• The needs arising from the COVID-19 pandemic, which in its worst moments saw the overloading of the health system, making it impossible for patients to get to health centres, have given eHealth solutions the decisive push they had been waiting for.
• Although many of the objections from the general public and health professionals have now been overcome, experts say that improvements in digital literacy are still required.
• The COVID-19 crisis has not led to changes in investment in eHealth, and in the year so far the figures have already outstripped the records achieved in 2019, consolidating the upward trend in the sector.

The second #BHHSummit held last Thursday, 29 October, has been a success, with more than 4,000 participants from 25 different countries signing up for an event held virtually because of the restrictions due to the COVID-19 pandemic. This helps the congress, organized by Barcelona Health Hub (BHH), to become established as the world’s leading eHealth event.

“We’ve had top panellists who have given us a clear picture of what eHealth really means today. And despite all the difficulties experienced due to the COVID-19 pandemic, one of the ideas they have passed on to us is that this situation has provided a stimulus for the development of new technologies. This year will be a real turning point for eHealth,” said Cristian Pascual, president of BHH. One of the important conclusions it has been possible to draw from the congress is that telemedicine is here to stay, breaking the mould of healthcare.

Improving healthcare

In the last few years there has been an explosion of Artificial Intelligence and machine learning, with applications in many areas, and health is no exception. Nowadays, these applications offer solutions for improving care for patients, making them increasingly the centre of attention and personalizing their treatment. All this is making it possible to overcome many health challenges, such as value-based care, burn-out among health professionals and insufficient security and availability of these tools.

Guy Spigelman, EMEA Lead Healthcare and Life Sciences Startups at Amazon Web Services reviewed the way these technologies are already helping to predict health events for patients and to personalize their care. “Through algorithms and data reading, machine learning helps us manage patients better and apply the treatments they need. We can now possible use apps capable of extracting data from audio and image files to help with diagnosis, for example.”

The COVID-19 pandemic has given a final push to all these new technologies intended to improve the efficiency of health processes, but it is undoubtedly telemedicine that has advanced most. “The pandemic has obviously had its negative side, with the loss of life and the effects on the economy. But it has also been an opportunity for the development of telemedicine, which is here to stay and will help us towards a better future,” noted Spigelman.

How to deal with a pandemic

One of the discussions at the #BHHSummit focused on analysing the role played by new technologies in dealing with COVID-19, both in the first wave and, now, the second. Some lessons in reducing the impact of the disease have already been learned. One of these lessons was the need to be able to trace infected people efficiently to help stop the spread of the virus. “With this type of app it is essential to be able to give people confidence that their data will be secure. Cooperation with institutions like universities is also important in order to perfect them,” said Roger Lim, Senior Policy Officer of the Netherlands’ Ministry of Health, Welfare and Sport.

This cooperation between institutions is crucial, as is collaboration between different countries to develop a global strategy, as Sameer Pujari, of the World Health Organization (WHO) wanted to stress. “A country can develop an app quite easily, but if there is no cooperation with other countries we’re not going to achieve good results in a case like this pandemic, which has affected the whole world. It’s also important to ensure that these solutions are used by as many people as possible.”

These new tools have served not only for tracking infections, they have also made it possible to substantially improve patient management, as Carolina García, a specialist in infectious diseases at Hospital Clínic in Barcelona, explained. Thanks to a smart data collection system, doctors were able to list patients in three categories, depending on whether they were undergoing serious inflammatory, infectious or thrombotic processes. “This allowed us to personalize treatment and make forecasts about the development of the disease so we could make early decisions.”

Symptom checkers, like the one from Mediktor, a virtual medical assistant based on Artificial Intelligence for triage, prediagnosis and clinical decision support, have also played an important role in dealing with the pandemic, as noted by Miguel Muñoz, Head of Business Development at Mediktor. On one hand, they worked well when it came to identifying people suspected of suffering from COVID-19 and allowed them to be isolated to reduce the propagation of the pandemic. “But they have also played a big role in distinguishing patients with COVID-19 from others with similar diseases. This capability also helped us to reduce excess demand for primary care services and decide on the most appropriate next step.”

“The technology has its limits, but it can be very useful and help us improve results. It has shown its usefulness in this pandemic and applications like telemedicine have managed to overcome any objections there may have been about it,” noted Jordi Serrano, founder of EpidemiXs, a website intended to publicize scientifically confirmed information effectively and efficiently to as many people as possible during the early stages of the pandemic. It also collects data, which is offered openly to scientists, and begins crowdfunding campaigns to finance research and develop solutions. “Technology clearly offers solutions, but we must never forget to ask the health professionals themselves about their needs so we can develop solutions that they will find genuinely useful and will actually use.”

Beyond drugs

Digital Therapeutics or DTX are demonstrating, through clinical trials, that they offer effective solutions that can help to deal with many diseases. They are also a tool that could become essential in caring for patients who are difficult to treat, like those suffering from chronic diseases. Small DTX startups are proliferating, but the big drug companies are also looking at DTX, as they can see that this is another new development in the industry. 

“First drugs with smaller and smaller molecules were developed, and then genetics. Now there are DTX. In short, the main aim is to improve results for patients,” said Celine Ulmann, Head of R&D at Almirall. One of the areas where the use of DTX could be very valuable is in dealing with patients with chronic diseases. “These are patients who are difficult to deal with, costing health systems a great deal of money because of their comorbidities, the multiple medication involved and the difficulty of sticking to treatments.” In these cases, DTX offer a holistic approach and a solution that goes beyond drugs.

Guido Senatore, Spain’s Country Medical Director for Bayer, agreed, also noting that the COVID-19 pandemic had completely changed the way of doing medicine. “And these changes are not going to go away. We won’t go back to doing medicine the way we did it before. Having digitally literate doctors is important in this process. Now, for example, they have seen that telemedicine is useful. We have been through a change and it is going to last.” Senatore also pointed out that Bayer is open to innovation and to all the options this opens up to develop new apps.

One example of what DTX can offer is Kaia Health, an app that uses a mobile phone camera to offer personalized advice on exercises that can be done at home to deal with chronic diseases affecting mobility. Jonas Duss is one of the cofounders of the company developing the app. “We need to understand that DTX are never going to replace conventional treatments, they’re going to complement them. That’s got to be our aim – working together.”

The importance of telemedicine in the future

One of the most often repeated ideas during the #BHHSummit has been the way that telemedicine has been strongly boosted by the situation resulting from the COVID-19 pandemic. The restrictions imposed during the first wave, seeking to reduce social interaction as much as possible, together with the overloading of health systems, meant many people could not go to health centres. Telemedicine offered an obvious solution.

Its advantages and possibilities had been praised for many years, but the final step had still not been taken. “Now we’ve been able to see the way telemedicine has helped us relieve the pressure on the health system, reduce the risk of infection and increase accessibility, improving comfort for patients and saving their time. We have seen that it works and it’s here to stay for good,” said Elena Torrente, Digital Health Development Deputy Director at DKV.

Not only has it shown its efficiency and effectiveness, some panellists, like Eloy Gómez, Hematology Business Franchise Head of Novartis Oncology, believe it has truly broken the mould. “We have moved from caring for patients when there is a health event to focusing on prevention. Now we will be able to shift the focus of health systems from disease to health, and that’s a real revolution.”

With the unavoidable implementation of telemedicine, it has been possible to make a true assessment of it, and the results clearly show that it works. “Between 60 and 70% of consultations made using telemedicine have prevented the need for a face-to-face visit and, after a year, up to 80% of users have still got the telemedicine apps on their devices, which tells us that they want to use them. It’s clear that telemedicine helps make the system more effective,” said Pablo Mas, COO at MeetingDoctors.

Telemedicine also provides solutions for one of the great fears of the generalized application of new technologies – the dehumanization of the health system. “On the contrary, remote consultations have made it possible to maintain the connection with doctors during the worst moments of the pandemic. And the use of video calls to deal with COVID-19 patients has also reduced the risk of exposure to the virus,” said César Morcilo, Medical Director of Sanitas Digital Health.

“In Spain, this has also been because we were starting from an excellent position in terms of the roll-out of infrastructures, which has allowed high levels of connectivity, even at the most difficult times,” added Manel Peiró, director of the Institute for Healthcare Management at Esade. He also pointed out that telemedicine is a very important tool for the sustainability of the health system.

Changes in the investment system

With the third quarter of the year now over, the total investment in digital health is already above the figure for 2019, which was a record year for funding. Although there were moments of doubt in the early stages of the COVID-19 pandemic, investment has never dried up. “We can see that more and more money is being invested in the digital health sector, above all in three main areas. The first is alternative care, including telemedicine and solutions to prevent journeys to hospitals. The second is related to clinical operations and using technology to make them more effective. Finally, there is the digitization of clinical trials,” said Sophie Ehrlich, Senior Vicepresident Life Sciences & Healthcare at Silicon Valley Bank.

Rocío Pillado, a partner in Adara Ventures, also explained that the pandemic has offered an opportunity to everyone developing telemedicine apps. “Investors have been very keen to invest in this type of solution and, in general, in all solutions that help the health system to be more cost-effective. As well as telemedicine, there has also been interest in applications concerning clinical trial processes and clinical processes like radiology.”

“COVID-19 has changed the rules of the game and we have seen that many changes have speeded up, often driven by pure necessity,” noted Miguel Valls, founding partner of Alta Life Sciences. These changes have affected the regulatory process, as Lara Koole, partner in Philips Ventures, noted. “We knew these processes were taking years, but now they have speeded up quite surprisingly.”

The COVID-19 pandemic has also represented an opportunity to develop new and so far little-explored areas, as Logan Plaster, Media Director of Startup Health, was quick to highlight. “The targets in the next few years are related to cancer, women’s health and mental health.” Plaster was also optimistic for eHealth investment in 2021.

#BHHAwards and Investment Forum

This year, the #BHHSummit once again provided the backdrop for the presentation of different initiatives and startups competing in the #BHHAwards. Voting was open for several weeks in the four categories established this year and, in the end, more than 30,000 votes were counted. The final results were:

1. Best startup: Famileo
2. Best startup growth: Doctoralia
3. Best corporate initiative for dealing with COVID-19: Sanitas
4. Best startup initiative for dealing with COVID-19: Covidwarriors and Epidemixs

The Investment Forum was also held, focusing for the first time on eHealth. This is a joint initiative by BHH, the Col·legi de Metges de Barcelona (Official Barcelona Doctors’ Association – COMB), Esade Ban and Barcelona Activa. This eHealth Investment Forum is intended to provide a space for digital health startups to meet investors, not just from Spain and Europe but from all over the world.

A total of ten proposals were selected, divided between Early Stage, for startups seeking funding of less than one million euros, and Growth Stage, for those needing more. A jury of international experts chose a winner in each category, which received a prize equivalent to 25,000 dollars in credit for Amazon Web Services (AWS). The others were given aid worth 10,000 dollars, conditional in both cases on never having received credit of this kind before.

In the Early Stage category, the chosen initiative was Wemby, an app to offer online therapy for emotional well-being, while at the growth stage the winner was Lactapp, the first app devoted to maternity and breast-feeding.