Canadian Health Technology Assessment (HTA) agency CADTH has recently published a "Horizon Scan" naming health technology trends with expected large impact on Canada that have the potential to harness large volumes of data, improve clinical workflows, and bring accessible health care closer people everywhere. With Canada's spot in the top 20 most innovative countries in the world we can attempt to extrapolate the trends to what we can eventually expect on a global scale as well. Interestingly, a half of these trends were directly related to diagnostics. Let's take a closer look at those.
1. Point-of-Care (PoC) Testing
Diagnostics anytime, anywhere. According to CADTH, the emergence and integration of point-of-care testing has the potential to ease demand on central laboratories and support public health efforts in disease control and surveillance. Many point-of-care tests can be performed in a variety of care settings without specialized training or even at home by patients themselves. COVID-19 has dramatically sped-up the adoption and popularized PoC testing. Devices and testing workflows which can provide service of a full molecular biology lab also in remote and hostile conditions are now intensely sought after.
2. Molecular and Genomic Testing
"The emergence of whole genome sequencing (or more commonly, sequencing of protein-coding regions) will be disruptive and transformative to the Canadian health care landscape", CADTH states. We at ambiom expect with great certainty this will eventually pertain to all other regions of the world. This is owing to sequencing dramatically increasing in speed, precision and portability whilst significantly decreasing in price. According to CADTH, molecular and genomic testing has the potential to have a major impact on routinizing precision medicine in health care of Canada.
3. Artificial Intelligence for Diagnostics and Public Health
CADTH believes that in the field of public health, artificial intelligence (AI) may help improve disease surveillance, detection, and mitigation by facilitating analyses of large volumes of complex, multi-sourced data from around the world. By using AI to support health data collection, researchers can investigate new methods for assessing the effectiveness of public health interventions and informing targeted health promotion activities and disease incidence forecasts.
Moreover, in terms of diagnostics, CADTH highlights importance of AI in medical imaging. XrAI is an AI radiology tool approved for use in Canada that uses deep learning to assist clinicians in interpreting chest X-rays. XrAI was recently deployed across Canada to confirm pneumonia and other respiratory symptoms associated with COVID-19.
4. Companion Diagnostics
Long gone are the days of one-size-fits all when it comes to approach to therapy. One of the hallmarks of ongoing personalization of medicine is emergence and development of companion diagnostics. CADTH explains that companion diagnostic tests assess predictive biomarkers in individuals, such as genetic variation or protein expression, to determine whether associated therapy is safe and effective to use.
We need to point out many novel oncology therapies, such as checkpoint inhibitors - typically indicated for a range of different cancers, already require pre-prescription diagnostics and we can expect this trend to spread across all therapeutic indications. Increasingly, companion diagnostics is based on molecular and genomic testing (see point 2).
5. Remote Diagnostics, Remote Monitoring, and Remote Care Management
Remote care refers to the delivery of care at a location and time that is convenient for all members within the circle of care. CADTH believes the expansion of remote care technologies that allow for the diagnosis, monitoring, and management of patients may fundamentally shift the way people access health care in Canada. Remote care technologies may help expand access to quality health care across also for people living in rural and remote areas, and allow them to connect with specialty care that would be otherwise unavailable without travel.
Emerging tools to assess “digital biomarkers” that monitor hand and eye movements or changes in speech may allow clinicians to monitor changes or diagnose people with conditions such as Alzheimer disease or dementia. COVID-19 has had tremendous impact on this trend, on all levels. According to report by McKinsey & Company, utilization of telemedicine has stabilized at 38x the pre-COVID-19 baseline which has also forced payers to start taking reimbursement of telemedical solutions more seriously.
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