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D-day: time to make digital deliver

Chris Ross looks at why a platform-based, outcomes-focused approach could be key to demonstrating the value of digital health solutions

digital

The pharmaceutical industry’s clunky relationship with ‘digital’ is poised to enter a new phase. There’s a school of thought across many industries that the application of digital is now so ubiquitous that the term itself should be erased from the common vernacular. The logic is simple: digital has become the ‘new normal’, so to treat it as a distinct function that’s divorced from the wider machinery of business is not only a mistake, it’s no longer necessary. It’s hard to argue against that. In the modern world, digital touches everything and it’s difficult to think of a role or process that isn’t in some way influenced by it. That’s why in some sectors there’s a growing clamour to ditch digital job titles and acknowledge digital as part of the mainstream. It’s an inevitable direction of travel. But in pharma, it isn’t that simple.

The industry, commonly accused of being behind the eight-ball when it comes to digital adoption, has not yet reached the levels of digital maturity required to make the leap. Bedevilled by regulation and risk-aversion, the sector is still learning the digital ropes. Sure, there are pioneers and early adopters. But for every innovator courageously striding out, there’s a longer line of cautious companies nervously inching forward. Something has to give. As the world rapidly moves towards outcomes- based healthcare, digital solutions are widely recognised as the key to unlocking value and driving patient outcomes. The problem for pharma is that, despite heavy investment in digital tools, it’s still difficult to quantify the value they’re providing. The next phase of digital maturity must address this critical challenge.

The profusion of digital health solutions is vast and growing. The World Economic Forum reported that 325,000 mobile health apps were launched in 2017 alone. It’s unlikely that 2018 will have yielded any less. The interventions are wide-ranging; an abundance of apps, wearables and portals are helping patients and prescribers manage long-term conditions, while clinical decision support systems and medicines adherence tools are supporting health stakeholders in the management of disease. The use of telehealth and telemedicine is – after a bumpy start – advancing, with personalised care programmes leveraging digital technology to monitor patients and improve interaction between HCPs and patients. We’re also seeing the application of Artificial Intelligence, with emerging examples of chatbots in areas like diabetes redefining the management of care.

On the face of it, it’s all good stuff. As healthcare processes become increasingly digitised, hopes are high that the cost of care and demand on systems will dramatically reduce. But therein lies the problem. Hopes are high but evidence is less forthcoming. Proving the value of digital innovation and its impact on care remains difficult, with good outcomes data the exception not the rule. So where do we go from here? The platform is there. It’s time for the industry to build on it.

Connecting the ecosystem

“There is no shortage of digital tools in the marketplace; there are literally hundreds of thousands of solutions, many of which – on their own – have a narrow utility and provide little demonstrable value,” says Aaron Bean, EY, Life Sciences, UK & Ireland. “The problem is that the pharma industry is already incredibly fragmented. The continued proliferation of niche tools and the propensity for every drug company to do its own individual thing only adds to that fragmentation and creates more confusion. So the current approach is not sustainable. For example, patients with chronic conditions and multiple morbidities could end up with hundreds of disparate apps on their mobile devices, limiting usage and squandering the opportunity to maximise data sets. The challenge for health systems is clear: how do we consolidate and optimise existing tools – because there’s a lot of good stuff out there – and how do we aggregate that data to string the experience together? The answer is likely to come through establishing platforms that connect, combine and share data across the ecosystem.”

So how does the industry progress? “There’s a strong argument for a ‘not built here’ mentality,” says Aaron. “Pharma companies must stop thinking that they’ve got to build everything themselves and instead tap into what’s good, scalable and useful elsewhere. The development of digital tools and services is not a traditional strength for pharma. However, the market is full of world-class tech companies that have proven capability to design, build and scale these types of assets. Pharma companies should leverage those where they can.”

Collaborate to innovate

The suggestion that industry needs to look outside its core is not new. There is widespread consensus that by collaborating with medtech and health tech companies, pharma can help co-create new tools that drive patient outcomes. Yet examination of the existing crop of digital tools suggests that the approach is rare.

“There are lots of businesses creating health apps, but it’s questionable how many of them are building them in collaboration with pharma companies, patient advocacy groups or other health stakeholders,” says Neil Rees, Head of Research, The EarthWorks. “Moreover, many apps are disparate, stand-alone tools rather than integrated digital solutions. In certain chronic diseases there are large numbers of apps that focus on specific symptoms to help patients manage important aspects of their condition.

However, many of these solutions appear to have been built by developers that don’t understand the holistic needs of the patient and have instead created tools that focus on just one part of the management of the disease. There are lessons for pharma in this approach. While the industry is getting better at understanding the patient journey, there are still examples where pharma companies rush to the endpoint of designing an app without first considering the unmet needs they’re trying to solve for patients or HCPs.

“It’s important to start at the macro level to identify the main challenges in the management dynamics of a disease – and use that as a platform from which you can develop the services and solutions to support it. If you start with an understanding of the problem you’re trying to solve – and why – then the nature of the solution will evolve from there. This approach inevitably lends itself to collaboration and co-creation to derive the insight and ideas that deliver value and drive outcomes.”

Fortunately, the industry is beginning to move in the right circles for digital innovation. “Pharma companies are finally realising that disruption is coming – and that they can either be driving the steamroller or be part of the road,” says Alex Brock, Head of Digital, Europe, Syneos Health Communications. “A sea change is taking place characterised by three distinct but related trends. Primarily, there are encouraging signs of pharma collaboration with digital health start-ups and tech companies. Alongside this there has been a proliferation of ‘innovation labs’ across the industry as companies look to establish the infrastructure and processes to develop customer-centred digital solutions. The archetypal example is Leo’s much-trumpeted Innovation Lab – but there are countless others too. Finally, to underpin everything, we’re seeing the widespread introduction of new roles around innovation as companies try to find new ways of working that mitigate against the risk of disruption. These are exciting times and the building blocks are in place to power digital maturity. However, progress won’t happen overnight. While we wait, there remain key areas where pharma’s approach to developing digital tools could improve to drive greater value.”

Partner and pivot – but keep it simple

The importance of customer insight as a foundation for developing solutions is widely understood, says Alex. “At a high level, pharma understands this. It’s always been a risk-averse industry that relies on establishing a robust evidence-base to validate its work. However, there’s a common tendency for companies to consider ‘insight’ as something you do at the beginning – and once you’ve got your research, it’s ‘job done’. Arguably, the most effective digital tools are derived from a more iterative approach. Instead of doing one large monolithic piece of research that tries to answer every possible question, it’s often more beneficial to break it down into smaller pieces; do an initial piece of research that sets the direction, but support it with incremental and periodic research that helps you redefine, adjust or consolidate your approach. This allows you to respond to market dynamics, recognisable through the ongoing triangulation of perspectives from all your stakeholders. The iterative approach fuels continuous co-creation, enabling you to pivot where appropriate, rather than basing everything on a single, early piece of research.”

Responsive collaboration also helps ensure that the solutions you build are simple and effective. “This is vital,” says Alex. “The development process is inherently complex, often involving a multitude of internal and external stakeholders. This can often lead to ‘feature bloat’, where an inordinate amount of functionality gets bolted on as developers pander to the whim of every stakeholder. It’s counter-productive. Simplicity is key. The easier it is for physicians or patients to use a digital tool, the more likely they are to derive value from it. Ultimately, despite the inevitable tensions of co-creation, it pays to remain disciplined and maintain a concise feature list that aligns with clearly defined user needs. Co-creation is about finding the right balance, rather than trying to be all things to all people.”

Redefining co-creation

Co-creation has, in recent years, been elevated to buzzword status in pharma. However, its definition continues to evolve. “To progress, the nature of co-creation must be broad,” says Neil Rees. “It should not only encompass advocacy groups and patient organisations, it must extend both beyond industry and across industry. Moreover, it may require collaboration with sectors and players that have traditionally been positioned as a ‘threat’ to pharma. We’ve known for some time that the likes of Google and Apple have identified health as a growth opportunity – but pharma shouldn’t perceive that as a threat to its model. It’s a huge opportunity. In fact, the tech giants may help us move away from this era of multiple, disparate, disconnected apps and instead bring everything together in ways that add value. At present, a number of chronic diseases are crowded with a range of treatments in-market and in development. As such, a patient could potentially encounter many of those products during a ten-year period, while an HCP will likely encounter them all throughout. Are these users really going to move between apps throughout their journey? That’s far too complicated. With companies increasingly developing tools that are ‘above brand’ and provide ‘services to medicine’, it’s likely that the future will see a reliance on ‘platforms’ rather than individual tools. Tech giants like Apple, or indeed industry-led platforms, will most likely establish centralised hubs that house, aggregate and share data across the ecosystem for the wider cause of health outcomes.”

There are encouraging signs that the penny is dropping. For example, at the beginning of 2018, Roche Diagnostics announced a partnership with GE Healthcare to jointly develop and co-market digital clinical decision support solutions in cancer and critical care. Other pharma companies have followed suit. Elsewhere, Sanofi and Google have been collaborating for some time to develop digital technologies that improve diabetes control. Google’s work in health is, among many diverse projects, seeing it explore how wearable technology can measure pulse, heart rhythm and skin temperature to detect disease. These projects, as well as platforms being created by Apple and other tech giants, present clear opportunities for pharma to leverage that data to improve care. But exploiting them requires a collaborative approach.

A platform for value

One of the biggest opportunities, says Aaron Bean, will likely emerge through ‘industry platforms’ where stakeholders from across the ecosystem can access, contribute to and share relevant data. “This is a foreign mindset for pharma. Traditionally, companies create their own IP, build the walls and lock everything to protect it. However, if industry is to optimise the value of digital solutions, it needs to challenge that mindset and become more open and collaborative.”

The drivers for a platform-based approach are compelling. “As we move towards the era of outcomes-based contracting, the best digital tools will be rooted in a strong purpose that aligns with a defined outcomes strategy,” says Aaron. “Collaborative industry platforms can become the engine room for those solutions, harnessing data that can help shape services that deliver those outcomes. Fundamentally, companies that connect the ecosystem by participating and co-creating via industry platforms will inevitably become more customer-centric and more likely to develop solutions that provide demonstrable value.

“The step-guide for progress is simple. Firstly, adopt a design thinking-led approach that focuses on the issues you’re trying to solve. Secondly, tap into the ecosystem. Look at what’s already out there and partner and co-create with others. That’s far better for the consumer and reduces fragmentation. Finally, adopt industry platforms that connect, optimise and share high-value data – platforms that help you develop digital solutions that focus on the outcomes you’re trying to improve.”

Digital D-day

There’s little doubt that digital technology can make a major contribution to the wider goal of unlocking global access to effective healthcare. With many of the world’s biggest health challenges compromised by poor disease awareness leading to suboptimal behaviours, good digital solutions can play an important role in increasing engagement and nudging healthy behaviours. However, if the development of digital tools is to benefit from the undoubted expertise that pharma can bring to disease management, the industry needs to rethink its approach and forge more open and collaborative partnerships with stakeholders across the ecosystem. Digital D-day is upon us. If pharma gets it right, it really could be a platform for demonstrating and delivering value across the system.

Article by
Chris Ross

Chris Ross is a freelance writer specialising in the pharmaceutical and healthcare industry

18th December 2018

From: Regulatory

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