Stanford Medicine 2020 Health Trends Report The Rise of the Data-Driven Physician 2020 Health Trends Report Foreword from Dean Minor Since its inception, the Stanford including those from health apps and Medicine Health Trends Report has wearables, as part of routine care. examined the most consequential These developments have significant developments and technologies that potential to advance patient care and are changing health care delivery. empower tomorrow’s health care Our 2020 report describes a health providers to predict, prevent, and cure care sector that is undergoing disease—precisely. seismic shifts, fueled by a maturing And yet, the promise of this future is digital health market, new health not assured. Among those surveyed, laws that accelerate data sharing, few feel “very prepared” to implement and regulatory traction for artificial emerging technologies in clinical intelligence in medicine. practice, especially for innovations In 2020 and beyond, these trends have that physicians and students say enormous implications for patients, have the greatest potential benefit influencing how they will experience for patients. This Transformation Gap health care as well as the services they represents both a major challenge may soon have access to. But to truly and opportunity for health care understand how this future is taking stakeholders. Certainly, we will need shape for patients, we felt it was critical to heighten our focus on providing to start by asking those who will be physicians and clinicians with directing their care. adequate training. But we must also As a proxy for the health care delivery account for other issues. Lloyd B. Minor, MD system, Stanford Medicine conducted From our survey, we see a future Dean, Stanford University School of Medicine a national survey of physicians, health care workforce that today residents, and medical students to is grappling with high levels of understand how key health care trends student debt, poor work-life balance, will manifest themselves in the doctor’s and administrative distractions— office over the next decade. issues that are influencing career What we found boils down to one choices, including whether to central idea: physicians expect new remain in medicine. Educators, technology to transform patient care health administrators, government in the near term, and they are actively officials, and the private sector—now preparing to integrate health data— enmeshed in health care delivery—all and the technologies that harness have distinct opportunities to alleviate it—into the clinical setting. In other these burdens. words, we are witnessing the Rise of The findings presented in this report the Data-Driven Physician. are just the beginning of an important Physicians and medical students conversation. As we embark on a now pursue supplemental education new decade, there is no better time in data-oriented subjects such as to have a discussion about how we advanced statistics, coding, and can prepare and support tomorrow’s population health. And they express health care providers to rise to their openness to using novel datasets, fullest potential. 2 2020 Health Trends Report Table of Contents Introduction 4 Methodology 5 Findings 1. Transformation of Health Care 6 2. The Rise of the Data-Driven Physician 10 3. The “Transformation Gap” 15 4. Under Pressure 17 Conclusion 21 3 2020 Health Trends Report Introduction The 2020 Stanford Medicine Health Trends Report identifies the Rise of the Data-Driven Physician as one of the industry’s most consequential developments—one that has significant implications for patients. To understand this trend, there are four factors to appreciate: 1. An industry under transformation. In 2020, it is clear that the heath care sector is being profoundly altered by a number of trends, from technology advancements, to consumer adoption of novel health services, to policy and regulatory developments. Taken together, these trends place a high premium on new skills that fall outside the traditional domain of health care delivery. 2. Health care providers awake to new developments. The next generation of physicians is developing a broader skillset. Our research found that nearly three-quarters of all medical students and nearly half of all physicians are planning to pursue additional education in data-oriented such as advanced statistics and data science. 3. A transformation gap in health care. Currently, physicians and medical students report low levels of readiness to implement the technologies they believe have the most transformative potential for health care and their patients. While physicians recognize the benefits of many new technologies, education and training currently lag in fully preparing them for these new developments. 4. Under pressure. Even with a new skillset, tomorrow’s physicians face significant practice pressures today that are influencing their decision-making, including which specialties they choose and even whether they will remain in medical practice. Moreover, issues such as private industry getting involved in health care loom over the medical profession. How these trends play out will ultimately determine the future success of the Data-Driven Physician. These trends and developments present important challenges and considerations for health care stakeholders. What’s clear is that, if they can be successfully navigated, we will witness a revolution in health care, one that will bring significant innovation and data-driven insights to patient care. 4 2020 Health Trends Report Methodology In addition to conducting a secondary review of news articles, white papers, and peer-review research for the 2020 Health Trends Report, Stanford Medicine worked with Brunswick Insight to conduct a comprehensive survey of 523 U.S. physicians and 210 medical students and residents. (The student and resident sample included 77 current medical students and 133 medical residents.) Respondents were contacted through a list of American Medical Association (AMA) verified physicians and survey sample panels of medical professionals. Respondents were compensated for their involvement in the survey and were informed that their responses will be used to inform public-facing research. Respondents were given the opportunity to opt- out of any and all questions in the survey. Respondents were contacted between September and October of 2019. Percentages are rounded up to the nearest whole number when calculating totals. 5 2020 Health Trends Report Findings 1. Transformation of Health Care The Rise of the Data-Driven Physician is the direct consequence of data and technology transforming the health care sector The Rise of the Data-Driven Physician investments that were made in 2018. is a sign that the entire health care While the total number of deals seems market is now grappling with the likely to stay consistent with 2018, practical application of data and new the average size of the deals has technologies. Specific developments increased.iii that are driving these changes include: Consumer behavior also • The maturation of the digital health demonstrates a growing maturation care market of digital health care. Analysis from • The availability of data Rock Health shows an increase in • Artificial intelligence moving from the use of digital health tools by theory to practice consumers over time, including wearable health-tracking tools and The Digital Health Market Is Maturing provider reviews.iv The digital health market is showing Data Sharing Is Increasing signs of maturity as it moves from a Landmark legislation and regulatory realm of ambitious early-stage start-ups priorities are pushing the health to more established companies with care sector to make data sharing validated products. In part, this helped a priority. The 21st Century Cures to fuel several high-profile IPOs of Act, passed in December 2016, has digital health companies in 2019. Last led to new data sharing rules for year, we also saw major corporations Electronic Health Record (EHR) make multi-billion-dollar offers to systems—the technology now used acquire digital health companies that by most medical practices to digitally have, over time, amassed a significant document patient care. consumer following. The rules, which are now under Notable health care companies that final review with the U.S. Office of went public in 2019 include Livongo Management and Budget, define and Health Catalyst, which both and limit information blocking entered the market with billion-dollar practices, greatly expand patients’ valuations.i Also prominent was access to their own medical records, Google’s announcement to acquire and promote standardized language Fitbit for $2.1 billion dollars.ii and application programming Analysis from Rock Health indicates interfaces (APIs) that encourage that investments in digital health technical interoperability across care in 2019 are keeping pace with EHR systems. 6 2020 Health Trends Report Digital Health Funding 2011-H1DIGITAL 2019 HEALTH FUNDING 2011-H1 2019 TOTAL ENTURE FUNDING OF DEALS 10B 1,000 $8.2B $8.4B 8B 800 6B $5.8B 600 $4.7B $4.6B $4.2B $4.1B 4B 360 400 363 376 320 340 $2.1B 291 2B B 200 $1.5 196 180 $1.1B 142 93 0 2011 2012 2013 2014 2015 2016 2017 2018 H1 2019 AERAGE DEAL $12.0M $10.6M $10.7M $14.0M $14.7M $13.5M $15.9M $21.9M $23.1M SIE Source: Rock Health (2019). 2019 Midyear Digital Health Market Update: Exits are heating up. AdoptionADOPTION of Digital OFHealth DIGITAL Tools HEALTH TOOLS 2015-20192015-2019 LEGEND 2015 2016 2017 2018 2019 100% 80% 75% 79% 76% 71% 72% 64% 64% 58% 50% 50% 51% 42% 38% 34% 33% 33% 33% 32% 31% 25% PERCENT OF ALL RESPONDENTS 24% 24% 22% 19% 18% 13% 7% 0% LIE IDEO WEARABLE DIGITAL HEALTH ONLINE PROIDER ONLINE HEALTH TELEMEDICINE OWNERSHIP TRACING REIEWS INFORMATION Source: Rock Health (2019). Digital Health Consumer Adoption Report 2019. 7 2020 Health Trends Report For an industry that has long struggled is also central to having a learning The algorithms approved cover a broad with low levels of information sharing health care system, advancing spectrum of treatments and diagnoses.