By Harsha Madannavar, Justin Wang and Helen Chen
Harsha Madannavar, Justin Wang and Helen Chen are Managing Directors at L.E.K. Consulting.
In mid-November 2017, the United States’ Food and Drug Administration (FDA) approved what is perhaps the boldest use of digital technology in healthcare: a pill that is integrated with an ingestible sensor that captures information about whether the patient has complied with her medication regimen. A patient ingests the pill and it sends the data to a patch worn on her torso, which adds various physiologic measures. From there the information is wirelessly sent to a mobile phone app, allowing both the patient and her physician to track how the patient is using and responding to her medication.
L.E.K. Consulting believes that the FDA’s approval of the Japan-based Otsuka Pharmaceutical’s ‘Abilify MyCite’ for certain psychiatric conditions, a first for digital medicine, will be seen as a landmark in patient-centred care. The problems that digital medicine addresses are profound. Approximately 50 percent of patients do not adhere to their medication as prescribed, taking it sporadically or with contraindicated foods or medicines and 20-30 percent of prescribed medications are never even picked up at a pharmacy. This nonadherence problem varies in acuity depending on the disease and the population that is affected. The cost of this waste runs into billions of dollars in unused medication and in addition, often more expensive medical care.
Bridging gaps in global healthcare
The benefits of digital medicine go beyond the saving of costs to the healthcare system. Over time, we believe that it can help solve three core problems which are bedevilling the development and the delivery of healthcare around the world.
Outcomes: For starters, digital medicine can bridge the outcomes gap. When physicians can track their patients’ compliance with a prescribed medication and how patients are responding to it, they can manage their care better. The result is superior health outcomes. In fact, when precise information about an individual’s use of drugs is analysed and then aggregated, healthcare professionals can gain much better insight about when to intervene with specific patients and how best to allocate nurses’ time with respect to prioritising care based on need. Imagine Amazon.com algorithms applied to your health instead of your shopping.
Physicians benefit by being able to track their patients based on accurate, continuous data such as their heartbeat and temperature, whether they’re sleeping or walking and whether they’ve taken the right medication at the right time. Also, patients are empowered with that same data to become more engaged in their overall health. Health outcomes are most likely to be improved when health professionals and patients work in concert.
Access: Digital medicine holds the promise of bridging the access gap. In many parts of the world, in developed countries and particularly in developing countries, many patients live far from a modern physician practice or a large medical centre. Digital medicine, by enabling the remote monitoring of a patient’s medical adherence coupled with physiological data, can alert a physician to events that may require intervention, such as a skipped dose or an alarming side effect. This dramatic improvement in a patient’s remote access to a healthcare professional holds the potential for upgrading the speed and accuracy of medical decision-making.
Proteus Digital Health (which licensed the enabling digital pill technology to Otsuka) has been working to bring its platform to China. The following factors about China make the country ripe for digital medicine: A majority of the population uses the mobile messaging platform WeChat and the capacity of healthcare services in both urban and rural areas is insufficient. The rollout of digital medicine in China will revolve around such mobile-powered applications, including telemedicine and remote consultations.
Innovation: Digital medicine may also play a role in ensuring the sustainability of innovation. First, there is the sheer novelty of the technology: A pill joined with an FDA-approved ingestible sensor made of silicon, magnesium and copper that captures critical data about whether we’re complying with our medications. Second, it securely and wirelessly sends this data to a wearable patch on the patient’s side that adds physiologic measures and transmits the combined information to a physician via the cloud. We expect it may take the healthcare world up to a decade to fully wrap its head around the extraordinary potential of digital medicine; how to value it, how to use it for optimal benefit and how society should reimburse for it.
Getting back to the aggregated data it can yield, disease by disease or drug class by drug class, across different patient populations, digital medicine offers the potential to be used to select the right patients for a clinical trial or to better understand how patients respond to drug treatment. It can suggest new avenues of pharmacological research and support portfolio planners in their evaluation of assets and allocation of resources. It can significantly streamline and focus pharmaceutical research and development.
Challenges facing digital adoption
The ability of digital medicine to bridge all the above gaps and become a global standard presupposes that it has achieved a critical mass, that doctors have adopted it, regulators are comfortable with it, patients are demanding it and payers are covering it.
Here’s where two key challenges come in. Foremost, there is a degree of scepticism among pharmaceutical companies and some physicians. Pharmaceutical companies, like other large organisations, can be notoriously slow to integrate innovative technologies or platforms. Physicians, particularly those in large hospital systems, have barely enough face time with patients and even less time to adapt to new care delivery models or new decision-making paradigms.
Many of them will take a wait-and-see attitude toward digital medicine. A few early applications like Otsuka’s Abilify MyCite will raise awareness of the technology and speed its acceptance in the market. Other parts of the world, China, for instance, will likely be early adopters, leading the way in healthcare innovations, particularly ones that rely on mobile phones, apps and social networks.
Another challenge is that privacy concerns may hinder adoption in some parts of the world. The concern may be greater in Western societies. Our experience in China suggests that volunteering of personal information, including health data, is prevalent, though the government has begun to explore privacy issues. Physicians’ attitudes will evolve over time, likely shaped by patients’ attitudes. US and European patients quickly understand that they have control over who sees their data and allowing a physician to see it reinforces the benefits that flow from digital medicine. We believe they may quickly start to demand access to digital medicine solutions.
Global pharma’s continued evolution
One thing is for sure: We are entering a brave new world of patient-centred digital health. We believe that digital medicines will play an important role in the evolution of global pharma, from today’s industry that sells products and enables doctors to prescribe medications to tomorrow’s industry that offers servicing solutions and enables consumers to reach health outcomes in partnership with their care team.
Editor’s note: This article was first published in Pharmaceutical Online.
Stay updated with all the insights.
Navigate news, 1 email day.
Subscribe to Qrius