Source : Medtech Insight
The best-laid plans earn individuals no plaudits when they go wrong, rather it is how well they manage through unexpected events (and even crises) that make the foundations on which future success is built.
Roy Jakobs was head of Royal Philips NV personal health businesses when last autumn he accepted group CEO Frans van Houten’s offer to transfer to the same role at the €4.7bn ($5.3bn) connected care division. It meant Jakobs was moving to the beating heart of outcomes-based, global health care delivery transformation.
Roy Jakobs has led Philips Connected Care through the COVID-19 crisis
Philips’s connected care remit embraces predictive analytics, continuous monitoring, as well as remote and community-based care. These elements are the future – and increasingly the present ̶ of high-quality health care for an ever larger and more demanding patient population that now expects consumer-type experiences. Jakobs, 46, seized the opportunity.
Enter COVID-19, circulating quietly but ever more widely in early 2020 from its initial China outbreak center. The full gravity of the SARS-CoV-2 virus were not accepted globally until the city of Wuhan locked down on 23 January. When, five days later, Jakobs started his new role as executive VP and chief business leader of connected care, he was already facing up to the reality that his early weeks would be very different to what he had imagined.
“It’s been quite an introduction,” said Jakobs. The need to rapidly go into firefighting mode gave him a deep understanding of how to work through a crisis and the challenges it presents for health care systems, he said. “For Philips, it showed us how to ramp up and rally all the resources need to respond in an appropriate way.”
While his early plans for the divisions have mostly gone back on the shelf, the journey has not been without excitement, he said. From Jakobs’ angle, the medtech industry and providers were seeing the threat posed by the rapid coronavirus spread through the same lens. “We were having the same challenges, the first of which was how to deal with enormous volumes patients with a new disease, and specifically the need to diagnose, monitor and treat them in the appropriate manner.”
Coping with the extraordinary challenge called for Philips to engage a “triple duty of care.” That meant it was able to look after patients’ needs and those of the hospital systems, safeguard its own staff and continue operations during COVID-19, and protect its business against potential volatility in the economy. It called for an exceptional response to deal with the huge task at hand. “You need extraordinary means to deal with such a challenge,” said Jakobs.
Within the connected care portfolio, two elements stood out more than others as tools to control COVID-19. One was Philips’ monitoring capabilities, given that some patients are prone to deteriorating very fast and need to be connected to monitors quickly. The other was patient ventilation, a technology area where Philips sits among the global leaders.
The aftercare needed to improve patients’ outcomes was also critical, as patients often took weeks or more to recover from COVID-19. This was much longer than Philips or the clinicians had initially anticipated, said Jakobs.
Hospitals had to double or even triple ICU capacity, putting huge pressures on the system in terms of the need for nurses, doctors and equipment. And all this while respecting the personal distancing measures recommended by governments to forestall further spread of the disease. It was becoming very clear, very fast, that hospitals needed to accelerate new methods of handling these risks.
“The urgent needs among hospitals include scalability, and how to monitor patient-flow closely over a long period of time. But monitoring is also needed at the patient’s home, where the first signs might be seen,” Jakobs said. Philips can develop the individual support solutions, “but more importantly, we can connect them, and that’s where the hard- and software come together to produce the dataflow from the patient. This is where workflow solutions show their value,” Jakobs said.
Connected care includes monitoring using different care systems, making systems interoperable and using the cloud to make data flow fast. Crucially, patients need to be able to trust that their care is being delivered in the right way. In this sense, COVID-19 has effectively showcased what certain technologies can do. “It has presented opportunities to many health systems that have started to realize that connected care is no longer an option,” said Jakobs, observing that crises can drive necessity.
COVID-19 hastened certain realizations about the value of connected care solutions. Where providers had been stalling over new technology adoption and system transformation, they suddenly became more decisive; there was a change in behaviors. “That was a very favorable development, and from the doctors’ and nurses’ perspective, it opened up new ways of diagnosing, monitoring and treating,” Jakobs noted.
In the US, pathologists dealing with the COVID-19 emergency were able to work from home after the US Food and Drug Administration granted a temporary waiver for the use of consumer monitors with Philips’ IntelliSite Pathology Solution. In New York, which was an initial hub of US infections, additional screens were installed in hospitals, enabling pathologists to access digital images of patient tissue remotely.
With the compelling impetus of the virus, telehealth and remote patient monitoring have suddenly come into their own in a very big way. Teleconsulting was fully recognized for its value in allowing coronavirus patients to receive health care without going to hospital. Patients could use video-assisted modules and surveys, and also sensor-based monitoring for when they entered or left the hospital. In the Netherlands, hospitals and GPs have been able to remotely to screen and monitor patients with COVID-19, based on Philips’ Patient Reported Outcomes Management solution.
Seeing very quickly that this was a learning environment, Philips set up a COVID-19 Hub as a forum to exchange ideas with industrial partners, governments and clinician experts and to suggest new solutions. “I loved seeing the spur given to innovation during the crisis, using what we have already or doing different things,” Jakobs said.
Depending on the region, the coronavirus first-wave peak has largely passed, but SARS-CoV-2 remains the focus of a very vibrant discussion. Coronavirus is expected to be around for a considerable period, and health systems are still working on the structural consequences of what is a very new disease to the world, said the Philips executive. He said, “We have gone through a big first wave and are seeing the need for structural change for the health system, ahead of a second wave or indeed another pandemic.”
On the positive side, Philips has demonstrated to itself and others that it can scale-up rapidly when needed. That capability – physical and digital ̶ is “here to stay,” said Jakobs. Every player in the health care ecosystem has had to recognize their constraints during this COVID-19 crisis, he said. But many players have also seen how they can break through traditional boundaries in being able to, say, increase monitor numbers or nurses multi-fold in mere days or weeks.
Philips, for instance, developed a new ventilator, the E30, in four weeks (“a record time”) and it was brought to the market in six weeks. It was an “extraordinary effort” that resulted in the noninvasive and invasive ventilator receiving a US FDA emergency use authorization on 8 April,” said Jakobs. The group planned to produce 15,000 units per week, alongside 4,000 Trilogy and Respironics V60 ventilators per week. It is partnering in this effort with US-listed manufacturing and design partners Flex Ltd and Jabil Healthcare in a bid to expand its assembly lines and strengthen its supply chain. “We are talking weeks to develop medical technology where normally, it takes a year or even years,” said Jakobs.
COVID-19 also called for new ways to maintain support and installations for hospitals. IT installations normally take months to complete, but by adjusting its methods and approach, Philips has been able to install configured solutions in just weeks. Hospitals prefer this in the current environment, where there is a drive to have as few people on site as possible.
“These are the eye openers that we can really build on and learn how to sustain,” said Jakobs. Going forward, “we want to be able to retain some of the agility we have seen happening at our end and at the customer/hospital end.” One thing is certain: “COVID has been an interesting time for facing new realities.”
It is not just Philips’ connected care unit that has played role during the COVID-19 crisis. Other parts of the group have provided diagnostic imaging and services, mobile diagnostic X-ray and mobile ultrasound systems. In fact diagnostic imaging and connected care have both been leveraged significantly.
On the downside, COVID-19 has meant subdued image guided therapy business, as elective procedure volume have been reduced heavily. In addition, Philips’ sleep business has not been a priority sector, and the group’s consumer business came to a virtual standstill. “Parts of the portfolio have been impacted, but connected care was in the right place to provide the support where it was needed.”
The elective care side now needs to begin managing its way back to more normal business routines. But COVID-19 has seen social distancing become an ingrained behavior for many, who still view hospitals as high-risk locations. Hospitals are aware of this perception among patients, and have reacted by engaging with them before they arrive at the hospital, using telehealth surveys or other forms of dialogue.
This new style of approach does not apply only to COVID-19 patients, but can be extended to cardiac patients, for instance, who, after intervention, are discharged with biosensors provided by Philips that can monitor them at home over a prolonged time and keep delivering relevant data and signals back to the provider.
To ensure its service and solutions reached those areas of the global market where the need was greatest, Philips established its own fair and ethical allocation rules, guided by the WHO Coronavirus Disease (COVID-19) Dashboard. The “red zones” were given priority, in shipping volume terms. Then, the decision-making became more granular, based on ratios like the number of patients to ICU beds, to gauge the risk of mortality in a given market.
A major pinch-point arrived when both the US and Europe were impacted heavily by the virus during March and April. “That was a difficult time,” said Jakobs, adding that Philips is ramping up further even now. “Across the whole industry we could not cope, and we are still dealing with the demand.” In the first quarter of 2020, Philips spent €100m to ramp up production volumes, in collaboration with suppliers and partners.
Some of the COVID-19 applications will find wider applications in routine health care. Technologies and techniques such as telehealth, remote monitoring, wearables, better use of data flows, and much earlier engagement with patients will gradually become more common. This is partly because consumers and patients have changed. They realize that no longer do they always need to go to a hospital to get good treatment. Neither do they always need face to face consultations, as a lot of care can be done in a virtual way.
The silver lining of the coronavirus is that, for health care systems, certain preconceived ideas about delivery system change have been blown away. Attitudes to care have changed, and boundaries that have been in place for a long time have been removed. An unexpected and deeply disruptive global public health episode, ironically, has created the opportunity for new health care behaviors.
By Ashley Yeo