Digital tools improve adherence if patients adhere to them
“It all starts with talking to the patient populations that you are seeking to support but also the medical professionals around those patients to understand what is actually going to create value,” says Bonam when explaining the core principles that guide AstraZeneca (AZ) in its efforts when developing DTx.
Adding another digital solution to the market and hoping patients will accept it is the worst approach. Why? Because there are already thousands of digital tools available with a marginal number of downloads. Many digital solutions promise wonderful things, but in most cases there is little or no evidence to support these claims. This can be confusing for patients and healthcare professionals alike.
AZ knows DTx has vast potential, but has also learned that digital products are complex to develop and successfully implement.
The problem regarding tools designed to support long-term care of patients is that you’re asking the patient to adhere to yet another thing. And I think that can be quite challenging.
Digital and medicine therapies: when two become one
Bonam believes in DTx but doubts if every medicine will get a companion app. “Consider that most people with long-term chronic diseases have more than one condition and more than one therapist. I think that having apps completely tied to a single therapeutic drug won’t be useful”, he claims.
Instead, he shares his vision: a modular approach with solutions supporting patients at a particular disease level or an overall care level.
Some modules may support adherence to a particular therapy or improve its management. For example, a digital tool will determine whether a treatment selected for a new patient is actually having the expected effect on specific biomarkers that are measured digitally.
This scenario will come true only if we manage to create a connected healthcare ecosystem. Therefore, we need close cooperation between pharma, the tech industry, and healthcare systems to deliver full integration within health delivery.
No player alone will manage to build their own perfect system to address all patient problems.
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Unmet needs of patients create room for innovation
AstraZeneca has a clearly defined digital strategy that focuses on areas in which the company has already been delivering value to society: cardiovascular, respiratory and metabolic diseases; vaccines, immunology, oncology and rare diseases.
“When we think about digital, we are searching for solutions that address unmet patient needs,” highlights Bonam. For example, the company has recently been working on a better diagnosis of COPD. One in five new COPD diagnoses occurs after the patient has already been admitted to an emergency room with the first exacerbation of COPD.
In order to improve the diagnosis, the company analyzed the diagnosis pathway to understand what the pain points are and how the COPD cases have been successfully recognized.
The next step was to identify and implement the right toolkit to intervene in the neglected parts of the patient journey and – as a result – deliver the right solution and impact. So, the problem comes first and a solution or set of different solutions follow that can combine digital, medical, systematic or organizational interventions.
Digital solutions and cancer care
The area where digital solutions prove their value is cancer care. “We have had a lot of collaborations with digital health developers for early diagnosis. Another focus is developing an ability to detect certain fairly general side effects of chemotherapy. In this case, digital apps and platforms support patients in the management of side effects, allowing us to understand not only the patient experience but also the physiological and biochemical perspective of the treatment”, remarks Bonam.
Early support and intervention for the patients and their healthcare professionals can help prevent worsening patient conditions and even avoid hospitalization.
“Clinical trials are always the final deciders. We have to demonstrate the impact of every new intervention, no matter if it’s a pill or an app. It must be obvious – for the patients, clinicians and healthcare system – that the solution brings value”, adds Bonam.
No room for shortcuts
AZ is open to collaborating with startups, but only if they are confident that the solution is safe and effective. So, it must be carefully developed and evaluated.
Bonam puts it plainly: “I don’t see any reason for less rigor around the evidence for digital therapies than pharmacotherapies. And I know some people will make their arguments, but I have little understanding for them. At the end of the day, you’re making claims about your ability to deliver an outcome, so you need robust data demonstrating that you have that effect. And that the solution is safe and effective”.
Some would call it a conservative approach. But paradoxically, this might actually help speed up the adoption of DTx in the long term. The logic is that the more evidence there is, the more trust from the stakeholders there will be. And the more trust there is, the quicker the adoption will be. Which in turn will create more evidence.
However, AZ is also aware of the challenges. Digital solutions that evolve over time are becoming increasingly popular because they can be customized to individual needs. Therefore, according to Bonam, there needs to be a level of change management from a regulatory perspective that allows evidence-based changes to be made to a product as it moves through the lifecycle.
Nonetheless, the starting point is always strong evidence. “Some developers try to question it, and that’s wrong. Not having the budget to validate a solution is not an excuse for not validating it”, explains Bonam.
Digital care is “care everywhere”
This transparent policy towards value assessment should not be misunderstood. Actually, AZ harnesses the power of digital health solutions with enthusiasm.
The company has noticed that the demand for healthcare is growing faster than the supply of resources. DTx and digital solutions, in general, can serve large populations who can’t be served via the classical approach. For those who already have access to care, digitalization offers simplicity, convenience, individualization, and 24/7 care.
Imagine that AI-based tools are able one day to predict the onset of heart diseases, COPD exacerbations, or even lung cancer progression. Those are fantastic things that digital tools can do. What we need to do is get those solutions to scale in the right populations of people.
Before it comes true, we must start working hard to remove the barriers blocking digital transformation in healthcare. The lack of interoperability is one of them – its danger lies in keeping healthcare in silos. Every new solution must be created following data exchange standards and the patient journey. The healthcare system should be improved to deliver better outcomes, instead of adding another layer of complexity.
We should also consider the cultural aspects of digital transformation. If new healthcare delivery models are to be accepted, they should be designed to integrate closely with existing workflows.
“Having the right technology is only a prerequisite – what’s even more important is to understand the solution’s impact on the processes in healthcare, on the people involved in those processes, and how it fits the culture around us. This is the only way to get digital tools to scale”’, according to Bonam.
How startups can partner with pharma
For many startups, collaboration with a pharma company is the number one goal to scale up the solution. AZ gets many requests from different developers, but only a few are chosen for partnership. Even fewer manage to seize this opportunity.
“Do I expect startups to come to me with evidence? Not necessarily. But I expect them to come to me with the understanding of the need to generate evidence”, says Bonam. For AZ, another critical factor is a “cultural match.” Startups must understand the patient’s pathway; they have to incorporate the generation of really high-quality evidence in their roadmap.
I want people to come to me in love with the problem they want to solve, not in love with their solution to that problem.
Bonam gives some final advice: digital health developers should have a high degree of realism around their roadmap and business models. They should think as a startup in terms of innovativeness and agility but also have the mind-shift of a mature company operating in a highly responsible market – healthcare.
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