Despite the increasing focus on health, health systems globally are still inefficient due to an imbalance between spending on treatment and prevention. The rise of new remote monitoring technologies can help prevent many diseases

The pandemic has rekindled the spotlight on health and the centrality of an efficient and accessible health system in the light of demographic dynamics, in particular the growth and ageing of the world’s population. But the healthcare sector, as it is currently configured, is still highly inefficient in many countries, where much is spent on treating the sick but little on prevention, which would help keep people healthy. Suffice it to say that in the European Union more than €2,300 billion is spent annually on health (more than 14% of the Gross Domestic Product), with an average of more than €4,500 per year per citizen. Both public and private entities spend this money. However, in recent years (with an acceleration after the COVID-19 pandemic), the focus on prevention has undoubtedly increased, driven by the growth of telemedicine platforms and vital sign monitoring devices.

Prevention needs technological innovation

With the right technologies, up to 5 million deaths per year in Europe (55% of total deaths, according to World Health Organization estimates) could be prevented, as they are caused by diseases that could be detected early – and therefore treated early – through remote monitoring of vital parameters.

The prevalence of preventable diseases with remote monitoring technologies is higher than previously thought, as these diseases often do not give symptoms until the clinical picture suddenly worsens, leading to death or permanent consequences that significantly worsen the quality of life. One example is arterial hypertension, which affects between 30% and 45% of the adult population and can trigger heart attacks or strokes.

When assessing a person’s health, the World Health Organization (WHO) indicates five specific vital parameters to be monitored, accompanied by an electrocardiogram: blood pressure, heart rate, respiratory rate, saturation and body temperature. The traditional instruments for measuring these vital parameters are the sphygmomanometer for blood pressure, the pulse oximeter for saturation and respiratory rate, the thermometer for temperature, the heart rate monitor, and the electrocardiograph for ECG. Still, except for temperature, checks are usually done sporadically. Some traditional instruments are invasive for the patient and often lack timely data monitoring. Therefore, many companies have started to develop technologies that, based on AI algorithms, can replace traditional instruments and are also able to track user data.

The most innovative technological solutions for prevention

The landscape of companies offering vital sign monitoring solutions is vast and varied. However, only a few of these instruments have been certified as medical devices, and they are often solutions aimed at a B2B market. Having CE/FDA certification as a medical device allows a physician to use the data generated by the technology for diagnostic purposes. Among the companies offering products that are not certified as medical devices, the most popular in the B2C market are Apple, Fitbit and Garmin. It should be noted that Apple Watch 7 and Fitbit can calculate ECG (for which they are certified as medical devices), heart rate, respiratory rate and saturation. In contrast, Garmin only calculates heart rate, respiratory rate and saturation.

One certainly innovative company among those not yet certified as medical devices and aiming at a B2B (mainly insurance) market is Binah. The Israeli company, founded in 2016, has developed a technology that allows monitoring of vital parameters through the camera of one’s mobile phone by breaking down the image captured by the camera into the colour components and recreating a PPG signal that is then analysed by the AI algorithm. Through this technology, Binah.ai can simultaneously measure the five vital parameters outlined by the WHO.

The companies that have proposed solutions for monitoring vital parameters and have obtained certification as a medical device include the American Biofourmis, the Israeli Biobeat and the Italian IppocraTech, all of which are currently operating in the B2B market only.

Biofourmis was founded in 2015 and has a technology that uses an AI algorithm to measure heart rate, respiratory rate and saturation through signals sent by a watch. Furthermore, Biofourmis’ AI algorithm can calculate personalised health indices for individual users to help them monitor their health.

Biobeat was founded in 2016 and has developed a technology that allows the monitoring of the five vital parameters indicated by the WHO through PPG signals sent through a watch featuring the AI algorithm and the measurement of the ECG through a disposable patch to be attached to the chest, whose signals are then sent to the AI algorithm of the same watch.

IppocraTech, on the other hand, was founded in 2017 and launched a system that allows the calculation of the five vital parameters and the ECG through a single measurement, by placing the palms of the hands on the two sensors of the device (the temperature is detected through an infrared thermometer placed on the same instrument) and sending the PPG and ECG signals to the AI algorithm located in the company’s Cloud.

Venture Capital interest in the industry

The interest of the Venture Capital funds in this industry vertical has grown significantly in recent years. As is often the case in high-tech sectors, the most significant rounds have been on companies in the US and Israel.

The US company Biouformis has raised €125 million, including €85 million in the latest round in September 2020, in which Softbank, Sequoia, Openspace Ventures and MassMutual Ventures participated. Israeli company Cnoga (which developed a medical device to simultaneously measure heart rate, saturation and blood pressure from the finger) raised €63 million, including €10 million in a Series A round in October 2014, led by Chinese fund Fortune Capital and €47 million in a Series B round in March 2017 led by Chinese company BOE Technology Group.

Binah.ai raised €41 million, including €16.5 million, in the latest round closed in February 2021, participated by Israel’s iAngels and operator Tomahawk.VC. US-based Caretaker Medical (which developed a device to simultaneously measure all five vitals and ECG via a disposable wristband and finger sensor) raised €3 million in June 2020 Series A round led by Venture Capital firm Philips Ventures.

The future of prevention

Preventive healthcare based on remote monitoring technologies will become part of our daily lives, although there are still barriers to be overcome for its deployment. The main hurdles to overcome relate to the cost of using these technologies and the user’s commitment to continue monitoring themselves. In addition, the most comprehensive and efficient technologies are still only intended for the B2B market and are available at high prices. A system of government incentives for this category of products would undoubtedly help to enter the B2C market.

Moreover, at the moment, these technologies are mainly used by chronically ill people, and healthy people almost always lack a certain constancy in the continuous use of these technologies. In fact, in addition to awareness-raising campaigns on prevention, both the consensus of the scientific community (so doctors must promote the use of these technologies) and the integration of the technologies into telemedicine platforms would be necessary in order to actively monitor the tests performed by users, so that the latter know that there is someone watching their tests, warning them in time in case of problems. An example of this integration comes from FibriCheck, which has created an App that can be installed on Fitbit watches to detect heart arrhythmias. Whenever a suspicious measurement is detected in the users’ parameters, the data is analysed by doctors connected to FibriCheck, and a report is automatically sent to the users to alert them of any problems.

In the not too distant future, we can imagine the possibility of quickly and frequently checking our vital parameters so that our doctor (or another doctor who has access to the technology we decide to use) has a constantly updated database with all the readings and trends concerning our health, and can promptly intervene if there is any suspicious value. This scenario would lead on the one hand to critical cost savings for the healthcare system, which would become much more efficient, and on the other hand to an immediate benefit for people’s health (physical and mental). Life has many variables that are beyond our control and that often influence the very sphere of health. Thanks to the spread of remote monitoring technologies, we will be able to reduce the likelihood that these external variables will negatively affect our lives or those of our loved ones and thus live more peacefully.