AI-Powered Medical Device: Here, we provide an overview of the IDx-DR system, an innovation that has brought disruptive change to the field of ophthalmology. (iv) The Potential Benefits of Full AI Integration for MedTechs: This section briefly describes 10 potential benefits that can be expected from a comprehensive embrace of AI by MedTechs. (v) Potential Obstacles to the Adoption of AI by MedTechs: Finally, we describe some obstacles that help to explain some MedTechs reluctance to embrace AI strategies. Despite the substantial advantages that AI offers, not many large, diversified enterprises have fully integrated these transformative technologies into their operations. Takeaways outline the options facing enterprises.
 
Part 1

Defining Artificial Intelligence (AI)

Artificial Intelligence (AI) is a ground-breaking concept that transcends the simulation of human intelligence. Unlike human cognition, AI operates devoid of consciousness, emotions, and feelings. Thus, it is indifferent to victory or defeat, tirelessly working without rest, sustenance, or encouragement. AI empowers machines to perform tasks once exclusive to human intelligence, including deciphering natural language, recognizing intricate patterns, making complex decisions, and iterating towards self-improvement. AI is significantly different to any technology that precedes it. It is the first instance of a tool with the unique capabilities of autonomous decision making and the generation of novel ideas. While all predecessor technologies augment human capabilities, AI takes power away from individuals.
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AI employs various techniques, including machine learning (ML), neural networks, natural language processing, and robotics, enabling computers to autonomously tackle increasingly complex tasks. ML, a subset of AI, develops algorithms that learn, adapt, and improve through experience, rather than explicit programming. The technology’s versatile applications span image and speech recognition, recommendation systems, and predictive analytics. In the quest to comprehend the intersection of artificial and human intelligence, we encounter Large Language Models (LLMs), like ChatGPT, which recently have gained prominence in corporate contexts. These advanced AI models grasp and generate human-like text by discerning patterns and context from extensive textual datasets. LLMs excel in language translation, content generation, and engaging in human-like conversations, effectively harnessing our linguistic abilities.


Part 2

Highlighting AI-Driven MedTech Success

This section briefly describes three examples of MedTechs that have successfully leveraged AI technologies to illustrate how AI’s growing influence drives improvements in accuracy, efficiency, patient outcomes and in the reduction of costs, which together, and in time, are positioned to transform healthcare.
 
Merative, formally Watson Health, a division of IBM that specialised in applying AI and data analytics to healthcare. In 2022, the company was acquired by Francisco Partners, an American  private equity firm, and rebranded Merative. The company leverages AI, ML, and LLMs to analyse extensive medical datasets that encompass patient records, clinical trials, medical literature, and genomic information. These technologies empower healthcare professionals by facilitating more informed decisions, identifying potential treatment options, and predicting disease outcomes. For instance, Merative employs ML to offer personalised treatment recommendations for cancer patients based on their medical histories and the latest research. Integrating LLMs enables natural language processing to extract insights from medical literature, helping healthcare providers stay current with scientific and medical advancements.
 
Google Health, a subsidiary of Alphabet Inc., focuses on using AI and data analysis to improve healthcare services and patient outcomes. It employs AI and ML to develop predictive models that can identify patterns and trends in medical data, which improve early disease detection and prevention. One notable application is in medical imaging, where the company's algorithms can assist radiologists to identify anomalies in X-rays, MRIs, and other images. LLMs are used to interpret and summarize medical documents, making it easier for healthcare professionals to access relevant information quickly. Google Health also works on projects related to drug discovery and genomics, leveraging ML to analyze molecular structures and predict potential drug candidates.
Medtronic is a global leader in medical technology, specializing in devices and therapies to treat various medical conditions. The company incorporates AI, ML, and LLMs into their devices and systems to enhance patient care. For instance, in the field of cardiology, Medtronic's pacemakers and defibrillators collect data on a patient's heart rhythms, which are then analyzed using AI algorithms to detect irregularities and adjust device settings accordingly. This real-time analysis helps to optimize patient treatment. Medtronic also employs AI in insulin pumps for diabetes management that can learn from a patient's blood sugar patterns and adjust insulin delivery accordingly. Additionally, LLMs are used to extract insights from electronic health records (EHR) and clinical notes, which help healthcare providers to make more personalized treatment decisions.
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Part 3

Showcasing a Disruptive AI-Powered Medical Device

AI has been applied to various medical imaging tasks, including interpreting radiological images like X-rays, CT scans, and MRIs and there are numerous AI-driven medical devices and systems that have emerged and evolved in recent years. As of January 2023, the US Federal Drug Administration (FDA) has approved >520 AI medical algorithms, the majority of which are related to medical imaging. Here we describe just one, the IDx-DR system, which was developed by Digital Diagnostics. In 2018, it became the first FDA-approved AI-based diagnostic system for detecting diabetic retinopathy. If left untreated, the condition can lead to blindness. Globally, the prevalence of the disease among people living with diabetes is ~27% and every year, >0.4m people go blind from the disorder. In 2021, globally there were ~529m people with diabetes, which is expected to double to ~1.31bn by 2050.
 
The IDx-DR device utilizes AI algorithms to analyze retinal images taken with a specialized camera and accurately detects the presence of retinopathy that occurs in individuals with diabetes when high blood sugar levels cause damage to blood vessels in the retina. Significantly, the device produces decisions without the need for retinal images to be interpreted by either radiologists or ophthalmologists, which allows the system to be used outside specialist centres, such as in primary care clinics. Advantages of the system include: (i) Early detection, which can improve outcomes and quality of life for individuals with diabetes. (ii) Efficiency. The system analyzes images quickly and accurately, providing results within minutes, which allows healthcare providers to screen a larger number of patients in a shorter amount of time. (iii) Reduced healthcare costs. By detecting retinopathy at an early stage, the system helps prevent costly interventions, such as surgeries and treatments for advanced stages of the disease, which can lead to significant cost savings for healthcare systems. (iv) Patient convenience. Patients undergo retinal imaging as part of their regular diabetes check-ups, reducing the need for separate appointments with eye specialists, which encourages enhanced compliance.

 
Part 4

The Potential Benefits of Full AI Integration for MedTechs

Large, diversified MedTechs stand to gain significant benefits by fully embracing AI technologies that extend across all aspects of their operations, innovation, and overall value propositions. In this section we briefly describe 10 such advantages, which include enhanced innovation, improved patient outcomes, increased operational efficiency, cost savings, and access to new revenue streams. Companies that harness the full potential of AI will be better positioned to thrive in the highly competitive and rapidly evolving healthcare industry.
 
1. Enhanced innovation and product development
AI technologies have the potential to enhance R&D endeavours. They accomplish this through the ability to dig deep into vast repositories of complex medical data, identifying patterns, and forecasting outcomes. This translates into a shorter timeline for the conception and creation of novel medical technologies, devices, and therapies. In essence, AI quickens the pace of innovation in healthcare. The capabilities of AI-driven simulations and modeling further amplifies its impact. These virtual tools enable comprehensive testing in a digital environment, obviating the need for protracted physical prototyping and iterative cycles, which can shorten the development phase and conserve resources, making the innovation process more cost-effective, and environmentally sustainable.
 
2. Improved patient outcomes
Beyond improving the research landscape, AI improves the quality of patient care by enhancing diagnostic precision through the analysis of medical images, patient data, and clinical histories. Early detection of diseases becomes more precise and reliable, leading to timelier intervention and improved patient outcomes. Additionally, AI facilitates the personalization of treatment recommendations, tailoring them to individual patient profiles and current medical research. This optimizes therapies and increases the chances of successful outcomes and improved patient wellbeing.
 
3. Efficient clinical trials
Increasingly AI algorithms are being used in clinical studies to identify suitable patient cohorts for participation in trials, effectively addressing recruitment challenges and streamlining participant selection. Further, predictive analytics play a role in enhancing the efficiency of trial design. By providing insights into trial protocols and patient outcomes, AI reduces both the time and costs associated with bringing novel medical technologies to market, which speeds up the availability of treatments and facilitates the accessibility of healthcare innovations to a broader population.
 
4. Operational efficiency
Operational efficiency is improved with the integration of AI technologies by refining operations. AI-driven supply chains and inventory management systems play a significant role in optimizing procurement processes. They analyze demand patterns, reduce wastage, and ensure the timely availability of critical supplies. By doing so, companies can maintain uninterrupted operations, enhancing their overall efficiency and responsiveness. Another component of operational efficiency lies in predictive maintenance, which can be improved by AI. Through continuous monitoring and data analysis, AI can predict equipment failures before they occur. Such a proactive approach minimizes downtime and ensures manufacturing facilities remain compliant and in optimal working condition. Consequently, healthcare providers experience improved operational efficiency, strengthened compliance, and a reduction in costly disruptions. The automation of routine tasks and processes via AI relieves healthcare professionals from repetitive duties and frees up resources that can be redirected towards more strategic and patient-centric initiatives. This reallocation reduces operational costs while enhancing the quality of care provided.
 
5. Cost savings
Beyond automation, AI-driven insights further uncover cost efficiencies within healthcare organizations. AI identifies areas where resource allocation and utilization can be optimized, which can result in cost reduction strategies that are both data-informed and effective. AI's potential extends to the generation of innovative revenue streams. Corporations can develop data-driven solutions and services that transcend traditional medical devices. For instance, offering AI-driven diagnostic services or remote patient monitoring solutions provides access to new revenue streams. Such services improve patient care and contribute to the financial sustainability of enterprises. Further, AI-enabled healthcare services lend themselves to subscription-based models, ensuring consistent and reliable revenue over time. Companies can offer subscription services that provide access to AI-powered diagnostics, personalized treatment recommendations, or remote monitoring, which have the capacity to diversify revenue streams and enhance longer-term financial stability.
 
6. New revenue streams
AI's ability to analyze vast datasets positions MedTechs to unravel the interplay of genetic, environmental, and lifestyle factors that shape individual health profiles. With such knowledge, personalized treatment plans and interventions can be developed, ensuring that medical care is tailored to each patient's unique needs and characteristics. This level of customization optimizes outcomes and minimizes potential side effects and complications. AI's ability to process vast amounts of patient data and detect patterns, anomalies, and correlations, equips healthcare professionals with the knowledge needed to make more informed decisions. Such insights extend beyond individual care, serving as the basis for effective population health management and proactive disease prevention strategies. In short, AI transforms data into actionable intelligence, creating a basis for more proactive and efficient healthcare practices.
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7. Regulatory compliance and safety
In an era of stringent healthcare regulations, AI is a reliable ally to ensure compliance and enhance safety standards. Through automation, AI streamlines documentation, data tracking, and quality control processes, reducing the risk of errors and oversights. Also, AI-powered systems excel in the early detection of anomalies and potential safety issues, which increase patient safety and the overall quality of healthcare solutions and services. This safeguards patient wellbeing and protects the reputation and credibility of companies.
8. Competitive advantage
MedTechs that are early adopters of AI stand to gain a distinct competitive advantage. They can offer AI-powered solutions and services that deliver superior clinical outcomes and improve overall patient experience. By harnessing the potential of AI, companies can position themselves as leaders in innovation and technological capabilities, likely drawing a loyal customer base, valuable partnerships, collaborations, and investments.
 
9. Talent attraction and retention
Embracing AI technologies also has an impact on talent attraction and retention. The allure of working on novel AI projects that improve lives attracts scarce tech-savvy professionals who seek to be part of dynamic, purposeful, and forward-thinking teams. Such talent contributes to a skilled workforce capable of extending the boundaries of AI innovation within MedTech companies. Further, fostering a culture of innovation through AI adoption encourages employee engagement and job satisfaction, leading to improved talent retention.
 
10. Long-term sustainability
The integration of AI goes beyond immediate advantages; it positions MedTechs for longer-term strategic growth and resilience. As the healthcare landscape continues to evolve, adaptability and innovation become more important. AI enables companies to adapt to changing market dynamics, navigate regulatory challenges, and remain relevant amidst industry transformations. By staying at the forefront of technological advancements, companies ensure their relevance and contribute to shaping the future healthcare landscape.
 
Part 5

Potential Obstacles to the Adoption of AI by MedTechs

The integration of AI technologies into numerous industries has demonstrated its potential to significantly enhance operations, improve R&D, and create new revenue streams. However, despite AI’s potential to contribute significant benefits for business enterprises, its adoption by many large, diversified medical technology companies has been limited and slow. This section describes some factors that help to explain the reluctance of senior MedTech executives to fully embrace AI technologies, which include an interplay of organizational, technical, and industry-specific issues. Without overcoming these obstacles, MedTechs risk losing the growth and value creation they once experienced in an earlier era.

Demographics of senior leadership teams
According to Korn Ferry, an international consultancy and search firm, the average age for a C-suite member is 56 and their average tenure is 4.9 years, although the numbers vary depending on the industry. The average age of a CEO across all industries is 59. If we assume that the MedTech industry mirrors this demographic, it seems reasonable to suggest that many corporations have executives approaching retirement who may be more risk averse and oppose the comprehensive introduction of AI technologies due to a fear of losing benefits they stand to receive upon retirement.

Organizational inertia and risk aversion
Large medical technology companies often have well-established structures, processes, and cultures that resist rapid change. In such an environment, executives might be hesitant to introduce AI technologies due to concerns about disrupting existing workflows, employee resistance to learning new skills, and the fear of failure. The risk-averse nature of the medical technology industry, where patient safety is critical, further amplifies executives' cautious approach to implementing unproven AI solutions.
 

Technical challenges and skill gaps
AI implementation requires technical expertise and resources. Many MedTech executives might lack a deep understanding of AI's technical capabilities, making it difficult for them to evaluate potential applications. Further, attracting and retaining AI talent is highly competitive, and the scarcity of professionals skilled in both medical technology and AI can hinder successful implementation.
Regulatory and ethical concerns
The medical field is heavily regulated to ensure patient safety and data privacy. Incorporating AI technologies introduces additional layers of complexity in terms of regulatory compliance and ethical considerations. Executives might hesitate to navigate these legal frameworks, fearing potential liabilities and negative consequences if AI systems are not properly controlled or if they lead to adverse patient outcomes.
Long development cycles and uncertain ROI
The R&D cycle in the medical technology industry is prolonged due to rigorous testing, clinical trials, and regulatory approvals. Although AI technologies have the capabilities to enhance R&D efficiency, they can introduce additional uncertainty and complexity, potentially extending development timelines. Executives could be apprehensive about the time and resources required to integrate AI into their R&D processes, especially if the return on investment (ROI) remains uncertain or delayed.
 

Industry-specific challenges
The medical technology industry has unique challenges compared to other sectors. Patient data privacy concerns, interoperability issues, and the need for rigorous clinical validation can pose barriers to AI adoption. Executives might view these complexities as additional hurdles that could hinder the successful implementation and deployment of AI solutions.
  

Existing Revenue Streams and Incremental Innovation
Many large, diversified MedTechs generate substantial revenue from their existing products and services. Executives might be reluctant to divert resources towards AI-based ventures, fearing that these investments could jeopardize their core revenue streams. Additionally, a culture of incremental innovation prevalent in the industry might discourage radical technological shifts like those associated with AI.

 
Takeaways
 
Hesitation among MedTechs to integrate AI technologies poses the threat of missed opportunities, diminished competitiveness, and sluggish growth. This reluctance hinders innovation and limits the potential for enhanced patient care. Embracing AI is not an option but a strategic imperative. Failure to do so means missing opportunities to address unmet medical needs, explore new markets, and access new revenue streams. The potential for efficiency gains, streamlined operations, and cost reductions across R&D, manufacturing and supply chains is significant. Companies fully embracing AI gain a competitive advantage, delivering innovative solutions and services that improve patient outcomes and cut healthcare costs. Conversely, those resisting AI risk losing market share to more agile rivals. AI’s impact on analysing vast amounts of complex medical data, accelerating discovery, and enhancing diagnostics is well established. MedTechs slow to leverage AI may endure prolonged R&D cycles, fewer breakthroughs, and suboptimal resource allocation, jeopardising competitiveness and branding them as ‘outdated’. In today’s environment, attracting top talent relies on being perceived as innovative, a quality lacking in AI-resistant MedTechs. As AI disrupts industries, start-ups and smaller agile players can overtake established corporations failing to adapt. A delayed embrace of AI impedes progress in patient care, diagnosis, treatment, and outcomes, preventing companies from realising their full potential in shaping healthcare. The time to embrace AI is now to avoid irreversible setbacks in a rapidly evolving MedTech ecosystem.
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  • The MedTech industry has undergone a transformative journey marked by prolific mergers and acquisitions (M&A)
  • Between 2006 and 2016, the industry witnessed 2,680 acquisitions totaling US$607.8bn
  • In the pursuit of efficient integrations corporations often overlooked the significance of fostering a distinct organisational culture
  • In many cases this resulted in cultural dissonance, which is a silent but substantial obstacle to growth and value creation
  • Stories can overcome this obstacle and help to bridge gaps, align interests, and cultivate a shared sense of purpose among employees and stakeholders for long-term MedTech success
 
 The Silent Obstacle to MedTech Growth and Value Creation
 
The MedTech industry, marked by decades of prolific mergers and acquisitions (M&A), has undergone a transformative journey fuelled by factors like the pursuit of economies of scale, technological access, and navigating regulatory challenges. While strategic consolidations have yielded financial and organisational benefits, often they have inadvertently overlooked the softer facet of corporate identity - organisational culture.
 
Illustrating the magnitude of M&A within the industry, the decade from 2006 to 2016 witnessed 2,680 acquisitions with a value totaling US$607.8bn. Noteworthy is the consistency in the frequency of these acquisitions, juxtaposed against the variability in the consideration of individual deals.
                                                                                                                     
By 2023, a notable shift occurred within the MedTech M&A landscape. The deceleration of M&A activity led to a saturation in market segments with products and services, which intensified competition for market share and exerted pressure on pricing and profit margins. As the M&A market cooled, the accessibility to cutting-edge technologies became more elusive, putting companies at a disadvantage in terms of product development and maintaining competitiveness. Simultaneously, heightened geopolitical tensions and trade restrictions further complicated supply chains and distribution channels. The constrained M&A environment raised hurdles for expanding into emerging markets, which narrowed potential growth opportunities. Integrating talent from acquired companies, a common practice in M&A, also faced challenges amid the slowdown, which impacted the ability to sustain a competitive edge in expertise and innovation. Without the efficiency gains typically associated with M&A, numerous companies encountered escalating cost pressures, which encompassed R&D costs, manufacturing expenses, and other operational outlays that adversely affected overall profitability. The heighted expectations from shareholders for consistent growth, a hallmark for large diversified MedTechs, faced added difficulties due to the deceleration of M&A activity, potentially influencing stock prices and investor confidence.
 
Periods of integrating acquired enterprises tend to be dominated by the pursuit of efficiency, cost savings, and regulatory compliance, which often means relegating the significance of cultivating a distinct and cohesive organisational culture. In the current landscape, where M&A activity has decelerated and corporate values have plateaued, the ramifications of this neglect are becoming increasingly evident. Some enterprises are finding themselves with fragmented cultures, which have low levels of solidarity: employees disagree about organisational objectives, critical success factors, and performance standards. This can make organisations challenging to manage, and leaders unable to affect change. Organisational culture is not simply rhetoric; it is a critical element that molds how employees perceive their roles, comprehend their company's mission, and ultimately contribute to innovation and value creation. Further, a robust and distinctive culture plays a role in attracting and retaining top talent. In an industry driven by innovation, retaining the brightest minds is important for success. When employees sense a misalignment between their personal values and the organisational culture, it can result in disengagement, increased turnover rates, and a depletion of institutional knowledge - all of which undermine long-term growth.
 
Consider this scenario: A MedTech company with a clear and supportive culture is well equipped to navigate the intricacies of the industry. Such an environment fosters a shared sense of purpose and identity among employees, creating a collaborative space where diverse talents can thrive. This, in turn, augments a company's capacity to adapt to industry changes, respond to emerging healthcare needs, and drive sustainable value creation.
 
Culture embodies community; it is the essence of how individuals connect with each other. Flourishing communities arise from shared interests, mutual obligations, and a foundation of cooperation and camaraderie. A common oversight in certain management literature concerning corporate culture is the assumption that organisations are inherently homogeneous. However, just as one organisation differs from another, so do its internal units. Consider the contrasting nature of, for instance, the R&D function compared to manufacturing within a MedTech company. Moreover, hierarchical distinctions within an enterprise add layers of diversity; the cultural dynamics of senior leadership teams may differ markedly from those of middle managers and blue-collar workers.
 
In the MedTech industry, where financial and organisational factors maintain their importance, a strategy that develops a distinctive organisational culture is equally important. Overlooking cultural integration presents a nuanced yet potentially significant barrier to growth and value creation. This challenge manifests itself through indicators such as disengaged employees, talent attrition, and a lack of adaptability in meeting the evolving demands of the industry. Recognizing and addressing this cultural deficit extends beyond employee satisfaction; it emerges as a strategic imperative for long-term success in the dynamic landscape of MedTech.
 
Further, as corporations expand globally they encounter challenges to unite and motivate their constituencies. Internationalization means transcending geographical, linguistic, cultural, and religious boundaries. Multinational corporations operate in a world where employees are from various countries, speak different languages, and possess diverse cultural backgrounds, which emphasises the significance of establishing common ground and fostering a sense of belonging. Moreover, modern organisations are linked to an array of stakeholders, including governments, patients, insurance firms, advocacy groups, and a wide spectrum of customers. These often hold distinct interests and priorities, occasionally leading to conflicts with both each other, and the organisation's objectives.
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The power of stories

In this interconnected ecosystem, a cohesive and inspiring narrative emerges as a potential remedy for dissonance. A well-crafted story has the capacity to bridge divides, align interests, and instil a collective sense of purpose among both employees and stakeholders. This, in turn, contributes to a corporation's overall success.
The impact of a unifying narrative does not confine itself to an organisation's internal boundaries. It acts as a catalyst for collective action, motivating employees, and stakeholders alike toward shared objectives. This shared story becomes the driving force behind innovation, it bolsters problem-solving capabilities, and shapes the organisation into a responsive and adaptable entity. In a world where trust, differentiation, innovation, talent attraction, stakeholder engagement, and customer loyalty wield substantial influence, a captivating narrative emerges as a positive force for a diversified MedTech company. It adeptly communicates the company's mission, values, and impact, establishing trust, distinguishing the brand, fostering innovation, attracting top talent, engaging stakeholders, and cultivating customer loyalty. Ultimately, it solidifies a company's brand identity, nurtures relationships, and fuels long-term commercial success.
 
The potency of an inspiring company narrative lies in its ability to weave a common thread through the diverse interests of employees, creating unity and a shared company culture. A compelling story acts as a connective tissue, transcending departmental and hierarchical boundaries, resonating universally regardless of individual roles or backgrounds. Such narratives instill a collective sense of purpose and pride, fostering a shared identity embraced by every employee. When everyone is tethered to a common story, it encourages a cohesive culture where values and goals are not just communicated but lived and upheld by each member of the organisation. This shared narrative becomes a wellspring of motivation, aligning the workforce toward a singular vision and propelling the company forward as a unified and harmonious entity.
 
These claims may seem exaggerated when applied to a company narrative. However, to grasp the potential impact of storytelling, let us briefly examine the realms of religion, politics, finance, and the women’s movement. All these domains are predicated upon narratives that not only inspire and motivate diverse groups of individuals but also make them reshape their lives and dedicate their time and energy to the causes these narratives portray.
 
Religion

Religion plays an important part in the spiritual lives of billions of people around the world. Religious stories hold a significant influence over the beliefs and practices of faith communities, providing them with a sense of meaning and purpose. The potency of a narrative's impact is exemplified in the case of Jerusalem, a city that embodies the enduring power of stories.
 
For Jews, Jerusalem is a testament to the divine intervention of their narrative, where God commanded Abraham not to sacrifice his son Isaac. For Christians, Jerusalem holds multifaceted significance across various church factions, but it universally marks the hallowed ground where Jesus Christ delivered his teachings and shared the Last Supper with his disciples before his crucifixion. Similarly, for Muslims, Jerusalem bears importance as the place where the Prophet Mohammad started his mission and experienced a divine vision.
 
What is striking about these narratives is that they have endured through centuries, despite the absence of any scientific evidence, relying on the power of spiritual belief. This emphasises the influence of storytelling. People hold these stories dear to their hearts, embracing them with unwavering faith. Such narratives have the power to shape cultures, societies, and even geopolitical landscapes. The enduring power of religious narratives, like those surrounding Jerusalem, teaches us that stories are more than tales, but the scaffolding upon which belief systems are constructed, and they have the potential to move nations and shape destinies.
 
Politics

Consider politics. Political ideologies are founded upon stories that individuals hold so firmly that they are prepared to resolutely defend their convictions, even at the cost of armed conflict. These ideologies shape the governance, policies, and destinies of nations, and their power lies in the stories they tell.
 
Consider democracy, for instance. It is a powerful narrative that extols the virtues of power vested in the hands of the people or their elected representatives. Democracy's story emphasizes principles of equality, individual rights, and the regular exercise of those rights through elections. It speaks to the idea that citizens should actively participate in shaping their government and society through voting and civic engagement. This narrative has led people to fight for democratic values, even in the face of oppressive regimes, as they believe in the story of democracy's inherent worth.
 
Socialism is another political ideology grounded in a compelling narrative. It advocates for collective or state ownership and control of the means of production, distribution, and exchange. The story of socialism centres on reducing economic inequality and ensuring that resources and wealth are more equitably distributed among society's members. This narrative has inspired revolutions, social movements, and political changes across the world, as believers are motivated by the story of a fairer and more just society.
 
In contrast, authoritarian states are political systems characterised by centralised power and limited political freedoms. They too are predicated on stories. Such states often feature a single leader or a small group of individuals with substantial control over the government, little or no opposition, restricted civil liberties, and limited or no free elections. They prioritize order and control over individual rights and freedoms, often relying on censorship, propaganda, and coercion to maintain their authority. Despite its repressive nature, it has garnered fervent adherents who are willing to defend their vision of a disciplined and ordered society, sometimes at great human cost.
 
These political narratives are strong forces that shape the world we live in. They are stories that compel people to action, and at times, to support and engage in conflict. Understanding the power of these narratives is essential for comprehending the dynamics of political movements, governance, and global affairs. It emphasises that the stories we believe in are not just words; they are forces capable of reshaping societies and history itself.
 
Money

Money, in its essence, is a symbol devoid of inherent value. Take a $100 bill, for instance. It possesses no intrinsic worth; you cannot eat it, clothe yourself with it, or find shelter beneath its folds. In today's digital age, most monetary transactions occur virtually, further emphasizing that money is not a tangible commodity but a representation of value. What makes money intriguing is that its value is predicated upon a story, a narrative that commands the largest following worldwide, surpassing the collective adherents of all religions combined. Money, in essence, is a story with believers numbering billions.
 
This narrative begins with the idea that a particular piece of paper or digital entry holds value. It is a shared belief system, one upheld by individuals, corporations, and governments across the globe. This shared belief is what allows us to exchange money for goods, services, and even intangible assets like trust or promise. Consider the notion of a banknote. Its value exists because we believe in the authority and stability of the issuing government or institution. It is a mutual understanding that a piece of paper, despite its lack of intrinsic value, can be exchanged for something tangible or intangible in the real world.
 
This shared belief in money's value creates a complex web of economic interactions and relationships. It fuels trade, investment, and economic growth. It enables people to plan, save for retirement, and invest in education and healthcare. Money, as a story, is a unifying force in the modern world, transcending borders, cultures, and languages. Yet, like all narratives, money is not without its challenges and contradictions. Economic disparities, financial crises, and questions about the fairness of wealth distribution persist. But the fact remains that money, as a story, is a force of unparalleled influence, guiding the decisions and actions of individuals and nations alike. In a world where the value of money is woven into the fabric of society, it becomes clear that its true worth lies not in the physical notes or digital records but in the collective trust and beliefs that sustain this narrative. Money, in the end, is a story that shapes our lives, economies, and the world at large.
 
Women’s movement

The women's movement is a testament to the power and influence of a story about equality. Over decades, this movement has enhanced the status of women worldwide. What makes this narrative particularly interesting is that, unlike the stories underpinning religion, politics, and money, the pursuit of women's rights has largely been achieved through peaceful means, which is a testament to the millions of people around the world who embraced the story that activists told.
 
The narrative of the women's movement is simple: equality. It tells a story of a world where women and men stand on equal footings, where gender should not be a barrier to opportunities, rights, or dignity. This story resonated with countless individuals who recognized the inherent justice in this vision. The power of this story lies in its ability to inspire action. It mobilized women and men from all walks of life to come together and advocate for change. Grassroots activists, iconic leaders, and ordinary citizens joined forces, fuelled by the belief in the story's inherent truth. They organised rallies, signed petitions, and engaged in peaceful demonstrations, all with the goal of dismantling systemic inequalities and securing equal rights for women.
 
What sets the women's movement apart from many other stories that shape our world is its peaceful nature. While religious, political, and economic narratives have often been associated with conflict and violence, the women's movement has predominantly relied on peaceful activism and advocacy. This nonviolent approach has garnered widespread support and sympathy from people of diverse backgrounds, fostering a sense of unity and shared purpose.
 
The influence of this narrative has been significant. It has led to legal and societal changes, from suffrage and reproductive rights to workplace equality and gender representation in leadership roles. Women's rights have advanced on a global scale, improving the lives of millions. The women's movement is a powerful example of how a story can shape the world when embraced by a collective of individuals who believe in its message. It demonstrates that narratives grounded in principles of justice and equality can bring about transformative change, even without resorting to violence. The women's movement serves as a reminder that stories have the power to move societies and bend the arc of history toward progress and justice.
 
Takeaways

The MedTech industry's journey through decades of M&A activity has been a transformative one, marked by the pursuit of economies of scale, technological access, and regulatory mastery. The resulting financial and organisational benefits, however, have inadvertently overlooked a critical aspect: organisational culture. The magnitude of M&A activity, exemplified by 2,680 acquisitions totaling US$607.8bn between 2006 to 2016, showcases both consistency and variability in deal considerations. As we fast forward to 2023, global uncertainties prompted a recalibration of strategic initiatives, especially as MedTech companies aimed for operational scaling and global expansion. The challenges of uniting diverse constituencies in an internationalized context - spanning geographical, linguistic, cultural, and religious boundaries – emphasized the importance of establishing common ground and fostering a sense of belonging. The consequences of prioritizing efficiency and not cultivating a cohesive organisational culture during the integration of acquired enterprises has become increasingly apparent. Some companies find themselves with fragmented cultures, marked by low solidarity and disagreements about organisational objectives. This cultural deficit makes organisations challenging to manage, and leaders often feel powerless to effect change. In the MedTech sector, where collaboration and creativity are important for healthcare breakthroughs, cultural dissonance poses a significant risk. A robust and distinctive culture, however, is instrumental in attracting and retaining top talent, which is essential for success in an innovation-driven industry. A MedTech with a clear and supportive culture is better equipped to navigate industry intricacies, respond to emerging healthcare needs, and drive sustainable value creation.
 
This Commentary suggests that culture is community: a network of shared interests and obligations that thrive on cooperation and friendships. Acknowledging the heterogeneity within organisations is crucial, recognizing differences across departments and hierarchical levels. While financial and organisational considerations are critical, an approach encouraging a distinctive organisational culture is equally important. Neglecting cultural integration poses a silent yet substantial obstacle to growth and value creation - a challenge manifested through disengaged employees, talent attrition, and a lack of agility in meeting industry demands. Recognizing and redressing this cultural deficit transcends employee satisfaction; it emerges as a strategic imperative for long-term success in the dynamic landscape of MedTechs. As MedTech companies expand globally, the challenges to unite and motivate constituencies intensify. We have suggested that within this interconnected ecosystem, a unifying and motivating narrative emerges as a potential solution. A well-crafted story has the power to bridge gaps, align interests, and cultivate a shared sense of purpose among employees and stakeholders alike, contributing to a company’s success. The influence of a unifying narrative extends beyond an organisation's boundaries, serving as an inspiration for collective action. This shared story fuels innovation, enhances problem-solving, and transforms an organisation into a responsive and adaptable entity. In a world where trust, differentiation, innovation, talent attraction, stakeholder engagement, and customer loyalty are important, a captivating narrative becomes a positive contribution to the success of a diversified MedTech company. In the grand scheme of human endeavours, the power of stories seems undeniable. Whether in religion, politics, finance, or the women's movement, it is through stories that movements are built and legacies are shaped. Thus, for MedTechs to overcome the silent obstacle to growth and value creation, they might consider harnessing the power of narratives to fortify their brand identities, nurture relationships, and fuel long-term commercial success.
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  • The MedTech industry faces a pivotal moment as it confronts the challenge of adopting transformative technologies amidst a rapidly changing healthcare ecosystem
  • Despite progress in other sectors, MedTech has shown reluctance to fully integrate digitalization, potentially hindering its growth and competitiveness
  • There have been some notable exceptions such as Medtronic, Siemens Healthineers and Philips
  • Many large diversified MedTechs could unlock growth and value by capitalizing on the potential synergies between traditional medical devices and innovative digital solutions and services
  • The convergence of digital offerings with legacy medical devices provides opportunities for improved patient care, operational efficiency and R&D innovation
  • There is a pressing need for MedTechs to comprehensively embrace digitalization to avoid reduced competitiveness, limited growth, and diminished value enhancement
 
Forging a path for digital excellence in the MedTech Industry

In an era of rapid technological advancement, the medical technology (MedTech) industry is at a crossroads. While numerous other sectors have enthusiastically embraced digitalization and moved forward, the MedTech sector, barring a few notable exceptions, has been hesitant to embrace these transformative technologies. However, the time has come for large diversified MedTechs to recognize the opportunities that digitalization offers for growth and value creation. The convergence of traditional medical devices with digital solutions and services presents an opportunity for the industry to improve patient care, streamline operations, and drive innovation. Failing to fully integrate digitalization into their operations in a timely way may lead to unexpected consequences, including a shorter window of competitiveness and a struggle to enhance growth rates and augment value. The reluctance of many MedTechs to adapt now could translate into a significant handicap in the rapidly evolving landscape of healthcare technology.
 
In this Commentary

In this Commentary, we tackle four questions: (i) What is digitalization? (ii) Why is digitalization important for MedTechs? (iii) Which MedTechs have implemented successful digitalization strategies? and (iv) What defines an effective digitalization strategy? In addressing the fourth question, we present a strategy that encompasses 20 'essentials', which are not meant to follow a linear, sequential path. Instead, they are orchestrated by agile cross-functional teams, collaborating and pooling resources. Together, these teams oversee the execution of various elements of the strategy, while assuming responsibility for its overall effectiveness. This approach signals a departure from hierarchical departments and advocates a matrix-style organizational structure characterized by a web of interconnected reporting relationships. This structure goes beyond the confines of the conventional linear framework and incorporates specialized clusters, akin to "nests," each housing unique competencies, spanning multiple dimensions, and encompassing responsibility, authority, collaboration, and accountability.
 
1. What is digitalization?
 
Digitalization, also referred to as digital transformation, involves harnessing digital technologies to improve and refine business operations, processes, and services. By integrating digital tools across all facets of an organization, digitalization streamlines workflows, amplifies customer experiences, and achieves strategic goals. This includes automating tasks, utilizing data analytics for informed decision-making, and leveraging cloud computing for scalable and flexible operations. The Internet of Things (IoT) facilitates data exchange through connected devices, while artificial intelligence (AI), machine learning (ML) and large language models (LLM) empower computers to perform tasks requiring human-like intelligence. Virtual and augmented reality (VR/AR) enrich experiences, while cybersecurity measures are important to safeguard digital assets.
 
2. Why is digitalization important for MedTechs?
 
Digitalization is important for the MedTech industry since it acts as a driver for significant and positive change. By fully embracing this transformation, the industry develops the ability to use data and analytics to create innovative medical solutions and services. These are built on insights and predictions obtained from large amounts of information. Apart from these benefits, digitalization also affects the core of how clinical operations work. It makes workflows more efficient and frees-up healthcare professionals to focus more on taking care of patients. One significant development is the rise of collaborative telehealth platforms, which play a role in improving the quality and efficiency of healthcare delivery. Additionally, the power of technologies like AI, and ML becomes more evident. These advanced tools, driven by their ability to rapidly analyse vast data sets and make predictions, contribute to breakthroughs in care with the potential to improve patient outcomes while reducing costs.
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Is the digital transformation of MedTech companies a choice or a necessity?

 
The collaboration between smart devices and blockchain technology becomes important in a digital transformation, enhancing patient safety, and ensuring regulatory compliance. As the MedTech sector embraces digitalization, it enables companies to succeed in value-based healthcare environments, which results in quality care becoming more accessible and affordable. This is partly made possible through remote monitoring and proactive interventions that overcome distance. A distinctive aspect of digitalization is the ability to provide personalized care. Focusing on creating solutions and services tailored to individual needs helps to create an innovative environment within MedTechs, which can be leveraged to drive continuous growth and value creation. As digitalization becomes more influential, the MedTech industry should move closer to personalized health, which means care is centered around patients, innovation is continuous, and growth is more certain.
3. Which MedTechs have implemented successful digitalization strategies?
 
There are several large MedTechs that have successfully leveraged digitalization strategies to gain access to new revenue streams. Here we briefly describe just three. Philips is known for its diverse healthcare products and services, including imaging systems, patient monitoring, and home healthcare solutions and services. They have successfully utilized digitalization by creating a connected ecosystem of devices that capture and transmit patient data, enabling real-time monitoring and personalized care. Their strategy also includes software solutions for data analysis, predictive analytics, and telehealth, contributing to the creation of new revenue streams beyond traditional medical devices. Siemens Healthineers focuses on medical imaging, laboratory diagnostics, and advanced healthcare IT. Their digitalization strategy involves offering integrated solutions that connect medical devices, data analytics, and telemedicine platforms. For instance, their cloud-based platforms enable healthcare providers to store, share, and analyze medical images and patient data, resulting in streamlined workflows and new revenue opportunities through data-driven insights. Medtronic, a global leader in medical technology, offering a wide range of products and services in various medical specialties, has successfully embraced digitalization by incorporating smart technologies into their devices, such as pacemakers and insulin pumps, allowing remote monitoring and data collection. This has improved patient care and given the company access to new revenue streams through subscription-based services for data analytics and remote monitoring.
 
4. What defines an effective digitalization strategy?
 
In today’s business climate, developing an effective digital strategy has shifted from being a ‘nice to have’ to a necessity. As MedTechs navigate the dynamic technology landscape, digitalization has become a priority. In this section, we present a 20 'essentials' for crafting and implementing a digitalization strategy. These are not linear, but collectively constitute a path towards a digital transformation for a large diversified MedTech company.   

1. Crafting a Cohesive Vision
Digitalization starts with an evaluation of a company's existing products, services, processes, and technologies. This forms the basis upon which a vision and strategic goals are constructed. The main objective here is to align a company's aspirations with the dynamic MedTech landscape, creating a basis for innovation. Digitalization entails more than the integration of peripheral technologies. It is a paradigm shift. The initiation of a digitalization vision depends upon sound long-term strategic objectives. This involves not only envisioning the transformative potential of digitalization within an organization but also projecting its impact, whether that be improved patient experiences, data-driven operational enhancements, or the exploration of new revenue streams. As this vision takes shape, often in the form of a story that everyone in an organization can buy-into, it should steer decisions and guide investments throughout the entire digital transformation process. Further, it provides tangible benchmarks against which progress can be gauged and strategies can be refined. It is important that digitalization goals are aligned to the evolving needs of healthcare. MedTechs should harness the power of digitalization to meet the expectations of patients and adapt to dynamic clinical practices. This requires reconciling digital innovations with a company’s core values. A comprehensive and forward-looking vision (story) functions to safeguard a company's strengths against potential challenges. This first step toward a digitalization strategy serves to position a company for sustainable growth and enduring value creation.
2. Leadership commitment
The significance of securing buy-in from senior leadership teams lies in its assurance of resources, funding, and support, which are vital for the success of such an initiative. The endorsement from executives, beyond being a signal of change, serves as a catalyst for the allocation of both financial and human resources and has a substantial impact on the direction and depth of a digitalization strategy. By wholeheartedly supporting such an initiative, leaders disseminate not only a positive message about the importance attached to digitalization, but they also foster employee engagement, subsequently paving the way for the potential integration of digitalization across an entire company.

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3. Cross-functional synergy
Creating cross-functional teams is central for driving change, and should span departments like IT, R&D, operations, marketing, and regulatory affairs. The nature of a MedTech's digitalization strategy requires diverse expertise to successfully release technology's full potential. IT professionals contribute technical knowhow, which ensures the implementation and integration into existing infrastructure. R&D members provide visionary insights, encouraging innovative solutions and services. Operations specialists optimize processes for digital efficiency. Marketers strategize effective communications of digital progress. Regulatory experts ensure compliance and ethical considerations. Each contribution plays a distinct yet interconnected role, fostering collaborative brainstorming, shared goals, and pooled talents within a developing culture of agility and innovative. This approach breaks down silos, and aims to create a unified, technology-optimized future. Cross-functional teams act as the driving force to transform digital potential into a tangible reality.

4. Informed market insight
Market and consumer research is an important element of the strategy, as it uncovers customer needs, preferences, and pain points in digital healthcare. Such insights form the basis for tailored technologies that cater to specific needs, increasing patient engagement and satisfaction. Additionally, a successful digitalization strategy needs to identify and adapt to evolving trends in the digital MedTech sector. This entails monitoring emerging technologies, shifts in consumer behaviour, and advances in medical practices. Equally important is analyzing the competitive landscape to benchmark offerings and drive innovation. When companies are aligned to market dynamics, they are more likely to become digital leaders, fostering continuous improvement and innovation.

5. Technology assessment
Assessing a company's existing technology infrastructure helps to gauge whether a strategy can effectively leverage current investments and assets. Simultaneously, the assessment should uncover gaps and shortcomings. Identifying these informs targeted resource allocation for new technologies that support digital goals. Thus, a technology assessment allows organizations to strike a balance between leveraging existing capabilities and making targeted investments, in pursuit of their digital transformations.
6. Effective digital solutions
An essential aspect of a digitalization strategy involves identifying effective solutions and services. This process entails exploring various facets of an organization to integrate innovations; from improving customer engagement to optimizing workflows. Equally crucial is deploying technologies that improve patient outcomes, diagnoses, treatments, and monitoring. This stage also identifies potential revenue streams derived from new digital solutions and services, like remote patient monitoring, telemedicine, data analytics, and AI diagnostics, which strengthen existing offerings.
7. Partnerships
Engaging in collaborations with technology companies, start-ups, and various stakeholders creates opportunities for synergistic growth. Such partnerships enable enterprises to tap into diverse expertise, gain fresh perspectives, and access specialized resources, all of which support the development and implementation of digital solutions and services. Collaboration facilitates knowledge and resource pooling, enhancing innovation cycles and ensuring a comprehensive transformation of healthcare services. Simultaneously, acquisitions can enhance in-house capabilities. Exploring the acquisition of companies possessing relevant digital competencies or disruptive technologies offers a potential competitive edge. Such moves can help with assimilating novel technologies and developing a culture of innovation. Acquisitions can assist companies to position themselves as key players, advancing their digital health agenda and solidifying their position in an evolving industry.

8. Data management and security
Enhancing data management entails developing and implementing robust protocols. This involves refining data collection procedures, enforcing privacy and security measures, and adhering to healthcare regulations like the US Health Insurance Portability and Accountability Act (HIPAA) and the EU General Data Protection Regulation (GDPR), which safeguard patient data from breaches or misuse. Such measures establish a foundation for data management and security and help to foster stakeholder trust. Compliance with regulations like HIPAA and GDPR should not simply be viewed a legal obligation, but also as a moral commitment when handling sensitive patient data. Such a proactive stance strengthens a company's reputation for data integrity and helps to avoid legal repercussions.

9. Technology roadmap
A technology roadmap is a blueprint charting a course toward enhanced efficiency, patient-centric care, and heightened competitiveness. Beyond action planning, it provides clarity and purpose in navigating technological advancements. It consolidates an enterprise's digitalization efforts by integrating initiatives with timelines and resources, thereby establishing a framework for goal setting and assessment. Such planning assists timely project execution and supports the rationale for digitalization with measurable benefits. With a well-structured roadmap, stakeholders can appreciate how digital initiatives improve operations, trigger innovation, and enhance patient outcomes.

10. Pilot programmes
Pilot programmes serve as incubators and evidence-based validators for innovations, offering a means to test and enhance digital solutions before they are fully implemented. Such initiatives provide tangible evidence to support an enterprise's commitment to a digitalization strategy. Pilots offer concrete proof of an enterprise’s commitment to its digitalization strategy. Each programme should concentrate on specific solutions and establish a controlled setting for gathering user feedback, which constitutes an on-going effort to refine functionality. Additionally, pilots demonstrate a commitment to user-centric offerings by proactively tackling challenges, thereby improving the chances of successful, large-scale digital deployments.

11. Scalability and integration
Establishing scalability and integration capabilities is important for MedTechs to realize their digital transformation. As healthcare technology landscapes evolve and organizational needs change, the ability of digital solutions to scale and integrate with existing structures increases in importance. Ensuring these attributes contributes to a digital transformation. Scalability emphasizes a company’s adaptability to evolving demands. A scalable digital solution that expands in scope without sacrificing functionality invokes confidence. Further, integrating novel solutions and services with existing systems signals operational intelligence, which adds credibility to the digital transition. When digital solutions merge with legacy structures, they reflect an alignment of traditional expertise and cutting-edge technology. Emphasising scalability and integration involves anticipating future requirements and aligning digital strategies with longer-term organizational objectives.

12. Change management
By supporting a mindset that views digital technologies as enablers rather than disruptors, companies demonstrate their commitment to progress and cultural change. Implementing change management acknowledges the importance of cultural shifts and affirms an intent to embrace digital technologies holistically and sustainably. It acts as the vehicle, which guides an enterprise through transformation, and ensures stakeholder support for technological evolution. Through communication, training, and engagement policies, enterprises lay the groundwork for digital adoption, and smooth technology integration. This strengthens the case for change and demonstrates an organization's commitment to fostering an innovation-receptive environment.

13. Training and skill development
Central to a successful digitalization strategy is an investment in training and skill development. This underlines an organization's commitment to harnessing and effectively utilizing the transformative potential of technology. By training, corporations equip their employees with capabilities required to support digital solutions and services. Training bridges the gap between skill shortages and technological advancements. Empowering employees with the capacity to navigate digital technologies positions an enterprise for a successful transition, by a process that reconciles change with employee growth. Training reinforces the notion that digitalization is not just an operational enhancement but also a means to cultivate a workforce with capabilities, which contribute to operational excellence and sustainable expansion.

14. Regulatory adherence
Regulatory compliance is an important feature of a digital shift, as it demonstrates a company's commitment to upholding the highest standards of patient care and industry excellence. It shows that transformation is about embracing the future with integrity by ensuring that an enterprise’s  innovations are synchronized with the values underpinning medical practice. Adherence to regulatory standards is a declaration of an organization's commitment to patient safety and industry integrity. By ensuring all digital solutions and services adhere to rigorous medical regulations, corporations strengthen their case for digitalization within ethical and legal boundaries. Demonstrating adherence to medical regulations and industry benchmarks reinforces a new digital strategy as a responsible and trustworthy pursuit and showcases an organization's commitment to delivering technologies that both innovate and enhance patients' therapeutic journeys while respecting established medical protocols.

15. Market communication
Crafting a communication strategy is important as it underlines an organization’s commitment to transformation. Employing a variety of smart communication methods to describe the benefits of new digital offerings enables MedTechs to garner support from stakeholders and thereby strengthen their market position. By aiming at healthcare professionals, investors, payers, patients, providers and other stakeholders, these messages inform and persuade by highlighting the tangible benefits they bring to patient care, operational efficiency, and industry progress.

16. Feedback loop and iteration
Stakeholder feedback can be used to enhance digital solutions and services. By engaging users and patients, healthcare technologies can be tailored to cater to specific needs and preferences, fostering a user-centric design ethos. This collaborative approach identifies bottlenecks, deficiencies, and possible enhancements, which contribute to efficacious digital solutions and services. Moreover, stakeholder involvement helps to ensure a company's technological endeavours support broader healthcare goals, enhancing the overall quality of care. Iteration should be synonymous with evolution. Regularly integrating feedback to enhance the functionality of digital offerings enables an enterprise to adapt to market challenges and healthcare advancements.
17. Performance measurement
Effective evaluation of a company's digitalization strategy demands the use of key performance indicators (KPIs). These serve as a compass to assess the impact of digital solutions across patient outcomes, operational efficiency, and business expansion. By selecting relevant KPIs, MedTechs can show stakeholders the tangible effects of their digitalization strategy. These quantifiable metrics offer a lens to observe enhanced patient care, rectify operational inefficiencies, and decipher trends in business growth.
18. Fostering a culture of continuous innovation
An effective digitalization strategy relies on fostering a culture of perpetual innovation, which is essential to maintain a market-leading position. Such an approach encourages the creation, implementation and refinement of smart technological solutions and services. It equips MedTechs with the agility to quickly embrace emerging trends, capitalize on novel prospects, and tackle unforeseen challenges. Further, a culture of continuous innovation encourages an executive mindset that perceives setbacks as opportunities and views technology as evolving tools to improve patient care and operational efficacy.
 
19. Adaptation to market changes
MedTechs must rapidly adjust their digital strategies to match prevailing technological trends, regulations, and market dynamics. These ever-changing elements emphasize the need for a proactive, flexible digitalization approach that can swiftly adapt. By staying ahead of shifting trends, businesses are better positioned to leverage emerging technologies and provide solutions for evolving market needs. Navigating regulatory changes is equally important. Balancing compliance with innovative solutions ensures the integration of digital offerings in a dynamic healthcare setting. Flexibility should extend to market fluctuations, aligning digitalization strategies with customer demands and competition. This not only helps a company to navigate volatile markets but also positions it as an agile player, primed for change and enduring growth.

20. Embracing longer-term sustainability
For MedTechs, it is important that their digital strategies align with their principal longer-term objectives. Instead of solely pursuing immediate gains, this strategy should support a company's core purpose and future aspirations, which are embedded within its day-to-day operations. Such an approach establishes an innovative, adaptable, and resilient framework and strengthens the potential for growth. When a digitalization strategy is aligned with a company’s longer-term goals, it assumes the role of a catalyst for growth by optimizing the utilization of resources, improving brand resilience, and securing a distinct competitive advantage. During constantly evolving technologies and markets, such an alignment provides the capacity for a company to effectively confront challenges and capitalize on emerging opportunities, thereby either moving into, or securing, a leadership position within the rapidly changing market landscape.
 
Takeaways 
 
In the face of rapid technological evolution, the MedTech industry finds itself at a crucial juncture. While other sectors have embraced digitalization, many large diversified MedTechs have been hesitant in adopting these transformative tools. Yet, the imperative is clear: for sizable companies, the present demands recognition of digitalization's potential to drive growth and cultivate value. The fusion of conventional medical devices with digital innovations not only augments patient care but also streamlines operations and encourages innovation. The consequences of delaying this integration are significant. Without prompt action, corporations risk narrowing their competitive horizons and struggling to accelerate growth and enhance value. Failure to adapt may result in a substantial disadvantage in the rapidly changing arena of healthcare technology. It is important for MedTechs that have not already done so, to pivot towards digitalization and transform their challenges into opportunities, ensuring a dynamic and thriving future in an increasingly interconnected world.
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  • Digitalization, big data, and artificial intelligence (AI) are transformational technologies poised to shape the future of MedTech companies over the next decade
  • Fully embracing these technologies and integrating them in all aspects of a business will likely lead to growth, and competitive advantage while treating them as peripheral add-ons will likely result in stagnation and decline
  • MedTech executives’ analogue mindsets and resource constraints prevent them from fully embracing transformational technologies
  • There are also potential pushbacks from employees, patients, providers and investors
  • Notwithstanding, there are unstoppable structural trends forcing governments and payers throughout the world to oblige healthcare systems to leverage digitalization, big data, and AI to help reduce their vast and escalating healthcare burdens
  • Western MedTechs are responding to the rapidly evolving healthcare landscape by adopting transformational technologies and attempting to increase their presence in emerging markets, particularly China
  • To date, MedTech adoption and integration of digitalization, big data, and AI have been patchy
  • To remain relevant and enhance their value, Western MedTechs need to learn from China and embed transformational technologies in every aspect of their businesses
 
Unleashing MedTech's Competitive Edge through Transformational Technologies
Digitalization, Big Data, and AI as Catalysts for MedTech Competitiveness and Success
 
 
In the rapidly evolving landscape of medical technology, the integration of digitalization, big data, and artificial intelligence (AI) [referred to in this Commentary as transformational technologies] has emerged as a pivotal force shaping the future of MedTech companies.  Such technologies are not mere add-ons or peripheral tools but will soon become the lifeblood that fuels competition and enhances the value of MedTechs. From research and development (R&D) to marketing, finance to internationalization, and regulation to patient outcomes, digitalization, big data, and AI must permeate every aspect of medical technology businesses if they are to deliver significant benefits for patients and investors. To thrive in this rapidly evolving high-tech ecosystem, companies will be obliged to adapt to this paradigm shift.
 
Gone are the days when traditional approaches would suffice in the face of escalating complexities and demands within the healthcare industry. The convergence of transformational technologies heralds a new era, where innovation and success are linked to the ability to harness the potential of digitalization, big data, and AI. MedTech companies that wish to maintain and enhance their competitiveness must recognize the imperative of integrating these technologies across all facets of their operations. From improving their R&D processes by utilizing advanced data analytics and predictive modeling, to optimizing internal processes through automation and machine learning algorithms. Embracing such technologies opens doors to enhanced marketing strategies, streamlined financial operations, efficacious legal and regulatory endeavours, seamless internationalization efforts, and the development of innovative offerings that cater to the evolving needs of patients, payers, and healthcare providers.
 
This Commentary aims to stimulate discussion among MedTech senior leadership teams as the industry's competitive landscape continues to rapidly evolve, and the fusion of digitalization, big data, and AI becomes not only a strategic advantage but a prerequisite for survival in an era defined by data-driven decision-making, personalized affordable healthcare, and a commitment to improving patient outcomes.
 
In this Commentary

This Commentary explores digitalization, big data, and AI in the MedTech industry. It presents two scenarios: one is to fully embrace these technologies and integrate them into all aspects of your business and the other is to perceive them as peripheral add-ons. The former will lead to growth and competitive advantage, while the latter will result in stagnation and decline. We explain why many MedTechs do not fully embrace transformational technologies and suggest this is partly due to executives’ mindsets, resource constraints and resistance from employees, patients, and investors. Despite these pushbacks, the global healthcare ecosystem is undergoing an unstoppable transformation, driven by aging populations and significant increases in the prevalence of costly to treat lifetime chronic conditions. Western MedTechs are responding to structural shifts by adopting transformational technologies and increasing their footprints in emerging markets, particularly China. To date, company acceptance of AI-driven strategies has been patchy. We suggest that MedTechs can learn from China and emphasize the need for organizational and cultural change to facilitate the comprehensive integration of transformational technologies. Integrating these technologies into all aspects of a business is no longer a choice but a necessity for companies to stay competitive in the future.
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Transformational technologies in MedTech

Digitalization in the MedTech industry involves adopting and integrating digital technologies to improve healthcare delivery, patient care, and operational efficiency. It transforms manual and paper-based processes into digital formats, enabling electronic health records, connected medical devices, telemedicine, and other digital tools. This allows for seamless data exchange and storage, improving clinical processes, decision-making, and patient empowerment. Big data in the MedTech industry refers to the vast amount of healthcare-related information collected from various sources. It includes structured and unstructured data such as patient demographics, clinical notes, diagnostic images, and treatment outcomes. Big data analysis identifies patterns, correlations, and trends that traditional methods may miss. They aid medical research, drug discovery, personalized medicine, clinical decision support, evidence-based care, population health management, and public health initiatives. Data privacy, security, and ethical use are crucial considerations. Artificial Intelligence (AI) in the MedTech industry uses computer algorithms to simulate human intelligence. AI analyzes medical data to identify patterns, make predictions, and improve diagnoses, treatment plans, and patient outcomes. It assists in medical imaging interpretation, personalized medicine, and patient engagement. In R&D, AI accelerates the development of devices and the discovery of new therapies and has the capacity to analyze scientific literature and molecular data. The technology serves as a tool to augment healthcare professionals' expertise and support decision-making.
With the proliferation of large language AI models (LLM) and to borrow from a recent essay by Marc Andreeseen - an American software engineer, co-author of Mosaic, [one of the first widely used web browsers] and founder of multiple $bn companies - everyone involved with medical technology, including R&D, finance, marketing, manufacturing, regulation, law, international etc., “will have an AI assistant/collaborator/partner that will greatly expand their scope and achievement. Anything that people do with their natural intelligence today can be done much better with AI, and we will be able to take on new challenges that have been impossible to tackle without AI, including curing all diseases.”

Two scenarios

We suggest there are only two scenarios for MedTechs: a company that fully embraces transformational technologies and one that does not. The former, will benefit from strengthened operational efficiencies, improved patient outcomes, and enhanced innovations, which will lead to increased market share and investor confidence. By leveraging digital technologies, such as remote monitoring devices, telemedicine platforms, LLMs, and machine learning, a company will be able to offer more personalized, effective and affordable healthcare services and solutions. An enterprise that integrates these technologies into their strategies and business models will, over time, experience improved growth prospects, increased revenues, and potentially higher profitability. These factors will contribute to a positive perception in the market, leading to an increase in company value. MedTechs that fail to fully embrace digitalization, big data, and AI will face challenges in adapting to the rapidly evolving healthcare landscape. They will struggle to remain competitive and relevant in a market that increasingly values transformational technologies and data-driven approaches. As a result, such companies will experience slower growth, lower market share, and limited investor interest, which will lead to a stagnation or decline in their value.
 
The analogue era's influence on MedTechs

If the choice is so stark, why are many MedTechs not grabbing the opportunities that transformational technologies offer? To answer this question let us briefly remind ourselves that the industry took shape in an analogue era, which had a significant effect on how MedTech companies evolved and established themselves. During the high growth decades of the 1980s, 1990s, and early 2000s, the medical technology industry operated with limited access to the technologies that have since radically changed healthcare. The 1980s marked a period of advancements, which included the widespread adoption of medical imaging such as computed tomography (CT) scans and magnetic resonance imaging (MRI). These modalities provided detailed visualizations of the human body, supporting more accurate diagnoses. Medical devices like pacemakers, defibrillators, and implantable cardioverter-defibrillators (ICDs) were developed and improved the treatment of heart conditions. The 1990s witnessed further advancements, with a focus on minimally invasive procedures. Laparoscopic surgeries gained popularity, allowing surgeons to perform operations through small incisions, resulting in reduced patient trauma and faster recovery times. The development of laser technologies enabled more precise surgical interventions. The decade also saw the rise of biotechnology, with the successful completion of the Human Genome Project and increased emphasis on genetic research. The early 2000s saw the emergence of digital transformation in some quarters of the medical technology industry. Electronic medical records (EMRs) began to replace paper-based systems, increase data accessibility and upgrade patient management. Telemedicine, although still in its nascent stages, started connecting healthcare providers and patients remotely, overcoming geographical barriers. Robotics and robotic-assisted surgeries gained traction, enabling more precise and less invasive procedures. During these formative decades, the medical technology industry focused on enhancing diagnostic capabilities, improving treatment methods, and streamlining healthcare processes. The industry had yet to witness the transformational impact of digitalization, big data and AI that would emerge in subsequent years, enabling more advanced analytics, personalized medicine, and interconnected healthcare systems.
 
From analogue to digital

During these formative analogue years, MedTechs experienced significant growth and expansion, where innovative medical technologies changed healthcare practices and improved patient outcomes. Companies thrived by leveraging their expertise in engineering, biology, and clinical research and developed medical devices, diagnostic tools, and life-saving treatments. For MedTechs to experience similar growth and expansion in a digital era, they must fully harness the potential of transformational technologies, and to achieve this, there must be a receptive mindset at the top of the organization.
 
According to a recent study by Korn Ferry, a global consulting and search firm, the average age of CEOs in the technology sector is 57, and the average age for a C-suite member is 56. Thus, as our brief history suggests, many MedTech executives advanced their careers in a predominantly analogue age, prior to the proliferation of technologies that are transforming the industry today. Thus, it seems reasonable to suggest that this disparity in experience and exposure colours the mindsets of many MedTech executives, which can lead to them underestimating and under preparing for the significant technological changes that are set to reshape the healthcare industry over the next decade. Senior leadership teams play a pivotal role in developing the strategic direction of companies and driving their success. Without a proactive mindset shift, these executives may struggle to fully comprehend the extent of the potential disruptions and opportunities that digitalization, big data, and AI bring.
 
By embracing such a mindset shift, senior leadership teams could foster a culture of innovation and agility. But they must recognize the urgency of preparing for a future fueled by significantly different technologies from those they might be more comfortable with. Such urgency is demonstrated by a March 2023 Statista report, which found that in 2021, the global AI in healthcare market was worth ~US$11bn, but forecasted to reach ~US$188bn by 2030, increasing at a compound annual growth rate  (CAGR) of ~37%. As these and other facts (see below) suggest, the integration of digitalization, big data, and AI has already begun to redefine healthcare delivery, patient engagement, and operational efficiency and is positioned to accelerate in the next decade. To remain competitive and relevant in this rapidly evolving high-tech world, MedTechs must foster a culture of openness to change and innovation. Leaders should encourage collaboration, both internally and externally, and create cross-functional teams that bring together expertise from various domains, including AI and data analytics. This multidisciplinary approach facilitates the integration of transformational technologies into all aspects of the business, ensuring that the organization remains at the forefront of the evolving industry.

 
Implementation and utilization

Limited resources, such as budgets and IT infrastructure, can hinder the adoption and utilization of digitalization, big data, and AI, especially for smaller companies. Compliance with healthcare regulations like HIPAA and GDPR adds complexity and can slow down technology implementation. Resistance to change from employees, healthcare providers, and patients also poses challenges. Fragmented and unstandardized healthcare data limit the effectiveness of AI-driven strategies. The expertise gap can be bridged through collaboration with academic institutions and technology companies. Demonstrating the tangible benefits of digitalization, big data and AI is essential to address concerns about return on investments (ROI). Strategic planning, resource investment, collaboration, and cultural change are necessary for the successful implementation and utilization of transformational technologies in MedTech companies. 
 
Organizational and cultural changes

MedTechs must embrace agility and innovation to harness the potential benefits from transformational technologies. This requires fostering a culture that encourages risk-taking and challenges conventional practices. Creating cross-functional teams and promoting collaboration nurtures creativity and innovative solutions. Transitioning to data-driven decision-making involves establishing governance frameworks, ensuring data quality, and leveraging analytics and insights from big data. Talent development and upskilling are crucial, necessitating training programmes to improve digital literacy and add analytics skills. Collaboration and partnerships with external stakeholders facilitate access to cutting-edge technologies. Enhancing patient experiences through user-friendly interfaces and personalized solutions is essential. Investing in agile technology infrastructure, including cloud computing and robust cybersecurity measures is necessary. MedTechs must navigate complex regulatory environments while upholding ethical considerations, transparency, and patient consent to gain credibility and support successful technology adoption.
 
Investors

A further potential inhibitor to change is MedTech investors who may harbour conservative expectations that tend to discourage companies from taking risks, such as fully embracing and integrating digitalization, big data, and AI across their entire businesses. This mindset also can be traced back to the formative analogue decades on the 1980s, 1990s, and early 2000s when investors became accustomed to growing company valuations. During that time, most MedTechs catered to an underserved, rapidly expanding market largely focussed on acute and essential clinical services in affluent regions like the US and Europe, where well-resourced healthcare systems and medical insurance compensated activity rather than patient outcomes. However, the landscape has since undergone a radical change. Aging populations with rising rates of chronic diseases have significantly increased the demands on over-stretched healthcare systems, which have turned to digitalization, big data, and AI in attempts to reduce their mounting burdens. These shifting dynamics now demand a more forward-thinking approach, but investor expectations often remain fixed on a past traditional model, which impedes the adoption and full integration of transformational technologies into MedTech enterprises.

To overcome investor conservatism and reluctance to embrace transformational technologies requires a concerted effort by MedTechs to demonstrate the tangible benefits of these technologies on the industry. Companies can focus on providing evidence of improved patient outcomes, increased efficiency, cost savings, and competitive advantages gained through the integration of digitalization, big data, and AI. Engaging in open and transparent communications with investors, showcasing successful case studies, and highlighting the long-term potential and sustainability of a technology-driven approach can help shift investor expectations and encourage a more receptive attitude towards risk-taking and innovation.
Global structural drivers of change

For decades, Western MedTechs have derived comfort from the fact that North America and Europe hold 68% of the global MedTech market share. These wealthy regions have well-resourced healthcare systems, which, as we have suggested, for decades rewarded clinical activity rather than patient outcomes, and MedTech’s benefitted by high profit margins on their devices, which contributed to rapid growth, and enhanced enterprise values. Today, the healthcare landscape is significantly different. North America and Europe are experiencing aging populations, and large and rapidly rising incidence rates of chronic diseases in older adults. Such trends are expected to continue for the next three decades and have forced governments and private payers to abandon compensating clinical activity and adopt systems that reward patient outcomes while reducing costs. This shift has put pressure on healthcare systems to adopt transformational technologies to help them cut costs, increase access, and improve patient journeys. MedTech companies operating in this ecosystem have no alternative but to adapt. Their ticket for increasing their growth and competitiveness is to adopt and integrate digitalization, big data, and AI into every aspect of their business, which will help them to become more efficient and remain relevant.
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Most developed economies are experiencing aging populations, which affect everything from economic and financial performance to the shape of cities and the nature of healthcare systems. Let us illustrate this with reference to the US. According to the US National Council on Aging, ~56m Americans are ≥65 and this cohort is projected to reach ~95m by 2060. On average, a person ≥65 is expected to live another 17 years. Older adult Americans are disproportionately affected by costly to treat lifetime chronic conditions such as cancer, heart disease, diabetes, respiratory disorders, and arthritis. ~95% of this older adult cohort have at least one chronic disease, and ~80% have two or more. Multiple chronic disorders account for ~66% of all US healthcare costs and ~93% of Medicare spending.

According to a May 2023, Statista report, the US spends more on healthcare than any other country. In 2021, annual health expenditures stood at US$4.2trn, ~18% of the nation’s Gross Domestic Product (GDP). The demographic trends we described in the US are mirrored in all the principal global MedTech markets. Many of which, particularly Japan, are also experiencing shrinking working age populations resulting from a decline in fertility rates, and curbs on immigration. This shrinkage further impacts a nation’s labour force, labour markets, and tax receipts; all critical for resourcing and paying for healthcare services.
 
MedTechs’ response to structural changes

Western MedTechs’ response to these structural challenges have been twofold: (i) the adoption of transformational technologies, which contribute to lowering healthcare costs, improving innovation, and developing affordable patient-centric services and solutions and (ii) targeting emerging markets as potential areas for growth and development. As we have discussed the first point, let us consider briefly the second. Decades ago, giant MedTechs like Johnson and Johnson (J&J), Abbott Laboratories and Medtronic established manufacturing and R&D centres in emerging economies like Brazil, China, and India, where markets were growing three-to-four times faster than in developed countries. Notwithstanding, many MedTechs, were content to continue serving wealthy developed regions - the US and Europe - and either did not enter, or were slow to enter, emerging markets. More recently, as a response to the trends we have described, many MedTechs are either just beginning or accelerating their international expansions. However, such initiatives might be too late to reap the potential commercial benefits they anticipate. Establishing or expanding a footprint in emerging economies is significantly more challenging today than it was two decades ago. 

For instance, two decades ago, China lacked medical technology knowhow and experience and welcomed foreign companies’ participation in its economy. Today, the country has evolved, enhanced its technological capacity and capabilities, and is well positioned to become the world’s leading technology nation by 2030. No longer so dependent on foreign technology companies, the Chinese Communist Party (CCP) raised barriers to their entry. In 2017, government leaders announced the nation's intention to become a global leader in AI by putting political muscle behind growing investment by Chinese domestic technology companies, whose products, services and solutions were used to improve the country's healthcare systems. Over decades, the CCP committed significant resources to developing domestic STEM skills, and research to achieve “major technological breakthroughs” by 2025, and to make the nation a world leader in technology by 2030, overtaking its closest rival, the US. According to a 2023 AI Report from the Stanford Institute for Human-Centered Artificial Intelligence, in 2021, China produced ~33% of both AI journal research papers and AI citations worldwide. In economic investment, the country accounted for ~20% of global private investment funding in 2021, attracting US$17bn for AI start-ups. The nation’s AI in the healthcare market is fueled by the large and rising demand for healthcare services and solutions from its ~1.4bn population, a large and rapidly growing middle class, and a robust start-up and innovation ecosystem, which is projected to grow from ~US$0.5bn in 2022 to ~US$12bn by 2030, registering a CAGR of >46%. 

>4 years ago, a HealthPad Commentary described how a Chinese internet healthcare start-up, WeDoctor, founded in 2010, bundles AI and big data driven medical services into smart devices to help unclog China’s fragmented and complex healthcare ecosystem and increase citizens’ access to affordable quality healthcare. The company has grown into a multi-functional platform offering medical services, online pharmacies, cloud-based enterprise software for hospitals and other services. Today, WeDoctor owns 27 internet hospitals, [a healthcare platform combining online and offline access for medical institutions to provide a variety of telehealth services directly to patients], has linked its appointment-making system to another 7,800 hospitals across China (including 95% of the top-tier public hospitals) and hosts >270,000 doctors and ~222m registered patients. It is also one of the few online healthcare providers qualified to accept payments from China's vast public health insurance system, which covers >95% of its population. WeDoctor, like other Chinese MedTechs, has expanded its franchise outside of China and has global ambitions to become the “Amazon of healthcare”. China’s investment in developing and increasing its domestic transformational technologies and upskilling its workforce has made the nation close to technological self-sufficiency and has significantly raised the entry bar for Western MedTechs wishing to establish or extend their presence in the country.

China's progress in AI and digital healthcare underscores the urgent need for Western MedTechs to adopt and implement these technologies. To remain relevant and survive in a rapidly changing global healthcare ecosystem, Western MedTechs might do well to learn from China's endeavours in leveraging AI, big data, and digitalization to drive innovation, enhance competitiveness, and ultimately contribute to the transformation of the global healthcare landscape. Notwithstanding, be minded of the ethical concerns Western nations have regarding China’s utilization of big data and AI in its healthcare system and its potential to compromise privacy and individual rights due to the CCP's extensive collection and analysis of personal health data.

 
Takeaways

Digitalization, big data, and AI are transformational technologies that have the power to influence the shape of MedTech companies over the coming decade, and their potential impact should not be underestimated. Fully embracing these technologies and integrating them into every aspect of a business is necessary for growth and competitive advantage. On the other hand, treating them as peripheral add-ons will likely lead to stagnation and decline. However, the path towards their full integration in companies is not without its challenges. MedTech executives, hindered by their analogue mindsets and resource constraints, often struggle to fully embrace the potential of digitalization, big data, and AI. Moreover, there may be pushbacks from various stakeholders including employees, patients, healthcare providers, and investors. These concerns and resistances can impede the progress of transformation within the industry. Nonetheless, governments and payers across the globe are being compelled by unstoppable structural trends to enforce the utilization of digitalization, big data, and AI within healthcare systems. The large and escalating healthcare burdens facing economies throughout the world leave them with little choice but to leverage these technologies to reduce costs, improve patient access and outcomes. In response to the rapidly evolving healthcare landscape, Western MedTechs are making efforts to adopt transformational technologies and expand their presence in emerging markets, particularly China. They recognize the need to stay ahead of the curve and adapt to the changing demands of the industry. However, the adoption and integration of digitalization, big data, and AI by companies thus far have been inconsistent and patchy. To remain relevant and enhance their value, Western MedTechs, while being mindful of ethical concerns about China’s use of AI-driven big data healthcare strategies, might take cues from their Chinese counterparts and embed these transformational technologies in every aspect of their businesses. The transformative impact of digitalization, big data, and AI on MedTech companies cannot be overstated. While challenges and resistance may arise, the inexorable drive towards leveraging these technologies is unstoppable. MedTech companies should shed their analogue mindsets and resource constraints and fully embrace the potential of these transformational technologies.
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  • MedTechs have experienced significant transformation through mergers and acquisition (M&A) to achieve steady growth, diverting resources from innovative research and development (R&D) initiatives
  • The industry’s M&A activities were fueled by a prolonged period of low interest rates and easy access to capital
  • Consequently, R&D efforts focussed on incremental improvements rather than breakthrough innovations
  • This financial-centric business model led to risk-averse bureaucracies among many MedTechs, resulting in a strategic deadlock with limited growth prospects
  • Adding to the challenges, the current era witness’s debt and asset prices surpassing productivity and economic output
  • For many MedTechs, these macro-economic conditions potentially pose funding constraints, reduced market demand, tightening regulatory challenges, cost pressures, and market volatility, further hindering their ability to overcome the deadlock
  • To address these issues and help MedTechs break free from their strategic deadlocks and create long-term value we propose seven strategic initiatives
 
The Financialization Dilemma of MedTechs
 
In the 1990s and 2000s, medical technology companies received praise for their rapid growth. However, they currently find themselves at a crucial juncture, facing challenges of low and stagnant growth rates. Additionally, an uncertain long-term outlook looms over them due to the expansion of global balance sheets surpassing GDP, as well as debt and asset prices outpacing productivity and economic output. This Commentary aims to shed light on how many MedTechs reached this strategic deadlock. It also proposes strategies that these companies can pursue to break free from this predicament, which have the potential to significantly enhance growth rates, improve balance sheet health, and foster value creation.
 
An era of low interest rates and cheap capital

The financialization of MedTechs has played a significant role in their current strategic deadlock, and the most viable solution lies in accelerating productivity. This financialization was facilitated by a prolonged period of low interest rates and easy access to inexpensive capital. Over the span of four decades, starting from the 1980s to the early 2020s, interest rates steadily declined across most industrialized nations. In the aftermath of the 2008-09 financial crisis, many countries adopted a low interest rate environment to stimulate economic recovery and restore liquidity in their banking systems. For example, the US Federal Reserve Board (Fed) lowered short-term interest rates from 4.25% in December 2007 to nearly zero by December 2008, registering the lowest rate in the Fed's history.
 
During the era of persistently low interest rates and readily available capital, MedTechs experienced a surge in merger and acquisition (M&A) activities, primarily targeting companies in near-adjacent sectors to capitalize on low-risk opportunities for incremental growth. This trend fostered a culture of consolidation, driven by the desire to access new technologies and broaden product portfolios. While M&A activities bolstered short-term profits and shareholder value, they often led to a neglect of research and development (R&D) initiatives. Acquisitions were perceived as a less risky and quicker avenues for expanding product lines, overshadowing investments in R&D. Consequently, many MedTechs adopted a risk-averse approach, channeling their R&D efforts towards incremental improvements of existing products rather than pursuing ground-breaking innovations that could significantly improve patient outcomes and disrupt the industry. Moreover, the increasingly stringent regulatory environment for medical devices, particularly in Europe, further discouraged companies from investing in R&D due to longer development timelines and escalated costs.
 
Over the years, these policies resulted in the consolidation of power and resources among a few large players, leading to the emergence of market oligopolies and the decline in industry diversity. This scenario posed challenges for smaller companies with innovative ideas, as they struggled to compete with established enterprises, thereby impeding both innovation and healthy competition. Moreover, established MedTechs benefited from the significant and rapidly growing healthcare demands in affluent Western markets, particularly North America and Europe, which account for ~65% of the global medical device market. In these markets, compensation was often tied to medical and surgical procedures rather than focussing on patient outcomes, further favouring the established industry players. While M&A can be an effective growth strategy, it is important for companies to strike a balance and prioritize innovation alongside their consolidation efforts to ensure sustainable success and drive meaningful advancements in the industry.
 
An era of surging prices and low productivity

We have now entered a distinct era that differs significantly from the previous era characterized by low interest rates, and easily accessible funds. Starting from March 2022, the Fed has implemented 10 consecutive rate hikes, bringing its benchmark rate to 5.25%. These increases, coupled with high leverage in the corporate sector, escalating geopolitical tensions and  instability in the banking world triggered by the Silicon Valley Bank (SVB) collapse in March 2023, compounds the challenges faced by MedTechs. Furthermore, global balance sheets have expanded at a much faster pace than Gross Domestic Product (GDP). Debt and asset prices have surged far more rapidly than productivity and economic output. This trend is underscored by a report published in May 2023 by the McKinsey Global Institute, which reveals that the past two decades have resulted in the creation of US$160trn in paper wealth but have been marked by sluggish growth and the rise of inequality. According to the report, every US$1 invested has generated US$1.9 in debt.
 
Strategic initiatives to adapt and thrive

When global balance sheets expand at a faster rate than GDP and debt and asset prices outpace productivity, it becomes a concerning sign for MedTechs who find themselves trapped in a strategic deadlock characterized by sluggish growth and a fading belief in long term value creation. Under these conditions, companies should expect to encounter funding limitations, decreased market demand, stricter regulatory obstacles, cost pressures, and increased market volatility. In such a testing business environment, it is important for MedTechs to adopt bold adaptive strategies and navigate wisely to ensure continuous growth and enhanced value. We suggest seven such initiatives that are likely to help MedTechs break free from their strategic cul-de-sacs. By implementing these with vigour, companies can position themselves for success in an ever-changing and demanding economic and geopolitical landscape.
1. Revamp R&D
 
In recent times, costs associated with MedTech R&D have escalated. A study published in the September 2022 edition of the Journal of the American Medical Association (JAMA), and carried out by the US government’s Office of Science and Technology Policy, found that the development cost for a complex therapeutic medical device, from proof of concept through post approval stages, is US$522m. Significantly, the nonclinical development stage accounted for 85% of this cost, whereas the US Food and Drug Administration (FDA) submission, review and approval stage comprised 0.5%.
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Re-imagining healthcare
Thus, MedTechs have the potential to optimize their R&D processes, enabling them to develop more swiftly and economically ground-breaking devices that result in enhanced patient outcomes and expanded market share. To achieve this, companies may consider the following strategies to improve their R&D processes: (i) Integrating artificial intelligence (AI), machine learning, and big data techniques into their R&D endeavours and harnessing the power of these advanced technologies. (ii) Collaborating with academic institutions and start-ups to gain access to novel innovations and expertise. This collaboration can involve joint development and co-creation of innovative offerings. To tap into a diverse pool of expertise and resources, companies should consider a platform-based approach to R&D, which potentially improves the capacity to drive breakthrough advancements that improve patient care. (iii) Implementing agile methodologies to accelerate the R&D process, which involves breaking projects into smaller, more manageable segments and swiftly iterating based on stakeholder feedback. (iv) Engaging patients in the design process to ensure that newly developed offerings cater specifically to their needs, ultimately enhancing patient satisfaction.
 
2. Emphasize patient-centric care
 
Enhancing patient-centric care to improve outcomes is a crucial factor in the future of healthcare provision. There is a growing body of evidence indicating that patient choices will have an increased influence on the provision of healthcare over the next decade. With patients having more options and autonomy, MedTechs can leverage patient-centric strategies to better understand and address their needs, ultimately leading to improved market share. To achieve this, companies must prioritize effective communication, product education, and support services to build stronger relationships with patients. This requires increased utilization of electronic health records, advanced AI, data analytics capabilities, active engagement with patient communities, leveraging social media platforms, establishing patient advisory boards, and forging partnerships with payers and providers.
 
Further, embracing value-based care models is important for MedTechs. By prioritizing positive patient outcomes over quantity, companies can contribute to the development of sustainable care. As global healthcare systems transition toward value-based care, MedTech companies should align their offerings accordingly. Emphasizing solutions that enhance patient outcomes, reduce healthcare costs, and provide overall value positions, MedTechs become indispensable partners in the evolving healthcare landscape. This also may involve developing outcome-based pricing models, implementing remote monitoring solutions, and demonstrating real-world evidence of product effectiveness.
 
3. Revitalize organizational and operating models
 
Revitalizing organizational and operating models is essential for MedTechs to boost their growth rates and adapt to a rapidly evolving market. While companies experienced significant growth in the past, recent trends have shown a shift towards risk-averse bureaucracies, accepting modest annual growth rates as the "new normal". To overcome this stagnation and meet evolving customer demands, traditional MedTechs should consider embracing agile and flexible structures.
 
By flattening hierarchies and fostering cross-functional teams, organizations can facilitate faster decision-making processes. Implementing lean manufacturing and optimizing operational processes can reduce waste, enhance productivity, accelerate time to market, and lower costs. Leveraging AI-driven data analytics enables the extraction of valuable insights from vast datasets, empowering MedTechs to anticipate customer needs and market trends.

 
4. Harness the power of digital, AI and big data
 
Digital transformation has become a necessity rather than a choice. Although companies like Stryker and Siemens have championed digitalization, widespread implementation still remains a challenge. Indeed, Siemens’ suggests digitalization is “something that is often talked about but not fully implemented”. Previous Commentaries have shown how MedTechs can employ digital technologies to improve products, streamline operations, enhance customer experiences, and reduce costs. Streamlining operations and optimizing costs without compromising quality is crucial in the face of escalating economic pressures. This may involve re-evaluating supply chains, improving manufacturing processes, and adopting digital solutions.
 
In today's rapidly evolving digital age, investing in digital and analytics capabilities has become indispensable for companies as they shape their R&D, hone their processes and shift to a customer-centric stance. The seamless integration of digital and AI-driven techniques, along with data-driven decision processes, has emerged as a crucial factor in maintaining and improving competitiveness. For MedTechs, it is imperative to cultivate a culture of innovation that encourages and rewards experimentation and risk-taking. By doing so, organizations create an environment where employees are empowered to explore ideas, learn from failures, and ultimately drive meaningful innovations.  Therefore, actively seeking external partnerships with technology companies, start-ups and academic institutions is a strategic move for MedTechs to access cutting-edge technologies and expertise in digital and analytics. By embracing these capabilities as core rather than adjunct components of their strategies, fostering an innovation-centric culture, and investing in talent development and retention, corporations position themselves optimally to leverage the transformative potential of digital and analytical technologies. This, in turn enables them to thrive in an increasingly interconnected and data-driven healthcare ecosystem.

 
5. Talent acquisition and retention
 
The rapidly changing landscape of globalization, the increasing influence of AI techniques, and the demands of a new generation of consumers seeking personalized experiences have compelled MedTechs to reassess their approach to talent acquisition and retention. To keep up with the pace of change, it is crucial for these companies to attract and retain highly skilled professionals with expertise in technology, healthcare, and business. A talented workforce plays a vital role in driving innovation, ensuring efficient and safe processes, navigating complex market dynamics, and effectively executing growth strategies. To achieve this, companies should invest in the development of their employees, foster a culture of innovation, and offer competitive compensation packages to attract and retain top performers.
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According to a study published by the Harvard Business Review in January 2020, retaining top talent has become increasingly challenging for employers. The study revealed that in 2018, 25% of employed Americans left their jobs, with approximately 33% of this turnover attributed to unsupportive management and a lack of development opportunities. MedTech companies are not exempt from this trend, and to acquire and retain talent, they must strategically revamp their value propositions to align with the evolving needs and expectations of the modern workforce.
A crucial step in this direction is fostering a purpose-driven culture that highlights the significant impact medical technology companies have on improving people's lives. By instilling a sense of purpose, employees are more likely to develop a strong connection to the company's mission, inspiring them to consistently deliver their best work. Furthermore, providing ample career development opportunities is essential in empowering employees to enhance their skills and progress in their professional journeys. This can be achieved through training programmes, mentoring initiatives, and leadership development schemes.
 
Recognizing the importance of work-life balance is also critical. MedTechs can prioritize flexible working hours, a 4-day week, remote work options, generous vacation policies, allowing employees to effectively balance their personal and professional lives. By creating a supportive environment that promotes overall well-being and job satisfaction, companies can foster employee loyalty.
 
Competitive compensation and benefit packages are essential. Additionally, a commitment to diversity and inclusion is pivotal for MedTechs aspiring to become employers of choice. By emphasizing diversity in hiring practices and cultivating an inclusive work environment where every individual feels valued and respected, corporations can attract and retain a diverse array of talent. This, in turn, creates an environment conducive to enhanced innovation, creativity, and problem-solving.
 
Despite best efforts, there may be instances where companies are unable to attract and retain individuals with the necessary capabilities. In such cases, strategic partnerships, joint ventures, licensing agreements, and co-development initiatives allow MedTechs to tap into external expertise and resources, which can be employed to enhance product portfolios and gain access to new markets.

 
6. Realize global opportunities
 
MedTechs, traditionally reliant on most of their revenues from affluent US and European markets, now have the chance to expand their horizons and explore the untapped potential of the rapidly growing markets in Asia, Middle East and Africa, and Latin America. These regions boast transitioning demographics, with aging populations and a surge in chronic diseases. Additionally, their large and expanding middle-class populations demand advanced care, prompting governments to increase their healthcare expenditures significantly. By venturing into and expanding their footprints in these markets, Western MedTechs can diversify their revenue streams and leverage the growth opportunities stemming from the escalating demand for cutting-edge medical technologies and services.
 
Expanding into emerging markets not only provides a means to mitigate risks associated with economic volatility and changing regulatory environments but also necessitates acquiring new capabilities, fostering a change in executive mindsets, and embracing flexible pricing models. By adapting to the unique demands and challenges of these markets, MedTechs can position themselves strategically to tap into the vast potential they offer. This expansion serves as a catalyst for sustained growth and allows companies to seize opportunities that would otherwise remain untapped, thus bolstering their long-term success.

 
7. Align with rising ESG standards
 
To fully leverage their capabilities and resources and meet rising standards in ESG (Environmental, Social, and Governance), MedTechs might consider taking bold actions that: (i) embrace sustainable manufacturing practices to minimize their environmental impact, which entail reducing waste, water, and energy consumption, as well as transitioning to renewable energy sources. Such practices contribute to environmental conservation and mitigate a company’s carbon footprint, (ii) adopt circular economy principles, which involve designing products with a focus on reusability and recyclability. Additionally, establishing take-back programmes for end-of-life products, which ensure responsible disposal and encourage the reuse of valuable materials, thereby reducing waste and promoting sustainability, (iii) develop products that improve patient health, safety, and overall quality of life. This requires a patient-centric mindset, discussed above, that emphasizes the social impact and positive contributions MedTechs can make to society, (iv) produce offerings that are accessible and affordable to all segments of society. By addressing underserved communities and partnering with them to provide better healthcare solutions, companies can contribute to reducing healthcare disparities and promote equitable access to quality care, (v) enhance transparency and accountability, which includes setting clear targets, regularly measuring and reporting progress, and disclosing ESG performance, and (vi) engage with stakeholders, such as investors, customers, payers, employees, and patients, to better understand their expectations and concerns regarding ESG issues. Such a bold proactive approach to ESG issues contributes to a more sustainable and equitable world, strengthens a company’s reputation, and fosters its long-term success.
 
Takeaways
 
In today's rapidly evolving and technology-driven world, a successful pivot for MedTechs, which have been financialized and now find themselves in a strategic cul-de-sac, requires a simultaneous introduction of the suggested strategic initiatives, rather than a sequential approach. To regain high growth rates and create long-term value, MedTechs must:
  1. Revamp R&D efforts to develop innovative solutions and services that address evolving market needs, prioritizing cost-effectiveness, and improved patient outcomes as primary drivers of value creation.
  2. Prioritize patient-centric care by delivering solutions and services that significantly enhance outcomes, establishing a reputation for consistent value provision.
  3. Revitalize outdated organizational and operating models through increased collaboration with industry stakeholders, enabling accelerated technology development and adoption. This ensures alignment with patient needs and facilitates swift market entry.
  4. Harness the transformative power of digital technologies, AI, and big data to unlock new possibilities for innovation, efficiency, and personalized healthcare experiences.
  5. Attract, retain, and develop talent equipped with 21st-century capabilities while fostering a purpose-driven culture that fuels innovation and drives organizational success.
  6. Recognize and capitalize on the vast and rapidly expanding opportunities present in emerging markets, approaching them with a strategic mindset.
  7. Align with ascending ESG standards, demonstrating a commitment to sustainability, ethical practices, and social responsibility, which reinforces the credibility and long-term viability of MedTechs.
By embracing these strategies simultaneously, corporations position themselves to navigate policy shifts, overcome global uncertainties, and take advantage of evolving technologies, which stand them in good stead to enhance their growth rates, and significantly improve their value.
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  • MedTech growth strategies have taken advantage of low interest rates and cheap money to debt finance acquisitions of near adjacent companies with existing tried and tested products
  • This allowed companies to expand their product portfolios, geographic reach, and customer bases
  • Many MedTechs preferred such a growth strategy to investing in R&D to develop disruptive technologies that maybe outside their immediate field of interest
  • These technologies include 3D bioprinting, robotics, virtual reality, biometric devices and wearables, digital therapeutics, and telemedicine
  • All are patient-centric software driven technologies rather than hardware devices that serve the needs of hospitals
  • All are positioned to influence the shape of healthcare systems over the next decade
  • Many MedTech R&D investments are devoted to making small improvements to legacy products that prioritize the interests of large healthcare organizations over the needs of patients
  • Traditional MedTech M&A-driven growth strategies that have benefitted from an era of low interest rates and cheap money may now be challenged in the current period of higher interest rates, stagnate growth and rapidly evolving disruptive healthcare technologies.
  
Healthcare disrupters
 
On March 10, 2023, the Silicon Valley Bank (SVB) collapsed after a series of ill-fated investment decisions triggered a run on its assets. It was the largest bank failure since the 2008 financial crisis and the second largest in US history. The demise of SVB triggered a subsequent free fall in the shares of the Silvergate Bank, the Signature Bank, and the First Republic Bank. Then, on March 17, Credit Suisse shares crashed. Despite a US$54bn lifeline from theSwiss National Bankon  March 19, the bank collapsed and was ‘acquired’ by UBS for ~US$3bn. This banking crisis could create a weakness in corporate balance sheets more generally. Especially in MedTechs that have borrowed heavily in an era of low interest rates and cheap money, and now might be challenged by higher rates, economic stagnation, and rapidly advancing software driven healthcare technologies. These include, 3D bioprinting, robotics, virtual reality (VR), biometric devices and wearables, digital therapeutics, and telemedicine. All are positioned to influence the shape of healthcare over the next decade by: (i) changing the way healthcare is delivered, (ii) improving patient outcomes, (iii) lowering healthcare costs, (iv) increasing access to care, and (v) creating new business models as value shifts from hardware to software. Should the banking collapse be a warning to traditional MedTechs whose preferred growth strategies have been debt financed acquisitions of near adjacent companies with physical product offerings optimised for hospitals?
 
In this Commentary

This Commentary explores the potential vulnerability of some MedTechs that have taken advantage of the recent period of low interest rates and cheap money to pursue growth strategies dominated by the acquisition of near adjacent companies, and have not balanced this with investments in innovative technologies. These may not fit neatly into their existing product portfolios and business models but are positioned to have a significant influence on the medical technology industry and healthcare systems over the next decade. Such technologies include: 3D bioprinting, robotics, virtual reality (VR), biometric devices and wearables, digital therapeutics, and telemedicine. Before describing these, we briefly outline the causes of the recent banking crisis and suggest how it might signal a weakness in corporate balance sheets more generally.
 
The demise of SVB

Founded in 1983, headquartered in Santa Clara, California, USA, SVB was the preferred bank of the large and rapidly growing tech sector, and it quickly grew to become the 16th largest bank in America. Tech companies used SVB to hold their cash for payroll and other business expenses, which resulted in a significant inflow of deposits. Banks only keep a portion of such deposits as cash and invest the rest. Like many other banks, SVB invested billions in long-dated US government bonds. [Bonds are debt obligations, where an investor loans a sum of money (the principal) to a government or company for a set period, and in return receives a series of interest payments (the yield). When the bond reaches its maturity, the principal is returned to the investor]. Bonds have an inverse relationship with interest rates; when rates rise, bond yields and prices fall. During the past decade of historically low interest rates, bonds became a preferred investment vehicle. SVB’s problem arose when central banks throughout the world increased rates to curb inflation, partly caused by the hike in energy prices following the Ukraine war. For instance, in 2022, the American Federal Reserve raised interest rates seven times; from ~0 to 4.5%. As interest rates rose, SVB’s large bond portfolio lost money and the bank was forced to sell its bonds at a loss. On March 8, SVB announced a US$1.75bn capital raise to plug the gap caused by the sale of its loss-making bonds. This alerted customers to SVB’s financial challenges. They started withdrawing their deposits, which triggered a run on the bank.
MedTech growth strategies

Sudden hikes in interest rates may sound alarm bells for some traditional MedTechs that have pursued debt financing to acquire near adjacent companies rather than invest in R&D to develop disruptive technologies and innovative offerings. While R&D is a critical component of the industry, it is a complex and costly process, which often takes years to yield a product that can be marketed and generate revenue. By contrast, M&A activity allows companies to acquire existing products and technologies that have already been developed and tested, which reduces the risk and uncertainty of R&D. Further, with the industry becoming increasingly competitive, MedTechs need to achieve scale and market share to remain relevant. This can be achieved by the acquisition of near adjacencies, which allows acquirers to quickly expand their product portfolios, geographic reach, and customer base.

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The recent era of low interest rates and cheap money reinforced debt financed acquisitions as a growth strategy. Between 2011 and 2021, there were 2,365 M&A deals in the MedTech industry globally. However, to the extent that MedTechs focussed their acquisitions on near adjacencies, they may have missed out on acquiring innovative technologies positioned to reshape the industry over the next decade. This is because disruptive technologies often come from outside a company's core business and may not be immediately obvious to its leaders. Further, indebted companies facing high interest rates, might feel obliged to increase their revenues, which could result in them doubling down on cost cutting and optimizing their legacy products rather than investing in innovative R&D to drive revenue growth. Companies that adopt such business models could be at risk of having a dearth of technologies to drive future growth in a significantly more competitive healthcare ecosystem and challenging financial markets.
 
Disruptive technologies

The disruptive technologies we mention above shift the needle from hardware to software, from the needs of organizations to the needs of patients. While most of these are in their infancy, they all have the potential to transform healthcare in the next decade by providing new treatments for a variety of diseases and injuries, advancing drug development, enabling personalized medicine, reducing healthcare costs and improving medical training and surgical procedures. Let us explore these in a little more detail.

3D bioprinting

Three dimensional (3D) bioprinting is a relatively new technology, which involves the creation of 3D structures using living cells and holds promise for the future of regenerative medicine. The technology is an additive manufacturing process like 3D printing, which uses a digital file as a design to print an object layer by layer. However, 3D bioprinters print with cells and biomaterials, creating organ-like structures that let living cells multiply.

In 1999, a group of scientists at the Wake Forest Institute for Regenerative Medicine led by Anthony Atala, a bioengineer, urologist, and pediatric surgeon, created the first artificial organ with the use of bioprinting. Soon afterwards, bioprinting companies like Cellink (Sweden), Allevi (Italy), Regemat (Spain), and RegenHU (Switzerland) evolved. In 2010, Organovo, a biotech company founded in 2007 and based in San Diego, California, USA, introduced the first commercial bioprinter capable of producing functional human tissues that mimic key aspects of human biology and disease. In 2014, the company was the first to successfully engineer commercially available 3D-bioprinted human livers and kidneys. In 2019, researchers at Rensselaer Polytechnic Institute, New York, USA developed a way to 3D bioprint living skin, complete with blood vessels. Also in 2019, researchers at Tel Aviv University in Israel announced the creation of a 3D bioprinted heart using a patient's own cells. Today, 3D bioprinting is used to create a wide range of tissues and organs, including skin, bone, cartilage, liver, and heart tissue.
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One of the most promising applications of 3D bioprinting is the creation of replacement organs using a patient's own cells. This could potentially eliminate the need for organ donors and reduce the risk of rejection. The technology also can be used to create complex tissues and structures, such as blood vessels, skin, and bone, which could be useful for patients with severe burns or injuries, as well as those with degenerative diseases. Further, 3D bioprinting can be used to create realistic models of human tissues for drug development and testing, which could help to reduce the cost and time associated with drug development, as well as reduce the need for animal testing. 3D bioprinting could enable the creation of customized implants and prosthetics that are tailored to a patient's unique anatomy.

According to findings of a 2023 report by MarketsandMarkets, in 2022, the global 3D bioprinting market was ~US$1.3bn, and expected to grow at a compound annual growth rate (CAGR) of ~21% and reach >US$3bn by 2027.
Robotics

Medical and surgical robotics have a relatively short history. The first robot-assisted surgical system, the PUMA 560, [Programmable Universal Machine for Assembly], was developed in 1985 by the engineering firm Unimation, and used to perform a neurosurgical biopsy. A decade later, in 1994, the FDA approved the first robotic system for laparoscopic surgery, the Automated Endoscopic System for Optimal Positioning (AESOP), which was superseded in 2001 by the ZEUS Robotic Surgical System. In the late 1990s and early 2000s, researchers began exploring miniature in vivo robots for minimally invasive procedures. In 2000, the first robotic system designed for spinal surgery, SpineAssist, was developed by Mazor Robotics, an Israeli company, which Medronic’s acquired in 2018. In the mid-2000s, researchers began developing robots for use in orthopaedic surgery. Perhaps the biggest influence on robotic surgery was made by  Intuitive Surgical, an American company founded in 1995. Intuitive developed the da Vinci Surgical System, which was approved by the FDA in 2000 and quickly became the most widely used surgical robot in the world. It has been used in millions of procedures across a wide range of specialities. Today, Intuitive Surgical is a Nasdaq traded company with a market cap of >US$84bn, annual revenues >US$6bn and >12,000 employees.
Medical and surgical robotics continue to evolve, with new technologies and applications being developed all the time. Such technologies offer the potential for more precise, efficient, and less invasive procedures, reduced operating times, improved accuracy, and fewer surgical complications. Demand for surgical robotics is increasing as are investments in robotic surgery companies and an increasing number of hospitals around the world are investing in robots. In the US, >250 hospitals use surgical robots for complex operations. Europe has also seen an increase in the number of hospitals that utilize robots for medical purposes. In 2016, there were over 7,000 medical robots in use globally, today there are >20,000.


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According to a Verified Market Research report, in 2021 the global market for medical robots was ~US$11bn and is expected to reach ~US$35bn by 2030. Scientists are developing the next generation of microbots, which are small enough to seamlessly travel through the human body performing repairs.
 
Virtual reality

The use of virtual reality (VR) in healthcare has been growing rapidly in recent years, but its history only dates from the early 1990s, when the first VR applications in healthcare focused on pain management and distraction therapy. In the late 1990s and early 2000s, researchers began exploring the use of VR for a wider range of medical applications, including surgical simulation, medical education, and mental health therapy. In recent years, the technology has been used in pain management, physical therapy, treatment of phobias and anxiety disorders, and to improve quality of life for hospice patients. During the Covid-19 pandemic, VR was used to help healthcare workers train for and cope with the challenges of the pandemic, as well as to provide virtual healthcare visits to patients who were unable to receive in-person care.

VR healthcare start-ups have attracted attention from major players. For example, in February 2020, Medtronic acquired UK start-up Digital Surgery for >US$300m. Founded in 2013 by two former surgeons, Digital Surgery first made waves with an app to help train surgeons using a database of common procedures. It also developed VR software to train doctors as well as AI tools for surgeons in the operating room. OxfordVR is also a British VR start-up. Founded in 2017 by Daniel Freeman, Professor of Clinical Psychology at Oxford University, the company is focused on mental health applications and has successfully automated psychological therapy. Users are guided by a virtual coach instead of a real-life therapist, which allows the treatment to reach significantly more patients. Another notable VR start-up is Firsthand Technology, founded in 2016 and headquartered in California, USA.  The company's flagship product is a VR distraction therapy (VRDT) that offers immersive experiences designed to distract patients from the discomfort and anxiety associated with medical procedures. The company's offerings demonstrate the importance of addressing the psychological and emotional factors that impact health and well-being. In January 2020, Pear Therapeutics, a leader in digital prescriptions acquired Firsthand.

Over the next decade, expect VR to improve medical/surgical training by providing immersive, realistic simulations for medical students and health professionals, allowing them to practice procedures and techniques in a safe and controlled environment. In addition to helping patients to reduce pain and anxiety during medical procedures, VR can help to overcome barriers to care, such as distance and mobility, by providing virtual healthcare visits and remote monitoring of patients. Also, the technology is positioned to improve surgical planning. By providing surgeons with 3D models of patients' anatomy, allowing for more precise surgical planning, and reducing the risk of complications. Further, it can be used in physical therapy to improve patient engagement and motivation, leading to faster recovery times.

According to a 2021 Verified Market Research report, the VR healthcare market was valued at ~US$3bn in 2019, and is projected to reach ~US$57bn by 2030.
 
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Biometric devices and wearables

Biometric devices and wearable technologies aim to empower people with granular data that leads to actionable healthcare insights. It gives people the ability to collect their own health data and report them in a digital format to physicians, thus eliminating the need for in-person appointments for simple check-ups. Insurers and providers have also bought into wearable devices, relying on data collected from them to inform personalized health plans. Corporations too have adopted them to encourage healthy habits among employees working from home.
The use of biometric devices and wearables in healthcare has a relatively short, but influential history. In the early 2000s, the first commercial monitors were introduced, which allowed athletes to track their heart rates during exercise. The technology can provide a wealth of data about a patient's health, allowing healthcare providers to tailor treatment plans to individual patients, monitor chronic disorders, detect changes in real-time and intervene expeditiously. Biometric devices and wearables can help to detect early signs of illness or disease and can help patients to take a more active role in their own health and wellness. The technology has the potential to reduce the cost of care by enabling remote monitoring, preventing hospital readmissions, and reducing the need for in-person visits. Further, it can provide researchers with large amounts of patient data to facilitate AI-driven research into disease prevention and treatment.
 
One successful biometric device company is Fitbit, which was founded in 2007 and is headquartered in San Francisco, California, USA. Fitbit offers a range of wearable devices that track physical activity, heart rate, sleep patterns, and other biometric data. The company’s products include smartwatches, activity trackers, and wireless headphones that integrate with its mobile app and web-based platform to provide users with personalized health and fitness insights. The company has developed partnerships with insurers and healthcare providers to use its products as part of employee wellness programmes. Since its founding, the company has sold >120m devices. In 2019, Fitbit was acquired by Google for US$2.1bn, which is a testament to the value of biometric data and the potential of wearables to transform healthcare.
 
The Apple Watch is the other market leader. Its first edition, launched in 2010, included features for tracking physical activity, heart rate, and other health metrics. An upgraded version, released in April 2015, helped to establish the health tracking market, which led to the mass adoption of wearable technologies. From the outset, the Apple Watch was conceptualized as a device that would help people stay connected in less invasive ways than with smartphones. Each iteration since its inception has increased the watch’s focus on improving health and wellbeing. In 2018, it was approved by the FDA as a medical device capable of alerting users to abnormal heart rhythms. Today there are ~150m Apple Watch users.
 
Another leader in the wearable sensor market is Abbott Laboratories, which provides a range of services for diabetes and cardiology. In November 2018, the company received FDA clearance for its FreeStyle Libre, a glucose reader smartphone app. Oura Health, a Finnish company founded in 2013, has launched a health wearable product in the form of a small ring that tracks activity, heart rate, body temperature, respiratory rate, and sleep data. As the technology continues to evolve, biometric devices and wearables are likely to play an increasing role in healthcare by helping people to participate in their own health and wellness, improving medical outcomes, and reducing healthcare costs.
 
According to findings from a 2019 ResearchandMarkets report, the wearable health technology industry is projected to see a CAGR >25% between 2020-2027, and annual sales are expected to reach ~US$60bn by 2027.
 
Digital Therapeutics
 
Digital therapeutics (DTx) are software-based interventions that aim to prevent, manage, or treat medical conditions by modifying patients’ behaviours. The therapeutics are delivered through mobile apps, virtual reality, or digital platforms. Their use in healthcare is growing, and the history of DTx can be traced back to the late 1990s when the first digital intervention for substance abuse was developed. In the early 2000s, a few digital interventions were introduced to manage chronic conditions such as diabetes and hypertension. However, it was not until the 2010s when the use of DTx started to gain momentum, driven by technological advances, the growing prevalence of chronic diseases, and the need for more cost-effective healthcare solutions.
 
In the November 2020 edition of Scientific America, DTx were ranked in the top-10 emerging technologies, which have demonstrated an ability to prevent and treat a variety of chronic conditions. In September 2017, Pear Therapeutics digital software programme, reSET, became the first FDA-approved DTx for substance use disorders (SUD) involving alcohol, cocaine, marijuana, and stimulants. According to the US Centers for Disease Control and Prevention (CDC) >40m Americans, ≥12 years presented with SUDs in 2022. In 2020, Pear received FDA clearance for Somryst, an insomnia therapy app. The company has a pipeline of DTx offerings for a wide range of conditions, including multiple sclerosis, epilepsy, post-traumatic stress disorder and traumatic brain injury. In 2020, the FDA approved EndeavorRx, which is produced by Boston based Akili Inc and is the first DTx delivered as a video game for children with attention deficit hyperactivity disorder (ADHD). Omada Health, is another digital therapeutics start-up, founded in 2011 and headquartered in California, USA, which provides personalized coaching and support to individuals with chronic health conditions.

Given that DTx are evidence-based and personalized, they can be tailored to meet the unique needs of each patient. This individualized approach can lead to enhanced patient outcomes and improved quality of life. DTx are often more cost-effective than traditional therapies, as they eliminate the need for in-person visits and reduce the need for expensive medications. This could help to lower healthcare costs. Digital therapeutics can be accessed from anywhere, any time and on any device, making them particularly useful for patients in remote or underserved regions. This could help to improve access to healthcare for millions of people. DTx can be integrated with other healthcare technologies, such as wearables, mobile health apps, and electronic health records, to provide a comprehensive approach to healthcare. This could lead to improved coordination of care and better health outcomes. Further, DTx could bring about a shift in treatment paradigms and change the way we approach chronic diseases: instead of relying solely on medications, patients could use digital therapeutics to manage their conditions and improve their overall health.

The FDA has created a new classification for digital therapeutics, which is likely to make it easier for more DTx solutions and services to obtain regulatory approval. In a 2020 survey of MedTech leaders by Deloitte, a consulting firm, 63% of respondents agreed that DTx will have a significant impact on the industry over the next 10 years. A report by Grand View Research, suggested that the global digital therapeutics market was valued at US$4.20bn in 2021, and is estimated to grow at a CAGR of ~26% from 2022 to 2030. 

 
Telemedicine

The practice of using telecommunications and information technologies to provide remote medical services, has a history dating back to the early 20th century. In 1924, the first radiologic images were transmitted by telephone between two towns in West Virginia, USA. In the 1950s and 1960s, the technology began to advance, and the first video consultation between a patient and a physician was conducted. In the 1970s, NASA began using telemedicine to provide medical care to astronauts in space. In 2001, the Indian Space Research Organization successfully linked large city hospitals and healthcare centres in remote rural areas. With the development of the internet in 1990s, remote healthcare exchanges became more widespread, particularly in rural areas where access to medical services were limited. In 1993, the American Telemedicine Association (ATA) was founded to promote the use of the technology. Since then, telemedicine has continued to evolve and expand.
The Covid-19 pandemic led to a surge in telemedicine usage as healthcare providers looked for ways to provide care while minimizing in-person contact. Based on a survey by McKinsey, a consulting firm; before the pandemic in 2019, ~11% of US patients used telehealth services. After COVID, that number had grown to ~50%. Some estimates suggest that during the height of the pandemic, the number of telemedicine appointments increased by 5,000%. According to McKinsey’s, 76% of US consumers report that they are interested in using telehealth in the future as a way to complement in-person physician visits.In August 2020, digital health history was made with the merger of two of the largest publicly traded virtual care companies Teladoc and Livongo. The former, a multi-billion-dollar market leader in telemedicine founded in 2002, and the latter, a multi-billion-dollar market leader in remote patient monitoring. The deal created a US$38bn entity, which was the market’s first full-stack virtual health company. Today, virtual health is a rapidly growing field, and combines virtual physician visits, remote patient monitoring, chatbots, algorithms, and analytics.
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Over the next decade, AI-powered telemedicine tools are likely to become more prevalent, helping to streamline and automate many aspects of the care delivery process, such as triage, diagnosis, and treatment plans. Remote patient monitoring technologies are likely to become more advanced and widespread, allowing healthcare providers to monitor patients’ health and vital signs remotely, which can improve outcomes and reduce hospitalizations. Expect healthcare providers to increasingly work as part of virtual care teams, collaborating with other health professionals, including specialists, to deliver care to patients in real-time, regardless of location. Telemedicine will continue to improve access to care, particularly for underserved populations such as those in rural and remote areas, and those with limited mobility or poor transportation options. The technology will also facilitate more personalized and patient-centred care, as providers will be able to tailor care plans to the specific needs and preferences of individual patients.

According to a report by MarketResearchFuture, the current global telemedicine market size is valued at ~US$67bn and is expected to reach >US$405bn by 2030, exhibiting a compound annual growth rate of >22%.

 
Takeaways

We have described six evolving software driven technologies positioned to significantly influence healthcare systems in the next decade. Note that all are software driven and focused on patients to make care more personalized and sensitive to specific needs of individuals. Such technologies are in stark contrast to traditional medical devices, which overwhelmingly are physical devices designed to serve hospitals, rather than individual patients. Such a focus can lead to a lack of innovation, higher costs for patients, lower quality of care, and less personalized treatment options. A shift towards technology optimized to deliver patient-centered care is necessary to improve the quality of healthcare and ensure that patients receive the best possible outcomes. From our analysis it is not altogether clear whether traditional MedTechs are well positioned to achieve this.
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  • For the past three decades care has been moving out of hospitals into peoples’ homes
  • This is a significant and rapidly growing shift positioned to accelerate over the next decade
  • Driving this change are significant structural, organizational, and social factors
  • An early wave of new entrant digital ‘pure plays’ started to take advantage of this move ~3 decades ago and developed innovative software health solutions and services for people to consume in their homes
  • Later, there followed a second wave, comprised of several giant diversified healthcare companies that created and marketed digital home health offerings
  • The majority of traditional MedTechs have not responded to this shift and continue to produce physical devices for episodic surgical interventions in hospital operating rooms
  • Could their failure to develop software solutions for care in the home be an obstacle to their future growth and competitive advantage?
  
Out of the hospital into the home
A bridge too far or one that traditional MedTechs must cross?
 
On 30th January 2023, England's state funded National Health Service (NHS) announced a two-year recovery plan to help restore emergency care and frontline services. The plan, backed by a £1bn (US$1.2bn) fund, will increase virtual hospitals where patients receive high-tech care in their homes. It also includes 5,000 new hospital beds that will boost capacity by 5%, and 800 new ambulances, which will increase the fleet by 10%. Currently, England has ~7,000 virtual ward beds in the community. By 2024, ~50,000 patients a month are expected to benefit from these, which shall provide care mostly for elderly patients with chronic lifetime conditions. NHS virtual hospitals will be supported by a range of wearables and medical devices to diagnose and monitor patients’ conditions and share the data with their physicians in real time. This is not a new phenomenon; in 2006, China responded to its shortage of health professionals by developing virtual (internet) hospitals, and by mid-2021 there were >1,600 of them providing convenient and efficient medical services to millions of patients in their homes.

The UK government’s NHS recovery plan is a response to a series of strikes by health workers, protesting about staff shortages and deteriorating hospital conditions. Currently, there are >130,000 vacancies in the NHS; a vacancy rate of ~10%. Last December (2022), 54,000 people in England waited >12 hours for an emergency hospital admission. The figure was virtually zero before the pandemic. The average wait time for an ambulance to attend a stroke or heart attack in December 2022 was >1.5hrs, while the target is 18 minutes. In September 2022, >7m people in England were waiting to start NHS hospital treatments, which is the highest number since records began in August 2007. Surgeons were reported to being frustrated because operating rooms were not being used due to a lack of beds and staff.

This is not simply a UK problem. Since December 2022, health workers in the US, and France have engaged in similar strikes to protest about deteriorating hospital conditions. According to the World Health Organization (WHO), such protests are manifestations of a global shortage of medical staff. “All countries face challenges in training, recruitment, and the distribution of health professionals”, says the WHO, and suggests that by 2030, the global shortage of medical staff will mount to ~15m.  To the extent that a significant element of the challenges facing healthcare systems is staff shortages, it is not altogether clear how the British government’s recovery plan to increase NHS hospital beds and services will work if there is a dearth of health professionals.

 

In this Commentary

This Commentary suggests that the movement of care out of hospitals to peoples’ homes is not just a passing political response to a temporary crisis. The shift is driven by significant structural, organizational, and social factors, which we describe.  Since the late 1980s these factors have been gaining momentum and are positioned to have a defining influence over the next decade. Two distinct ‘waves’ of medical technology companies have taken advantage of this shift. The first wave started ~3 decades ago with several digital ‘pure play’ new entrants, which included ResMed, Propeller Health, Teladoc Health, Livongo Health, and Masimo. These companies all developed and marketed software health solutions to be consumed by patients in their homes. Later, there followed a second wave, comprised of a few giant diversified healthcare companies that included Philips,Medtronic, and Johnson & Johnson, which successfully entered the digital home care market. Notwithstanding, the overwhelming majority of traditional MedTechs have not developed digital solutions and services for patients to consume in their homes. Is this “a bridge too far” for them, or a bridge they must cross if they want to increase their growth rates and competitiveness?
1st wave: digital pure plays
 
ResMed
An early pure play that developed digital health solutions and services to be consumed by patients in their homes is ResMed, (an abbreviation of ‘respiratory medicine’), which started life in the late 1980s in Australia. In 1981, Colin Sullivan, a Professor of Medicine at the University of Sydney, developed and patented a continuous positive airway pressure (CPAP) device, which was the first successful non-invasive treatment for obstructive sleep apnea (OSA). Before Sullivan’s invention, the treatment for chronic OSA was a tracheostomy, where a hole is made through the neck into the trachea so breathing can bypass the nose and mouth. Initially, Sullivan partnered with Baxter, a US multinational medical technology company, to help commercialize his technology. In 1989, Baxter decided not to enter the sleep apnea market, and Peter Farrell, a Baxter executive, led a management buyout to acquire the technology and established ResMed in Australia. In 1990, the company relocated to San Diego, USA, and today, is a world leading software-driven, medical device enterprise, traded on the New York Stock Exchange (NYSE), with a market cap ~US$32.5bn, annual revenues ~US$3.6bn, >8,000 employees and a presence in >140 countries. Its main product offering, the AirView™ telehealth platform, is a secure, cloud-based system, which enables patients with sleep-disordered breathing and respiratory insufficiencies to be treated in the comfort of their own homes. The device provides real-time patient data, personalized insights, and proactive alerts that allow physicians to remotely monitor and connect to their patients. ResMed has >10m, cloud enabled, home care devices in the market and has accrued ~5bn nights of medical sleep and respiratory care data.
 
Propeller Health
In 2019, ResMed acquired Propeller Health for US$225m, but the company continued to operate as a standalone business. Founded in 2007, Propeller developed a mobile platform that offers sensors, mobile apps, analytics, and services to support respiratory health management. It is now a world leader in providing digital health solutions that keep patients with chronic obstructive pulmonary disease (COPD) and asthma out of hospital. The company’s sensors attach to patients’ inhalers and through its app, users can track their medication use, record their symptoms, receive environmental forecasts, which could affect their conditions, and download progress reports to share with their physicians. The app allows health providers to monitor their patients’ progress remotely, adjust treatment plans based on objective data and intervene when necessary. Propeller’s clinically validated solutions have found favour with US health insurers because they have demonstrated ~58% improvement in medication adherence, ~48% increase in symptom-free days, ~53% reduction in hospital visits and lowered costs of treating COPD, a condition that affects ~24m American adults and costs ~US$50bn to treat each year. In 2017, Fast Company named Propeller as one of the “most innovative companies”. In January 2019, the company launched ‘My Pharmacy’ with Walgreens as an in-app feature that allows users to manage their prescription refills for COPD and asthma and to locate a nearby pharmacy. The company quickly expanded this feature to CVS, Kroger, Rite-Aid and Walmartfive of the seven largest pharmaceutical providers in the US.
 

Teladoc Health
Another early digital pure play is Teladoc Health, an American enterprise founded 21 years ago to provide convenient home healthcare for those who have difficulty accessing traditional healthcare services. Initially, it provided telephone-based physician consultations and medical advice. In 2006, the company added a proprietary digital platform, which enabled patients to securely upload medical records, images, and notes and share them with their doctors. This allowed physicians to assess a patient’s medical information and provide appropriate treatment plans quickly and easily. Teladoc continued to expand its services, including the introduction of remote medical consultations and a suite of digital health tools. Today, the company is a multinational telemedicine and virtual healthcare corporation. Its offerings include virtual care services and digital health solutions, medical opinions, artificial intelligence (AI) and machine learning (ML) driven analytics, telehealth devices and licensable platform services. Its primary services, which have expansive clinical depth and breadth across >450 medical subspecialties, are available in 40 languages and 175 countries.
 

Livongo Health
In 2020, Teladoc acquired Livongo Health, another pure play, in a deal valued at US$18.5bn, which is the largest digital health transaction in history, and created a combined entity valued at ~US$38bn. Livongo was founded in 2008, with a mission “to make virtual care the first step on any healthcare journey”. In July 2019, the company successfully IPO’d and raised US$335m. Until its merger with Teladoc, Livongo traded on Nasdaq and reached a market cap of ~US$14bn. The company’s principal offering is a digital platform that collects data from connected devices, wearables, and mobile apps to provide users with personalized care plans, coaching, and support to help them accomplish their medical goals from the comfort of their homes. A joint statement from the two companies at the time of the merger said that the combination is expected, “to create substantial value across the healthcare ecosystem, enabling clients everywhere to offer high quality, personalized, technology-enabled longitudinal care that improves outcomes and lowers costs across the full spectrum of health".
Masimo
Masimo is a digital pure play founded in 1989 by Joe Kiani, an Iranian American with the mission to create innovative digital patient centric medical solutions that improve outcomes and lower health costs. Over the past three decades Masimo has helped to make in-home medical care more accessible and affordable. Its digital offerings help to automate processes, reduce costs, and streamline communications between providers and patients. The company’s first product was a digital stethoscope, a device, which enables doctors to monitor a patient’s heart sounds remotely.
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Kaini, an electrical engineer by training, has >500 patents or patent applications for advanced signal processing, optical sensors, and wearable technologies, and is the company’s current chair and CEO. Masimo became a Nasdaq traded company in 2007, and today is a global player with a market cap of ~US$9bn, annual revenues ~US$1.25bn and >5,300 employees. The company has grown to become a leader in the digital healthcare space by developing and marketing a range of offerings, including a clinical decision support and monitoring platform, which helps to provide convenient and cost-effective care in patients’ homes.  Its core offering, a pulse oximeter, is a non-invasive, medical device that can easily be clipped onto a finger or toe to provide accurate readings in just seconds and is used to diagnose and monitor the amount of oxygen in the blood of people with respiratory conditions, such as COPD and asthma. Previously, blood oxygen levels could only be determined in a laboratory on a drawn blood sample. The pulse oximeter is also used for monitoring newborns, the elderly, and athletes, and each year monitors >200m patients.
 
In 2020, in response to the COVID-19 pandemic, the company introduced the Masimo SafetyNet for smartphones. In addition to helping combat COVID-19, the device can also be configured to help physicians create, relay, and manage treatment plans for >150 other health needs. In 2022, the company launched its W1 Health Watch, which is a water-resistant and dust-proof consumer-oriented health monitoring device equipped with a range of sensors and sensor-based algorithms that are designed to give users a comprehensive overview of their health. The watch also has an emergency feature that can detect and alert specified contacts if the wearer is in distress.
 
Factors driving care out of hospitals into homes
 
Since this first wave of digital health pure plays, there have been several significant structural, organizational, and social factors that have gained momentum and together helped to drive care out of hospitals into homes. We briefly describe these.

(i) Demographics: aging populations and escalating chronic lifetime disorders
United Nation’s data on global population trends suggest that by 2050, one in six people will be ≥65, (16%), up from one in 11 in 2019 (9%). According to the US Census Bureau, in 2022, there were ~56m Americans ≥65, which is ~17% of the population. This figure is projected to reach >73m by 2030 and ~86m by 2050: ~22% of the population. In the US, ~60% of adults have chronic diseases. According to the Centers for Disease Control and Prevention (CDCP), 90% of America’s ~US$4trn annual healthcare costs is attributed to people with chronic lifetime diseases and mental health conditions.

Since 2000, in the US, 18% of healthcare professionals have quit their jobs. According to data published in June 2021 by the Association of American Medical Colleges (AAMC), the US could see a shortfall between ~37,800 and ~124,000 physicians by 2034, with the largest disparities being in specialty doctors. These data suggest that, over the next decade, there will be fewer hospital resources available to care for a growing aging population with complex healthcare needs.


(ii) Technological advances
Technological advances are changing how clinicians practice medicine, how consumers manage their own health, and how patients and providers interact.

Remote patient monitoring, video conferencing, telemedicine, and mobile health applications have enabled care to move out of hospitals and into peoples' homes. Remote patient monitoring allows healthcare professionals to monitor a patient's vital signs and other health data remotely. Video conferencing provides patients with the ability to have real-time consultations with their physicians. Telemedicine allows a patient’s medical information to be securely shared with a range of healthcare providers, which increases access to care, and enhances its coordination. Mobile health applications allow patients to track their health data and receive reminders for taking medications, scheduling appointments, and other health-related tasks. These technological advances have enabled healthcare workers to deliver care to patients in their own homes, reducing the need for in-person visits to a hospital. AI and ML big data advances have facilitated remote diagnosis and monitoring and improved communications between healthcare providers and patients. Further, AI-powered chatbots help patients navigate healthcare systems, make appointments, and answer medical questions more quickly and accurately than traditional methods.
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(iii) Regulations
The US Food and Drug Administration (FDA) has revised its healthcare regulations to include the acceptance of algorithms for use in the healthcare industry. Since 1995, the FDA has authorized >500 AI-enabled medical devices. By providing for the use of algorithms, the FDA is helping to move care out of hospitals into homes. Recently, the agency set up the Digital Health Center of Excellence (DHCoE) to “empower stakeholders to advance healthcare by fostering responsible and high-quality digital health innovation”.
(iv) Payors’ policies
In most nations, governments increasingly offer coverage for in-home health care services. We have mentioned government backed virtual hospitals in the UK and China. In the US, Medicare, and Medicaid [federal and state healthcare insurance programmes] have expanded their benefits to support home health care. The agencies' reimbursement policies are becoming more favourable in providing value-based healthcare for improved patient outcomes at lower costs. As a consequence, in-home care has become a modality of choice for treatment. Medicare now covers a variety of telehealth services, including remote patient monitoring, and the Medicare Advantage plans [Medicare-approved plans from private insurance companies] are now required to cover certain home health services, including skilled nursing, as well as medical equipment and supplies. Additionally, Medicaid programmes have implemented waivers that allow for some long-term health services to be provided in peoples’ homes. According to the US Centers for Medicare & Medicaid Services, spending on home healthcare services in America rose from ~$37bn in 2000 to >$97bn in 2018; an overall increase of ~161%.
 
Over the past decade, an increasing number of American private insurance plans have extended their cover for home health services. Research published in March 2022 by Deloitte, a consulting firm, suggests that over the next decade, as digital pure plays continue to grow and increase their capabilities, major health plans (government and commercial) will increase their partnerships with them. Deloitte suggests that by 2030, “>25% of health plans’ net profits will shift to digital health entrants”. According to a recent market analysis by GrandViewResearch, the global home healthcare market was valued at ~US$336bn in 2021 and is expected to expand at a compound annual growth rate (CAGR) of ~8% from 2022 to 2030.

 
(v) The rise of consumer power in healthcare
The rise of consumerism in healthcare has increased the emphasis on patient empowerment, convenience, cost-effectiveness, and home care. In 2018, Gordon Moore et al provided a compelling rationale of the significant rise of consumerism in healthcare in a book entitled ‘Choice Matters. Moore, Professor of Population Medicine at Harvard University Medical School, identified the growing influence of patients, which previously had been largely overlooked. Over the past three decades patients have become more knowledgeable about health and this has empowered them to take added charge of their own health and seek out the best possible care for their individual needs. This has helped to drive care out of hospitals and into the home, where patients can receive personalized treatment in a comfortable, familiar setting. Moore argues that patients have more choices than ever before and increasingly demonstrate an ability to make informed decisions about their health. Choice Matters stresses the importance to understand both the medical and financial implications of patients’ decisions and how they help to shape technology, inform public policy, and trigger healthcare initiatives. Moore’s thesis discusses the growing implications of consumer-driven healthcare and explores how the marketplace is evolving in response to the changing needs of patients. The book outlines a variety of arguments that support the idea of healthcare decentralization, such as the need for care to be tailored to an individual's unique needs and preferences, the advantages of providing care in the home, and the potential cost savings associated with these changes. Moore also highlights the value of integrating technology into the home-based care model and the potential of this delivering increased efficiency and improved outcomes for patients. Today, consumerism in healthcare is challenging the traditional medical modality of diagnosis and treatment by putting a greater emphasis on lifestyles and prevention.
 
2nd wave: giant healthcare companies
 
The commercial success of the first wave of digital health pure plays, together with the factors we outlined above, made some giant diversified healthcare companies rethink their business models and employ AI and ML big data strategies to develop and market health solutions and services for people to consume in their homes. These companies include Philips, Medtronic, and Johnson & Johnson; together they represent a second wave of healthcare companies that have successfully gained access to new revenue streams by serving the large and growing home care market. Here we briefly describe some of their digital offerings.
 
The Philips HealthSuite digital platform is designed to help healthcare providers deliver patient-centric  care, reduce costs, and improve outcomes. The platform is powered by the cloud and includes a suite of AI big data analytic tools, which support the monitoring of patients in their homes, and allows physicians to access real-time health information and respond quickly to any changes in a patient’s condition. Similarly, Medtronic’s CareLink™ remote monitoring platform supports home care by facilitating patients to monitor and manage their health information remotely. The device allows healthcare providers to access a variety of patient data, including vital signs, weight, diet, sleep, activity, and medication adherence. It also provides two-way communication between healthcare providers and patients, allowing for more personalized care. Johnson & Johnson has built on its consumer health business that “helps >1.2bn people” and, in August 2019, launched its CarePath Solutions platform to provide patients with personalized health plans and support in their homes. It also helps healthcare providers to make informed clinical decisions, reduce costs, and improve patient outcomes.
 
Takeaways
 
The commercial success that digital pure plays and giant healthcare corporations have gained by providing solutions and services for patients in their homes should raise alarm bells for traditional MedTechs that continue to focus on providing legacy physical devices for episodic surgical interventions in hospitals. Patient centric health, emphasizing convenience and accessibility, shifts the focus of healthcare from the hospital to the home, from physical devices to digital solutions and services. To take advantage of this shift companies will need to invest in developing new digital health innovations. Patient centric healthcare also emphasizes the need for data-driven decision making, which requires the use of more advanced analytics and AI, ML big data strategies. Traditional MedTechs producing physical devices may not be able to keep up with the rapid pace of software developments in healthcare. Pivoting to develop and market software health solutions and services for patients to use in their homes might be a “bridge too far” for these companies. However, can traditional MedTechs afford not to cross this bridge?
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  • The core business of medical technology companies (MedTechs) has been manufacturing and marketing physical devices
  • Physical devices will continue to be a substantial part of their business, but on their own, are unlikely to deliver high growth rates, which are more likely to come from artificial intelligence (AI) data driven strategies that improve patient outcomes
 
The impact of big data, artificial intelligence, and machine learning on the medical technology industry
 
James Carville, an American strategist, who played a leading role in Bill Clinton winning the 1992 presidential race, insisted that the campaign focus on the economy and coined the phrase “It’s the economy, stupid”. If Carville was asked today for a winning long-term growth strategy for medical technology companies, might he say, “It’s big data, stupid”?
 
This Commentary suggests that while physical products have been the backbone of MedTech companies in the past, they are unlikely to contribute significantly to future growth rates, which are more likely to come from artificial intelligence (AI) driven big data innovations, which create new solutions that improve patient journeys and outcomes.
 
In this Commentary
 
This Commentary describes the meaning of ‘big data’ in a healthcare context, explains ‘the data universe’ and stresses not only its immense volume, but also its variety, and the phenomenal speed at which the data universe is growing. Today, most industries leverage big data and AI techniques to create innovative offerings that drive growth and enhance competitive advantage. However, with few exceptions, traditional MedTechs have been relatively slow to collect and analyse a wide range of health, medical and lifestyle data which have the potential to provide innovative software offerings that improve patients’ therapeutic journeys and complement physical products. This is partly because the industry must adhere to strict regulations and partly because many medical technology companies lack the necessary capabilities and mindsets to collect and leverage big data. Most have business models that tweak legacy physical products and accept growth rates of ~5% as the ‘new normal’. We provide a brief history of big data and AI business strategies mainly to underline that these are relatively new. It was only in the early 2000s that electronic health records (EHR) began to replace paper-based patient records, which were stored in numerous filing cabinets in healthcare silos. It was not until ~2015 that EHRs became standard practice and researchers started to apply algorithms to EHRs and other data to detect patterns and make predictions that could improve diagnoses and treatments, enhance patient outcomes, and reduce healthcare costs. The increased use of big data and AI techniques in healthcare raises important cybersecurity concerns and trust issues because health professionals and patients do not understand how algorithms arrive at their conclusions and actions. Cybersecurity concerns are addresses by a range of encryption techniques and security protocols. Trust in algorithms has been helped by the development of  ‘explainable AI’, which is software that describes the essence of algorithms in easily understood terms. However, more work is still needed in these two areas. We introduce cloud and cloud services together with an explanation why these have experienced such rapid growth across all industries in recent years. The cloud makes it easier to store and access big data via the internet from anywhere in the world. Cloud services provide security for big data as well as a range of management and analytical tools that help to transform data into revenue generating software offerings. For MedTech companies, the cloud and cloud services provide the basis for more efficacious R&D. The medical technology industry has become bifurcated between companies that leverage AI driven big data strategies to enhance growth rates and those that predominantly focus on legacy physical product offerings and settle for lower growth rates. Over the past decade the nature of the medical technology industry has changed; partly because of AI big data strategies supported by the cloud computing and a large and rapidly growing range of open-source, easy-to-use AI tools. This has given small companies a competitive advantage. The Commentary concludes by describing a few of these small MedTechs with disruptive digital products that target large, rapidly growing, underserved market segments.       
 
Big data and healthcare

Big data are comprised of a wide range of information collected from multiple sources that surpasses the traditionally used amount of storage, processing, and analytical power and is unmanageable using conventional software tools. In healthcare settings, big data include hospital records, medical records of patients, results of medical examinations, and data generated by traditional medical devices as well as various biomedical and healthcare tools such as genomics, wearable biometric sensors, and smartphone apps. Biomedical research also generates data relevant for the medical technology industry.
 
The data universe

The massive amount of data, which is generated from the entirety of the internet is referred to as the ‘data universe’. It is not only its volume that makes this special, but it is also the variety of the data and the phenomenal speed at which the universe is growing. The International Data Corporation (IDC) estimated that the data universe grew from ~130 exabytes in 2005 to >40,000 exabytes in 2020.  To put this in perspective: 1 gigabyte of data is 1bn bytes (18 zeros after the 1 or 230 bytes), and 1 exabyte is equal to 1bn gigabytes.
Data generated healthcare innovations

In the past, collecting and interpreting vast quantities of data was not feasible, partly because computer systems were relatively small and did not generate much data, and partly because technologies to manage big data were underdeveloped. Fast forward to the present, and businesses across most industries now generate enormous amounts of data. Organizations apply AI and machine learning (ML) techniques to these data to create innovative product offerings to access new revenue streams with significant growth potential. Such technologies, combined with health-related big data, can positively impact the medical technology industry by generating novel diagnostics and treatments for patients, streamlining the process of medical record keeping and developing more personalized and responsive care plans that improve patient journeys and outcomes.

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The new rapidly evolving AI data driven healthcare ecosystem

Despite the potential commercial advantages of AI data driven diagnostic and therapeutic solutions, many traditional MedTechs have been slow to collect health and lifestyle data from multiple sources to develop software offerings, which complement their legacy physical products. One notable exception is Philips Healthcare. In the early 2000s, the company was challenged by new entrants to the market who were successfully leveraging information from health wearables and other sources to create and market AI data driven offerings. At the 2016 annual conference of the American Healthcare Information and Management Systems Society (HIMSS) in Chicago, Jeroen Tas, a Philips executive, said, “We are in the midst of one of the most challenging times in healthcare history, facing growing and aging populations, the rise of chronic diseases, global resource constraints, and the transition to value-based care. These challenges demand connected health IT solutions that integrate, collect, combine, and deliver quality data for actionable insights to help improve patient outcomes, reduce costs, and improve access to quality care”.
 
Philips had the mindset and resources to respond positively to this rapidly changing ecosystem. In 2017 the company appointed Tas as its Chief Innovation & Strategy Officer, tasked with launching a suite of big data AI driven solutions, the IntelliVue® patient monitors, which support the growing demands of health professionals to provide quality care and improved outcomes for an expanding population of older, sicker patients with fewer resources. These monitoring solutions seamlessly connect big data, AI technology and patients to support health professionals to manage patients as they transition through their care journeys. In 2016, Philips and Masimo, a medical technology company specializing in non-invasive AI data driven patient monitoring devices, entered a multi-year business partnership involving both companies’ innovations in patient monitoring. Philips agreed to integrate Masimo's measurement technologies into its IntelliVue® monitors, to help clinicians assess patients’ cerebral oximetry and ventilation status. The outcome of the collaboration was the launch of a new suite of patient solutions, called Connected Care, which give healthcare providers the ability to monitor patients more effectively and reduce costs.
 
The bifurcation of the MedTech market

In addition to large MedTechs such as Philips and Masimo, there are hundreds of small companies developing AI driven big data offerings aimed at improving patient outcomes. The reasons for many traditional companies’ slowness to fully leverage big data and AI applications are partly because medical devices are required to comply with stringent regulatory guidelines and partly because of the lack of capabilities. The different responses have bifurcated the industry. On the one hand there are traditional MedTechs, which predominantly focus on existing customers and market legacy physical offerings in slow growing markets. On the other hand, there are many small companies and a few very large medical technology corporations, which have embraced AI driven big data patient-centric solutions.
 
A brief history

Big data has its genesis in the 1950s and 1960s when scientists and mathematicians began exploring the possibility of using computers to process large amounts of data to make intelligent decisions. This led to the development of technologies such as the first neural networks, which laid the foundation for modern Deep Learning. In the 1980s, researchers at IBM popularized the concept of big data to describe the process of collecting and analyzing large amounts of data, which empowered organizations to gain insights from information that previously was too complex to process. The 1990s saw the development of AI and ML, which enabled computers to learn from data and make decisions without the need for explicit programming. By the early 2000s, AI-based algorithms empowered machines to learn from data and make predictions. Many organizations, across a range of industries, saw the commercial opportunities of this and acquired capabilities to collect, store and analyse large amounts of information to identify patterns and trends that were previously impossible to detect.  Without large amounts of data, AI and ML techniques are less effective, which is significant for healthcare and the medical technology industry.
 
Big data in healthcare

AI driven big data strategies are becoming increasingly important in healthcare. This is because AI techniques applied to masses of health-related information can improve patient care, enable more effective decision-making, reduce costs, identify new treatments, explore new markets, and create more efficient healthcare systems. Further, such applications can provide more accurate and timely diagnoses, as well as insights into how various treatments affect different people. As increasing amounts of health information become available, and data handling techniques improve, so traditional MedTech companies will have opportunities to boost their growth by complementing their physical devices and volume-based care with digital assets and personalised care.
 
Paper-based mindset

Until recently health professionals were responsible for most of the different types of data associated with a patient’s treatment journey, which included medical histories, known allergies, medical and clinical narratives, images, laboratory examinations, and other private and personal information. Until the early 2000s these data were recorded on paper and stored in filing cabinets across numerous healthcare departments. It was not until 2003 that the US Institute of Medicine used the term ‘electronic health records(EHR). By 2008, only ~10% of US hospitals were using EHRs, which increased to ~80% by 2015. As EHRs became standard practice across multiple providers and data interoperability issues were resolved, the provision of healthcare improved, and medical errors and healthcare costs were reduced. Currently, the American National Institutes of Health (NIH) is inviting 1m people from diverse backgrounds across the US to help build a comprehensive big data set, which can be used to learn more about how biology, environment and lifestyles affect health in the expectation of discovering new ways to treat and prevent disease.
 
Trust and medical algorithms
 
As AI driven big data applications have increased, so trust in algorithms has been raised as an issue. This has been a major concern in healthcare. To address this challenge, explainable AI, has been developed. This is an AI technology that explains decisions and actions made by algorithms in a way that is easily understood by health professionals and patients. Explainable AI has helped to create trust in algorithms by providing a level of transparency, understanding and accountability. Further, incorporating feedback from medical professionals, patients, and other stakeholders into the development of medical algorithms has also helped to build trust. However, this entails collecting a wider variety of data than many healthcare companies are used to.
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Have diversified medical technology companies blown their competitive advantage?
Big data healthcare strategies and security
 
With the increasing number of big data and AI healthcare solutions, cybersecurity has become a concern. Reducing this involves using technologies such as data encryption, secure cloud computing (see below), and authorization protocols to protect data stored in large databases. Additionally, organizations may use AI-driven applications to monitor their systems to find anomalies, detect malicious activity and unauthorized access to sensitive, personal information. To ensure the security of healthcare data, organizations also employ measures such as risk assessments, incident response plans, and regular security training of their staff.
Cloud storage and services

Since the early 1990s, big data have benefitted from cloud storage, which makes it easier to store and access data over the internet and helps businesses to become more efficient and productive. It also offers organizations scalability, more control over their data and reduced costs. Organizations can: (i) easily increase their storage capacity as their data needs grow, (ii) access their data from anywhere in the world, and (iii) stop investing in expensive local storage devices. Further, cloud storage is becoming more secure, with encryption and other security measures making it safer to store data.
 
Companies moving their data from local storage devices to the cloud is more than just a simple transfer process and can be a complex, multi-year journey. Any organization that has accumulated several legacy databases and infrastructures will have to develop and manage a hybrid architecture to transfer the data. However, once in place and shared among stakeholders, cloud-based platforms can assist in unlocking clinical and operational insights at scale while speeding up innovation cycles for continuous value delivery. In combination with a secure and interoperable network of connections to hospital systems, cloud-based solutions represent an opportunity for healthcare leaders to unlock the value of data generated along the entire patient journey, from the hospital to the home. By turning data into insights at scale, it is possible to empower healthcare professionals by helping them to deliver personalized care, improved patient outcomes and lower costs.
 
The cloud also offers an increasing number of computing services. These are provided by companies such as Amazon Web Services, Google Cloud Platform, Microsoft Azure, IBM Cloud, Oracle Cloud, and Rackspace Cloud. The services include: (i) Infrastructure-as-a-Service (IaaS), which provides users with access to networks, storage, and computing resources, (ii) Platform-as-a-Service (PaaS) helps users to develop, run, and control applications without the need to manage infrastructure, (iii) Software-as-a-Service (SaaS), provides access to a variety of applications, (iv) Data-as-a-Service (DBaaS), gives users access to several types of databases, and (v) Serverless Computing enables users to run code without needing to provision or manage servers. Such services are expected to continue growing and help to transform healthcare. The provision of cloud computing services in healthcare makes medical record-sharing easier and safer, automates backend operations and facilitates the creation and maintenance of telehealth apps. The increasing use of data and cloud services by MedTech companies helps to break down data silos and develop evidence-based personalized solutions for a connected patient journey. In 2020, the healthcare cloud computing market was valued at ~US$24bn, and it is expected to reach ~US$52bn by 2026, registering a CAGR of >14% during the forecast period. Major drivers of cloud services include the increasing significance of AI driven big data applications.
 
Changes the nature of R&D

Further, the cloud can change and speed up R&D. The starting point for MedTech R&D should be evolving patient needs and affordability. Healthcare-compliant cloud platforms offer a flexible foundation for the rapid development and testing of AI driven big data solutions created by cross functional teams working across an entire life cycle of an application: from development and testing to deployment. This changes medical technology companies’ traditional approach to R&D by transforming it into short cycles undertaken by multiple stakeholders. This modus operandi is replacing traditional lengthy and expensive R&D often carried out in an organisational silo and constrained by annual budgeting cycles. This often means that a significant length of time passes before an innovation gets into the hands of health professionals and patients for testing. Digital health solutions, on the other hand, can be tested by physicians and patients early in their development and improved features quickly added.   
 
Free and easy to use AI and ML software libraries

In the early 2000s, when AI and ML were in their infancy, companies needed data engineers with advanced mathematical capabilities to build complex AI systems. Today, this is unnecessary because of the development of simplified AI and ML libraries such as PyTorch and Tensorflow. These are free, easy to use, open-source, scalable AI, and ML packages, which reduce the need for data engineers to have advanced mathematical skills to build effective software health solutions. PyTorch, released in 2016,  was developed by Facebook and then Meta AI, and is now part of the Linux Foundation. The technology is known for its ease of use and flexibility, making it favoured by developers who want to rapidly prototype and experiment with new ideas. Its tools support graphics processing, which is popular with deep learning medical imaging strategies that involve training large, complex models on big data. TensorFlow was developed by the Google Brain team and originally released in 2015 for internal use.  It is a highly scalable library for numerical computations and allows its users to build, train and deploy large-scale ML models. Both platforms have become significant open-source tools for AI and ML due to their ability to support the development and training of complex models on large datasets. They have been widely adopted by researchers and developers throughout the world and are regularly used in a variety of applications relevant to the medical technology industry. Significantly, they give smaller MedTechs a competitive advantage. 
 
Disruptive effects of AI driven big data strategies

The development and availability of big data and predictive AI help small medical technology companies enter markets, grow, and strengthen their competitive positions, which has the potential to change market dynamics. Over the past decade, several large medical technology companies have experienced their markets dented by small companies, which have successfully used open-source AI applications to leverage big data. For example, Philips Healthcare’s market was affected by the emergence of innovative offerings developed by new entrants using cloud computing services and big data from medical wearables. Above we described how Philips robustly responded to this and became a market leader in AI data-driven patient monitoring technology. Siemens Healthineers’ market share suffered from small MedTechs with innovative AI driven offerings. Further, the rise of digital imaging technology caused GE Healthcare’s market share to shrink. These vast companies have since developed AI driven big data strategies and bounced back. However, traditional MedTechs that fail to leverage big data and AI capabilities risk being left behind in an increasingly competitive digitalized industry.
 
Small MedTechs using big data and AI

Examples of small MedTechs that leverage big data, AI, and ML techniques to capture share of large underserved fast-growing market segments include Brainomix, which was spun out of Oxford University, UK, in 2010 and serves the stroke market. Iradys, a French start-up specialising in interventional neuroradiology. Elucid, a Boston, US-based MedTech founded in 2013, which has developed innovative technology that supports the clinical adoption of coronary computed tomography angiography, and Orpyx Medical Technologies, a Canadian company that provides sensory insoles for people living with diabetes. These are just a few examples of small agile companies that collectively have helped to bifurcate and disrupt segments of the medical technology industry by developing offerings predicated upon big data, AI and ML that deliver faster, more accurate diagnoses to ensure that patients get the treatment they need, when they need it.

Brainomex’s lead product offering is a CE-marked e-Stroke platform, which has been developed using data from images sourced across 27 countries including the UK, Germany, Spain, Italy, and the US and provides fast, effective and accurate analysis of brain scans that expedite treatment decisions for stroke patients. The platform has been adopted across multiple healthcare systems throughout the world, and for the past two years, England’s National Health Service (NHS) has been using the technology on suspected stroke patients. Early-stage analysis of the technology predicated on >110,000 patients suggests that eStroke can reduce the time between presenting with a stroke and treatment by ~1 hour and is associated with a tripling in the number of stroke patients recovering with no or only slight disability - defined as achieving functional independence - from 16% to 49%. With this disease, time is of the essence because after a stroke, each minute that passes without treatment leads to the death of ~2m neurons (nerve cells in the brain), which cause permanent damage. It can be challenging for health professionals to determine whether stroke patients need an operation or drugs, because the interpretation of brain scans is complicated and specialist doctors are required. Sajid Alam, stroke consultant at a large regional hospital in the UK, (Ipswich Hospital), reflected: “As a district general hospital, we don’t have ready access to dedicated neuroradiologists to interpret every stroke scan. Having Brainomix’s AI software gives us more confidence when interpreting each scan.

Intradys is a French start-up, which develops algorithms that combine ML and mixed reality to empower interventional neuroradiologists and help them enhance the care of stroke patients. Orpyx Medical Technologies provides sensory insoles for people living with diabetes who have developed peripheral neuropathy to help prevent foot ulcers. The insoles collect data on pressure, temperature, and steps and give feedback to the wearer and healthcare professionals. Elucid is a Boston-based MedTech founded in 2013. The company’s offerings are predicated on big data, AI, and ML to provide fast and precise treatments that improve the outcomes of patients with cardiovascular disease and reduce healthcare costs. Heart attack and stroke are primarily caused by unstable, non-obstructive plaque (the buildup of fats, cholesterol, and other substances in and on the artery walls) that often goes undiagnosed and untreated. Current non-invasive testing cannot visualize the biology deep inside artery walls where heart disease develops. Elucid’s lead offering is an FDA-Cleared and CE-marked non-invasive software to quantify atherosclerotic plaque.
 
Takeaways
 
The potential benefits for medical technology companies that leverage AI driven big data strategies include: (i) improved diagnoses and treatments, (ii) enhanced patient journeys and outcomes, (iii) cost savings, (iv) a better understanding of stakeholders’ needs, (v) superior decision-making, (vi) more effective products and services, and (vii) increased competitive advantage. Big data strategies may also be used to uncover insights from large datasets to develop predictive models that can automate repetitive tasks, optimize care processes, free up resources for healthcare professionals to focus on providing care, and staying ahead of the competition by providing greater insights into customer trends and needs. Medical technology companies that do not leverage AI driven big data strategies to develop innovative products for growth and competitive advantage potentially risk: (i) falling behind the competition in terms of product innovation, (ii) missing out on key market opportunities, as data-driven insights can help identify new trends and customer needs, (iii) struggling to keep up with the changing pace of technological change, as staying ahead of the competition requires a deep understanding of the latest developments in data-driven product development and (iv) losing the trust of customers, as they may be wary of MedTechs that do not use advanced technologies to develop their product offerings. Future significant growth for medical technology companies is more likely than not to come from AI driven big data strategies. Start collecting data.
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