Medical technology, essentially consists of devices and information systems that diagnose, prevent, treat, or improve a person’s health and well-being. Understandably therefore, it a huge swath of tools and technology. The USFDA, a leading regulator of medical technology, along with many other regulators classify medical technology or devices across three very broad types, depending on their risk and need for safety and effectiveness; Class I is lowest risk, while Class III is highest.

The magazine, and thus this article is likely addressed to an audience with innate involvement in the task or ecosystem of medical treatment. You are already likely familiar with the myriad of medical technology. However, to look into the future, we must use a current lens.

For someone involved in medical technology for over three decades, I have a rather simplistic 9 X 9 approach; cluster medical technology around 9 broad applications and looking at 9 trends that I believe will propel the future.

1. Tools or systems that diagnose through physical or chemical analysis of tissue samples (microscopy, biochemistry, haematology, molecular biology, etc.)
2. Tools or systems that diagnose through the science of imaging (X-ray, CT, MRI, Fluoroscopy, etc.)
3. Devices used perform endoscopic or surgical procedures, both manually and by robotic means (to look into, cut open, drill, dissect, cauterise, ligate, suture, seal, etc.)
4. Implants of various sorts to enhance organ functions (stents, pacemakers, IOLs, orthopaedic, dental, vascular, gastrointestinal, etc implants)
5. Devices used to deliver nutrition, medication or a device or implant into the patient’s body (syringes, catheters, tubing, pumps, etc)
6. Devices to monitor or aid the patient’s condition, and ensure impairments are electromechanically or radiologically monitored or mitigated (ICU monitors, ventilators, heart lung machines, apheresis, dialyzers, radiation therapy equipment, etc.)
7. Bags, pouches, and containers to collect or store body fluids or discharges (blood bags, evacuated blood collection tubes, urine bags, etc.)
8. Furniture and electrical fittings that deliver the treatment infrastructure (beds, tables, speciality chairs, OT lights, etc.)
9. Software or information systems that aid by collecting, storing, analysing data, and providing insights to health care professionals on treatment options and success status.

With that as a perfunctory context, let me share the trends I see shaping, in various speeds, and not in any order, medtech’s future.

I am deliberately staying away from predicting the future treatment of specific clinical domains (e.g. neurotherapy as compared to infectious disease), or how medtech company business models are likely to morph (e.g. devices companies expanding into health services), but rather sharing my thoughts basis tech or engineering trends, as these trends may apply across several therapy domains.

(i) Minimally invasive / Non-invasive / Miniaturization

Over the past three decades there has been much advance in minimally invasive procedures. The march of this will continue. While the applications are virtually limitless, I am providing a few examples.

Even at a basic level we are likely to see needle-free injections, aided by lasers and bubble guns that will push liquid injectables at ~ 100km / hour, that will penetrate skin almost damage, wound or pain.

Such devices as ingestible cameras already significantly reduce patient stress and improve visibility.

Heart valve replacements are moving full throttle to minimally invasive, and I see that most of open-heart surgery will move to small incision procedures reducing blood loss, infections and hospital stay

(ii) Personalization / customization

Such technologies as better imaging and 3D printing are opening new vistas of heavily personalised devices. From AI powered predictive dental aligners to 3D printed prosthetics the power of personalisation will revolutionise outcomes.

(iii) Robotics  & Exoskeleton

General surgery, orthopaedics, interventional cardiology, etc. will largely migrate to precision robotics, improving control, flexibility and remote capabilities. Recently, there was robotic angioplasty performed across two different cities One can only imagine how the expansion of this technology will improve access to highly skilled physicians into remote locations around the world.

Exoskeletons will augment and correct neurobiological impairments and will create wonder devices that aid mobility and quality of life.

(iv) Connectivity / Interoperability

This is one area that will see the maximum rapid improvement in medical care. Applications and examples are limitless, but I am just providing a few illustrative examples.

As devices across different companies and different applications start connecting with each other, the ecosystem output will drastically increase and minimise cost.

Imagine the power of a syringe-pumps that seamlessly communicate with monitoring devices and anaesthesia machines and can deliver virtually robotic assisted anaesthesia.

Another example remotely monitored beds not only will reduce healthcare costs, but also carry quality of care to remote locations and non-hospital settings, thereby liberating access.

(v) AI driven decision (support) systems

While computerised clinical decision support systems (CDSS) existed since the 1970s and 80s, the advent of AI and high-speed computing will completely change the paradigm in future. Medical decisions are after all calls of evidence-based judgements, and the modern forms of CDSS rely on the billions and trillions of medical data points, triangulate several thousand patient parameters quickly, and suggest treatment protocols and watch out flags to clinicians that avoid complication, enhance outcomes, and reduce cost. Most medical technology companies are on a device to solution drive and are arming themselves with different forms of CDSS.

(vi) SAMD & Cybersecurity

While software often drives the medical device hardware, software as medical device is defined as software intended with a medical purpose running on a generally non-medical platform (e.g. medical apps on a smartwatch), or software that is linked directly to treatment planning.

Medical devices have always come out of medical device hardware companies and have been a physically engineered set of products. This paradigm is already changing fast and will further rapidly change and redefine the medical technology ecosystem, bringing in non-traditional disruptors (such a patient journey app designers) into the game.

As more and more software and connected devices come into play, healthcare cybersecurity threats will rapidly climb. IBM’s 2023 Cost Of A Data Breach report pegs the rise of health cybercrime at 53% over the past 3 years.
Medical records, treatment data, and online nature of connected devices (even lifesaving ones) are already targeted in such examples as attacks on  HCA, USA and Medibank, Australia.  

Governments and regulators around the world will become more vigilant and demand the medical technology companies to label the threat potentials and offer robust security features.

(vii) Combination of drugs and devices

While drugs and medical devices have been separate worlds so far, the lines between these two industries will blur, especially with many medical devices and medicinal products forming single integrated solutions (e.g. tissue allografts, pre-filled delivery devices, drug coated balloons, drug eluting stents, etc.)
 
(viii) Simulation training devices

This is where I have taken the liberty of a bit of crystal ball gazing.

Medical education is rather traditional and has not kept up with the rapidly changing technology landscape. It still tends to be very much in the hospital setting and using patients as subjects. This will transform fast. Due to massive improvements in sensor technology, medical training simulators these days can replicate clinical complexities almost one is to one, in risk free learning environments. No pilot today flies an aeroplane without being certified (and repeatedly) on a set of flight-simulators. Similar reality will come into the medical technology world. The transformation will mean that (a) most simulators will be strictly regulated, as in the airline industry, and (b) many medical technology companies will build and acquire simulation technology.

(ix) Sustainable materials & business models

Lastly, confronting the reality that used and single use medical devices comprising of plastics, metal, battery components have a big negative on the environment, there will be more societal and regulatory pressures to reuse, recycle, and use sustainable materials. This will require the medtech industry to rethink packaging, choice of raw material, as also the entire supply chain and business model. Most reputed medical technology have undertaken carbon neutrality goals and are redefining how they operate. This trend will determine their ‘right to operate’.

References:

https://www.medtronic.com/covidien/en-us/products/capsule-endoscopy/pillcam-sb3-system.html or https://www.mayoclinic.org/tests-procedures/capsule-endoscopy/about/pac-20393366
https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/what-is-tavr    
https://www.mayoclinic.org/tests-procedures/minimally-invasive-heart-surgery/about/pac-20384895
https://www.weforum.org/agenda/2021/10/new-technology-could-allow-you-to-have-a-needle-free-injection/
https://scopicsoftware.com/blog/the-rise-of-ai-orthodontics-and-how-its-transforming-dental-care/#:~:text=AI%2Dpowered%20virtual%20treatment%20simulations,that%20will%20occur%20during%20treatment
https://www.theguardian.com/technology/2017/feb/19/3d-printed-prosthetic-limbs-revolution-in-medicine
https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974
https://www.pcronline.com/News/Press-releases/2023/Robocath-performs-world-s-First-In-Human-remote-robotic-coronary-angioplasty-between-two-Chinese-cities-1-700-miles-apart
https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-020-00663-9
https://jamanetwork.com/journals/jama-health-forum/fullarticle/2788095
https://www.fiercehealthcare.com/finance/remote-monitoring-patient-beds-could-be-big-money-saver
https://www.nature.com/articles/s41746-020-0221-y
https://www.fda.gov/medical-devices/software-medical-device-samd/what-are-examples-software-medical-device
https://arcticwolf.com/resources/blog/top-healthcare-industry-cyberattacks/
https://www.csa.gov.sg/News-Events/Press-Releases/2023/cybersecurity-labelling-scheme-for-medical-devices-sandbox
https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/drug-device-combination-product
file:///D:/OneDrive%20-%20Terumo%20Corporation/Downloads/ey-drug-device-combination-products-whitepaper%20(2).pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8960604/
https://www.complianceandrisks.com/blog/medical-devices-and-sustainability/#:~:text=With%20regards%20to%20medical%20device,can%20have%20positive%20environmental%20implications.

--Issue 64--