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European Pharmaceutical Contractor

Making the Connection

 

Connected health processes are gradually being introduced into clinical research as a result of economic pressures and changes to the regulatory environment. Understanding the particular disease, demographic and drug being investigated is essential when considering adopting this technology. Throughout the last decade, most industries experienced a dramatic shift in consumer behaviour as activities migrated to the phone, then to the internet, and now increasingly to mobile technologies. Known as ‘channel shift’, this has offered ease of use to the consumer, provided a service differentiator, and reduced costs for the provider. The banking and airline industries have both pioneered this approach. However, a number of industries have been slower to act, including the healthcare and pharmaceutical industries. This is changing as wider adoption of these tools increasingly affects healthcare and pharma business models.

The ability of healthcare and pharma providers to utilise the power of the mobile telephone network, internet and mobile internet to their full extent has been inhibited until now by a range of factors. However it is likely that current fiscal issues, along with increasing certainty regarding the regulatory landscape, will create the environment required to promote digitisation. This in turn could result in the same ‘cost down, quality up’ outcomes that have been realised elsewhere.

Boundaries of Connected Health

If you are looking at informatics technologies that have the opportunity to impact the quality of patient care in high incidence chronic disease, change the economics of care by shifting the point of care from the hospital to outpatient or community care, and positively affect care in the developed and developing world, there is only one viable candidate – ‘mHealth’. This is due to the increasing ubiquity of access to mobile devices, both phones and, increasingly, tablets.

Despite being a relatively new concept, the boundaries of ‘mHealth’ are already blurring. Indeed, ‘connected health’ is probably a better description for the processes that will be adopted, as it reflects the way in which ‘eHealth’, ‘teleHealth’, ‘mHealth’ and electronic patient records are beginning to integrate for the benefit of the patient and the efficiency of the healthcare system. An illustration of this shift is that the European Connected Health Campus and the European mHealth Alliance recently merged to create the European Connected Health Alliance.

Connected health is one of a few healthcare informatics technologies that focuses on care in the community (where most healthcare delivery occurs). There are a range of factors that will drive its adoption in the next five years, including:

  • Handsets and networks that have evolved to a level that means they can support alternative care workflows
  • Handsets and networks that have penetrated the developed and developing world
  • General recognition that the economics of care must change, as current care protocols are unsustainable in an ageing population
  • The current economic situation, which will allow workflow changes to be forced through that previously would have been politically unacceptable to interest groups

Connected Health Across the World

Until recently, commercially viable mass-market connected health applications have been elusive in the developed world despite the development of complex clinical solutions, often focused on bespoke hardware. Many of the initial efforts appear to have been too expensive to be deployed at scale (or at least did not realise an adequate cost/benefit ratio) to be viable, certainly when deployed in the business models that were proposed. Applications of connected health include:

Developing World

mHealth applications have been reported to benefit HIV/Aids treatment adherence in Africa, with one investigation concluding from a study of 28 papers noting that “SMS can improve service delivery through appointment reminders and improve communication between healthcare workers. It improves diagnosis, prevention, treatment and rehabilitation by supporting adherence to medication, and monitoring illness and medical interventions. SMS is useful in public health programmes, such as contact tracing and partner notification, therefore playing an important role in control of HIV/AIDS. As South Africa has one of the highest uptakes and demographic distributions of cellular technology in the world, SMS is feasible as a tool to deliver quality healthcare with low cost” (1).

Middle East

Etisalat and Ericsson recently signed a Memorandum of Understanding to deliver services to the United Arab Emirates to enable medical professionals in that part of the world to remotely monitor the health of adult and paediatric patients, using mobile technology by deploying and integrating a remote patient monitoring (RPM) system that will measure medical parameters for patients across the Emirates. Patient measurement of parameters, such as electrocardiography (ECG), spirometry, blood pressure, pulse rate and oxygen saturation, will become easily accessible to medical personnel to review through web-based applications.

North America

text4baby, a free nationwide mobile health information service developed by Voxiva, is used to promote maternal and child health. Researchers at the University of California San Diego Health System’s Department of Reproductive Medicine and the National Latino Research Center (NLRC) at California State San Marcos University presented data at the American Public Health Association Conference in Washington DC, indicating that text4baby is increasing users’ health knowledge, facilitating interaction with health providers, improving adherence to appointments and immunisations and strengthening access to health services.

Maternity services are an ideal place to deploy connected health as they serve a younger and (generally) well engaged demographic, and as most of the patient’s interaction is driven through a limited number of clinical service providers.

If a pharma company is considering whether to introduce a viable connected health solution, a number of areas need to be researched:

The particular disease and what affects its management from a patient perspective – how will mHealth fit in?

  • Health economics
  • Existing healthcare workflows
  • That several parties (clinicians, commissioners and vendors) work in a partnership to implement it
  • A strategy that considers who in the pathway will be responsible for the engagement of patients and the drivers behind patient engagement from the clinician’s perspective

Applying the Principle

It is important that the pharma industry considers and understands the disease, demographic and drug as an integral part of the clinical content for mobile ‘apps’ and mHealth solutions.

This is a new area for pharma and everyone wants to get involved. However, unless time is taken to consider all of the above, adoption of mHealth solutions could lead to projects being delayed, poor engagement and output of results that demonstrate the impact of such solutions to healthcare.

Focusing connected health ‘lower down the pyramid of care’ may also be sensible. In general, the later it is in disease progression that you implement a change to workflow, the greater the cost of adoption due to the greater number of organisations, institutions and clinical specialities involved and the resulting increased complexity of any change programme.

Engaging consumers to live healthier lives and adhere to evidence-based treatment plans using technologies that enhance self-care is central to controlling healthcare costs. Realising this goal entails making the most of familiar technology with incentives for consumers and providers to manage preventive, chronic and post-acute care.

Connected health will be successful where it utilitises existing infrastructure to accomplish currently reimbursed activities, and does so at a lower cost than existing workflows. The next few years will see a tumbling of deployment costs, the realisation of large-scale connected health deployments, and innovative new business models, delivered by multiple partners working together to deliver disease-specific services.

The ability to gather data as part of such a programme will of course not be lost on professionals from the pharmaceutical industry, and in particular how it will impact on pharmacovigilance and (potentially) payment models in facilitating the inevitable shift to payment-byresults (in some form). It may also be the trigger for a fundamental re-valuation as to what service constitutes, redefining the relationship between pharmaceutical companies, commissioners and physicians.

PricewaterhouseCoopers’ report Pharma 2020: The Vision – Which Path Will You Take? details the specific challenges of the current business models and the opportunities to address them, and illustrates just how critical the digitisation agenda is to pharma.

One obvious application of connected health is in the digitisation of clinical trials. Clearly such an approach offers the potential for cost savings in terms of reducing the costs of data capture, but another area of interest is in creating value using some of the smaller trials to develop a cost effective adherence support programme for deployment once the product is marketed. Reducing the ‘adherence gap’ represented by the differences in persistence and compliance seen in trials and that which occurs in the field is potentially a major win for pharma companies.

Conclusion

There is little doubt that connected health can be complex to put into operation, but equally the evidence base (both clinical and economic) is forming as to how it can be most effectively applied. We should certainly expect to see more implementations of connected health. Dr Eric Topol, the Vice Chairman of the West Wireless Health Institute (a US institute that promotes wireless healthcare), had this insight: “Right now healthcare is incredibly expensive, but a lot of these new innovative technologies are frugal innovations. For the first time they not only fulfil unmet needs, but at lower costs…We’ve never seen that before.”

Connected health is one of the few areas that could allow pharma companies to ‘put value around the pill’ and to increase differentiation while reducing costs. It inevitably will become more of an area of focus, and is the obvious answer to the question ‘how do pharma companies digitise?’

Reference

  1. Bahadur KM and Murray PJ, Cell phone short messaging service (SMS) for HIV/AIDS in South Africa: a literature review, Studies in Health Technology and Informatics 160(1): pp530-534, 2010

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Mark Evans is co-founder and Director of Adherence Science Ltd, a founder member of the European Connected Health Alliance. Mark is also co-founder of Radius Diagnostics Ltd; and Mirada Medical Ltd, an MBO from Siemens focused on oncology. Mark’s background includes senior financial experience in imaging and diagnostics business units in CTI molecular imaging and Siemens Healthcare, and general management responsibility for medical imaging software development and a radiopharmaceutical facility.

Kavita Oberoi is the founder and Managing Director of Oberoi Consulting. After gaining a BSc in Applied Chemistry, Kavita embarked on a successful career with Bayer Pharmaceuticals. Spotting a gap in the market for clinical audit, IT training and business consulting for GP Practices, Kativa decided to set up her own consultancy company. By August 2001, demand for her services had become so great that she established her business and Oberoi’s clients now include GP Practices, PBC clusters, PCTs, pharmacy groups and the pharmaceutical industry. Kavita has been awarded the prestigious NRI Pride of India Gold Award and in 2009 she was named in the HBOS report as one of ‘Britain’s 100 Most Entrepreneurial Women’.

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