challenges and opportunities medical apps in...

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Challenges and opportunities Medical Apps in Belgium

The story of moveUP in a nutshell

Ward ServaesCofounder, CEO moveUP

WardAbout

About

WardServaes– moveUP©

WardServaes

Cofounder&CEOmoveUP

VlerickBusinessSchool– ExecutiveMBANikoHomeControlIoT – ProductManager

PhilipsConsumerElectronics– InnovationManager

KULeuven– MasterEngineering

37yFatherof2

Ideation

Arthroplasty

mHealth

startUP

moveUP

Takeaway

Lookingforopportunities

Standardofcare

Hugeopportunities

Leanapproach

What’snext?

Agenda

MedicalAppsinBelgiumTheStoryofmoveUPInanutshell


Lookingforopportunities

Ideation

Ideation


Dec2014 Jan2015

VlerickClass

GrandmotherofCharles-Eric

moveUPtimeline

Charles-EricWinandyMasterComputerScienceFinance- Trader

Philippe Van Overschelde OrthopaedicsurgeonBiomedicalEngineer

moveUP©

StartUP

moveUP©

Dec2014 Jan2015

VlerickClass

GrandmotherofCharles-Eric

moveUPtimeline

Apr2015

Elderlysports&leisure

May2015

RehabilitationPainofPhilippe

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EnjoyslifeLovesGardeningAdoreshergrandchildren

Patient

HighdegreeofarthritisTotalhip/kneereplacement

JacquelineGrandmother,71

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Jointreplacement- StandardofCare

Arthroplasty

Arthroplasty

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PatientOsteoarthritis

40%>65y:osteoarthritisofthehip/knee

80%ofpeoplewithosteoarthritishavelimitationofmovement

25%decreaseddailyactivitiesofliving

SourceWHO:TheBoneandJointDecade

OsteoarthritisPatient

moveUP©

Patient’sExpectationArechanging

Patient

Pain

1970 1980 1990 2000 2010

N°ofProcedu

res

RangeofMotion Function Sport

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JointreplacementAnewera

Past Complexsurgery

Patientimmobilised

Longhospitalstays– 2weeks

Uncertainoutcome

Difficult&longrehabilitation

Current Routinesurgery

Fitpatients

Shorthospitalstay– 3days

Predictablesurgeryoutcome

Predictableendresult?

Problem

moveUP©

Arthroplasty

Before After

InCompanyProject–moveUP–WardServaes 10

3. Arthroplasties&Rehabilitation

3.1. Evolutionoftotalhip&kneearthroplasties

3.1.1. Definition&Surgery

Arthroplastyisasurgicalproceduretorestoretheintegrityandfunctionofajoint(Hopkins,2016).Ajointcanberestoredbyresurfacingthebones,orbyreplacing(partof)thejointbyanartificialjoint,calledaprosthesis.Arthroplastyisappliedwhenmedicaltreatments(medication,physicaltherapy,weightloss,exercise,cortisoneorotherinjections,…)nolongerprovideadequaterelieffromjointpainand/ordisability.

Themostcommoncauseforahiporkneearthroplastyisosteoarthritis.Thisisadegenerativejointdiseasethatischaracterizedbythebreakdownofjointcartilageandadjacentboneinthehiporknees(Figure2&3).Otherforms/typesofarthritis,fractures,torncartilageoravascularnecrosisalsocanleadtoirreversibledamageandhencetoahiporkneereplacement.

Thetwomostcommontypesofkneeorhipprosthesesusedinreplacementsurgeryarecementedoruncemented prostheses. A knee or hip prosthesis ismade up ofmetalwith ceramic or plastic. Acemented prosthesis is then attached to the bone with a type of Polymer called PMMA(PolyMethylMethacrylate),whileuncementedprosthesisattaches to thebonewitha finemeshofholes on the surface, in order for the bone to grow into the mesh and attach naturally to theprosthesis.

Figure4-Hipprosthesis(Fischer, Hip prosthesis)

Figure2-Anatomyoftheknee Figure3-Arthritichipjoint


3. Arthroplasties&Rehabilitation

3.1. Evolutionoftotalhip&kneearthroplasties

3.1.1. Definition&Surgery

Arthroplastyisasurgicalproceduretorestoretheintegrityandfunctionofajoint(Hopkins,2016).Ajointcanberestoredbyresurfacingthebones,orbyreplacing(partof)thejointbyanartificialjoint,calledaprosthesis.Arthroplastyisappliedwhenmedicaltreatments(medication,physicaltherapy,weightloss,exercise,cortisoneorotherinjections,…)nolongerprovideadequaterelieffromjointpainand/ordisability.

Themostcommoncauseforahiporkneearthroplastyisosteoarthritis.Thisisadegenerativejointdiseasethatischaracterizedbythebreakdownofjointcartilageandadjacentboneinthehiporknees(Figure2&3).Otherforms/typesofarthritis,fractures,torncartilageoravascularnecrosisalsocanleadtoirreversibledamageandhencetoahiporkneereplacement.

Thetwomostcommontypesofkneeorhipprosthesesusedinreplacementsurgeryarecementedoruncemented prostheses. A knee or hip prosthesis ismade up ofmetalwith ceramic or plastic. Acemented prosthesis is then attached to the bone with a type of Polymer called PMMA(PolyMethylMethacrylate),whileuncementedprosthesisattaches to thebonewitha finemeshofholes on the surface, in order for the bone to grow into the mesh and attach naturally to theprosthesis.

Figure4-Hipprosthesis(Fischer, Hip prosthesis)

Figure2-Anatomyoftheknee Figure3-Arthritichipjoint


AhipprosthesisasshowninFigure4iscomprisedofthefollowingfourcomponents:ametalfemoralcomponent (titanium for cementless – CrCo for cemented), ametal or ceramic femoral head, anacetabularcomponentthatroutinelyconsistsofametalshellandalinerinceramicorpolyethylene(plastic). A knee prosthesis as shown in Figure 5 ismadeupof the following four components: a tibialcomponent, a femoral component, a polyethyleneinsertandapatellarcomponent.

3.1.2. EvolutionofArthroplasty

Arthroplasty surgery of hip& kneewent through arevolution the last decades (Kelly, 2010). However,theconceptofimprovingkneeandhipjointfunctionbymodifying thearticular surfacesdatesback fromthe 19th century. In 1863 Verneuil interposed softtissuebetweenthebonesofakneejointforthefirsttime.Resultsweredisappointingandwhenimplantsevolved from soft tissue to glassmoulded implantsthese could not withstand the great forces goingthroughhiporknee jointandshattered. John Insall(1973,US,NY) designedwhat has become the fourcomponent prototype for current total kneereplacements as described in 3.1.13.1.1. JohnCharnely(Early ‘60,UK,Wrightington)revolutionizedthemanagementofthearthritichipwiththedevelopmentofalow-frictionarthroplasty.

Typically, wear, breakage or local reactive effects of particles are causes for a revision surgery.However, with the evolution of materials that are applied, like polyethylene and ceramics incombinationwithmetal, the lifetimeof the implant rosesignificantly (Knight,2011).Thecostofarevisionsurgeryhasbeenforyearsthereasontopostponeatotalhiporkneearthroplasty.Meanreasontopostponesurgeryisthelimitedsurvivaloftheimplantsinyoungerpatientsbecauseoftherelationbetweenwearandactivity.

Now,howeverweseeabiggerspreadintheageofthepatients(Lohmander,2013).Theextendedlifetimeof implantsallowsyoungerpatients tobe treated,whilewealso seeolderpatientsbeingtreatedduetothelowersurgicalimpact.Indeed,togetherwiththeimplants,alsosurgeryhasevolved.What used to be a complex surgery has evolved into a routine.We now see minimally invasivetechniquesbeingapplied.Byminimizingincision,soft-tissueissparedwhichresultsinthepossibilityofreducedintra-operativebloodloss,shorterhospitalstaysandimprovedfunctionalresults.

The standard hospitalization period evolved from3weeks to 3 days in clinic. Patients used to beimmobilizedduringacoupleofdays,butnowadaystheyareencouragedtomovefromthefirstminutetheywake up after surgery. This has numerous advantages such as reduction in the incidence ofthromboembolicevents,quickerreturntodailyactivities,lesspainandlesscosttothesociety.Thegeneralhealthcareevolutioninimagingtechniques,abetterunderstandingofjointkinematicsandbetter perioperative management (bleeding management, pain management and ambulatorymanagement),togetherwiththesurgicaltechniquesandimplantinnovationshaveresultedintheseoutcome improvements.On top, patients getmore empowered by pre-operative counselling andinformationsharing.Morerecentlytheevolutionofcustomizeddesignforarthroplastyimplantsstartsto show its benefits for all stake holders involved. Implant manufacturers eliminate inventoryinvestments,hospitalsbenefitfromshorterset-uptimes,andsurgeonscanprovidethepatientwithimproved postoperative alignment and better fitting implants. Complex cases can benefit fromcustom made implants, 3D surgical planning software packages and additive manufacturingtechnologytocometoamorepersonalizedsolutionforeachpatient.

Figure5-Kneeprosthesis(Fischer,Kneeprosthesis)

27.000Hips

JointreplacementsperyearInBelgium

22.000Knees

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Implant

JointreplacementTools&implantsizing

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PatientOutcome&SatisfactionAfterKneeorHipReplacement

15- 30%arenotsatisfied

Highvariabilityin“standard”ofcareUnpredictableendresult

Drivenby WrongexpectationsComplicationsduring&afterhospitaldischarge– wound,DVT,overtraining,…

Underestimated Up to 45% of patients still taking painkillers 4 months after surgery 1

10-28% Chronic Post-Surgical Pain (CPSP) 2

Currentissues

à Importanceofadequateearlypatientmulti-modalfollow-upandcoaching

1 EurJAnaesthesiol. - 2010Persistentpainfollowingkneearthroplasty.- PuolakkaPA2 ArthritisCareRes.- 2013Assessmentofchronicpostsurgicalpainafterkneereplacement,asystematicreview- WyldeV

Problem

moveUP©

Hugeopportunities

Ideation

moveUP©

mHealth

eHealth

DefinitionofeHealth,WHO2015

Isthetransferofhealthresourcesandhealthcarebyelectronicmeans

DefinitionofMobileHealth,PWC2015

Theprovisionofhealthcare orhealth-relatedinformationthroughtheuseofmobiledevicesMobileapplicationsandservices… [like]remotepatientmonitors,videoconferencing,onlineconsultations,personalhealthcaredevices,wirelessaccesstopatientrecordsandprescriptions.

mHealthIsaformofeHealth

https://www.kaiserpermanente.org/

moveUP©

mHealth

Mobiledevices

Cloud

Healthcareproviders

Patient

Data

Ubiquitous

Wearables

Healthrelated

Source:liveclinic.com

mHealthIsaformofeHealth

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mHealth


4. moveUPinmHealth–focusandambition

4.1. mHealth

DefinitionofmHealth(PWC,2014):

Theprovisionofhealthcareorhealth-relatedinformationthroughtheuseofmobiledevices(typicallymobile phones, but also other specialisedmedical mobile devices, like wireless monitors).Mobileapplications and services can include, among other things, remote patient monitors, videoconferencing,onlineconsultations,personalhealthcaredevices,wirelessaccesstopatientrecordsandprescriptions.

mHealthisconsideredtobeasub-areaofeHealth,whichisthetransferofhealthresourcesandhealth

carebyelectronicmeans(WHO,2015).Onecomplicatingfactoristhateventhoughtermssuchasm-

health, e-health, telehealth, telemedicine, telemonitoring, andpersonalhealtharewell defined in

principle,theyarenotclearlydistinguishedfromeachotherinreal.

4.1.1. mHealthdrivers

mHealth is hot nowadays, and that ismainly driven by its potential.Where the evolution of key

technologytrendshasbeenpickedupindifferentsectorsalready(entertainment,communication,

banking,…) thenextwaveof technology solutions is impacting thehealthcare sectorondifferent

levels.Thekeytechnologyelementswhichdrivethisaremobile,bigdata,cloud,socialandinternet

ofthings.Themaindriversfromwithinthehealthcaresectoraretwofold.First,weareconfronted

with anever agingpopulation. This implicates anexponential increase inpathologies, andpeople

expectthesamequalityof lifeatanolderage.Aseconddriver istherisingcostconcern.Atypical

quality improvementor innovation inhealthcarecomeswithahighercost,whilemHealthhas the

potential toreducecost.OnekeyelementwhichvowsformHealth’schancesonsuccess is that in

mostcircumstancesitmakesuseofexistinginfrastructure.Forexample,theremotemonitoringofa

diabeticpatient requires theuseofabloodglucosemonitorand thepatient’smobiledevice. The

connectionbetweentheseandtheanalysisintheback-endaresimpleadditionstoexistingproducts

inthemarket.

4.1.2. mHealthpromises

mHealthpromisestoimprovepatientcare,treatmentandsafety,forexamplethroughearlydisease

diagnosis, improved patient compliance, and improved disease testing.mHealth helps to achieve

sustainablecostreductionsforthehealthcaresystemusingexistingtechnologicalinfrastructuresuch

assmartphonestotreatdiseasesandmonitorchronicallyillpatientsbetter,andreducehospital(re-

)admissions.mHealthpromisestoincreasethehealthcaremarket’sefficiency(ATKearney,2013)as

Figure9-Examplesofmobilehealthsolutionstoincreasethehealthcaremarket'sefficiency

7Mobile Health: Mirage or Growth Opportunity?

Mobile health can sustainably reduce healthcare costs. Apart from the qualitative advantages of m-health discussed above, new technology will reduce costs and increase service efficiency. New m-health solutions are far cheaper to purchase and maintain than previous e-health solutions. As most m-health services use mobile communication devices, they can make use of existing technological infrastructure. Moreover, the latest smartphones are considerably more capable and less expensive than portable PCs were just a few years ago. These phones use communication technologies (such as Bluetooth and near field communication) that enable complex networks to be set up among several mobile devices, a clear advantage over the traditional mobile devices from the days of telemedicine.

Various other actions can reduce costs (see figure 5).

Efficiency of healthcare provision

Source: A.T. Kearney analysis

Figure 5 How m-health can increase the healthcare market’s efficiency

System costs and benefits

Number of patients

Number of visits to the doctor

Number of activities per visit to doctor

Costs per activity

Population risk Efficiency of patient experience

Examples of mobile health solutions

= × × ×

• M-health provides an automated data pool of patients‘ devices and delivers information to doctors. Patients do not have to record data on their own and deliver it to their doctors.

• M-health improves patients’ treatment compliance and reduces the danger of emergencies.

• M-health consults on prevention so that fewer people have to visit a doctor or hospital.

• M-health enables remote monitoring of patients suffering from certain diseases, thus reducing the number of outpatient follow-up visits.

• M-health enables patients with portable devices that are connected to their mobile phones to be discharged sooner.

• Preventive educational and awareness-raising measures that cut the number of patients needing consultation services

• Early detection of diseases and their timely treatment at early stages

• Close monitoring of chronically ill patients to detect critical abnormalities early and help avoid hospital admission in some cases

• Remote-monitoring solutions that reduce the number of outpatient follow-up consultations after hospital treatment

• Remote-monitoring solutions that enable some hospital patients to be discharged sooner

Automated, structured data collection would give doctors immediate access to relevant patient information, simplifying communication and speeding up contact time with patients, especially in cases when patients see multiple specialists from different disciplines. According to the World Health Organization (WHO), chronic diseases account for about 80 percent of today’s health expenditures, and we believe this is where m-health solutions will provide the greatest benefits and biggest cost reductions.

A.T.Kearneyanalysis,2014

PotentialofmHealthInnovationatalowercost

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mHealth

4Mobile Health: Mirage or Growth Opportunity?

• How attractive will the mobile health market be for the German health industry in the future?

• Which players have the capabilities to exploit m-health’s full potential?

• How can the pharmaceutical industry profit from the mobile health market?

• What opportunities will arise for the medtech industry?

• How relevant will mobile health be to the health industry’s growth over the next five years?

What Is the Mobile Health Promise?The definition of m-health has evolved in recent years. Today m-health is considered a sub-area of e-health, and the term includes the use of both classic mobile communications technologies and also any mobile technologies through which health services can be offered or received. As such, m-health can provide added value for patients and consumers on top of e-health. As m-health spreads, the traditional health services market will converge with secondary health services, which includes prevention and wellness. Consequently, from a technological viewpoint, the boundaries between patients suffering from disease and healthy consumers are gradually blurring.

M-health’s development is particularly apparent in the spread of application-oriented innovations. For example, m-health links existing technologies such as mobile Internet and blood glucose monitors to solve complex issues and cut out unnecessary steps in the treatment pathway. By making use of readily available infrastructure, m-health will offer lasting improvements in the quality of care, the comfort patients’ experience during care, and the costs to the healthcare system.

M-health addresses a wide range of fields. Figure 2 shows the various categories of m-health solutions—including information, assessment, intervention, monitoring, and coordination— with their applicability distributed along the entire treatment path.

Source: A.T. Kearney analysis

Figure 2 M-health can be applied across the entire treatment path

Wellness Prevention Diagnostics Therapy Control

Information

Assessment

Intervention

Monitoring

Coordination

Remote monitoring of healthy people

Healthcare management

Remote monitoring of diseased patients

Compliance management

Communicating with and analyzing interest groups

Supporting practice management

A.T.Kearneyanalysis,2014

PotentialofmHealthStagesintheuser/patientjourney

moveUP©

LeanApproach

LeanApproach

moveUP©

startUP

May2015 Oct2015 Nov2015

FocusJointarthroplasty

ProofofConcept6patients

FoundedmoveUP

Dec2015

MinimumViableProduct26patients

moveUPtimeline SpecialistinputPatientCentered

moveUP©

ActivityandSleep Exercisevideos Messages&Exercises Survey

moveUPminimalviableproduct

moveUP©

ProblemStandardofCareBlindSpotsaftersurgery

Surgery 2monthfollowup

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Problem

Woundproblem DVT Under/Overtraining

StandardofCareBlindSpots


moveUP©

Solution

moveUPPatientfollowupMay2016


moveUP©

BuildingtheNetwork

Feb 2016 March 2016

mHealthhackaton

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PressAwardApril2016

PresscoverageJury:RIZIVKabinetDeBlockKabinetDeCrooPharma.beInvestorsMutualities

moveUP©

Workstreamkickoff

August 2016May 2016

SeedFundinground500k FFF

SubsidyVlaio

moveUP©

Oct2016

Health&CareAward

MSDAward

September2016

Wardasfull-timeCEOINAMIpilotproject

Medical AdvisoryBoard&Researchsetup

MultiDisciplinaryLiteratureAnalysisClinical EvidenceRisk assessment

Network

moveUP©

AP19

moveUP©

AP19

Aim

• Betterhealthandcomfortoftheuser

• CreateframeworkformHealth:legal,financial,organizational

• AssessandsupportqualityandaccessibilityofmHealth

eGezondheidsplan– ActionPoint19– mobilehealthAim,usecasesandtargets

Stroke

Timing

• Selectionprojects– December2016

• Kickoffprojects– Mei2017

• Duration:6months–May– October• 200patiënten

• 3hospitals

• Evaluation– End2017

• Legalframework– Early2018

Cardiovascular Diabetes Mentalhealth Chronicpain

Usecases

moveUP©

Charles-EricWinandyco-founder,Data&Operations(100%)

WardServaesco-founder,CEO(100%)

PhilippeVanOverscheldeco-founder,ChiefMedical Team

moveUPTeam

TobeAnnouncedPartner,BusinessDevelopment

Teamof12FTEProductdevelopmentHealthCareProfessionalsRegulatoryClinical

MedicalAdvisoryBoardInternational KOL

Advisory BoardMedDev,Hospital,Insurance,Digital

?

moveUP©

moveU

PmoveUPValuebasedhealthcare

100%Personalized

Outcomedriven

Evidencebased

Rehabilitation

Multimodal

Fromhome

Daily

InclusionsmoveUPresultsProspectiveMulti-CenterControlledStudy(n=190)CommercialisationBE,FR,NL(n=290+)

Hospitalinclusion Surgeryrepartition

12hospitals24surgeons

AgeDistribution

Inclusion - DischargetohomesituationafterprimarykneeorhiparthroplastyExclusion- Mentally notfittousemHealthserviceOutcomes- Functionality,Pain,Expectations,Satisfaction,HealthEconomics

8

34

110

182

128

171

0

25

50

75

100

125

150

175

200

30-40 40-50 50-60 60-70 70-80 80-90 90-100

THA,28960%

TKA,16134%

UKA,306%

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Crap?moveUPvsCrapApps– challenge1#

Endof2017:325.000mHealthApps(25%YoY)moveUPisamedicaldevice

ClassI/ IIa

?

Source:Research2Guidance

moveUP©

BenefitsWhopays?CurrentmHealth– challenge2#

BusinessModel

NationalPayer

Hospital

Surgeons

PhysicalTherapists

ImplantDeviceCompany

PeripheralPhysicaltherapists

€

€€

€

Prescribes

PrivatePayer

€

moveUP©

Benefits

Higherpatientsatisfaction,betteroutcomesLessunplannedconsultation/readmissionEffectivePROMcollection

ShorterhospitalstayQualitybasedoutcome

Effectivepatientmanagement

OutpatientClinicstrategy

Higheradherence

EvidenceBasedTherapy

Multi-disciplinarycommunication

Betteroutcomes

LowercostsQuickerreturntowork

Benchmarking

Post-clinicaldatacollection&surveillancePatient-productmatching

Medication/Protocoloptimization

Valueandbenefits

QualitybasedoutcomeLowercosts

ApainlessandpersonalrehabilitationforthepatientAndaddedvalueforallstakeholders

moveUP©

Patient

Surgeon

HealthInsurance

Government

MedicalDevice/Pharma

Hospital/Care

institution

PhysicalTherapist

BenefitsBusinessModelFuturemHealth– bundledpayment

BusinessModel

NationalPayer

Hospital

Surgeons

Physicaltherapists

ImplantDeviceCompany

PeripheralPhysicaltherapists

Service

€€

€

€

FromadisruptivealternativetofeeforserviceToanoutcomebasedbundledpayment

moveUP©

mHealth

moveUPinthepressReimbursement

CEMarking

Interoperability, Security,Privacy

ValueBasedHealthcare – Betteroutcomeatlowercost

moveUP©

Reimbursem

entmoveUPReimbursement

CEMarked,GDPRcompliant

Interoperability, Security,Privacy

ValueBasedHealthcare – Betteroutcomeatlowercost

IterationwithRIZIV/INAMIasone ofthe3firstmHealthservicesinBelgium

Mhealthbelgium.be

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BenefitsTakeAwayMessage

TakeAway

!""#"%&'(# = *&+,#-+.&+,./&0+,1- ∗ *&+,#-+1(+013#.4%#5&''01.+

FreeafterMichaelE.Porter– ValueBasedHealthcare

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