The pandemic is ushering in the next trillion-dollar industry
疫情正在催生下一个万亿美元产业​

数字医疗的黎明 The dawn of digital medicine-书迷号 shumihao.com

IN JANUARY 2019, Stephen Klasko, chief executive of Jefferson Health, which runs hospitals in Philadelphia, chatted to a bank boss. The financier told him that 20 years ago health care and banking were the only industries yet to embrace the consumer and digital revolutions. “Now”, Mr Klasko recalls him adding, “you are alone.”
二〇一九年一月,在费城运营医院的杰斐逊医疗系统(Jefferson Health)的首席执行官斯蒂芬·克拉斯科(Stephen Klasko)和一位银行老板有过一次聊天。这位金融家对他说,20年前医疗和银行是仅剩的两个尚未拥抱消费革命和数字革命的行业。“现在,”克拉斯科记得他又加了一句,“就剩你们了。”

The banker had a point. The McKinsey Global Institute, the in-house think-tank of the eponymous consultancy, reckons that when it comes to digitisation, health care has indeed lagged behind not just banking but travel, retail, carmaking and even packaged goods. Some 70% of American hospitals still fax and post patient records. The CEO of a big hospital in Madrid reports virtually no electronic record-sharing across Spain’s regions when the first wave of covid-19 washed over the country this spring.
这位银行家所言非虚。麦肯锡咨询公司的内部智库麦肯锡全球研究院认为,在数字化方面,医疗业确实不只落后于银行业,还落后于旅游、零售、汽车制造,甚至包装消费品。约七成美国医院仍使用传真和邮寄方式发送病历。马德里一家大型医院的首席执行官表示,今年春季第一波新冠疫情席卷西班牙时,全国不同地区之间几乎没能共享任何电子病历。

By exposing such digital deficiencies, the pandemic is at last spurring change. Confronted with shutdowns and chaos, doctors have embraced digital communication and analytics that have been common in other industries for years. Patients are growing more comfortable with remote and computer-assisted diagnosis and treatment. And enterprising firms, from health-app startups and hospitals to insurers, pharmacies and tech giants such as Amazon, Apple and Google, are scrambling to provide such services.
疫情暴露出这样的数字化不足,最终推动了变革。面对停摆和混乱的挑战,医生们积极采用了在其他行业已经普及多年的数字化沟通和分析。患者也越来越适应远程和电脑辅助的诊断与治疗。富有进取精神的企业——从健康应用创业公司、医院、保险公司、药房到亚马逊、苹果和谷歌等科技巨头——正在争相提供此类服务。

McKinsey estimates that global digital-health revenues—from telemedicine, online pharmacies, wearable devices and so on—will rise from $350bn last year to $600bn in 2024 (see chart 1). Swathes of America’s $3.6trn health-care market are in for a digital makeover. The same is happening in China, Europe and most other places where doctors ply their trade.
麦肯锡估计,到2024年,来自远程医疗、网上药房、可穿戴设备等的全球数字医疗收入将从去年的3500亿美元增至6000亿美元(见图表1)。美国价值3.6万亿美元的医疗保健市场当中,很大一部分将经历数字化转型。中国、欧洲以及大部分有医生行医的地区也在发生同样的变化。 ​

The groundwork for what looks poised to be the next trillion-dollar business has been accelerated by the pandemic. Money is pouring in. According to CB Insights, a research firm, a record $8.4bn of equity funding flowed into privately held digital-health darlings in the third quarter of 2020, more than double the amount a year ago (see chart 2). The industry’s unlisted “unicorns”, worth $1bn or more apiece, have a combined value of over $110bn, according to HolonIQ, a research firm. In September AmWell, a telemedic in which Google has invested $100m, raised $742m in an initial public offering (IPO); its market capitalisation is $6bn. On December 2nd JD Health, a digital pharmacy affiliated with JD.com, a Chinese online emporium, raked in $3.5bn in Hong Kong’s second-biggest IPO this year.
对于这个看起来势将成为下一笔万亿美元大生意的产业,疫情加速了其地基打造。资金正在源源不断地涌入。据研究公司CB Insights的数据,2020年第三季度,受青睐的非上市数字医疗企业已获得84亿美元的股权融资,创下历史新高,同比增加一倍以上(见图表2)。研究公司HolonIQ指出,该行业未上市的独角兽企业(估值10亿美元或以上)的总估值已经超过1100亿美元。9月,获谷歌1亿美元投资的远程医疗公司AmWell通过IPO融资7.42亿美元,市值达到60亿美元。12月2日,中国在线商城京东旗下的数字药房京东健康在香港招股融资35亿美元,是香港今年第二大IPO。

No wonder investors are giddy. Demand for digital medicine is surging. Doctolib, a French firm, says its video consultations in Europe have shot up this year from 1,000 to 100,000 a day. Ping An Good Doctor, a Chinese online health portal viewed by some as the choicest part of its insurer parent, is expanding to South-East Asia in a joint venture with Grab, a Singaporean ride-hailing giant.
投资者如此热情高涨不足为奇。对数字医疗的需求正在激增。法国公司Doctolib表示,该公司今年在欧洲的视频会诊量已从每天1000人次激增至每天10万。一些人认为中国在线健康门户平安好医生是其母公司平安保险旗下最优质的资产,它正通过与新加坡网约车巨头Grab组建的合资企业向东南亚扩张。

As with many technology fads, some of this will turn out to be hype. Sober analysts at Gartner, a research firm, pour cold water on exaggerated claims made by proponents of individualised “precision medicine” and medical artificial intelligence (AI). But even they admit there are reasons to think that not all the excitement is overblown.
与许多科技风潮一样,这其中的一些最终只会是一场炒作而已。研究公司高德纳(Gartner)的分析师们很冷静,给个性化“精准医疗”和医学人工智能(AI)倡导者的夸夸其谈大泼冷水。但即便他们也承认,有理由认为人们的兴奋之情并非全然过了头。

Technologies such as sensors, cloud-computing and data analytics are becoming medical-grade just as the risk of contracting covid-19 in hospitals and clinics makes their adoption look more enticing than ever. Specialist firms like Livongo and Onduo make devices to monitor diabetes and other ailments continuously. A study by Stanford University found that nearly half of American doctors surveyed used such devices. Of that group, 71% regarded the data as medically useful. In June the Mayo Clinic, a prestigious non-profit hospital group, teamed up with a startup called Medically Home to provide “hospital-level care”, from infusions and imaging to rehabilitation, in patients’ bedrooms. Even the Apple Watch has been shown to predict a medical problem known as atrial fibrillation in a clinical trial.
鉴于在医院和门诊感染新冠肺炎的风险,传感器、云计算和数据分析等技术的应用显得比以往更有吸引力,而这些技术也正发展为医疗级别。Livongo和Onduo这类专门化公司生产针对糖尿病和其他疾病的持续监护设备。斯坦福大学的一项调查研究发现,接近半数的受访医生曾经使用过此类设备,其中71%认为这些数据具有医学价值。6月,著名非营利医院集团妙佑医疗国际(Mayo Clinic)与创业公司Medically Home合作,在患者家中提供从输液、造影到康复等“医院级护理”。一项临床试验表明甚至Apple Watch也可以预测房颤这种病症。

An Apple a day
每日一苹果

Patients are keen. A study of some 16m American ones just reported in JAMA Internal Medicine, a journal, found that their use of telemedicine surged 30-fold between January and June. American consumers surveyed in May by Gartner were increasingly using internet and mobile apps for a variety of medical needs (see chart 3).
患者对此相当热衷。《美国医学会内科杂志》(JAMA Internal Medicine)上刚刚发表了一项对约1600万美国患者的研究,发现在1月到6月间对远程医疗的利用激增了30倍。高德纳5月对美国消费者的调查显示,他们正越来越多地使用互联网和手机应用来满足各种各样的医疗需求(见图表3)。

Critically, regulators around the world are pressing health-care providers to open up their siloed systems—a precondition for digital health to flourish. The EU is promoting an electronic standard for medical records. In August the Indian government unveiled a plan for a digital health identity with interoperability at its core. Kuantai Yeh of Qiming, a VC firm, says that China’s government, too, is trying to overcome resistance to electronic records from hospitals fearful of losing patients to rivals. Yidu Cloud, a big-data platform for hospitals, may already be the world’s largest health data set, thinks Lee Kai-fu of Sinovation Ventures, another VC firm.
至关重要的一点是,世界各地的监管机构也在向医疗服务供应商施压,要求它们开放彼此孤立的系统——这是数字医疗蓬勃发展的先决条件。欧盟正在推动一项病历电子化标准。8月,印度政府公布了一项数字医疗身份识别计划,其核心就是互通性。风投公司启明创投的叶冠泰表示,中国政府也在努力克服在医院推行电子病历受到的阻力——医院担心这会导致病人轻易转换医院。另一家风投公司创新工场的李开复认为,医院大数据平台医渡云可能已成为全球最大的健康数据集。

Apple, with its reputation for protecting users’ privacy, is also championing a common standard. A combination of such efforts and regulatory pressure heralds “a new era” for digital medicine, thinks Aneesh Chopra, a former White House technology chief. Judy Faulkner, boss of Epic, a leading maker of software to manage electronic health records that Mr Chopra has long urged to be more open, declares she is all for it; 40% of the data managed by her firm are already shared with non-customers, she says. Kris Joshi, who runs Change, which handles over $1.5trn in American medical-insurance claims a year, sees more interoperability, at least between businesses.
以保护用户隐私著称的苹果公司也在倡导一个通用标准。前白宫技术官员安尼什·乔普拉(Aneesh Chopra)认为,业界的努力加上监管的压力正引领数字医学进入“新时代”。乔普拉长期敦促电子病历进一步开放,而领先的电子病历管理软件开发商Epic的老板朱迪·福克纳(Judy Faulkner)称她对此完全赞成。她表示,其公司管理的数据中已有40%与非客户共享。Change公司每年处理超过1.5万亿美元的美国医疗保险理赔,公司掌门人克里斯·乔希(Kris Joshi)也观察到互通性有所增加,至少在企业间是如此。

All this is helping medicine evolve from “a clinical science supported by data to a data science supported by clinicians”, argues Pamela Spence of EY, a consultancy. Does this make health care big tech’s for the taking? Amazon wants Alexa, its digital assistant, to be able (with your permission) to analyse your cough and tell you if it is croupy or covidy. In November the online giant, which already sells just about everything else, launched a digital pharmacy to take on America’s drug-distribution coterie of pharma firms, middlemen and retailers. AliHealth, a division of Alibaba, China’s e-commerce champion, is disrupting its home pharmacy market. Its revenues leapt by 74% in the six months to September, year on year, to $1.1bn. Apple has its watch and nearly 50,000 iPhone health apps. Google’s parent company, Alphabet, has Verily, a life-sciences division.
咨询公司安永的帕梅拉·斯宾塞(Pamela Spence)认为,所有这些都在助推医学从“由数据支持的临床科学变为由临床医生支持的数据科学”。这是否意味着医疗这块蛋糕将成为科技巨头的囊中之物?亚马逊希望其数字助理Alexa能够(在你的许可下)分析你的咳嗽声,看它是哮吼性咳嗽还是疑似新冠肺炎。11月,这家几乎无所不卖的网络巨头还推出了数字药房,向美国的制药公司、中间商和零售商结成的药品分销小圈子发起挑战。中国电子商务领军企业阿里巴巴旗下的阿里健康也正在颠覆国内药房市场。截至9月的六个月里,其收入同比激增74%,达到11亿美元。苹果拥有苹果手表和近五万个iPhone健康应用。谷歌的母公司Alphabet旗下有生命科学子公司Verily。

Tech giants’ earlier forays into health care flopped, argues Shubham Singhal of McKinsey, because they had gone it alone. Medicine is a regulatory minefield with powerful incumbents where big tech’s business models, particularly the ad-supported sort, are not a natural fit. But the pandemic has also highlighted that existing providers’ snazzy hardware and pricey services too seldom genuinely improve health outcomes. If the new generation of digital technologies is to thrive it must “improve health, not increase costs”, thinks Vivian Lee of Verily. Her firm is moving away from fee-for-service to risk-based contracts that pay out when outcomes improve (eg, if diabetics get blood sugar under control or more people get eye exams).
麦肯锡的舒布哈姆·辛格尔(Shubham Singhal)认为,科技巨头进军医疗保健领域的早期尝试之所以失败,是因为它们选择了单打独斗。医药行业监管严格,处处雷区,其中的传统企业实力雄厚,而大型科技公司的商业模式,尤其是那些依靠广告收入的模式,并不天然契合这个市场。但是,这场疫情也凸显了现有医疗服务的弊端,各种医疗提供者的新潮硬件和昂贵服务也很少能真正改善健康。Verily的维维安·李(Vivian Lee)认为,新一代数字技术要想蓬勃发展,就必须能够“改善健康,而非增加成本”。她的公司正在从按服务付费模式转向基于风险的协议,也就是当用户健康有所改善时(例如糖尿病患者的血糖得到控制,或更多人接受眼科检查)向他们付费作为奖励。

That points to a hybrid future where Silicon Valley works more closely with traditional health-care firms. Epic is using voice-recognition software from Nuance, a startup, to enable doctors to send notes to outside specialists; it has also teamed up with Lyft, a ride-hailing firm, to ferry patients to hospitals. Siemens Healthineers, a big German health-tech firm, is working with Geisinger, an American hospital chain, to expand remote patient monitoring. Patients of India’s Apollo Hospitals can use an app to get drug refills, tele-consultations and remote diagnoses—and even secure a medical loan through Apollo’s partnership with HDFC Bank.
这预示着未来将是一种混合模式,硅谷与传统的医疗公司将更加紧密地合作。Epic正在使用创业公司Nuance的语音识别软件,让医生可以将记录发送给外部的专科医生;它还与网约车公司Lyft合作来将病人送到医院。德国大型医疗技术公司西门子医疗系统(Siemens Healthineers)正与美国医院连锁集团盖辛格(Geisinger)合作,扩大远程监护病人的范围。印度阿波罗医院(Apollo Hospitals)的患者可以使用一款应用续配处方药、远程咨询和获得诊断,甚至可以通过阿波罗与HDFC银行的合作获得医疗贷款。

Dr Klasko, keen to prove the banker wrong, is embracing the hybrid approach with gusto. “You must have partnerships with providers, not just hundreds of unconnected apps.” He has brought bright sparks from General Catalyst, a VC firm that made early bets on many digital-health startups including Livongo, to work alongside his innovation team in Philadelphia. “Moving fast and breaking things does not work well in health care,” observes Hemant Taneja of General Catalyst. But nor does standing still. ■
克拉斯科很想要证明那位银行家说错了,他正在满腔热情地拥抱这种混合模式。“你必须与供应商建立合作关系,而不是有几百上千个互不相干的应用就行了。”他把风投公司General Catalyst朝气蓬勃的人才带到费城,与他的创新团队一起工作。General Catalyst曾为包括Livongo在内的许多数字医疗创业公司提供早期投资。该公司的赫曼特·塔内加(Hemant Taneja)表示:“在医疗领域,快速行动、打破常规不大行得通。”但是一动不动也不行。