As part of the launch of the Business as Unusual book (click on badge on left to get to the Amazon page) by Thomas Saueressig and Peter Maier that we helped conduct interviews and research for, we will share excerpts from each of the 10 chapters/300 pages, and also give you a “behind the scenes” view by sharing snippets of some of the over 100 SAP, customer and partner video interviews that ended up in the book.
Here are some excerpts from the fourth Megatrend – Lifelong Health
The last few years have been sobering: As we reflect on the challenges we’ve faced, we must also look ahead to how these challenges and their solutions can be applied in the years ahead. We’ve seen exciting advancements in many spaces. The clinical trials for the COVID-19 mRNA vaccines were some of the quickest ever recorded. The logistics of global vaccine distribution were complex, demanding cold-chain specifications, and many distributors came through with flying colors. Applying machine learning to mRNA biology is leading to potential new applications and drug candidates. Telemedicine took off. Hospitals learned to reconfigure their facilities and workforces at breakneck speed. The lack of previous investment in public health highlighted a need for correction. Mental health received a lot more focus. Many companies elevated the role of the chief medical officer (CMO). Ordinary citizens became much more medically aware thanks to COVID-19-tracking dashboards like the one at the Johns Hopkins University School of Medicine. Focus on value for money has grown, increasing to attention to the many inefficiencies found in healthcare systems, especially in the US.
Let’s start with a perspective from Michael Byczkowski, SAP’s global vice president and head of the healthcare industry business unit. While healthcare is a highly local affair due to myriad regional rules and certifications, Byczkowski brings a global perspective when dealing with healthcare customers and partners around the globe—whether in Australia, Canada, Germany, Singapore, South Africa, the UK, the US, and beyond.
Byczkowski then turned to how workforce resilience, sustainability, and mental health became crucial because of the frequency of mutation of the COVID-19 virus, which brought waves of variants and thus surges of new patients and uncertainty about whether previous treatments and protocols would continue to be effective. He focused on Coppelia Rose, global human experience management and healthcare leader at DXC Technology in Brisbane, Australia.
As described by Rose, DXC designed a solution: We specifically saw an opportunity to help frontline healthcare workers and developed an eight-module Workforce Suite for Healthcare (available on the SAP Store). What we saw with the frontline workers was stress and burnout. So, we said, ‘What could we do to support that?’ It’s all well and good to measure it. We can do a survey and measure stress. But what are we offering to actually help on the ground? DXC developed a mental health support app that complemented the solution. This mobile application for frontline healthcare workers allows them to connect with other people in a similar role. Working long hours in protective gear fighting for (and often losing) the lives of patients created extreme stresses for frontline workers, and connecting with peers to talk about their experiences and struggles was important: I was interested to learn about the moral injury associated with healthcare workers where they ask, ‘Could I have done more? That patient didn’t get to say goodbye to their family, and I was standing there with an iPad.’ It’s different from trauma. Exposure to trauma is, ‘I’ve seen patients that have lost limbs.’ But with COVID they suffered from what is called moral injury, and that’s a different thing to cope with.
The solution uses features from SAP SuccessFactors. Then, DXC brought in SAP Fieldglass capabilities for contingent workers, travel nurses, agency nurses, and locum tenens (temporary) physicians. (Locum tenens is Latin for “placeholder.”) Next, they brought in Qualtrics XM for the employee experience and extended that product to incorporate an Oldenburg Burnout Inventory calculator, which runs on SAP Business Technology Platform (SAP BTP), to measure occupational burnout and stress.
SAP already had the Information Collaboration Hub (ICH) for Life Sciences to help the industry in its elaborate track-and-trace requirements to fight counterfeit drugs. The solution creates a network of marketing authorization holders (comparable to original equipment manufacturers in the automotive and other discrete manufacturing industries), contract manufacturing organizations, providers of active pharmaceutical ingredients and other substances, third-party logistics providers, and regulatory bodies. The ICH can exchange large volumes of data and messages in different formats to meet quality management and regulatory requirements. The Vaccine Collaboration Hub shown in Figure 5.2 extended the capabilities of the ICH to meet pandemic-specific requirements
Byczkowski commented on the importance of trusted data custody: Our core advantage at SAP is that we are trusted as being a kind of ‘Switzerland of data.’ We have a solid reputation across all industries as a good custodian of our customers’ processes and data. We don’t want to look at their data or mine them for secondary use cases. It’s like when you rent a safe deposit box in a bank vault: what you put in the box is not our business. SAP also doesn’t own our own clinical information system, so we are an attractive partner for health system vendors and healthcare providers. Because we are neutral, we can connect companies seeking to derive additional value from their data in the data economy."
In “The Industrialization of Intelligence,” Byczkowski cited the example of British ship doctor James Lind who conducted “the first controlled comparative study in the history of medicine in 1747, identifying the use of citrus fruits as an effective way of treating scurvy.” He also used a modern example how far we have come in another paper: The AI-driven Ping An Good Doctor online platform in China has more than 400 million registered users for services like online consultations, referrals, registrations, and online drug purchases. They have an in-house medical team with more than 1,800 experts. The Good Doctor knows 3,000 diseases and is continuously trained with data from hundreds of millions of consultations. The AI system doubles the efficiency of doctor consultations, and greatly reduces the number of misdiagnoses and missed diagnoses. This type of high-tech diagnostics is available in the most remote Chinese village and improves the patient’s experience with remote medical consultations.
We talk a lot about patient-specific drugs for rare diseases caused by monogenic disorders. There a drug is specifically designed for individual patients and their genetic setup. Defective genes can often be fully repaired, healing the patient completely. This can truly save people’s lives—and spare public health systems millions of dollars/euros because one does not need to treat or support the patients over their entire remaining lifetime. But more often one checks for specific biomarkers to ensure that a drug can actually deliver the expected results and not just cause negative side-effects. In breast cancer, for example, a treatment with Olaparib is only viable if the patient has a mutation in her BRCA1 or BRCA2 genes. The research is accelerating: In recent years, drugs to treat what are considered “rare” diseases represented 25% of all newly introduced drugs with new active ingredients.
Discovery Health….was founded in Johannesburg, South Africa, in 1992. One of its founders, Adrian Gore, wrote in McKinsey Quarterly about “gut instinct” when he saw the connection between lifestyle choices and sustainable insurance: When I started out as a young actuary in a life insurance company, South Africa was moving from an apartheid state to a proper democracy and was facing some serious challenges, particularly in healthcare. There was an undersupply of doctors, an unusual combination of disease burdens, and a new regulatory environment that had zero tolerance for the discrimination of the past, and rightly so. This meant you couldn’t rate customers on preexisting conditions. Finally, unlike most countries, where a national system partially covers risk, there was no unified public health insurance system at that time. When you put those four things together, sustainably financing healthcare becomes a very complex undertaking. When we formed Discovery, we asked, ‘How do you innovate and build a health insurance system that can work in this kind of environment?’ Our gut instinct was that if you can make people healthier, you can offer more sustainable insurance. It turns out that three lifestyle choices (smoking, poor nutrition, and poor physical activity) contribute to four conditions (diabetes, cancer, heart disease, and lung disease) that drive over 50% of mortality every year. So, lifestyle choices are fundamental to any social insurance system. The behavioral science tells us that people need incentives to make a change. But that wasn’t universally known at the time; we were just a start-up acting on a hunch.[
Maia Surmava was chief information officer (CIO) and head of clinical systems at Discovery Health and has recently been appointed CEO of Vitality US, a subsidiary of Discovery Health. She explained her company’s multi-faceted profile: We’re not your traditional health insurer that measures and prices risk; rather, we manage and reduce risk, delivering on our core purpose of making people healthier. As a payor and care enabler, we play several roles. For example, in the digital health space, we empower our members with health insights and identify preventable risks and best actions to improve their health. We’re laser-focused on navigating members to the right care, at the right place, at the right time, and supporting our members at the key points in their healthcare journey. At the same time, we empower providers with insights to personalize treatment and trigger appropriate interventions.
Zuellig Pharma, based in Singapore, is a $13 billion distributor for most major pharmaceutical companies. Daniel Laverick is the head of digital and data solutions at Zuellig Pharma. He is driving a “digital-first organization” in a region where many of their 13 Asian markets still run immature technologies on immature infrastructures. Zuellig Pharma had to move fast when the COVID-19 pandemic changed the distribution of medical supplies and vaccines to both big pharmaceutical chains and small pharmacies. Laverick described the challenge at the start of the pandemic: The pharmaceuticals industry relies on traditional, very labor-intensive processes. Sales reps would go out and visit customers. Collectors would pick up cash from the customers and take it to the bank. These were very manual processes. Overnight, there were no sales reps and there were no collections. People couldn’t process orders in the offices, and so we had to pivot very quickly just to run our standard day-to-day operations. We always had a plan to launch e-commerce and digitize our order-to-cash process. We always had a plan to automate collections rather than send out collectors. But this was a 24- to 36-month plan to roll out across 13 markets. We had to hugely accelerate that and launch in eight weeks in all of the markets.
Zuellig Pharma has a unique digital application, the eZTracker. This blockchain-based solution is built on SAP BTP and delivers the following features:
- Product verification for patients and healthcare providers to assure key stakeholders of product authenticity and quality, facilitate patient education, and streamline product recalls
- Tracking and tracing of sales rechanneling activities to monitor gray markets, reduce revenue loss, strengthen brand trust, and comply with local regulations
- Enhancing cold chain monitoring to verify that products are stored and delivered at temperatures that maintain their quality
- Driving auto-replenishment to minimize medicine stock shortages and facilitate customer returns
- Streamlining e-product information to shift from paper leaflets to digital documentation without compromising trust
SAP’s Mandar Paralkar talked about some of the rapid changes in life sciences, emphasizing both the need for improving value for patients and for common sense in regulations. We tried to keep pace with his rapid-fire examples: Traditional pharma makes small, comparatively simple, chemically synthesized molecules. Take aspirin, as an example. Each molecule is made from only 21 atoms in C9H8O4, and they flood your body to take your headache away and make your blood thinner. If you think that paracetamol is more sophisticated: C8H9NO2 has one less molecule and features a little blue extra nitrogen atom. But the industry is moving to big, complex molecules made from many thousands of atoms; they are called biologics. Here is a random example: Adalimumab is an antirheumatic drug with the sum formula C6428H9912N1694O1987S46. Of course, big molecules are more difficult to manage during the manufacturing process, and they are way more expensive to produce than small molecules. But they also promise great health outcomes, so patients will hope to get their (or their health insurer’s) money's worth.
SAP has been accelerating new industry-specific functionality delivered as cloud extensions that keep the digital ERP core free from modifications and complex add-ons. In prior years, we have delivered the cloud solutions SAP Information Collaboration Hub for Life Sciences and SAP Advanced Track and Trace for Pharmaceuticals. Paralkar provided an update on new cloud applications around broader functionality for R&D and clinical projects, sourcing and procurement, supply chain resilience, sustainable and compliant manufacturing, and commercialization via SAP S/4HANA, focusing on three new cloud applications (Intelligent Clinical Supply Management, Batch Release Hub for Life Sciences, Cell and Gene Therapy (CGT) Orchestration) and one (cold chain logistics) where SAP is in the early stages of developing specifications.
The department of urology at UKHD initiated the OP 4.1 project to develop a prototype digital platform for the operating room of the future that could better put technologies to work, such as robotics and IoT devices. Cooperating partners on this project include the German cancer research center DKFZ, the endoscope maker KARL STORZ, mbits imaging, SAP, and Siemens Healthineers. The project is funded by the BMWi, Germany’s Federal Ministry for Economic Affairs and Energy. Byczkowski of SAP added some perspectives on the project: One of the goals of the project is to show that we can simplify the market introduction of software-based innovations into clinical practice. For most software innovations, the barriers to market entry are currently still too high, which is why many do not make it into the operating room and into the daily clinical routine. This is often due to a lack of access to relevant data from medical devices or due to limited opportunities for professionally implemented sales and support.
Byczkowski has a bird’s-eye view of all the players that influence healthcare and their interactions. He envisioned a network for life sciences, healthcare, and beyond to inspire innovative business models, products, and services, all eventually supporting processes across industry boundaries, as shown in Figure 5.4.
Byczkowski was enthusiastic about the success of large platform providers in other sectors: When you look at Amazon, Alibaba, or Apple, you realize that the platform business model offers great commercial opportunities with a global reach. Different vendors and types of vendors can be all brought together on one single platform offering excellent consumer experiences.
A twin of this post will include video excerpts from conversations with many of these executives so you can put a face and voice to those in the book.
Other posts on the other chapters to come.
