Masters of Industry: Digital Health – Threat or Opportunity?

The “Masters of the Industry” panel at the recent OIS@ASCRS 2018 in Washington, DC, put into context the impact digital health is having on eye care practices, especially in this era of practice consolidation as private equity buys them up. As Tom Frinzi, worldwide president, surgical, for Johnson & Johnson Vision, said, “Private equity, as a new partner coming into our field, they are not buying ophthalmic practices to own ophthalmic practices. They are buying practices to make money.”

Push to Improve Efficiencies

Most of the real change for ophthalmology will come in practice efficiencies, said Alcon COO David Endicott, partly driven by the private equity discussion, partly by the inefficiencies that currently exist, and partly by the demand that’s coming in terms of total volume of patients. He predicts even more collaboration between optometry and ophthalmology to improve cost-based, not outcome-based, efficiencies. That goal is to achieve the same, or ideally better, outcomes for less cost.

Ludwin Monz, PhD, president & CEO of Carl Zeiss Meditec, agreed. “When private equity acquires practices or [ambulatory surgery centers], their interest is to maximize profits, and every technology that helps to improve efficiency certainly is appreciated,” he said. He pointed out, though, that efficacy is also important, in addition to efficiency, and technology has to fill both needs.

Dr. Monz provided some context for the discussion, saying there are three technologies to consider in this arena.

1. Big data. This is already being used in clinical research as it helps recognize correlations and patterns.
2. Machine learning. This is ideal for image analysis such as interpretation of fundus images for diagnosing diabetic retinopathy. Numerous companies are working on this including Zeiss. Probably the most well-known project is from Google.
3. Artificial intelligence. This aspect is not as well developed as the other two and will take time to have a significant impact.

“The general belief certainly is that technologies like big data, machine learning, and artificial intelligence will have a huge impact on healthcare, and I believe it’s going to happen,” Dr. Monz said. He thinks it will take some time before it does happen, though, and then he quoted Bill Gates: “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next 10.”

Allergan COO William Meury sees a lot of opportunity when it comes to diagnosis and compliance. Examples include smart lenses, smart eye droppers, the Apple watch with electrocardiogram capabilities, and the Google research project to diagnose diabetic retinopathy. While these are mostly in the concept stage, he says such initiatives could become “part of the DNA of a particular specialty” if they get incorporated into clinical studies.

The Big Hitters in Ophthalmology

Moderator Jim Mazzo, global president, ophthalmic devices, at Carl Zeiss Meditec, turned the topic toward Silicon Valley, asking how companies like Apple, IBM, and Google are impacting ophthalmology.

Endicott said Alcon has had a long relationship with the scientific arm of Google, developing an intraocular lens and a contact lens. He said Google’s technology advancements are rapid and are helping Alcon take a leadership role with micro-processing. Endicott also noted that Amazon has the largest cloud service, so anyone moving large volumes of data will probably encounter it.

Tracy Valorie, Bausch + Lomb SVP and general manager, US pharmaceuticals and surgical business, said that while statisticians for research teams are very good at mining and processing data, the emergence of companies like IBM and Google will move us from digesting data to acting on that data. She noted B+L has formed a partnership with IBM and is looking at ways to take elements of data and use them in an activation process to increase practice efficiencies.

Robert Dempsey, group VP and head of global ophthalmics franchise for Shire, said partnership opportunities abound. He pointed out that Shire’s headquarters location in Cambridge, MA, provides easy access to Google, Amazon, and IBM, and that Shire has frequent discussions about improving diagnosis and patient care with them. “I think it’s going to be important for us as an organization to look at the data that’s out there and partner with these technology giants who are looking to partner with us,” he said. “We’re not knocking on their door; they’re knocking on our door.”

J&J’s Frinzi said these companies can bring a fresh perspective to eye care. “They bring an unbiased whiteboard approach to things that those of us that have given years and years to this industry might be biased against or blinded to.” He added, “They can come in and, with their big data capability, look at something like, are there ways to monitor intraocular pressure that we don’t think about today? So, I think it’s exciting.”

Dr. Monz seconded that. “These large high-tech companies certainly have a different perspective on our market, and I really believe they will drive the way medicine is practiced and healthcare is delivered going forward,” he said. “So, I think we as the traditional companies in this field should prepare ourselves. In the end it’s about changing our mind-set.”

William J. Link, PhD, managing director, Versant Ventures, brought in a new thought, saying that healthcare companies and start-ups “redeploy technology that’s developed in other markets, to solve a problem here.” He added, “We’re not developing the artificial intelligence; it’s being developed out there and shame on us if we don’t find ways to channel it in and help this industry.”

Dr. Monz noted that Zeiss started to develop data management solutions more than 10 years ago, and now has a huge installed base in the market. Customers, large hospitals, and hospital chains are already using those databases to do big data analysis, he said, and added that Zeiss has invested in machine learning.

Mazzo summarized that there are two ways to look at the integration of digital health into ophthalmology – as an opportunity, or as a threat. He said to the panelists, “All of you have been successful because you’ve turned your threats into opportunities.”

For questions about this article, please contact Steve Lenier at Steve@stevelenier.com.