Connected Healthcare

Shifting from paper to electronic records has allowed information to be shared between healthcare professionals, automated patient reminders to be sent and has made it easier for physicians to examine trends in individual patients over time. Meanwhile, they can now access useful information – and pass it on to other HCPs and patients – with unprecedented ease.

In fact, four out of every five doctors now have access to a tablet or smartphone for their work, according to a 2015 survey by Cello Health, and around three-quarters of EU doctors say they use these devices regularly for professional purposes.

Sitting alongside this is an increasing trend for EU consumers to be more engaged in their health, and an increasing expectation among doctors that pharma companies willhelp provide patient support programmes.

Recent analyses by Decision Resources Group reveal that nearly half (49%) of doctors in Germany, France, the UK, Spain and Italy said their patients had become more involved in treatment decision-making over the past 12 months. More than half (52%) felt their patients are better informed about drug choices and treatment options, and 58% agreed that their patients have greater expectations of their care.

Similarly, Cello's survey showed that 62% of doctors say that patients often attend surgery with a self-diagnosis from web research, with 40% saying that patients often specifically request named prescriptions.

Meanwhile, research by EPG Health Media suggests that scepticism about information supplied by pharma is present, but this does not reduce their willingness to engage if the information is productagnostic. In fact, more than 80% of HCPs polled in a 2013 survey said pharma should be funding more educational resources such as online content and mHealth apps.

Another study conducted in the US found that two-thirds of HCPs believe the industry will have to provide more resources and services alongside drugs in order to stay relevant as the healthcare system evolves.

Greater acceptance also seems to be emerging in Europe, with 46% of physicians in Germany saying they visit pharma websites at least once a month, and 55% of French doctors indicating they would use online pharma resourcesfor information about specific conditions, according to Decision Resources data. And that extends to mobile – 44% of UK doctors with smartphones would welcome being able to access formulary data via an app.

Both electronic medical records and health information exchange (HIE) have had a positive impact on reducing medical errors

So what does all this mean for pharma? Overall it seems that HCPs are looking for credible, unbranded tools and materials, such as downloadable patient education information, that would help prepare doctors for more in-depth discussions with their patients, according to EGP.

Pharma seems to be over-supporting branded promotional material at the expense of unbranded content, it found, indicating that a gap exists between how doctors want to view online content and how pharma is currently presenting it. Moreover, only 15% of pharma marketing is currently digital, despite the fact that digital and online platforms are used by a significant and growing proportion of doctors.

Drilling down, the EPG survey also revealed the importance of doctor-only and specialty websites as information resources for doctors. A majority (79%) of HCPs said they 'always' or 'usually' visited these sites for online searching, with a little over half turning to Google and less than a quarter seeking information from pharma websites.

Recognising the opportunity, competition among doctor-only platforms has been heating up. Sites such as Medscape and Sermo have been expanding from their US homeland and targeting doctors in France, Germany, Spain and the UK, among others, throwing down the gauntlet to Europe's most established player Networks in Health which reaches more than 750,000 European doctors.

Despite the inexorable shift to digital, Cello's research has found that information received face-to-face from peers, key opinion leaders (KOLs), pharma sales representatives and sponsored conferences remain the most trusted channels of communication. Face-to- face interactions were also found to have the most influence on prescribing habits.

Healthcare IT
Aside from online search and social media, one of the oft-cited benefits of a digital, connected health service is the potential to streamline workflows, improve clinical decision-making and avoid medical errors.

Last year for example, a UK study found that in NHS hospitals around 750 patients a month are dying unnecessarily, with 1 in 28 resulting from diagnosis, monitoring or prescribing/ dosing mistakes which might be side-stepped by using connected electronic systems.

Accenture data reveals that in the UK, four out of five doctors believe that both electronic medical records and health information exchange (HIE) have had a positive impact on reducing medical errors, with 70% saying they have improved outcomes for patients.

While the benefits of connected healthcare seem self-evident, recent history tells us that things are not necessarily so straightforward. One example across the Atlantic – detailed in Robert Wachter's 2015 book The Digital Doctor – involved a case in which a teenager received 38 tablets of an antibiotic – rather than one – despite state-of-the-art digital systems.

The life-threatening case is notable in that it highlights the hazards inherent in becoming reliant on technology. Design flaws in the software (tiny type and a default to the wrong unit of measurement) were compounded by a tendency of 'alert fatigue' by hospital staff. Warnings occur with great frequency – perhaps to protect the system's designers from liability – but fail to distinguish between minor and major threats.

Errors are less common than in the days of interpreting doctors' handwriting. However, Wachter paints a picture in which skilled and professional HCPs can start to rely less on their own judgment and more on the IT systems they are using, and communicate less with their colleagues when delivering patient care.

There are clearly technical challenges to getting systems to work and training users properly, but there is also an adaptive challenge. While the proportion of 'digitally native' doctors is on the increase, convincing late-adopters that there are benefits to changing practices remains a challenge.

Moreover, Accenture's research found that doctors made far less use of the collaborative aspects of digital systems than of the routine functions like record-keeping, and often reported that interfaces were not intuitive and user-friendly. It concluded that doctors need to embrace and engage more with new technology platforms and the collaborative doctor-patient care models that underpin them.

A majority (55%) also reported that patient time was suffering as a result – which backs up suggestions that digital health systems can affect the bond between doctor and patient. In the UK patient consultations now average 8 to 10 minutes – compared to 20 minutes in France and Germany. This is unpopular with doctors, with just 8% believing this amount of time is adequate, according to the British Medical Association (BMA).

Given that patients complain that doctors spend much of the consultation time interacting with their computer rather than the person in front of them, it is important to ensure that the digitisation of healthcare does not divert attention from the patient to the disease.

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