Zannat Reza: Technology has revolutionized every aspect of our lives.
It's changed the way we work, the way we shop, and the way we interact with each other.
Much of our world today would be unrecognizable even ten or fifteen years ago.
But what about healthcare?
How can technology disrupt the system and change the way we access care?
How do things like wearables, virtual reality, and AI create new possibilities for keeping us healthy?
And where does Canada stand in all of this?
I'm Zannat Reza, welcome to The Future Age podcast, where we explore bold ideas and creative solutions in reimagining life as we get older.
I spoke with two futurists who've dedicated their careers to answering these questions.
First, Dr.
Bertalan Meskó, who calls himself The Medical Futurist and is the director of the Medical Futurist Institute.
In a recent post on his website titled, Looking Back at Today's Healthcare in 2060, he imagines a utopian future that includes robosurgeons, drone deliveries of medical equipment, and personalized 3D printed pills.
Then, Dr.
Zayna Khayat, a leader in healthcare innovation in Canada who calls herself a future maker and silo buster.
I started my conversation with Bertalan by asking him about his vision for healthcare transformation and what he's most excited about in this space.
His answer surprised me.
Bertalan Meskó: While of course I'm as a science fiction fan, I'm very excited about technologies like, uh, 3D printing medications or, or direct to consumer genetic tests, all the variable and consumer devices I can use to measure data about myself to make better decisions on the go.
Uh, of course, artificial intelligence and now a generative artificial intelligence are sort of becoming an interface between physicians and the range of technologies they can use.
All these make me really excited about the near future, but patient empowerment is a single most important milestone in the history of medicine.
Zannat Reza: I do remember you writing an article about this and you call this a paradigm shift where the person is at the center of really, everything.
And when we think of some of the work that we're doing in terms of, uh, helping people live and age on their own terms, one of the themes there is bringing health and healthcare, even social care, to people's homes, or really healthcare everywhere.
So what are some of the trends that you're seeing that could help with having the person at the center, but also bringing care to where they are?
Bertalan Meskó: Of course, I think there are a few trends that, that are very important to be mentioned here.
And the first one I need to mention is how all these digital health and advanced technologies started making patients the point of care themselves.
Exactly what you just mentioned, that patients can now finally receive care even at their homes.
But it goes a bit beyond that, not just at their homes, but wherever they are, they should be able to receive diagnosis, monitoring and even treatment through the access to technologies, information and global supply chains that they have now because of this digital health paradigm shift that has been going on for over a decade.
Zannat Reza: So trend one is bringing care directly to the patient rather than sending them to a facility.
I'll explore this in more depth later in the episode.
As for trend two...
Bertalan Meskó: I think a second important trend here is how All these technologies started making healthcare globalized.
I mean that individual's access to information and technologies has a bigger impact on their lifespan now, then which country they are living in, which country's healthcare system they are able to access.
Zannat Reza: There's an example on Bertalan's website of how this could work.
Let's say you're in Canada.
You send a cancerous tissue sample to a medical startup in Belgium that has technology we don't have to sequence the genome.
That company connects you to a clinical trial happening in Spain, run by a French pharmaceutical company.
And now you're getting treatment you couldn't have gotten locally.
And Bertalan's final trend.
Bertalan Meskó: A third trend is about digital therapeutics.
Just the pure idea that the use of a technology can work like a treatment.
You know, it's, it's extraordinary.
For hundreds of years, we have been using medications and drugs and, and biotechnological treatments.
And the whole modern era of medicine from the 1950s has been around providing more and more of these treatments to people, to billions of people.
But what if we could achieve similar results just by using a, an evidence based smartphone application or a wearable sensor, a direct to consumer at home lab test.
This is, to me at least, this is such an extraordinary step forward in providing better healthcare for all.
For example, there was a great study I came across about sleep apnea.
You know, in that condition, patients have to wear a CPAP mask, which is really far from being comfortable.
It's actually, awful to fit, to sleep with that mask on, but it makes their health better.
And the more sleep sessions they have with the mask on, the better condition management they can achieve.
The old management was that every six months patients had to bring the device, the hardware to a physician, and only the physician could download the data.
And they discussed it.
And in a new study, what they did, they used the same hardware, but they developed a smartphone application through which patients could access the data, the sleep session quality data, in the morning, after the session, immediately.
And you can imagine that their compliance got four times higher simply because they saw immediately in the very morning that I wore the CPAP mask during the night.
And that's how better my, my sleep quality became.
So I know it's not comfortable, but I see exactly and quickly how fast it can contribute to my health and wellbeing in general.
So that's how you engage patients.
Empower them to access the data they already own, but had no interfaces to access this.
The same rules apply to these technological innovations as for biomedical innovations like drugs and medications.
And only in the last couple of years we've been seeing a surge in peer reviewed studies and clinical trials proving the efficiency of these technological treatments.
Zannat Reza: Another area of digital therapeutics that excites Bertalan is how virtual reality can be used in pain management.
It's an area where there have been several peer reviewed studies.
Bertalan Meskó: So what these studies have been able to prove is that if you have a patient who stay at the hospital for a longer time and you give them a VR device through which they can travel through countries or swim in the ocean or fly above the sky, it makes them feel better and, and objectively they were able to measure that this VR experience reduced their pain scores.
Zannat Reza: You might be hearing this and wondering, when?
How long will it be until we're using VR headsets and smartphone apps as part of our regular healthcare routines?
Bertalan says there's no simple answer here.
Bertalan Meskó: For years, I've been trying to evangelize the idea, I think the fact that multiple futures exist.
And our job, not just futurists, but our job as people is to analyze, observe, and choose these multiple futures and find out which futuristic visions could be the best for all of us.
Like if the future was a singular predetermined timeline, and my job would be telling, well, this milestone will take place by 2032.
But for whom?
In, in which country, by how many people, which exact technology.
And it, to me, it makes no sense at all.
Because if one of my predictions turns out to be wrong, then how can you use my next prediction in your decision making process today?
Zannat Reza: Yeah, I like what you're saying about multiple futures.
Because yes, if you made a prediction, it didn't come true, people'd be knocking on your door to say, hey, what kind of futurist are you?
So I totally get the multiple futures and it also makes it rather exciting because what is that future you desire?
And then as you say, backtrack to how do we get to that?
I want to pick up on one of the trends that you talked about, which is that tech is globalized.
Does that actually exist now?
Are you seeing health data flowing between different countries?
Bertalan Meskó: I think the three trends I mentioned are not trends that will happen in the near future, but those trends have been around for at least a decade, depending on where exactly you live, information you get access to, or how digitally you can live your life.
But at least for me as a general patient or consumer, I've been feeling like my healthcare has been globalized already.
I've been using services, direct to consumer genomic tests, wearable sensors from a range of countries.
For me, I feel like a member of my own medical team.
I have an amazing primary care physician and we design a preventive plan at the beginning of every year because I try to live a healthy life.
I know it, it looks like a technological revolution because we talk about so many advanced technologies.
But primarily, this is a cultural transformation because how the hierarchical doctor patient relationship has been transforming into an equal level partnership is simply more impactful than, you know, which wearable sensor or AI based service comes out this year.
Zannat Reza: The implications of this type of technology are huge.
It wouldn't just mean a less invasive approach to pain management, or better data for monitoring a person's health, it also opens up questions about where you receive care.
Some of these technologies could exist at home, not just in a hospital.
This goes back to Bertalan's first trend, where a person is at the center of care, and it's something that Dr.
Zayna Khayat says could radically change the way we think about healthcare.
She's the health futurist in residence at Deloitte in Canada, an adjunct professor at the Rotman School of Management and has held many other positions in this space.
She not only monitors trends in healthcare innovation closely, but she also knows the health and regulatory landscape in Canada intimately.
Like Bertalan, she sees the transformative power of healthcare moving away from hospitals.
It's a concept she calls Care Anywhere.
It's not an idea that's entirely new, or a change that's entirely technological, but technology does have a role to play.
Zayna Khayat: First, step back and understand why we're moving to a paradigm of Care Anywhere.
So, healthcare has been anchored by a paradigm for seventy-five years, since post World War II, around care being driven by place and time.
So the idea that you have to be not only in the same place as a clinician for good care to happen, that exchange with this highly trained professional is at the same time.
Care Anywhere is now care agnostic to both place and to time.
When it's agnostic to place, that just means the clinician and the user of the service don't need to be in the same room, which opens up a lot of flexibility and access.
But when you separate it from time, you're now into asynchronous care, which is actually where I think seventy or eighty percent of all healthcare exchanges that are happening today in the same time could be done asynchronously.
And now that really opens up a lot more opportunity.
That's kind of Care Anywhere.
The anywhere is largely we think about the home, but anywhere now says you could be places closer to home.
So closer to your community.
So you don't have to go to a place to get care, it's kind of coming close to you.
Or it could be your truck if you're a truck driver, your school if you're a child with complex needs, your workplace if you're in a nine to five or in a job where you know, punch the clock, or if you're on vacation it could be wherever you are, you know, so that's the idea, that we emancipate health care from a facility based paradigm and a visit based paradigm.
This is huge.
And just quickly, what it's going to look like, the standard of care in most places, nursing home at home, where you don't need to be in a nursing home or a hospital.
We create the needs in the home.
Of course, I see health has been a big pioneer of designing some of those models.
All your recovery post hospital at home, post surgery, rehab, prehab etcetera.
Chemo at home.
What's coming is hospital at home, the full hospital level care in the home, at scale, as a standard of care, that is the case in other countries, not yet in Canada.
ICU at home, radiology and imaging at home, 3D printing your medicines at home, instead of going to a pharmacy.
Surgery at home, this starts to break up and remodel healthcare in many ways.
If everything I just said plays out at scale, we have a very different model of healthcare.
Zannat Reza: So which countries are doing this well?
Zayna Khayat: So in terms of Care Anywhere, I'll start with one way to get there is top down as a vision for your health care system.
So for example, the Netherlands, where I spent a year working with the Ministry of Health on a lot of aspects of the future of health, so I know it very well.
You know, they have a policy agenda for the country.
Again, they have a single payer health care system, uh, like we do, tax financed.
Their mantra is from waiting rooms to living rooms.
So they're literally moving half of their budget that they spend on hospital and facility based care to move that into the community.
Half.
Okay?
All we're doing in Canada is adding more hospitals and more buildings.
They're actually going the opposite way.
And demand curves are the same.
Aging population, growing complexity, all the same reasons we have high demand.
So when you make that a policy mandate and you get everyone galvanized around a big, hairy, audacious goal like that, then it's actually easy to enact the instruments of implementation, like what do you pay for?
Where do you pay for it?
What kind of workers do you need?
What's your seniors care model?
Because, most of the demand for resources, as we know, is in the aging population, depending on the country, eighty, eighty-five percent.
So that's kind of a top down, I'd say, gold standard.
The next top down that a lot of Canadians have studied and we always write every op-ed about is Denmark and many of the Nordics, who made policy decisions twenty-five, thirty years ago to de-institutionalize healthcare.
Zannat Reza: So you mentioned the Netherlands, you mentioned Denmark, we hear about this all the time and it sounds like you need a really strong policy mandate to make this happen.
So from the waiting room to the living room.
What is it going to take to shift the mindset here in Canada?
Zayna Khayat: So that's the top down when, you know, you've got an aligned governance model that everyone is on the same page of what they want and they're not trying to protect producer interests.
To me, that's a big reason why in Canada we don't move.
Because we're trying to meet patients needs and stay current with the twenty-first century while also protecting the financial and other interests of a lot of bodies.
Zannat Reza: In other words, changing the system requires changing a lot of minds, and there will always be people who resist moving beyond the status quo.
So, Zayna says making big changes in Canada is most likely to come from a bottom up approach, starting small and scaling up to a regional or provincial level.
There are a few examples of where she sees people innovating on a local level in ways that excite her, like Fraser Health, which is a regional health authority in BC where digital transformation is a big priority.
Zayna Khayat: Their big thing they've been working on is creating a digital twin.
So this is an in silico model of the entire operations of the whole health system.
Everything, every type of clinician, every procedure, where the resources are, where the capital is, where the equipment is.
And then you can in real time, see where the bottlenecks are.
Like you can literally visualize on a dashboard.
And then more importantly, you can now run scenarios.
Zannat Reza: Zayna says this lets you plan in real time for any issues or crises that may happen.
Zayna Khayat: I'll just share another lighter example.
Humber Hospital here in Toronto, a regional hospital, like most hospitals, because we have extremely lagging primary care infrastructure, kind of your first line, if you've got an issue or you want to prevent things from getting worse, that's crumbling in Canada.
It's not available.
So the safety net in our country is emergency departments.
It's the only place you can show up and they can't turn you away.
And so because that becomes a bottleneck, we ration that service.
So you wait, you wait eighteen hours, you wait three days in the hallway, because it's based on priority.
So that's not acceptable when you're suffering and there's actually massive quality issues with that.
Point is, you know, machines can do a lot of those upfront steps to triage people a lot more intelligently.
Then you showing up and verbally describing to the nurse triage your symptoms.
It will catch things that no human will.
And it will free up that human for when you need that human to do the triage.
Because they need to see some context that a machine can't.
They got results instantly.
I think the tech things is where I'm the most excited in Canada.
Not because they're new, not because they're groundbreaking, but we're finally able to actually do interesting things that other jurisdictions, this has just been standard of care for many years.
Zannat Reza: So Zayna does see changes coming, though maybe not as quickly as she would like.
But going back to this idea of Care Anywhere, I was curious to know how technology and digital health initiatives are affecting access to care in more rural or remote areas.
Zayna Khayat: Brilliant.
It's actually where it works really well.
So I'll just give a couple examples.
The future of health is flex everything.
It's adaptable.
It's configurable.
When the UK, to clear their waiting lists for elective procedures, they got these like company comes in with a trailer, a truck comes to a rural community that has the weight, clears the whatever, eye surgeries in three months, packs it up and goes to the next community.
So that's an example of these types of mobile clinics.
It's exactly designed for rural areas.
Another example of these mobile type clinics, like healthcare on wheels.
I'd love to give this example of Dollar Tree in the U.S.
So it's like Dollar Store in Canada.
They tend to be in these more rural communities.
The kind of population that's going there is the people who are often at the most risk for not accessing good care.
So they tend to be in what we call healthcare deserts, where there isn't a clinic because family doctor isn't going to want to, you know, set up shop or there isn't a hospital because they can't justify the volume.
And in their parking lots, bring the mobile clinic, do prostate screening, cardiac checks, mental health first aid, mammogram, whatever, you know, you're there anyway.
So that's to me an example of bringing the care to someone where they're at, which is Care Anywhere.
Zannat Reza: Zayna says this way of thinking can be applied to many different places, like getting a health screening at the barbershop since you're there anyway, or getting screened for skin cancer while you're at the laundromat waiting for your clothes to dry.
Just like she advocates for rethinking where we get health care, she also encourages us to rethink the tools that we use to monitor our health.
What we might call wearables, though Zayna prefers not to use that word.
Zayna Khayat: So the word wearable is dead.
So we're going to educate your listeners.
Everything is "able" right now.
Doable, peeable, menstruable, breathable, durmable, sockable, footable, anything that touches either your body or the things that come out of your body can now be monitored with a consumer level diagnostic device.
The sensor to detect those different things is well beyond like a watch and a pendant.
It could be on your body, in your body, it could be a tattoo, it could be worn, it could be in your sheets, it could be in your floor tiles, in your ceiling tiles, in your paint, in your car, in your TV camera, I mean, it's everywhere.
So that's no longer a barrier.
However, you and I, and for sure our parents, are not going to have sixty-five devices with sixty-five charging systems, sixty-five apps, and sixty-five subscription models in our house.
Like we're not going to do it.
So that's the next step, is how do any of these point solutions dock onto whatever platform I choose to be my operating system.
For me, it might be the Apple platform.
For you, it might be the Amazon platform, for someone else, it could be your hospital.
Zannat Reza: I also asked Bertalan about how new medical diagnostic tools could change access for people living in remote areas.
Like Zayna, he sees a lot of promise in this area, but his feelings about it were a bit more mixed than hers.
Bertalan Meskó: In the last five years, I've tested like four different company made technologies.
I used a handheld ultrasound device, and one of them was AI guided.
So without having any prior knowledge or training in doing ultrasound examinations, and of course I didn't have any.
I just told the device that I wanted to check the liver of this patient and the AI guided me through the process.
It absolutely felt like science fiction.
I still don't see ultrasound devices being used at home because I don't see the, you know, the, the healthcare purpose for that.
Plus it's a waste of time and money because these devices are still very expensive.
Less expensive than the big devices in the hospitals, but still much more expensive than smartwatches or wearable devices.
So the best like case scenario for me for the next few years would be that either in rural settings, or in those areas where there is a doctor shortage, such devices could find their place in the healthcare process.
So imagine that there is a rural location where there is simply no primary care physicians available, but what if we can have a professional nurse who doesn't know how to do an ultrasound examination, but they have access to a handheld ultrasound and the AI can guide them through the process.
And data, of course, can be sent via LSD to the nearest hospital.
And at that hospital, a professional sonographer can decide if that patient needs to be admitted or not.
What's happening now is that they just send the patient in to the hospital, make them travel a lot.
And, you know, of course, spending time and money and effort and all these, without having the knowledge whether they should be admitted or not in the first place.
Zannat Reza: You know, you've mentioned a few times science fiction and one of the articles that I've read recently that you've written, you know, you talk about zip up healing or healing wounds with electricity.
So when I see this, it reminds me of Star Trek.
Are you seeing more and more of these, like, very future forward technologies coming into play?
Bertalan Meskó: I have two like personalities fighting in myself about these technologies.
One of my personalities is a science fiction fan.
And I've read every science fiction book and I've seen every, I mean, every science fiction movie you can think.
And that personality loves the idea that there are really exciting technologies out there.
But the ones I mentioned in the article, uh, a device that patients can wear at home under their bra and it can detect breast cancer sooner than traditional devices.
Just the idea that I can use wearable sensors to measure my power or quantify my eye vision, my sleep quality, I've used a small skin patch to measure my blood glucose levels for two weeks.
All these make me feel like I live in a science fiction movie, and I'm truly excited about what new things might come out next.
But then comes my other half of my personality that is really sad about the idea and the fact that these technologies look great, but how will we bring them to, to the masses.
Like, it looks great that there is a patch that can close wounds much faster than traditional things.
But what if someone living in rural areas cannot access that?
I'm very privileged and, and, and lucky to have access to a myriad of wearable health sensors.
And I'm, I'm even happier to have a primary care physician I can share the data with so we can work together in one team.
But the vast majority of patients are simply not that lucky.
Not only they have no access financially or technologically to these devices, but they don't have the chance to discuss their issues with healthcare professionals who will be open about these patients becoming members of their own medical team.
And I think that other half of my personality is the one that's winning for now.
That simply, we have to come to the conclusion that health equity is almost impossible without technological equity.
And the challenge with that is that even though there are amazing experts and innovators and developers and digital health community coming up with better and better technologies day by day and AI based innovations that blow my mind away as a, as The Medical Futurist,
but without governments working on improving technological equity, even if there is a like smartphone based digital therapeutics that could change the lives of millions of patients with diabetes, if they don't have a smartphone in the first place, that technology won't help them.
Zannat Reza: Both of my guests left me with the impression that there's a lot to be excited about when it comes to emerging health technology, but that technology alone won't solve our problems.
It will also take cultural change and political will to make the type of big, sweeping transformations that will bring us the utopian future that they want to see.
One thing that struck me was how much they agreed on one basic thing, that empowering people is at the center of any kind of progress.
After all, what good is technology if we'd lose sight of the people on the other end?
At the end of every episode, I ask my guests to tell me one radical but realistic change they would make if they had a magic wand to improve our society's well being.
First, here's Bertalan.
Bertalan Meskó: I would make everyone understand the importance of taking matters into their own hands about their own health.
So it's not that I live in a country, I pay my taxes, so healthcare should take care of me.
When there is an issue, I think it's too late.
But it's about how I am living my life right now.
What, what more I can do to have a chance for a long and healthy life.
Because without my efforts, without my data, without losing some of my privacy, I don't see how it's possible to improve that chance.
Maybe for some it is, but they must be extremely lucky.
I, I don't feel like I'm that lucky.
I have to devote time, energy, privacy, data, efforts, and money into this.
And still with all these, I just believe that I have a, maybe a slightly higher chance, but just a chance to live a longer and have like still so many things can happen.
And I still depend on my healthcare system, but I understand and acknowledge that my role in all that as an individual patient is crucial and I have to lead my own healthcare system.
Zannat Reza: As for Zayna,
Zayna Khayat: So I'm going to kind of cheat a little because we kind of talked about one of them.
I think if we're obsessed about primary prevention and upstream health and put our money where our mouth is, to me that actually, I think it's the only way to both save health care from collapse and also do the mission of health care, which is to create health, right?
Not to treat disease.
A way to do that, there's many, we've talked about them, that I get excited about that I've yet to see done at scale that I think will make a big difference.
It's put patients and their families in charge of deciding what counts as good health care results.
Whether that's their experience that matters to them or the clinical outcomes that matter to them.
Imagine if we paid, maybe not all of what we pay our clinical expertise, but some portion that's sizable is based on whether patients, you know, report that they think it worked.
Wow would we have a very different health care situation.
Zannat Reza: A big thank you to Bertalan Meskó and Zayna Khayat for looking through their futurist lens to identify the biggest trends in health innovation.
Thanks for joining us for this episode.
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