The promise of e-health
April 5 2025, 10 am. An alert is displayed on Ted’s smartphone: the message asks him to change the dosage of his medication for high blood pressure. The source of this updated prescription? The retiree’s dialysis machine. The machine has just analysed his blood pressure and calculated the ideal quantity of calories he should ingest during lunch thanks to an AI (artificial intelligence) algorithm. It has also analysed his blood sugar levels and sent a change in insulin delivery directly to his subcutaneous pump. Is this a storyline straight from science fiction? Not any more.
Almost limitless potential for growth
The world of digital health is expanding rapidly, heralding a wave of innovation that will revolutionise the prevention, diagnosis and treatment of disease. This is evidenced by the strong growth of the global e-health market: it is estimated that its value will be 234.5 billion dollars by 2023, an increase of nearly 160% compared to 2019, according to the ‘Global Health Outlook 2020’ study published by Frost & Sulllivan. The boom in e-health, the application of information and communication technologies (ICT) to health-related activities, is in part based on ongoing and major societal changes: the ageing of the population, the sharp increase in chronic diseases (70% of deaths worldwide) and the massive democratisation of digital devices (161 million connected objects in 2020). “The increased incidence of chronic diseases linked to age and our sedentary lifestyles, representing around 60% of the health insurance budget in France, is a huge health challenge. It gives rise to a wealth of innovation in e-health aimed at prevention and care”, emphasises Isabelle Zablit-Schmitz, co- president of the Syntec Numérique Health Committee. If structural reasons alone give e-health an almost limitless potential for growth, it is the current crisis linked to the Covid-19 pandemic that could accelerate its formidable deployment even more. “Where technology has been used extensively, the consequences of the epidemic have been contained more quickly and more effectively”, writes entrepreneur Gilles Babinet in the preface of a recent report from the Institut Montaigne, citing the examples of Germany, Israel, South Korea, Hong Kong and Taiwan.
Citizens are increasingly asking for solutions that both create social value and are environmentally sustainable.
Pioneering countries
This crisis will undoubtedly accelerate a race for innovation in healthcare which is now global, supported by the American and Chinese markets, which are dominant in terms of investment and technology. “In the United States, the deployment and consolidation of innovations in the medical field are facilitated by the size of the population, as well as a common culture and language. Morever, China can easily roll out its use throughout the country”, explains Jérôme Leleu, president of Interaction Heathcare. By taking the strategic decision to go digital in terms of healthcare, many countries are banking on benefits in care quality and economic efficiency. Some countries are pioneers: Japan, South Korea and Israel, the latter has totally digitised its health system; the United Kingdom, which invested nearly 5 billion euros in 2016 to do the same; Estonia, often cited as a model in the deployment of e-health; Finland, which in ten years has multiplied by a factor of five the export of its health technologies; Denmark, where the performance of telemedicine is widely recognised; or Sweden, which has launched a strategic plan for 2025 aiming to make the country a champion of health tech. The need to expand e-health more rapidly is also a major issue in emerging countries. When half of the world’s population does not have access to basic health services, “it is essential that the possibilities offered by digital technologies are harnessed to achieve universal health coverage”, states Dr Tedros Adhanom Grebreyesus, Director General of the World Health Organization (WHO).
‘4P’ medicine
All around the world, e-health is raising great hopes for building the medicine of tomorrow by focusing on the ‘4Ps’: prediction, prevention, personalisation and participation. This is a medicine whereby individuals become proactive in their healthcare through digital solutions: monitoring their symptoms, their chronic disease and focusing more on their care paths. While the scope of e-health is vast, ranging from connected scales to digital diagnostics by AI, specific avenues with strong growth potential are emerging. ‘Telemedicine’ remains a pillar of the sector’s development, as highlighted by the Covid-19 crisis. During the epidemic, the number of remote medical consultations soared (500,000 in one week in March 2020 in France compared to 11,000 per month previously) and remote medical monitoring, thanks to remote monitoring tools, has proved essential to ensuring continuity of care for people with chronic illnesses. The crisis has highlighted the trump card of telemedicine: facilitating access to care for populations poorly covered by health systems, in the North as well as in the South. In French Limousin, considered by many to be a ‘desert’ of medical care provision, nursing homes have adopted remote consultations and the feedback so far has been positive. In Africa, the British start-up Babylon Health, based in Rwanda, is aiming to offer its mobile medical consultation application to the populations of all of the 25 member countries of the Smart Africa Alliance, by capitalising on the strong mobile phone penetration rate across the continent. Of the 150 or so initiatives of the e-health Observatory in Southern countries, 44% relate to telemedicine. The potential for digital solutions to reduce health inequalities in these countries is enormous, provided they are properly regulated and standardised, thus encouraging their deployment and ensuring their long-term viability, as highlighted by Béatrice Garrette, CEO of the Pierre Fabre Foundation.
AI comes into play
Mobile applications and connected devices are the main ingredients of ‘digital therapies’, and seem to have a bright future. Algorithms for the correct dosage of drug treatments, virtual reality programmes to manage pain, online behavioural therapies… This proliferation of solutions has led the industry to create the DTx Alliance in order to structure this new market. Pierre Laurent, the founder of the French start-up Voluntis, now based in the United States, explains the potential of these digital solutions through the example of his product Oleena, the first digital therapy in oncology to obtain the green light from the FDA. “Oleena provides the patient with personalised recommendations in real-time for the management of symptoms linked to treatment and the disease (…) The challenge is twofold: improving the patients’ quality of life and achieving savings for the healthcare system”. According to Laurent, more than 25 billion dollars could be saved in the United States by avoiding hospitalisation and emergency room care through the use of solutions of this type. A growing number of e-health innovations rely on the use of AI technologies that harness the massive volumes of ‘big data’ and are expected to become commonplace throughout the health sector by 2030. Globally, AI is developing in imaging and diagnostics, the discovery of ‘drug candidates’ and the collection and analysis of medical data. In medical imaging, it is already proving to be very effective. MIT researchers have developed an AI system that can detect signs of breast cancer four years before it is visible using traditional imaging. In epidemiology, AI could become a powerful ally, as illustrated by the project by Malaysian start-up AIME, which is capable of spotting an epidemic of the Zika virus and dengue fever in Africa with 90% accuracy .
Health data: a key issue
Essential for developing technologies, health data is the raw material from which e-health solutions are built. With the increasing use of connected devices and applications, its annual volume is expected to increase tenfold over the next five years according to the report by Frost & Sullivan.Given this prospect, “it is essential to promote the interoperability of health information systems (Editor’s note: their ability to communicate with each other) by developing common digital standards. This is a key condition for promoting the flow of information and improving the patient’s care pathway and medical decision-making”, insists Guillaume Laguette, chief marketing officer of Lifen, a start-up that offers a solution for the secure exchange of medical documents.The strategic nature of health data has not escaped the notice of the American digital giants, GAFAM (Google, Apple, Facebook, Amazon & Microsoft) and their Chinese equivalent, BATX (Baidu, Alibaba, Tencent, Xiaomi), who are more and more active in the e-health sector. Google’s intention to buy Fitbit (with 28 million connected customers), the announcement by Amazon in mid-August 2020 of the launch of its first online pharmacy in India, the creation of a telemedicine platform by Baidu in March 2020 are all signs of a sector in rude health. This has of course caused questions to be raised: “Should such e-health initiatives only come from American or Chinese companies or can we develop them at home, based on European data protection criteria?” posited Jens Spahn, the German Minister of Health in January 2020, at the French Embassy in Berlin. European sovereignty of health data is becoming a major issue.
A European cloud project
Thierry Breton, European Commissioner for Internal Market and Digital, has announced a Data Act for 2021, aiming to create an exclusively European data pool. In early June 2020, France and Germany launched the Gaia-X European cloud project, which should hopefully see the light of day in 2021 and to which 22 French and German companies are committed. In France, a national health data system is in the process of being established with the creation of the Health Data Hub at the end of 2019. “This secure platform brings together several databases, including that of Cnam, one of the richest in the world, which will be used by research projects in compliance with GDPR. It is a very attractive tool for research”, explains Olivier Clatz, director of the major challenge (‘Grand Défi’) for the improvement of medical diagnostics through AI at the General Secretariat for Investment, attached to the the French Prime Minister’s office. The Covid-19 crisis shows in concrete terms the importance of having reliable data and controlling its use. The example of the maladiecoronavirus.fr platform, created in France by the Digital Alliance against Covid-19, illustrates this. “By better directing the nine million users of the site, it was possible to divide the number of callers to the emergency services by eight and thanks to the use of the data received, which is anonymised and secured, the researchers were able to identify that loss of smell was a recurring symptom of the disease”, explains David de Amorim, director of innovation at Docaposte, a trusted third party and the leading health data host in France, a partner of the initiative. “When people understand the benefits of using health data, and that guarantees on its use are given to them in complete transparency, they tend to agree to their data being shared”, assures Régis Sénégou, company e-health market director. Confidence, security and ethics are more than ever the cement underpinning these advances of data science and e-health.
Three questions for Jesus Carrasco Abad
What are the main investor countries in the e-health market?
The largest healthcare market in the world, the United States, is a leader in the adoption of digital health technologies, due to its well-established funding markets, particularly in the venture capital industry. All of the American web giants are developing digital health business models. Google, for example, created a health division in 2018, Microsoft offers a cloud specifically aimed at health care providers ... Europe is also well advanced in developing its digital health offering and has many start-ups, some of which are valued at over 1 billion euros. This is the case, for example, for British firms Oxford Nanopore Technologies, which uses revolutionary technology to analyse DNA, and Babylon Health, a British app providing health checks and medical consultations. In the emerging markets, China, India, Saudi Arabia and Russia are sometimes even ahead of their developed market counterparts in certain domains. The percentage of healthcare professionals using e-health technologies in China now stands at 94% compared to 76% in the United States, 79% in France or 64% in Germany. Emerging market countries have contributed significantly to the introduction of artificial intelligence in the health sector.
What are the sectors with the highest innovation potential? How does Societe Generale support innovators?
Exceptionally complex and dynamic, the e-health market is difficult to categorise as business models are constantly developing, evolving and transforming. The telemedicine or tele-health sector, which was already expected to grow by around 20% per year (2019 — 2026) before the crisis, will be one of the big winners from the pandemic. It is estimated that nearly 40% of healthcare operators will increase their digital investment in the wake of the epidemic. Societe Generale has an abundant range of services and products to support innovators through its global platform with France in particular benefiting from its unique capabilities and broad customer coverage. In 2017, for example, the bank launched the ‘GLBA Incubator’ initiative which offers its customers with digital and innovative business models, tailor-made financing solutions, advisory services and institutional support. The team has so far successfully launched three businesses and is continually exploring new opportunities.
What are the key factors for building a competitive e-health sector in Europe?
The most important point for the creation of a competitive e-health sector is a favourable regulatory framework, as well as the presence of venture capital and financing possibilities. The regulatory framework for e-health varies from one European country to another. Policymakers should create a level playing field to encourage innovation which must also be supported by financial incentives. The willingness of patients to share their personal data with healthcare and technology providers is a very sensitive issue. When surveyed in 2018, more than 40% of consumers in the United States were willing to pay healthcare providers at least $1/month to protect their private data. The e-health sector is probably one of the most disruptive in the use of new technologies: efforts from all stakeholders — public authorities, healthcare professionals, patients and capital providers — are needed so it can prosper and develop.
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