5G networks in MedTech
The coronavirus has affected every single one of us in many ways. Essentially, it has shown us that many industries are not ready for such uncertain events. For example, the healthcare system was not flexible enough to fully function throughout the entire pandemic. This lack of flexibility calls for new ways of serving future patients in healthcare. Also, many patients prefer to be hospitalized at home, which requires digital applications in or outside of the hospital. But how can we digitize hospitals while keeping up the service quality offered?
During my time at Flashpoint VC, I decided to have a more detailed look into these questions in order to come up with solutions. The answer lies in strong and reliable network support, as many of these digital applications exchange massive amounts of data and require instant feedback from servers. This can be solved through 5G infrastructure.
In terms of timing, ironically enough, 2020 was THE 5G kickoff year — large telecommunication companies such as AT&T and Telekom have partnered with network infrastructure providers like Ericsson and Nokia to establish 5G support in selected locations. The map below shows 5G coverage by AT&T that is be available from August 2020 onwards. Most major cities like New York and Los Angeles will be covered. By the end of 2020, many carriers have promised to cover the entire US with some sort of 5G. Other countries like Germany are following this rollout as well, providing faster network support for up to 10 million users by the end of the year. For the healthcare system, practitioners and patients, many business use cases arise that may help be more flexible in the future while increasing the quality of care.
On top, I was motivated to assess how advanced the 5G MedTech startup landscape is. I started with identifying business opportunities and pursued only the ones that will be adopted first or that I personally found to have the greatest potential. For the identified use cases within 5G MedTech, I analyzed 800+ startups by using Crunchbase and Google search. I will briefly explain every use case and later provide an analysis based on location, funding and other criteria. Disclaimer: This analysis was performed and finalised in July 2020 and does not incorporate recent changes in the technological infrastructure and deployment of 5G networks as well as in the 5G MedTech startup ecosystem.
What is 5G about?
5G is actually a quite broad term and I want to point out that there are different layers to it:
● Network layer
● Infrastructure layer
● Business application layer
When you search for 5G startups in Google or use it as a keyword on Crunchbase, actually most of the results are ventures focusing on rolling out 5G networks. These include manufacturers of hardware like antennae and service operators for managing the network. However, I want to focus on business use cases and startups that are advancing in their area and will greatly benefit in their way of operation after 5G networks have become widespread.
5G Network Specs
Let’s take a look at the advantages that 5G networks offer in order to understand why it is such a powerful driver for future business opportunities in general. There are 3 main reasons why 5G is living up to its hype:
- Highspeed. Higher peak power of up to 20 Gigabytes per second (Gbps) will be possible. Comparing this bandwidth to 4G’s 1Gbps, it becomes evident that this gives rise to Ultra-HD video calls and streaming on the go. As a point of reference, an entire 2 hour movie can be downloaded within a couple of seconds, which requires around 6 to 7 minutes at current technology levels.
- Latency. 5G will minimize latency incredibly and enable actual real-time applications. Latency or lag time is the difference between a user’s action and a web application’s time of reaction. 5G latency will be 5 to 50 times lower than 4G meaning that the user gets feedback (almost) instantly.
- Connected Devices. 5G supports massive numbers of connected devices as many people already have more than just one device that is in a way connected or able to access the internet. The internet of things will connect 21.5 billion devices in 2025, requiring a new standard that can keep up this large volume.
All of these features will be driving innovation and give rise to new opportunities of doing things differently than usual.
One more aspect that I found quite interesting is that 5G is the first generation of mobile networks that can outcompete traditional fiber cable networks in terms of speed. This gives rise to many applications as moving solutions to being completely wireless does not have the disadvantage of reduced speed anymore when compared to a wired solution.
How does 5G work?
5G technology is pretty different from previous generations. Usually, data is interchanged in forms of wireless radio waves between cell stations. To enable the transmission of huge amounts of data, 5G radio waves have a higher frequency and can only travel short distances. As a consequence, many small cells need to be installed on existing infrastructure to ensure sufficient coverage, instead of deploying a few large cell stations.
In the past months and years, there has been quite some backlash and protest regarding 5G because of the many stations that need to be placed on buildings that cause health concerns. According to Vodafone, a recent study found that more cell stations provide a more stable network connection and are consequently less harmful because radio waves can be weaker to reach cell stations. However, long-term studies are not available yet, so nobody can confirm that 5G networks do not have any (negative) side-effects.
For MedTech, 5G networks mainly have two benefits:
- Bandwidth. Medical files are often around a couple of gigabytes large. These files are exchanged between different departments or doctors, which can take on some time if you want to send 50 files to your colleague for review. Hence, flash drives are still a big thing for that, which is fine as long as you don’t miss data or forget it in your car. 5G solves this easily with its high bandwidth enabling downloads within milliseconds per file. This could cut out some of the waiting time and streamline the entire process of seeing doctors. Also, additional files can be easily provided during the session, if available on your phone or cloud.
- Latency. As the latency is extremely low, real-time applications for monitoring patients or VR-based tech becomes feasible. In healthcare low latency is a requirement as in many situations, there would be no time to wait longer than milliseconds for the application to respond. Minimal lag time will be an important factor for the business applications coming later in this article.
When will 5G applications hit the market?
Even if these specs sound amazing, yet, there is no device or software that is really living up to its potential. The reason is that 5G networks aren’t available in the form described earlier because 5G coverage is limited to selected locations only. Though, we can see it as an investment for the next 10–15 years and even longer as, for instance, 4G networks will work as a backup network after 5G coverage is rolled out everywhere.
So, the first applications using 5G networks will come to the market within the next two years. Thus, it is even more important to start thinking about possible applications now such that a planning process starts for areas that should be prioritized and for the ones that will follow-up. The switch to 5G will not be from one day to another but rather gradual depending on how ready the different industries are for adoption.
Healthcare: How will 5G improve healthcare for professionals and patients?
Our current healthcare system does not yet recognize the huge benefits of data and offering interconnected services in hospitals. Many things are done using inefficient offline solutions (remember flash drives for data transfer). On the other hand, the healthcare sector is calling for more personalized treatment methods relying on data generated through IoT-devices like smartphones and wearables. These current trends show that healthcare is getting more and more digital, which will be driven by 5G networks in the future. Let’s have a look at the different business use cases in healthcare that will primarily benefit from 5G properly in place.
5G Business Use Cases in Healthcare
Every business use case has its own subareas that will be explained separately. The following graph shows an overview of all use cases:
Important to note is that many startups fall into more than one use case and subarea. The assignment is based on the core purpose of the business, for example, you will find RPM solutions that use AI. Finally, I have to say that those are just applications that stood out most to me. You will find more use cases and startups making use of 5G networks in MedTech.
1. Remote Patient Monitoring (RPM)
What would it be like if doctors could constantly get feedback about a patient’s vital signs like pulse rate, body temperature or blood pressure? What if doctors would be notified when a patient experiences problems with his heart function? This is what remote patient monitoring (RPM) solutions are tackling. They come as small devices or wearables like an ECG monitor that remotely records your heart activity. Another form are biosensors and implants that, for example, observe glucose levels (check out this). The generated data is analyzed via integrated platforms in real-time to prompt alerts, messages and reminders for patient and doctor.
The RPM-subareas are:
● Devices & wearables
● Biosensors & implants
● RPM platforms
Through RPM, more opportunities for personalized healthcare are provided. Based on changes in the data, doctors can intervene earlier and improve treatment plans when necessary. This can be a game changer for patients with chronic diseases as they require lifelong monitoring, especially when living in rural areas. It would free up a lot of time for patients, if they could be tracked, diagnosed and alerted remotely. For hospitals, higher operational efficiency can be reached through RPM by monitoring more patients simultaneously with the same or an even smaller workforce.
RPM-devices would also make it easier for patients to move in a hospital. Usually, patients are connected to stationary monitoring equipment which is impractical when being transferred to another station for checkup. If this patient’s situation is critical, a nurse has to accompany him, taking on a lot of her valuable time. RPM-solutions could solve both pains by being connected constantly and having the freedom to move freely. Also, if you remember that 5G performs equally well as wired solutions, shifting to wireless monitoring solutions in hospitals might be trending in the future.
As can be seen, RPM can be useful not only in remote situations but also for patients in-house. Current 4G-technology is mainly limited in terms of its bandwidth as it doesn’t support the amount of data exchanged. Guaranteeing reliable connections that make it possible to move tracked data quicker to practitioners helping them make the right decisions in the right moment.
Telemedicine has been on the rise since the outbreak of COVID-19. Many patients were not able to go see a doctor for consultation because the risk of getting infected was very high. Moving consultation online helped many patients in these difficult times. In telemedicine (or “healing from a distance”), remote consultation via video calls combined with remote diagnostic tools like digital stethoscopes are used. In the future, there will be a trend towards getting consultation not only from home but also from anywhere in the world, even when being in rural areas or when getting sick on a vacation abroad.
The subareas in telemedicine are:
● Remote diagnostics platforms
Telemedicine could be the first step towards a global healthcare system without the boundaries of distance. Having 24/7 access to doctors, therapists and health coaches all over the world, many efficiencies would arise for patients. They could spend their time in better ways than traveling to the doctor’s office and even losing more time in the waiting room. Also, a greater selection of doctors available helps patients get consultation quicker. If necessary, medical experts can join digital appointments to minimize the patient’s number of doctor visits. For international patients, there wouldn’t be the need to travel to another country for specialist consultation. Even translators could be part of telemedicine in this case.
Conversely, also practitioners benefit from solved inefficiencies through telemedicine. Medical advice through your iPhone is complemented by digital tools. These tools are very diverse and can diagnose symptoms by identifying vital signs through your smartphone camera or “hearing” your breathing problems (pretty cool, right?). This way, routine checkups can be performed from any place at any time granting doctors more flexibility.
Other tools are “background listeners” and document everything that has been said during an online session to update the doctor’s electronic health record (EHR). This eliminates the doctor’s need to take notes, while having it available for upload or sharing right after the session. It is possible that a standardized EHR system could be established through these tools, which would make it possible for doctors to share it across borders. By having a quickly updated EHR system, there would be less time spent on explaining health histories in follow-up appointments as well.
Finally, care centers equipped with remote ultrasound stations could make it easier to get medical images for many people instead of going to a hospital that might be further away.
But why is 5G important here? I’ll give you a straight-forward example. Imagine you have to diagnose a patient that experiences shoulder pain. Face-to-face, a doctor would ask the patient to move his arm so he can understand where the pain is coming from. Is this something that works with current technology? If you think back to your countless video calls on Zoom or Google Hangouts, you might remember that it is quite normal to experience lag or connectivity problems. Now, how should a doctor assess the patient’s movement when he can’t be sure if the reason is the movement itself or because of technology shortcomings? 5G networks with its ultra-HD and super reliable video calls could solve exactly this next to having tools that can do quick remote checks of a patient’s vitals.
3. Surgical Robotics
In the beginning of 2020, I saw a social media post about a kid in the US that needed surgery in Switzerland. As the kid wasn’t born in a wealthy family, there was a link included where you could donate to pay for surgery and the flight. Imagine if it was possible that a Swiss doctor performed the surgery remotely? This would cut costs and may help save somebody’s life!
The field of telesurgery is being brought into connection with 5G more and more as it might bring commercial applications to the market soon. The identified subareas in surgical robotics are:
● Remote surgery
● Robot-assisted surgery
● Fully automated surgery
Operating control elements with his hands and wearing special lenses, a surgeon can see and “feel” the patient in order to be successful (click here and here to watch some robots in action). Being able to remotely perform surgery, many patients can be helped that have not been able to get expert treatment. Eliminating the distance between surgeon and patient will save many lives in the future.
There are also other robots that assist the surgeon increasing his precision and improving the quality of the operation overall. In 2019, those types of medical procedures amounted to 900,000, only in the US, projected to rise to 3 million by 2025. Surgeons can rely on the consistency of their “robotic partner” and this way reduce the chance of mistakes.
5G may further enable methods that might even replace the surgeon and let robotics do the entire procedure on its own. Large clouds could work as knowledge silos for surgeries and medical procedures that can be accessed by all robots connected to the system. Generally, surgical robotic methods will require an extreme version of network support, where latency is close to zero. If a surgeon wants to operate remotely, he needs to be able to have his controls transmitted and executed in real time. A minimal lag only may be sufficient to cause severe complications. Without 5G supporting these kinds of responsive networks, there will be no way of leveraging this opportunity in the future.
Even though fully automated and remote surgical robots will need more time to become available, it is an important area in healthcare that will move telesurgery from a niche into common practice. As there is highly specialized expertise, equipment and a lot of investment required, this subarea is currently being served mainly by collaborations between big healthcare and robotics companies. Startups may find it difficult to find hold in these conditions.
4. Virtual and Augmented Reality
Our sense of sight forms the connection between us and our environment. By relying on our vision we can perceive our surroundings to make quick evaluations of different situations. Virtual and augmented reality (VR & AR) allow us to “switch” the view and experience new dimensions, while staying alert about reality. Applications running with VR & AR introduce new treatment methods for patients and better operational efficiency in hospitals.
The subareas of VR & AR applications are the following:
● Assistive technology
● Education & training
Surgeons equipped with VR lenses may rehearse a procedure right before it takes place by using 3D-imaging technology. During procedures, the same glasses guide and navigate the surgeon to increase his control and improve the quality of treatment. On top, instant access to 3D models of organs or limbs is available at all times during the operation, which further assists the medical staff.
Also, ultra-realistic simulations of numerous procedures give medical students and doctors the opportunity to gain hands-on insights at any time no matter the place. As many doctors rely heavily on their experience, it is important to start gaining it early in a learning-by-doing setting. In fact, by studying with VR-applications medical students gain more knowledge and simultaneously incur lower costs compared with traditional learning methods.
Moreover, therapeutic treatment procedures emerge not only for patients who experience joy and happiness if they could see a sunny beach when being hospitalized. Benefits arise particularly in the field of cognitive behavior therapy because practitioners start to look for unconventional methods for treating anxiety, phobia or addiction. In VR-therapy, patients face their problems in a highly immersive environment. Recent studies have shown that these applications may increase the quality of life while reducing symptoms of depression.
Many AR & VR applications have found their way into healthcare already by relying on existing technology. Though, 5G networks will ensure that visualizations run smoothly and timely. Surgeons won’t have to wait for their 3D-model to be loaded during surgeries as it is available immediately. Students will not only experience excellent performance when doing simulations, but also have the chance to learn together with their fellows in one virtual classroom. The same can be said for therapeutics, 5G will make VR & AR much more impressive and realistic, this way enhancing the virtual reality created for patients.
5. Artificial Intelligence
Artificial intelligence (AI) is a big topic not only in healthcare but will become mainstream in hospitals when 5G networks are ready. There are numerous kinds of applications mainly based on data analysis, which will shift future medicine from being reactive to becoming proactive. The internet of (medical) things connects more and more devices with objects found in the hospital. Large amounts of data can be collected through this interconnectivity. But massive amounts of data require strong network support in order to be analyzed.
AI data analysis can be divided in the following subareas:
● Predictive medicine
● Drug discovery
● Disease detection
The most prominent subarea are applications trying to find patterns and anomalies in medical information to indicate if a patient might have a certain disease and what course of action fits his profile best. These AI algorithms access large databases containing millions of medical images coming from different sources in the hospital like MRI or CT scanners. The software can analyze new files and compare them with all historic data to provide new insights that can aid doctors in detecting early signs of diseases like cancer. Apart from the prediction, new data will be another “learning experience” for AI, further improving it for the future.
Other AI-algorithms are run for the purpose of finding novel drugs for rare diseases where it’s often unclear which treatment methods actually work and which don’t. AI can analyze data generated in clinical trial testing of new drugs to generate insights quicker than normal. But also in detecting new diseases, AI has proven to work efficiently better than conventional methods. By measuring biomarkers (naturally occurring molecules like blood), researchers can identify new forms of diseases that have never been seen before.
The calculations and analyses prepared by AI-algorithms often require an enormous amount of time to run, which delays the overall process. Accessing millions of files on servers and comparing a recent medical image to them, can become almost instant with 5G support. With these speeds, it would be possible to integrate something like database-streaming to access even more data and improve algorithms. There is no explanation needed to understand that patients always want to be diagnosed right away and sometimes even depend on quick analyses. Consequently, timing and precision are crucial in predictive analysis to guarantee a patient’s wellbeing. Combining AI and 5G in healthcare will cut process times and deliver better results much quicker.
Other areas that might be worth checking out
Here are two other trends that are getting attention and seem interesting as well:
The healthcare-network Rush System for Health installed a local 5G network in two of its hospitals in partnership with AT&T. They enabled massive and instant data-transfer everywhere in the area next to integrating telemedicine and remote diagnostic solutions. As Rush is pushing forward with 5G integration, it’s likely that others will follow, especially, when 5G networks will be broadly available.
Real-time emergency tech
Connected ambulances are trending as emergency tech will have huge benefits through low latency 5G networks. Doctors will have the opportunity to provide first advice to paramedics through ultra-HD video calls (Check this out). This use case provides even faster care for patients when they most need it.
Business Use Case and Subarea Overview
Below you can find the complete overview of all use cases with its respective subareas:
A glimpse of the future?
The use cases that I have talked about will bring more efficient workflows and better treatment methods in the future. However, the real benefit for patients will arise when all these exciting technologies are used in conjunction. I made up a hypothetical example of the future to show how 5G MedTech could be intertwined.
A patient experiences shortness of breath, his or her wearable would trigger an emergency call from a practitioner that could use a digital stethoscope while a connected ambulance is on their way to the patient’s home. There would almost be no need for the patient’s own action beside picking up a connected device allowing for the video consultation. When the paramedics arrive, they could stay in contact with a doctor that could join in via ultra-HD video. All the video material that was gathered during this procedure could serve as excellent material for students that are trying to understand the process. Of course, this is just an example that probably would not need this type of effort but it nicely shows how 5G MedTech could work together and reinforce each other.
5G MedTech Startup Landscape (2020)
After exploring the most exciting use cases of 5G in healthcare, let’s have a look at the startup scene that will largely benefit from next generation mobile networks. The data relies on both, top-down search via Crunchbase and bottom-up googling for startups in every subarea. A filter has been applied to focus on recently emerged and more advanced startups: Only startups founded no earlier than 2010 and having at least $1m of total funding are considered in this analysis. Overall, I classified 310 startups to fit into the identified use cases, and this way, will benefit from 5G rollout in the next few years. Among those startups, 4 have reached unicorn status already. The full list features 34 columns per startup which are grouped as follows:
● Business Use Case
● Basic information
● Contact information
You can access the full list by clicking here.
Before diving a bit deeper and dividing the data set into different categories, let’s get some basic background about the identified startups.
Analyzing employee counts per startup, we can see that the majority is in the 11–50 bucket (185). Between 1 and 10 people work in 72 startups, while 31 count 51–100 employees. More than 100 employees are found in only 22 companies.
In terms of revenue (estimates), 93 startups generate less than $1m per year. 113 fall between $1m and $10m, and only 12 startups reach more than $10m so far. Unfortunately, there was no estimate found for 93 companies. As the global healthcare spending is usually around 10%, there is still a lot of space that can be captured by startups to boost their revenue in the future. However, they have to overcome large healthcare companies that exert a lot of power on many segments in the market.
Finally, I created funding buckets to have a better overview of how much capital the startups in the data have raised. The following four categories show that most startups have raised up to $5m and between $5m and $24.99m. This shows that startups are still in its beginning stages and will attract more funding when 5G networks are available. After that, they will leverage their technologies to become mainstream and common practice in hospitals around the world. 54 companies raised $25m to below $100m meaning that about 17% of startups are already in later stages of their venture journey. 11 companies have raised $100m and more: As pointed out before there are 4 unicorns that also fall into this bucket. On average, $24m were raised in approximately 3 funding rounds.
5G MedTech by Business Use Case
Every second startup in the dataset is categorized as AI, more specifically, 127 AI-companies are doing Predictive Medicine. This shows that AI is the most uprising area in terms of numerical representation. Second largest is Telemedicine with roughly a quarter, pushed forward through the Covid-19 pandemic. Finally, RPM and VR & AR are making up the remaining 25% together with only 14 startups in Surgical Robotics. Robotics are currently only used for minimally invasive procedures, which is why 5G networks will enable more automation and remote interventions and thereby increase its representation in the market.
When looking at total funding, we get a similar picture. In total, there have been invested almost $7.5b of which AI captures a bit more than 50% with $3.8b. Telemedicine’s total funding is around $2b, while the other use cases almost equally share another $1.7b. Babylon Health, a Telemedicine unicorn, raised an astonishing $635m since its inception in 2013, followed by Tempus (AI) with $620m. The 10 biggest companies with regards to funding account for $2.7b or 36.5%. The largest subarea, which is Predictive Medicine (AI), raised $3.2b.
The key takeaways from the analysis by use case are:
● AI accounts for about 50% of startups and total funding
● Telemedicine’s share is 25%
● The other use cases are smaller and almost equally making up the remainder
● Predictive medicine (AI) is the largest subarea (127 companies & $3.2b raised)
5G MedTech by Geography
Instead of focusing on use cases only, there are additional insights when looking at where startups in the dataset are based. North America clearly is the home to every second startup, followed by Europe and Asia which roughly take on a quarter each. Australia, South America & Africa are quite irrelevant in the continental comparison with only 10 startups.
North America has raised around 56% of all funding raised followed by Europe with roughly 25%. Asia comes after with about 18%. Again, the other continents are negligible. It becomes evident that North America is leading in terms of count and total funding.
The big hubs are around San Francisco and New York, which both attracted funding worth $1.6b combined. In Europe, UK-cities Cambridge and London are on the forefront with $1.27b in capital raised. Asia’s Singapore and Beijing account for $334m funding.
What is most interesting to me from the geographical analysis:
● Most startups are located in North America (166) and have raised the most funding amount ($4.2b)
● Europe comes second (73 startups & $1.9b funding) with a bit of an advantage over Asia (61 startups & $1.36b funding)
● The other continents do not seem to play a role
● The most important cities internationally are San Francisco and New York
● North America is the place to be for 5G MedTech having a bigger ecosystem and more capital raised
To reflect about what was found in the analyses, it is clear to say that 5G MedTech is in its beginnings. The foundation is there, meaning that use cases have been identified and startups started working on solutions. But in order to fully unveil its potential, 5G needs to be the new industry standard, readily available for healthcare providers as well as patients. After, a transition will follow: More network support will boost applications and adoption rates in the mass market. Startups that are currently early stages (revenue, employees, total funding) will move towards raising new capital and increasing their service offerings.
The use case analysis showed that AI is the most pushing segment in terms of number of companies and total funding. On the other hand, surgical robotics will be the last use case to become available. The reason is that entry barriers of robotics are rather high because a lot of capital, expertise and time is required for development.
Looking at the geographical comparison, North America is the most important one because of its first-class business infrastructure and access to funding. However, Europe and Asia are smaller but still playing an important role in the global landscape. Australia, South America and Africa are outsiders and rather irrelevant for 5G MedTech.
The following startups are a selection from the full list (access it here) based on different criteria like total funding and relevance to its subarea.
Outlook — Didn’t we forget anything?
Even though 5G networks are being established as you read this article, there is still a lot that has to be done in order to get closer to a 5G MedTech reality. I will just drop three points that are equally important as being innovative about 5G in healthcare:
- Security. The more data is being used and the more sensitive this information is, the bigger the need for appropriate cybersecurity systems. In the future, there will be a big focus on that as nobody wants to share his or her medical history with hackers. The key words here are data encryption for all devices that are connected.
- IT infrastructure. Not only establishing 5G networks is important but also ensuring that potential users like hospitals, physicians and patients are equipped with systems and devices that allow benefiting from 5G. Especially for hospitals and doctors this means updating their network environment and their network management systems.
- Spreading awareness and promoting adoption. It will be crucial to let people know of these new methods and also make patients feel more comfortable when getting consultation via the internet or even when trusting a machine for performing surgery on them. Particularly older generations like Baby Boomers and Generation Xers might be unwilling to shift away from traditional healthcare solutions like in-person consultations. Consequently, it is the task of hospitals and practitioners to educate and take away their patient’s fears and concerns regarding 5G MedTech solutions. Finally, also practitioners need the willingness to accept new methods of treating patients, which means constant professional development.
After diving deep into what 5G is, how it creates new business opportunities and analyzing the startup landscape, we can be more than excited about what the future holds for 5G in MedTech!