At BIO-Europe Spring 2022, Javier Nunez Vicandi of Heal Capital hosted a wide-ranging panel discussion on the timely topic of ‘How Digital Health Technologies Can Support Systemic Change in Healthcare’. The panellists were David Braun from Merck Healthcare, Ed Cox from EVERSANA, Nino da Silva from BC Platforms, and Valerie Kirchberger from Heartbeat Medical. The panel focussed on how real-world data can make a meaningful difference to society, and what the drivers are for a digital transformation in healthcare.
If our collective humanity’s truly difficult experience over the last two years has shown us anything, it’s that digital health is here! To try and see a doctor in person in 2022 can now be as impossible a task as trying to have a simple tele-health call was in 2019. But it is impossible until it is done, and now many stakeholders are avidly looking at ways to make the most of patient data, including the more subjective patient reported outcomes, and build a new generation of healthcare.
But as sci-fi author William Gibson once famously said, ‘the future is here but it’s not evenly distributed.’ Whilst we’ve seen a tremendous leap forward in data collection and handling technologies that have enabled new approaches such as decentralised clinical trials, we’re still struggling to derive basic value from public health data.
Tomorrow’s transformation, today
As Ed highlighted, the much-promised digital health transformation has been coming in cycles for decades, but the pandemic has swept us all up in a permanent sea change as to how we make use of digital. Imagine how many grandparents could do a Zoom call in Jan 2020 and compare that with Jan 2022. What would normally be twenty years of clinical trials innovation has been compressed into just two. There’s been a radical shift in how digitally advanced society has become. This is the moment to lean in, and lean in more, as we’re on the crest of a wave of meaningful change.
Valerie drew the important distinction between data that can be used for public health purposes, e.g., disease surveillance, and that used to inform the development of medicines and treating patients. Valuable data points on the continuum can include disease co-domains, with variables of a more subjective nature, such as levels of pain, and social participation, which reflect an individual’s general quality of life. Such patient reported outcomes are also part of the care continuum, but without good connectivity, they can just be a sea of data points dotted across an archipelago of islands containing isolated use cases.
Different use cases are needed for advancing different aspects of digital health, as David outlined. From a pharma perspective, digital data from R&D and clinical trials can provide significant value, especially in enabling more to be done with fewer patients, and quicker. This is not just about patient data, but wider aspects of the global provision of medicines, such as monitoring the supply chain, medicine consumption patterns, and patient support programmes. These provide other value drivers including efficiency, reducing waste, and risk sharing with payers. It is not just about monetisation. It is also about other players, such as big tech companies, who are collecting millions of data points from people connected by their wearable devices, such as smart watches, and need to find a way to make best use of that data.
Leaving colonisation behind
Nino’s view was that whilst we have all these new ways of collecting data, our thinking is still caught up in old ways. Companies talk in traditional ways about harvesting data, which is a form of colonisation, and unsustainable. Data belongs to the citizen, and the society they live in. Its portability is also low: polygenic risk scores derived from data from UK diabetes patients, with over 60 markers, does not translate well into clinical insights for Spanish patients. The same goes for Schizophrenia with over 100 markers. Patient data should reside in multiple places, but be useable, not left as islands of use cases as Valerie mentioned. The technology is already here, and in use, to look at different patient cohorts with different haplotypes. This valuable Real-World Data, including genomics, can provide insights, using carefully trained algorithms on federated data, to inform clinical decision making, without any data needing to live the citizen’s home country.
Ed spoke to what’s holding transformation back: the lack of a clear pathway to commercial value. Innovators are looking at what might be paid for, and working back from there, which inherently constrains the overall benefit that could be derived. This also explains why, for example, oncology data is orders of magnitude more valuable than general population health data. The former can be more easily, and obviously, monetised: pharma will buy that data. Government intervention is needed to make data deliver more, and wider, breakthroughs.
Plus, as he outlined, people don’t always make the best choices: stopping smoking and taking more exercise are transformational but only if people do make those lifestyle choices. There’s a burden on innovators to help make it easier for individuals to take informed action from the outcome of digital health approaches. Digital health should help people make easier, faster, more impactful decisions. It should make data actionable and provide high-touch recommended lifestyle choices. And that’s where the gaps are at the individual level.
An associated problem, as Nino highlighted, is that payors are not made for this: hospitals are not rewarded to prevent, they are rewarded to treat. This needs to be solved to better deploy digital health approaches for the widest societal benefit. Ed posed the philosophical question of whether society’s overall goals should be around ensuring as many people as possible remain generally healthy or focus on those who might die of something specific. Valerie highlighted how this speaks to the ethics of medicine, and how despite having the technology we are not leveraging it enough to make the changes we could. Some lifestyle apps can be excellent for nudging individuals towards healthier behaviour.
Making the last mile meaningful
The last mile issue, as David laid out, is measurement. What really makes a change in behaviour is having trusted feedback to show that the change is making a difference. Diagnostics can help close the loop in showing the impact of real-world data and enable the monetisation of its value. But having multiple apps for an individual with a chronic disease is not user friendly, and a barrier to adoption and diffusion of innovation. Value creation from digital health approaches is still evolving, with a challenge being different stakeholders in the ecosystem have different perceptions of value. Although, as Valerie said, overall everyone should be aligned on seeking improved quality of life and improving humanity’s health. To achieve this, the system needs to change so money flows towards value-based care, with, for example, goals for reimbursement linked to patient outcomes.
Nino commented on how, in the Nordics, there has been significant investment into researching how to improve care through systemic change, but the findings have generally not been put to much use. Now, with new European regulations about sustainable marketing and monetisation of data, citizens can engage, should feel they receive something, and will substantially change how the money flows, just as Valerie calls for.
Currently many groups in many places are taking different approaches with different payment structures, which, as Ed said, is fine, as a proliferation of innovation is needed, for both the general health of society, and the specific health of individuals. We should push forward on all fronts, see what the best ideas from around the world are, then see where there’s a more universal way. Circling back round to Valerie’s observations, connectivity is what will make all this happen. BIO-Europe® is just the place to help make the connections that will enable a sea change in healthcare.
