Pharma is starting to exploit the potential of data from connected devices and smartphones to help patients better manage their conditions
We’ve all read about the potential for data to transform healthcare by enabling patients to better understand their conditions and engage better in their treatment.
Now a handful of pioneers are starting to demonstrate the potential and to justify some of the hype. Some rapid improvements in outcomes and adherence point the way to a future in which agile pharma teams routinely work with ever more real-time, real-world data to rapidly and iteratively improve patient insights and outcomes.
In the era in which payments will increasingly be tied to results, such innovations should be of huge value, and will have the added benefit of nurturing much closer relationships between pharma, patients and healthcare providers, paving the way for further new insights and new products.
If pharma can overcome concerns about privacy and restrictive approaches to data sharing, as well as its lack of digital skills the opportunities are vast.
Novo Nordisk is pioneering the use of data from smart devices to help patients and physicians work more effectively on managing diabetes.
It identified diabetes as an area where patient adherence was poor and proving especially difficult to improve, says Anders Dhyr Toft, Corporate Vice President of Commercial Innovation for Digital Health, Patient Support Programmes, Device Strategy & Marketing at Novo Nordisk.
“We wanted to make sure people get more out of our products and one of the biggest issues and barriers to achieving good control is poor adherence. In diabetes that is worse than any other disease.”
The marked discrepancy between clinical trials and the real world where adherence was lower was especially striking, adds Toft. “That is appalling for us as a diabetes care company.”
While advances in glucose monitoring in recent years have undoubtedly helped improve the quantity and quality of useful data for both patients and doctors, it remains a tough disease to manage, says Toft.
Part of the reason is that sometimes patients avoid taking insulin when they should or they take sub-optimal doses. The lack of data on insulin dosage and the difficulty recording dosage was clearly a problem. Bridging this data gap promised a way to significant adherence improvements.
Early results with its ‘smart' insulin pen, designed to log insulin dosage data, are promising. A recently completed observational study in Sweden showed Type 1 diabetes patients and their physicians acting on the data from the pen cut the number of missed insulin injections by 43%. As dosages were optimised, control improved: patients showed a 20% improvement in good blood sugar control versus a baseline.
Mapping the patient journey
Connected devices are just one example of the possibilities. Getting the right data to people at the right time has huge value throughout the patient journey, from before diagnosis and beyond.
Allergy solutions company ALK offers another insight into the potential here. ALK’s consumer brand klarify.me engages with allergy sufferers on the main social media platforms and has developed the Klara pollen app. “It asks users to log how affected they are by their allergies in a simple way and whether they have used medicine or other remedies. It can track how users felt on a particular day when there was a high pollen count locally and even track it to a particular tree type that was in bloom, for example. This creates large new data sets that hold new allergy insights. Through machine learning, the app personalizes and predicts how the users might be affected, which is more precise than traditional pollen forecasts that are not personalized, says Louise K. Hjernø, Head of Digital Projects, at klarify.me.
These insights are presented in an interactive dashboard that helps users understand their allergy better, says Hjernø. Users can answer further allergy questions, enriching the app experience and personalising the in-app content. Most usersconsent for their data to be used in so that clarify.me can continue to engage with them. This enables the app to direct them to more articles helping them understand the different diagnosis and treatment possibilities.
The patients that begin allergy immunotherapy, can now start using ALK’s adherence app, which presents helpful information. This includes offering tips and tricks to help manage their condition and offering a dashboard to enable them to track symptoms and to see how they are managing their condition over time.
Results from users of the adherence app include patients reporting being adherent 80% of the time. The app also creates valuable real-world data that promises to yield further insights for both patients and physicians.
Mapping the patient journey in this way not only helps foster deeper engagement with patients, it also creates the possibility to accelerate the process of treatment in a virtuous circle of iterative actions, says Hjernø.
Closing the loop
By working with people suffering from a condition and nudging them to the right information and interventions in these ways, pharma can create a ‘closed loop’ of advice and treatment that enables them to quickly identify a problem, secure a diagnosis, find the most appropriate treatment and optimise adherence, says Cecilia Damgaard-Buyse, Head of Global Brand Management for the SLIT-tablet portfolio at ALK.
“What we have tried to do with our engagement is create different tools and websites to help steer them in the right direction. We give away data and receive data and use that to further nudge them on their journey.”
It’s an exciting prospect but pharma must overcome three main challenges if it is to realise the gains from getting valuable and timely data to the patient.
Suspicion about sharing data is one barrier they must overcome. This is more likely to come from HCPs than patients, says Toft, meaning there is much work to be done to build trust with providers.
Sharing data between different healthcare players poses the further problem of establishing legal boundaries when it comes to liability. With hardware and software adding to the complexity of regulated medicines this is a challenge, says Toft.
Being able to combine glucose and insulin data so patient and physicians could see a holistic picture of their data, required signing collaboration agreements with the leading glucose monitoring companies and finger prick meter makers.
Faster cycle times
Such complexity will be a reality others will need to navigate in an era of far more digitalised healthcare but it can also focus minds on new solutions. Novo Nordisk had to move fast to develop its smart pen solution which was realised in two years. In an industry used to decades long timelines this is a good thing.
It forced the company to focus harder on how it approached innovation, says Toft. “It required a new way of working in R&D and significant investment and focus from executive management on digital health.”
It also demanded a more agile way of working, adds Toft. "We realised we had to partner up and not produce all the solutions - for glucose monitoring and on the hardware and software side. We collaborated much more than we had done before and secured great external knowledge and compressed timelines.”
Arguably the greatest barrier pharma faces is its relative lack of digital savvy, in an industry that struggles to attract digital talent. Where the data is stored and consumed via apps, to have any value patients must want to use them. This is seldom the case. According to Damgaard-Buyse, only 18% of healthcare apps that are downloaded are used long term.
For klarify.me 43% of those downloading its Klara pollen app went on to use it long term. It achieved this by concentrating on the user experience and by bringing in outside digital expertise to ensure the user experience was compelling.
Easing the burden
Toft agrees that ease of use for patients is vital, when it comes to digital health. The data needs to be delivered in a friction free and easy to understand format. “Data needs to be captured automatically. Apps where patients have to enter information into the app will largely fail in my view. They have to be easy to use and they need to deliver value to the patient.”
One important lesson pharma companies that have consumer divisions can draw from the klarify.me experience is experience of building apps and other digital solutions on the consumer products side, where the regulatory requirements will typically be far less onerous.
Lessons learned on the app development side can then be applied to clinical solutions, dramatically reducing the risk of costly failures.
Perhaps the most vital lesson of all that pharma needs to learn when developing digital solutions is that it must always keep the patient front and centre whatever the clinical and regulatory constraints, says Toft.
“Sometimes the patient is a little forgotten. We have to remember that people living with chronic disease want get rid of their meds. In pharma and medtech we sometimes think patients are interesting in being a good patient. Actually they just want rid of their disease and their meds. We need to relieve some of their burden, otherwise these apps won’t be used.”