For centuries, Edinburgh has been at the forefront of medical innovation: from the development of the hypodermic syringe (1853); insulin (1922); penicillin (1928); the Hepatitis B vaccine (1978); the MRI scanner (1980) to advanced prosthetic hands and fingers (2009). That reputation has given rise to the image of Edinburgh as an 'Ideopolis' – a sustainable knowledge-intensive city that continues to blend a strong research community with university teaching, world-renowned life sciences and a thriving tech cluster.

The result is a city at the heart of today’s global revolution in digital healthcare.

Thanks to a collaborative ecosystem between public and private sectors, as well as academia, Edinburgh has already introduced a number of telehealth improvements using existing technology to improve access to health services for vulnerable members of the community.

“One such project involves the introduction of Home Health Monitoring in a sheltered housing complex, which will support residents with long-term conditions such as hypertension, chronic obstructive pulmonary disease, chronic heart failure and diabetes,” explains Heather Laing, Technology Enabled Care Lead with City of Edinburgh Council. “Patients are able to take regular recordings, which are sent to their local GP, enabling doctors to monitor patient health from a distance. It enables residents to self-monitor, which in turn, reduces trips to GP surgeries and unscheduled hospital admissions.”

Efficient and convenient healthcare

A growing, ageing global population will have a profound impact on health spending across the world. Estimated at $7.5 trillion last year, it is predicted to rise to $9.3 trillion by 2018.

This huge challenge is central to why technology is increasingly blurring the boundaries between the physical, biological and digital worlds. And nowhere is this trend more evident than in wearable technology.

San Diego-headquartered continuous glucose monitoring (CGM) market leader, Dexcom, has recently expanded into Europe with the opening of a new product support and research and development office in Edinburgh. For people living with diabetes who require intensive insulin therapy, advances in CGM are delivering life-changing improvements to their insulin control regimes.

Dexcom’s passive CGM devices are worn on the skin, 24-hours a day, delivering real time information on glucose levels and providing users with alarms if glucose levels exceed pre-defined limits.

Diabetes costs the NHS in England and Wales more than  £1.5m every hour, or nearly 10% of the total NHS budget.

“Diabetes is one of the leading causes of morbidity, mortality and cost in today’s healthcare sector, which is why it’s such an important topic,” explains John Lister, General Manager, Europe, Middle East & Africa.

In terms of clinical benefit, dozens of studies have been published that demonstrate the benefits of CGM; one of the reasons why Dexcom is collaborating with Google Verily to develop the next generation of miniaturised and inexpensive CGM sensors.

There’s also the convenience of being able to wear a sensor and check blood glucose levels on a smartphone, enabling parents and carers of those with diabetes, to monitor blood glucose remotely.

With the patient monitoring market estimated to be worth $35 billion globally, considerable opportunities exist for technology businesses to make their mark. Companies such as Edinburgh start-up snap40 are already capitalising. In what is thought to be the largest ever seed round by a Scotland-based start-up, it has just secured £2m in seed funding through Par Equity for its wearable, health-monitoring armband. snap40’s technology enables hospitals and GP practices to monitor a whole host of patient vital signs, enabling the early detection of major health risks.

Big data, bigger impact

Technology also aims to personalise medicine in order to provide each patient with their own treatment plan – that is, to tailor treatments to individual patients based on their genetic makeup.

It’s in this respect that Scotland is fortunate to have some of the best data in the world. Few other countries offer researchers the opportunity to work with high quality, consistent data at a national level. Supported by Scotland-wide initiatives such as The Data Lab, as well as regional infrastructure such as the Edinburgh BioQuarter, new collaborations between industry, public sector and universities are paving the way for commercially viable ground-breaking innovations.

“Medicine and medical expertise remains key. Technology allows us to articulate that expertise in new ways,” explains Professor David Robertson, Co-head of the Medical Centre for Informatics, part of the Usher Institute of Population Health Sciences and Informatics.”

“If you consider the impact of the telescope on astronomy, then we’re potentially looking at a similar seismic shift in our ability to understand the human body and revolutionise the efficacy of treatments.” Professor David Robertson.

Professor Robertson continues: “To have statistically relevant medical studies, you need bigger populations, because you’re looking for a very precise set of characteristics that define a small section of the wider population. That means you’re driven to collecting data on a very large scale – something that we’re focused on at the Usher Institute.”

Collaboration is key, with multidisciplinary teams combining excellence in data science, clinical practice and large-scale public health systems, such as those employed by NHS Scotland. “That’s what we have at the Edinburgh BioQuarter, both at the Usher Institute and the Scottish hub of the Farr Institute, which works at a UK level,” adds Professor Robertson. What’s more, for medical informatics to fulfil its potential, data intensive healthcare requires the commercialisation of ideas, systems and products – precisely the type of environment found within the Edinburgh BioQuarter.

“While innovations are driven by medical need, the sheer scale of the data science challenge is immense. To make real progress in this field, you need all three working collaboratively. There aren’t many places in the world where that sort of culture is being nurtured; where innovation goes way beyond developing new sensor technologies to look at the population level.”

Decoding the data

One enterprise already having a commercial impact in data intensive healthcare is Edinburgh-based Aridhia. As a key partner in the creation of the Stratified Medicine Scotland Innovation Centre (SMS-IC), Aridhia’s data science platform, AnalytiXagility, underpins the centre’s work.

This vital collaboration tool is able to capture and integrate research studies, trials and clinical care data, combining workflows and enabling data sharing across widespread teams. The result is a system that helps to unlock the potential of precision medicine research, accelerating the commercialisation of the resulting assets and expertise.

“Society is so digitally driven now that from the moment that a patient steps into their doctor’s surgery, they expect their healthcare to be as personalised as their internet shopping, banking or travel experience. But that’s not how it currently works,” says Rodrigo Barnes, Chief Technology Officer. “As people move from being passive recipients to active, informed consumers in all other walks of life, there is a need to deliver a personalised experience to patients that allows them to become active participants in their own care.”

“We’re certainly at the dawn of a new era in digital healthcare,” summarises Professor Robertson. “It’s a race however. There are many transformational, possibly revolutionary, discoveries to be made at this current junction between medicine and informatics.”

The rewards are likely to be significant for successful researchers and businesses, but ultimately, this revolution has the potential to benefit all of mankind.

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