Tools for the digital world

If you want one illustration of the way that digital, tech companies and healthcare interact then you could do worse than consider an evening event which was held in London in July. ‘The Future is Now: Digital Technology for NHS General Practice’ was aimed squarely at HCPs - and hosted by Amazon Web Services, a company first known as an online book retailer, but which has since moved into music streaming, TV, film-making - and, of course, health.

The increased use of digital tools, both in person and through various channels such as smartphones, apps, social media and websites, is a logical next step for the pharma industry as it seeks to facilitate more comprehensive engagement with a raft of doctors who are comfortable using technology - and patients who have become far more savvy and demanding.

There is already some evidence that pharma can improve patient outcomes through the creation and use of digital tools. But for this to work there needs to be significant collaboration between pharma and technology companies. To some extent, this has already started, with tech giants such as Amazon, Apple and Google looking seriously at health.

People are now well used to accessing information and services online. Millennial HCPs - and patients - expect the same technological convenience they see in other areas of their lives - booking taxis, buying tickets and so on - to bleed into their experience of healthcare. Patients in particular are often no longer the passive recipients of whatever treatment is prescribed for them, but active participants in their own care.

A McKinsey & Company paper, ‘How pharma can win in a digital world’, suggested that pharma organisations must increasingly look at themselves as solutions companies rather than asset companies - a move which mirrors pharma’s general shift from product to service. As patients take greater control of their own health, pharma must work out how to serve them, tapping into third parties’ skills.

From wearables to ingestibles

In June, Sanofi announced a tie-up with biopharma services organisation Parexel International Corporation to see how wearable devices could be used to help the collection of data in clinical trials. Parexel’s patient sensor, powered by the Perceptive MyTrials Analytics platform, facilitates the remote collection of study subject data. “We believe the use of wearables to collect data from trial participants represents a breakthrough in the digital transformation within the industry,” said Xavier Flinois, president of Paraxel.

The companies are looking in particular at how information collected from several wearable devices can be streamlined into a single, scalable data system to provide valuable insights. They are banking on the idea that wearables might increase patients’ ability to participate, thereby driving patient engagement and creating more opportunities for decentralized trial sites - and optimising study performance and even accelerating drug development. Publication of final study results is expected in the near future. Lionel Bascles, Global Head of Clinical Sciences and Operations at Sanofi, said: “Wearables are a core component of Sanofi’s digital trials strategy, and represent an important approach to automate patient processes using the latest technologies to bring new therapies to patients sooner.”

This is the sort of digital activity designed to help patients at some point in the future - but there are many products with an eye on the ‘here and now’. For instance, personification has been used in some digital tools designed to help patients make basic assessments - though not medical diagnoses - of their own health. These include Noble.MD’s iPad-based Theo, which initiates five-minute, self-guided assessments through questionnaires. It identifies specific patient risks and delivers a ‘before and after’ view of a patient’s ‘knowledge, attitude and readiness for change in connection with an intervention for a specific topic’. There is also Ada (‘Hi, I’m Ada. I can help if you’re feeling unwell’), which seeks to help patients understand their health, building up a personalised picture of what is going on. The company, also called Ada, has now developed software for HCPs too. Ada2020, funded by the European Commission, provides ‘a unique visual reasoning support for medical professionals during the diagnosis process’, with the aim of reducing the costs and patient suffering associated with misdiagnosis.

The development of consumer electronics, in particular the ubiquity of tablets, provides a ready-made platform for one-to-one communication. Other digital technology has also taken hold in healthcare. Bluetooth, for instance, is now routinely used to help diabetes patients control their blood glucose levels, as with Ascensia’s Contour Next One smart meter which connects with the app to help patients stay organised and work out whether they are on target to manage their condition successfully.

All of these products are for external use, but others go further: patients are even swallowing some digital tools. Proteus Discover consists of an ingestible sensor the size of a grain of sand, a wearable sensor patch, a mobile app and a provider portal. When patients takes their medication with the tiny sensor, a signal is transmitted to the patch and a digital record goes to the patients’ mobiles and on to the Proteus cloud. This latter step allows HCPs to analyse it on their portal. One study showed that patients with uncontrolled hypertension and diabetes achieved significantly greater reduction in blood pressure (BP) and LDL cholesterol, and were more likely to reach their BP goal, than if they had been using normal care. The company behind this ‘smart pill’ technology, Proteus Digital Health, believes that patients will become more engaged and therefore more adherent to their therapies - leading to better health outcomes. In May Proteus and Otsuka Pharmaceutical Co resubmitted a New Drug Application for the drug-device combination product of Ablify (aripiprazole) embedded with a Proteus ingestible sensor in a single tablet. The US FDA is expected to make an announcement on this by the end of this month.

Social patients

Social media is among the best-established of all digital platforms and patients with serious conditions can find relief in a variety of online forums where they can communicate with fellow sufferers, thereby reducing stress and helping to improve outcomes. HealthUnlocked (HU) is one such network, designed to provide patients with a space in which they can discuss symptoms, relief and ways of coping with day-to-day chronic pain. What distinguishes it from other forums is the sheer scale of involvement: five million people come to the platform each month. Chief medical officer and co-founder Matt Jameson Evans explains that while it is providing support rather than knowledge, there are positive knock-on effects: more than half of patients say they have better interactions with doctors after joining HU.

In a recent study with the University of Manchester, HU found that outcomes were also improved, when benchmarked using the Patient Activation Measure (PAM). This is the sort of information that is needed to convince the sceptics and cynics who hold pharma’s budgets of the importance of investing in digital. “Pharma companies are interested in PAM because it is linked to things like adherence and changing lifestyles,” says Evans.

He believes that digital tools are increasingly making their mark “if you can get beyond the ‘shiny new thing’ which seemed to captivate people a few years ago but increasingly doesn’t”. When it comes to developing these products, “the companies that move the slowest will be penalised”, he concludes.

Aiming for effective tools

While there are myriad examples of where pharma is using digital tools to help improve patient outcomes, many are ongoing initiatives, which means data is sketchy - at least as yet. However, some schemes have produced concrete results. For example, MSD partnered with Celesio on an intervention programme which improved adherence to diabetes medication by up to 61%.

And the digital tool involved here? The simple text message. The LloydsPharmacy pharmacist-led Clinical Contact Centre contacted patients via telephone and SMS over a six-month period. The team was trained in behavioural change, including motivational interviewing, and helped to empower patients to take control of their disease and get the most out of their medication.

“The aim was to improve patients’ knowledge of how and when to take their medication, explain why the medication is beneficial and dispel any myths, address any of their concerns and improve overall adherence and persistence to their prescribed regime as intended by their GP,” explains Laura Southall, service design manager for medicines adherence and patient support at Celesio.

Samuel Pygall, pharmacy strategy lead for MSD, said the company is committed to developing patient services, solutions and resources to support pharmacists in managing diabetes in primary care. “Pharmacists are in an excellent position within the patient journey to make impactful interventions,” he added.

Adherence remains a major health and financial bugbear for pharma and for healthcare systems worldwide. Straightforward text communication between HCP and patient is by no means the most hi-tech use of digital tools available - but the success of the Celesio/MSD Patient Support Programme is proof that simple ideas should not be overlooked in the race to find new ways to improve patient outcomes.