Trends old and new, and the Holy Grail of health care

August 5, 2021

A serial blog by Charles J. Shanley, M.D., and David Ellis, M.S.

Katie Adams, a writer for Becker’s Hospital Review, has pertinently, succinctly and accurately identified five trends emerging in 2021.[i] Or so it seems to us, on the biased basis that they track closely with our Wayne Health blog posts this year. They are:

  1. Rising investment in digital health: At $14.7 billion in the first six months of 2021, digital health[ii] start-up investment has already surpassed the $14.6 billion raised in all of 2020. Cleveland, Mayo, Kaiser, Ascension and Providence are among the bigger investors. Included in those billions is a Kaiser and Mayo joint investment of $100 million in a hospital-at-home services provider, which we wrote about in our last Wayne Health blog post.
  2. Artificial intelligence for clinical decision support: Hospitals are increasingly adopting AI clinical decision tools. Investment in that sector alone raised $1.1 billion in the first half of 2021.
  3. Health data sharing: We’ve also written in a previous blog about the inevitable trend to electronic health record interoperability. Adams mentions Athenahealth spinoff Zus Health, which creates tools and apps to mine shared data records, and the opening up of Amazon’s health care “data lake” to providers to encourage and facilitate health information sharing.
  4. Hospital-at-home: The pandemic accelerated hospital-at-home programs (see #1 above), which use remote monitoring and telehealth technologies to provide lower-cost and lower-risk hospital-level care at home.
  5. Wearable monitoring devices: While such devices are increasingly used on patients in the hospital, they also greatly facilitate the hospital-at-home trend and could arguably be lumped together with it. Adams singles out Amazon’s Halo device, which uses sensors to collect temperature, heart rate, sleep and fitness activity and is integrated (only) with Cerner’s EHR, as an example.

These trends are not new – we have been writing about them for decades and, as noted, we essentially covered them in our first three posts on this Wayne Health blog.[iii] They are newsworthy today not only because they have climbed higher up the exponential curve than they were two years ago, but because practical ways of dealing with them are beginning to emerge. These trends received a boost from the pandemic, but they were already on their way up and it is important to note that, a few short years from now, they will be noticeably higher up the curve and require radical adaptation.

Major players in the old health care industry (such as those mentioned at the beginning of this post) are already taking steps to adapt to the disruption from these trends. But even the new entrants – the Walmarts and Amazons – are not immune from disruption as these trends, and others not yet on people’s radar, rocket up exponential curves of their own.

In coming posts to this blog, we will put those largely unknown trends on the radar, starting with this one: the trend to systems biology, the computational and mathematical analysis and modeling of complex biological systems.

The canary in the coal mine of systems biology was a program called Archimedes developed by Dr. David Eddy and colleagues in the late 1900s/early 2000s. Archimedes was used to conduct virtual clinical trials of interventions – a vital capability for truly personalized medicine, since it is obviously impossible to conduct billion-dollar, multi-year trials on an N of 1.

Archimedes was also used to model anatomy, pathophysiology, tests, treatments and outcomes in diabetes patients to provide clinical and administrative approaches that could be validated ahead of their application to a patient. This too was personalized medicine, before the term was barely known, and it is the future of personalized medicine going forward.[iv]

Like most groundbreaking technologies, Archimedes was ahead of its time and quietly faded away, but not without leaving seeds from which more advanced technologies are already sprouting. In other words, it started a trend. Today, we are witnessing that same trend higher up its exponential development curve, albeit (as often happens) under new nomenclature: “digital twins,” which seems to convey its meaning better than “systems biology.”

According to the Accenture Digital Health Technology Vision 2021 survey,[v] 87% of 399 health care executives across six countries think this technology will become essential to “strategic ecosystem partnerships.” We wonder if it was on the radar of these 399 executives only because the survey put it there (the report does not include the actual questionnaire so we cannot check for bias and validity.) But in our experience, digital twinning is not exactly a common topic of conversation in the surgical break room or at health care conferences.

But neither is it unknown. The American Hospital Association recently reported that “Oklahoma State University and Ansys, a simulation software developer, have explored using digital twins to more precisely target tumors.  By experimenting with digital versions of human lungs and various factors, they found a delivery method that may let physicians increase the accuracy of drug delivery to 90% versus 20%, common for conventional aerosol methods.”[vi]

Holy Grails tend to be bandied about like plastic cups these days. But at risk of adding to the debris, we would venture that if there is one Holy Grail worthy of the name in medicine, it is digital twinning – the ability to model every aspect of a patient, from her anatomy to his environment, down to the molecular level and eventually even below that.

We further speculate that within a decade, patient monitoring devices, AI monitoring and diagnostic systems, and EHR-sharing + big data analytics, will be combined into a high-tech data, lake-sized Holy Grail powered by quantum computers. This will represent health care nirvana for the patient, but potentially a nightmare for the health care provider, at least as we define the terms “health,” “care” and “provider” today.

We took pains early in this article to show that our Wayne Health blog is up with salient, current trends coming through the front door. Becker’s, the AHA and others are now starting to focus on these front-door trends. What we really want to do with this blog going forward is to surface some of the less salient trends sneaking in through the back door, giving health care executives, professionals and policymakers practical guidance for future planning. Having hopefully established our credentials as trend-spotters, we will take up a post at the back door and put these trends on your radar.

We hope you will keep an eye on our radar screen, and don’t hesitate to share your thoughts and questions by posting comments.

[i] Adams, Katie (2021) “5 healthcare innovation trends to keep a close eye on.” Beckers Hospital Review, July 20. Online at

[ii] In this context the “digital health” business includes telemedicine, wellness, mobile apps, analytics, and clinical decision support.

[iii] Blog post #1. ”Haven: Much ado about nothing” was about accelerating tech sector encroachment in the healthcare industry (; #2. “The apple bites back” shows how Apple, Google, Amazon and Walmart are weighting in to force EHR interoperability (; and #3. “The Patient Will See You Now, Doctor: A Sea Change In the Hospital–Patient Relationship” notes that the trend to outpatient has gotten a shot in the arm from major investment in hospital-at-home movement (

[iv] Eddy, David M., and Leonard Schlessinger (2003). “Archimedes: A trial-validated model of diabetes.” Diabetes Care Nov; 26(11): 3093-3101.

[v] The Accenture report is available online at

[vi] American Hospital Association (2021). “Digital transformation’s next wave: Creating a mirrored world.” AHA Center for Health Innovation Market Scan, July 13. Online at

Trends old and new, and the Holy Grail of health care
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