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The Digital Patient

Earlier this year, the European Commission published a broad-ranging plan to digitise EU industries to help usher in what has become known as the fourth industrial revolution.
Digital patient

From a healthcare perspective, the vision is for EU citizens to have access to online prescribing, electronic health records and digital health applications that will improve patient care and outcomes and – it is hoped – usher in a new era of real-world, 'big data'-driven R&D that will lead to new and improved therapies.

That is a worthy aspiration, but how far away from that goal are we? The use of online services in the delivery of healthcare services is fragmented, and data from the European Commission's Digital Agenda Scoreboard reveals disparities across Europe, with north-western countries generally performing better than their southern, central and eastern European neighbours.

In some EU countries – notably Spain, Denmark and Finland – up to a third of appointments are booked via a website, according to 2014 data from the EC Scoreboard. However in most other countries the rates were much lower, typically in single-digit percentages, with the UK a little higher at 12% and Italy at around 10%.

When it comes to the electronic transfer of prescriptions from doctors to pharmacists, the divide between different EU countries is particularly marked. In the Nordic countries this happened with almost all scrips (85%-97%) in 2013 and with a majority of prescriptions in the Netherlands, Spain, Croatia and Romania. Rates elsewhere in the EU were generally around or below 20% in that year.

Looking at the sharing of patient data between healthcare practitioners, the picture is a little better. Roughly two-thirds of GPs in Nordic countries, Spain and the Netherlands shared patient data in 2013, along with more than half of GPs in the UK, 40% in Germany and more than 25% in most other western EU countries. Outside that group rates remained low.

What is abundantly clear is that the internet is often the first port of call for many patients and their carers seeking information on health matters.

Over 60-70% of people in Germany, Norway and Finland look online for this kind of information, as do more than half of people in the UK, Spain and Sweden, according to the Scoreboard. In France and Italy the proportion is just a little lower at around 47%.

Interestingly, research by Decision Resources Group suggests that in countries where the public pay for healthcare at least in part through health insurance, consumers tend to be more digitally engaged when it comes to their health. They are also more likely to use digital resources from pharma companies such as health tracking tools, condition or treatment info, patient support programmes and help with adherence.

In countries where the public pay for healthcare... consumers tend to be more digitally engaged

European consumers also seem prepared to use digital healthcare tools if they are available and can be trusted. A 2014 survey from McKinsey & Co showed that three quarters of consumers in the UK, Germany and Singapore would like to make use of digital healthcare services – contrary to the perceived wisdom of many healthcare executives.

The McKinsey survey also exploded the myth that only younger people want to go digital in health – finding plenty of interest in the over-50s group that accounts for the bulk of healthcare service usage. Meanwhile, a recent Spanish study revealed a high level of sophistication among older consumers in terms of gauging the reliability of online information, as well as a nuanced understanding of its potential for fostering 'cyberchondriasm'.

The rise of mobile
While many healthcare interactions still take place via a PC, there is no denying the relentless increase in mHealth – including apps and wearable devices. An EC Green Paper on mHealth concluded that increased use of mobile technologies could improve care through better planning, thereby reducing unnecessary consultations and resulting in better guidance on treatment, particularly for chronic diseases.

Another report published by the UK government last year concluded however that for now, mHealth is most commonly being used by consumers to make decisions about wellness, and is some distance away from assisting with higher-impact clinical decision-making and developing the interaction between clinicians and patients.

There is a high consumer demand for mHealth apps, it says, but monetising them is difficult due to a lack of clear reimbursement models, particularly in the NHS.

Nevertheless, there is no denying the efforts going into mHealth apps. IMS Health reported that there are escalating numbers of health apps – more than 165,000 at last count – with 1 in 10 of them using a smartphone or some other device or sensor to feed back data from the user.

Many of those apps have few users however – 40% of them show less than 5,000 downloads – revealing they are still some way from become an integrated part of healthcare delivery. Part of the problem is the bewildering choice and difficulty of sorting the good apps from the bad, says IMS. As a result people tend to behave like a 'herd' – sticking to the most popular app regardless of whether it is the best choice for them.

Half of respondents in the US and UK said they would use a connected health device or tool if it was recommended to them by a physician

McKinsey meanwhile cautions that the demand for mobile healthcare is by no means universal, even though it is more so in younger people – and there is little evidence that consumers want innovative features and apps. In fact, its survey revealed consumers' requirements were mundane – showing the importance of efficiency, better access to information, integration with other channels and the availability of a real person to complement the digital service.

An Ipsos Healthcare survey last year revealed that around half of respondents in the US and UK said they would use a connected health device or tool if it was recommended to them by a physician. However, a corresponding survey among 200 physicians found that only a minority felt confident enough to select the right device – 24% of US doctors surveyed and just 12% in the UK.

The results also showed that one in five US citizens is already using some form of connected device to manage their health, compared to 1 in 10 in the UK, and a third and a quarter of respondents respectively said they planned to use them in future. However, the poll also revealed steep dropout rates – 32% in the US and 42% in the UK – suggesting that satisfaction with the current services is below par.

So what are the challenges involved in splicing mHealth technology into the healthcare system? According to patient advocacy group PatientView, while patients and members of the public are embracing health apps, doctors are not yet helping them do so, in part because of the confusion about the regulatory requirements for prescribing apps.

The evidence base for most apps remains limited, not least because of a lack of agreed standards. The World Health Organization's mHealth Technical Evidence Review Group recently developed a checklist to standardise the reporting and assessment of apps and improve the quality of mHealth evidence, but as it stands there is no recognised arbiter for the quality and trustworthiness of health apps.

Regulations governing health apps are 'opaque and outdated', according to PatientView, with many developers unaware of their legal responsibilities. A key challenge is the fast-changing nature of medical information, which means apps need to be continually refined and upgraded to ensure they remain current. That is timeconsuming and costly, which could drive up costs to users and restrict access.

Overall, there seems little doubt that Europeans are willing to embrace digital health. What is needed now is a concerted drive by regulators, the medical profession, and industry and patient groups alike to make sure that the systems and tools put in place are fit for purpose.

Article by
Phil Taylor

is a freelance journalist specialising in the pharmaceutical industry

29th June 2016

From: Healthcare



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