Telemedicine, predictive diagnostics, wearable sensors and a host of new apps will transform how people manage their health
遠程醫療、預測診斷、可穿戴感知器及大量新的應用程式(app是application的縮寫)，將改變人們如何管理健康。
圖1. 圖援用自原文
When someone goes into cardiac arrest, survival depends on how quickly the heart can be restarted. Enter Amazon’s Echo, a voice-driven computer that answers to the name of Alexa, which can recite life-saving instructions about cardiopulmonary resuscitation, a skill taught to it by the American Heart Association.
當有人心臟停止時，能否存活取決於，心臟重新被啟動的速度。腦海浮現亞馬遜公司發售的Echo，這是一種由語音驅動、能朗誦有關心肺復甦術救命說明(由美國心臟協會講授的一項技能)，被稱為Alexa的一種電腦。
Alexa is accumulating other health-care skills, too, including acting as a companion for the elderly and answering questions about children’s illnesses. In the near future she will probably help doctors with grubby hands to take notes and to request scans, as well as remind patients to take their pills.
Alexa也正在增添其他醫療保健技能，包括充當一種年長者的伙伴，及回答有關兒童疾病的問題。於不久的未來，除了提醒病人服藥之外，它也將可能協助手骯髒的醫生們，做筆記及要求掃描。
Alexa is one manifestation of a drive to disrupt an industry that has so far largely failed to deliver on the potential of digital information. Health care is over-regulated and expensive to innovate in, and has a history of failing to implement ambitious IT projects. But the momentum towards a digital future is gathering pace. Investment into digital health care has soared (see chart).
Alexa是混亂，迄今為止，大部分一直未能實現數位信息潛力之行業的一項具體化(證明)。醫療保健受到過度管理及創新成本高昂，因此有未能實現雄心勃勃之信息技術(IT：Information Technology)計劃的歷史。不過，邁向數位化未來的動量正逐漸增強。數位醫療保健的投資已經升高(見圖表)。
圖2. 圖援用自原文
One reason for that is the scale of potential cost-savings. Last year Americans spent an amount equivalent to about 18% of GDP on health care. That is an extreme, but other countries face rising cost pressures from health spending as populations age. Much of this expenditure is inefficient.
升高的一種原因是，諸多潛在節省成本的規模。去年(2016年)，在醫療保健上，美國人花費的總數相當於GDP的18%。那是一個極值，不過隨著人口老齡化，其他國家面臨著，來自醫療保健花費上升的成本壓力。此花費大部分是低效率的。
Spending on administration varies sevenfold between rich countries. There are huge differences in the cost of medical procedures. In rich countries about one-fifth of spending on health care goes to waste, for example on wrong or unnecessary treatments. Eliminating a fraction of this sum is a huge opportunity.
於富裕國家間，在管理上的開銷差異七倍。在醫療過程的價格上，有巨大差異。在富裕國家中，大約五分之一的醫療保健花費被浪費掉。譬如，錯誤或不必要的治療。有很大的機會能避免部分此花費。
Consumers seem readier to accept digital products than just a few years ago. The field includes mobile apps, telemedicine—health care provided using electronic communications—and predictive analytics (using statistical methods to sift data on outcomes for patients). Other areas are automated diagnoses and wearable sensors to measure things like blood pressure.
消費者似乎比僅幾年前，更願意接受數位產品。此領域包括，行動應用程序、遠程醫療(使用電子通信提供的醫療保健)及預測分析(使用統計方法詳審有關患者結果的數據)。其他領域是自動診斷及測量諸如血壓等，事情的可穿戴感知器。
If there is to be a health-care revolution, it will create winners and losers. Andy Richards, an investor in digital health, argues that three groups are fighting a war for control of the “health-care value chain”.
倘若要進行一場醫療保健革命，這會產生贏家及輸家。在數位醫療保健方面的投資者，Andy Richards認為，三個團體正在進行一場，為掌控“醫療保健價格鏈”的戰爭。
One group comprises “traditional innovators”—pharmaceutical firms, hospitals and medical-technology companies such as GE Healthcare, Siemens, Medtronic and Philips. A second category is made up of “incumbent players”, which include health insurers, pharmacy-benefit managers (which buy drugs in bulk), and as single-payer health-care systems such as Britain’s NHS.
一種團體包括，製藥公司、醫院及諸如GE Healthcare(美國跨國集團通用電氣的子公司)、西門子、美敦力及飛利浦等，醫療技術公司的“傳統創新者”。第二種團體由包括，健康保險公司、藥房獲利經理(批量購買藥品的人)及諸如，英國國民醫療保健署(NHS：National Health Service)等，身為單一付款人之醫療保健系統的“負有義務付款人”組成。
The third group are the technology “insurgents”, including Google, Apple, Amazon and a host of hungry entrepreneurs that are creating apps, predictive-diagnostics systems and new devices. These firms may well profit most handsomely from the shift to digital.
第三種團體是包括，谷歌、蘋果、亞馬遜與諸多正在開發應用程序、預測診斷系統及新裝置之雄心勃勃企業家們的技術“起義者”。這些公司很可能從轉向數位化，而可觀地獲得最豐厚的利潤。
The threat to the traditional innovators is that as medical records are digitised and new kinds of patient data arrive from genomic sequencing, sensors and even from social media, insurers and governments can get much better insight into which treatments work. These buyers are increasingly demanding “value-based” reimbursement—meaning that if a drug or device doesn’t function well, it will not be bought.
對傳統創新者的威脅是，隨著醫療記錄被數位化，及來自基因體排序、感知器、甚至社群媒體、保險公司及政府的新型病患數據，能獲得哪些治療方法起作用的更佳洞察力。這些購買者日益要求“基於價值”的償還(回報)。這意味著，倘若一種藥物或裝置不能適切起作用，就不會被購買。
The big question is whether drug companies will be big losers, says Marc Sluijs, an adviser on investment in digital health. More data will not only identify those drugs that do not work. Digital health care will also give rise to new services that might involve taking no drugs at all.
數位醫療保健方面的投資顧問，Marc Sluijs表示，最大的問題是，製藥公司是否會是大輸家。更多的數據不僅能識別那些不起作用的藥物。數位醫療保健也會招致，可能完全不服用藥物的新服務事業。
Diabetes is an obvious problem for the pharma business in this regard, says Dan Mahony, a partner at Polar Capital, an investment firm. Since evidence shows that exercise gives diabetics better control of their disease (and helps most pre-diabetics not to get sick at all), there is an opening for new services. UnitedHealthcare, a big American insurer, for example, has a prevention programme that connects pre-diabetics with special coaches at gyms.
英國Polar Capital投資公司合夥人，Dan Mahony表示，在這方面，糖尿病是製藥業的一個明顯問題。因為證據顯示，運動使糖尿病患者更佳控制其疾病(且幫助大多數糖尿病前期患者，完全不患病)。因此，有一種新服務事業的開張。譬如，美國大型保險公司，UnitedHealthcare具有一項，將糖尿病前期患者與健身房特殊教練聯繫起來的預防計劃。
An app or a wearable device that persuades people to walk a certain distance every day would be far cheaper for insurers and governments to provide than years of visits to doctors, hospitals and drugs. Although Fitbits are frequently derided for ending up in the back of a drawer, people can be motivated to get off the sofa.
對保險公司及政府而言，一種說服人們每天步行一定距離的應用程序或可穿戴裝置，提供的會遠比多年找醫生、醫院及藥物更為廉價。
Players of Pokémon Go have collectively walked nearly 9bn kilometres since the smartphone game was released last year.
打從去年發布智慧型手機遊戲以來，Pokémon Go(一款基於位置服務之擴增實境類的智慧型手機遊戲)的玩家們已經集體走了近90億公里。
That is the backdrop to a new firm called Onduo, a joint venture that Google’s health-care venture, Verily Life Sciences, and Sanofi, a French drug firm, set up last year. Onduo will start by developing ways to help diabetics make better decisions about their use of drugs and their lifestyle habits.
那是一家，谷歌所屬Verily生命科學之醫療保健事業與法國賽諾菲製藥公司之合資企業，被稱為為Onduo新公司的背景。
Later on, Onduo wants to help those who are at risk of diabetes not to develop it. The startup is a good hedge for Sanofi, which faces a slowdown in sales of its blockbuster insulin medication, Lantus, which lost patent protection in 2015.
後來，Onduo想協助那些，冒有糖尿病風險的人，不要罹患糖尿病。對在其耗費巨資之胰島素藥物，Lantus於2015喪失專利保護，在銷售上面臨減緩的賽諾菲公司而言，此新創公司是一項不錯的兩邊押寶。
This kind of thinking does not come easily to drug firms. Switzerland’s Novartis is one of the few to have acknowledged that digital innovation will mean selling products based on patient outcomes. But if pharma firms do not design solutions that put the patient, rather than drug sales, at the centre of their strategy, they risk losing relevance, says Mr Sluijs.
對製藥公司而言，實現這種想法並不容易。瑞士諾華製藥公司，是少數已經承認數位創新將意味著，根據病患結果銷售產品的公司之一。Sluijs先生表示，不過倘若製藥公司不設計出，將病患而非藥品銷售，置於其戰略中心的解決方案，它們就冒有失去實用性的風險。
Large hospitals, some of which count as both incumbents and traditional innovators, will also be affected. The rise of telemedicine, predictive analytics and earlier diagnoses of illnesses are expected to reduce admissions, particularly of the emergency kind that are most lucrative in commercial systems.
有些被視為兼具老牌醫院及傳統創新者的大型醫院，也會受到影響。遠程醫療、預測分析及疾病早期診斷的興起，預計會減少住院率。特別是，屬於商業系統中，最有利可圖的緊急類型。
The sickest patients can be targeted by specialist services, such as Evolution Health, a firm in Texas that cares for 2m of the most-ill patients across 15 states. It claims to be able to reduce the use of emergency rooms by a fifth, and inpatient stays in hospitals by two-fifths.
病情最嚴重的患者會被，諸如Evolution Health(一家於德克薩斯州，為包括15個州、200萬重症病患提供護理之公司)等，專科醫師服務事業鎖定。它聲稱能減少急診室的使用達五分之一，及住院病人停留醫院的時間減少五分之二。
Rapid medical and diagnostic innovation will disrupt all businesses that rely heavily on physical facilities and staff. A mobile ultrasound scanner made by Philips, called Lumify, means that a far larger number of patients can be seen by their own doctors.
快速的醫療及診斷創新，將擾亂所有嚴重依賴實體設施及工作人員的行業。一台由飛利浦醫療技術公司所製造，被稱為Lumify的移動式超音波掃描儀，意味著他們自己的醫生能為更多的病患看病。
As for data-based diagnostics, one potential example of its power to change business models is Guardant Health, a startup that is analysing large quantities of medical data in order to develop a way of diagnosing cancer from blood tests.
至於以數據為基礎的診斷，其改變商業模式之能力的一個潛在例子是Guardant Health。這是一家為了開發一種從血液檢測，來診斷癌症之方法，正進行分析大量醫療數據的新創公司。
If the firm can devise an early test for breast cancer, demand for mammograms and the machines that take them would fall, along with the need for expensive drugs and spells in hospital.
倘若該公司能夠設計出一種，乳腺癌的早期檢測法。那麼對乳房X-射線照片及拍攝機器，連同對昂貴藥物及住院時間的需求也會下降。
There is also good news for hospitals, however. Increasingly, machine-learning programs are able to make diagnoses from scans and from test results. An intriguing recent project has been to stream and analyze live health data and deliver alerts on an app that is carried around by doctors and nurses at the Royal Free Hospital in London.
不過，對醫院也有好消息。越來越多，機器學習程式能根據掃描及測試結果，來進行診斷。最近一項引人好奇的方案已經是在，一種由英國倫敦皇家慈善醫院醫師及護士們，隨身攜帶之應用程式上，傳輸及分析實況的健康數據，及發出警報。
The app, which is the work of DeepMind, a British artificial-intelligence (AI) research firm owned by Google, identifies the patients at greatest risk of a sudden and fatal loss of kidney function. The Royal Free says that the app is already saving nurses’ time.
該應用程式(是谷歌公司所擁有之英國人工智能(AI)研究公司DeepMind的產物)能確認，冒有腎臟功能突然及致命性喪失之最大風險的病患。倫敦皇家慈善醫院表示，該應用程式已經在節省護士們的時間。
Naturally enough, the health-care entrepreneurs have the boldest visions. The point of care will move rapidly into the home, they say. People will monitor their heart conditions, detect concussions, monitor the progress of diseases and check up on moles or ear infections using apps, mobile phones and sensors. Last year the FDA approved 36 connected health apps and devices.
很自然，此些醫療保健之企業家們具有最大膽的遠見。他們表示，護理點會迅速進入家庭。人們將使用應用程式、手機及感知器，來監視心臟狀況、察覺腦震盪、監視疾病進展及檢查痣或耳朵感染。去年，美國食品暨藥品管理局(FDA：Food & Drug Administration)批准了，36款連結的醫療保健應用程式及裝置。
A new app, called Natural Cycles, was recently approved in Europe for use as a contraceptive. Its failure rate for typical use was equivalent to that of popular contraceptive pills. A smartphone may eventually be able to predict the onset of Alzheimer’s, Parkinson’s or even the menopause (if the information is wanted).
一種被稱為Natural Cycles的新應用程式，最近於歐洲被批准供作避孕藥使用。其獨特用法的失敗率與普遍的避孕藥相當。有種智慧型手機，最終或許能預測阿茲海默氏症、帕金森氏症，或甚至更年期的發作(倘若需要此信息)。
In emerging economies, where regulations on health data are less onerous and where people often already expect to pay to see a doctor, there is faster growth and innovation. China, which is building 400 hospitals a year, saw its two largest VC investments in digital health care last year.
在新興經濟體中，對醫療保健數據的法規較不繁瑣，而且人們通常已經認為，看病付費理所當然。因此，有更快的成長及創新速度。目前，一年建造4百家醫院的中國，去年在數位醫療保健方面，確定了兩項最大的風險投資。
One went into a Chinese medical-service app, Ping An Good Doctor, which raised $500m; a video-consultations app called Chunyu Yisheng raised $183m. India is another innovator. To take one example, LiveHealth, based in Pune, is an app that lets patients assemble all their health records in one place, see test results and communicate with doctors.
其中一個投入了，籌募5億美元之中國醫療服務的平安好醫生(Ping An Good Doctor)應用程式。有一項是籌募了1.83億美元，被稱為春雨醫生(Chunyu Yisheng)的視頻諮詢應用程式。印度是另一個創新者。舉個例子，總部位於印度馬哈拉什特拉邦，浦那市的LiveHealth是一款，可讓病患將所有健康記錄聚集於一個地方，查看檢驗結果並與醫生們進行溝通。
In the short term, the greatest disruption will come from a growing array of apps in many countries around the world that give consumers direct access to qualified GPS on their mobile phones. Overall, telemedicine is expected to grow rapidly. In America, GPs will conduct 5.4m video consultations a year by 2020, says IHS Markit, a research firm.
在短期內，最大的混亂將來自，於世界各地許多國家中，提供消費者們在其手機上，直接使用合格全球定位系統(GPS：Global Positioning System)之日益數量龐大的應用程式。總體而言，遠程醫療預期會快速成長。有家研究公司，IHS Markit表示，到2020年，於美國全科醫生(GP：general practitioner)們，每年將進行540萬次視頻諮詢。
Britain’s NHS is testing a medical AI from a London-based startup called Babylon which can field patients’ questions about their health. A paid service called Push Doctor offers an online appointment almost immediately for £20 ($24). The firm maximises the efficiency of its doctors by reducing the time they spend on administrative duties.
英國國民保健署(NHS：National Health Service)正在測試，來自倫敦一家被稱為Babylon之新創公司，能解答病患有關其健康問題的醫療人工智能(AI：Artificial Intelligence)。一項被稱為Push Doctor的付費服務，幾乎能立即以20英鎊(24美元)的價格，提供線上預約。該公司藉由減少，他們花費在行政職責上的時間，來最大化提高其醫師們的效率。
They spend 93% of their time with patients compared with only 61% in Britain’s public sector. Babylon reckons that 85% of consultations do not need to be in person.
他們將93%的時間花在病人身上，相較下於英國公共部門僅61%。Babylon認為85%的諮詢，不需要當面進行。
圖3. 圖援用自原文
In the longer term, the biggest upheaval may come from the large technology firms. Amazon and Google are not the only giants to be stalking health care. Apple has expressed a strong interest in it, though it is taking time to decide exactly what it wants to do.
從長遠來看，最大的劇變可能來自大型科技公司。亞馬遜及谷歌並非唯一，正在悄悄靠近醫療保健的巨頭。蘋果已經表達了強烈興趣，儘管需要時間來確定想要做什麼。
For several years it has provided a way of bringing together health data on its iPhone, and tools for health researchers to build apps. As personal-health records accumulate on its platform, from sensors such as Fitbits to medical-grade devices, it will encourage more app development.
多年來，它已經提供一種，在iPhone上整合醫療保健數據的方法，並為醫療保健研究人員們，提供構建應用程式的工具。隨著個人醫療保健記錄，從諸如Fitbits等感知器到醫療級裝置，在其平台上的累積。它將促進更多應用程式的開發。
An app using data from an iPhone or another smartphone might be able to warn users that a sedentary lifestyle will exacerbate a heart condition or that, based on social-media patterns, they are at risk of depression, for example. Apple and other tech firms may also be able to help patients take greater control of their existing health records.
譬如，使用來自iPhone或其他智慧型手機之數據的應用程式，或許能警告用戶，久坐不動的生活方式會加劇心臟病，或根據社群媒體模式，他們冒有罹患抑鬱症的風險。蘋果及其他科技公司或許也能協助病患處理，更多有關其現有醫療保健記錄的管理。
For now medical records mostly remain under the guard of those who provided the care, but this is expected to change. If patients do gain proper access to their own data, Apple is in a particularly strong position. Its platform is locked and fairly secure, and the apps that run on it are all screened by the firm.
當前，醫療記錄大多是在提供護理者們的保管下。不過，預期這種情況會改變。倘若病患確實獲得進入自己數據的特有權限，蘋果將處於特別有優勢的地位。其平台被鎖定因此相當安全，且在其上運作的應用程式，全經由該公司篩選。
None of this will materialise quickly. Regulated health-care systems will take time to deal with concerns over accuracy, security and privacy. In Britain the Royal Free is already under scrutiny over how it shared its patients’ data. That suggests a broader worry: that technology companies are too cavalier with their users’ data.
這一切都不會很快實現。受管理的醫療保健系統會需要時間，來處理有關準確性、安全性及隱私的擔憂。於英國，倫敦皇家慈善醫院已經在探究，如何分享其病患數據。
Such firms typically use long agreements on data rights that are hard for individuals to understand. The medical world places importance on informed consent, so a clash of cultures seems unavoidable.
有關數據權，此類公司通常使用，個人難以理解的長期協定。醫療界非常重視知情同意，因此文化衝突似乎是不可避免。
Yet enormous change looks inevitable. Investors hope for billion-dollar health-tech “unicorns”. Payers eye equally sizeable savings. Amid such talk it is worth remembering that the biggest winners from digital health care will be the patients who receive better treatment, and those who avoid becoming patients at all.
然而，巨大變化似乎不可避免。投資者們期盼成為，數十億美元之醫療保健科技的"獨角獸"。付款人同樣關心可觀的節省費用。在這樣的討論中，值得記住的是，數位醫療保健的最大贏家，會是那些接受更佳治療的病患，及那些完全避免成為病患的人。
網址：https://www.economist.com/business/2017/03/02/a-digital-revolution-in-health-care-is-speeding-up?fsrc=sponsor%2Fopenandsecure
翻譯：許東榮
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