A roundtable report based on the Topol Review

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Healthcare has entered the digital age

The digital era is transforming healthcare. All stakeholders, including pharma, will need to adapt, finding new solutions to meet evolving challenges and opportunities. February’s Topol Review offers useful pointers. The inquiry, led by US cardiologist, geneticist, and digital medicine expert, Dr Eric Topol, explored how to support the deployment of digital healthcare technologies throughout the NHS.

There are wide-reaching implications for the industry.

With healthcare at this crossroads, MSL Health convened a roundtable discussion, consulting industry leaders, including communications executives, digital transformation experts, marketing chiefs and clinicians/clinical scientists to look ahead to the NHS’s digital future and the role of pharma within it.

HEALTHCARE IS ENTERING THE

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The healthcare workforce needs expertise and guidance to evaluate new technologies, using processes grounded in real-world evidence.

Patients need to be included as partners and informed about health technologies, with a particular focus on vulnerable/marginalised groups to ensure equitable access.

The gift of time: wherever possible the adoption of new technologies should enable staff to gain more time to care, promoting deeper interaction with patients¹.

1. https://www.hee.nhs.uk/our-work/topol-review

The three principles proposed by the Topol Review

IS TECHNOLOGY REMOVING THE ‘CARE’ FROM HEALTHCARE?

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The Topol Review calls for patients to be included as partners, with a particular focus on providing the same access to vulnerable and marginalised groups. It says the healthcare workforce should have the expertise to maximise the benefits from these new technologies. And staff should, as a result, have more time to care for and interact with patients. But the pursuit of these principles raises key questions for the pharmaceutical industry given its core role in developing new treatments – and its conspicuous absence among the large number of stakeholders who contributed to the report.

The roundtable focused on three critical questions to guide the discussion

Q.1How do stakeholders ensure that vital personalised care is supported in an environment where remote interactions with healthcare professionals are becoming the norm?

Q.2What is the solution to bridging the ‘digital divide’ to help prevent those with limited access becoming further marginalised?

Q.3Where can the greatest benefit be gained from the application of new technologies such as genomics, digital medicine, artificial intelligence and robotics?

How do stakeholders ensure that vital personalised care is supported in an environment where remote interactions with healthcare professionals are becoming the norm?

Personalised care means people have choice and control over the way their care is planned and delivered. It is based on ‘what matters’ to them and their individual strengths and needs.Today’s increasingly digital savvy patients appear willing to embrace new technology. Patients may welcome a quicker way to get health advice rather than going to see a GP for a face to face visit. Direct consultations with healthcare professionals are already being supplemented with video and phone consultations.

Up to 30 per cent of the population lives with two or more long-term conditions². The increasingly complex nature of chronic disease management will make it even more important for stakeholders to communicate effectively with each other. Digital tools can allow time to be used more effectively and care to be customised. Digital technology might free up more time for those who need personal interaction with their clinicians, while others could use an algorithm and self-prescribe. There is some evidence that algorithms can offer

sound advice. Empathy, though, is conveyed differently across a machine interface. Patients are changing: the next generation may not need or even expect face to face engagement. This could change even further with artificial intelligence.

But is the pharma industry paying enough attention to skilling patients in communication for this new digital world, or giving sufficient thought on how it’s going to reach them? The aim is to make

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companies digitally focused, with patient engagement upper-most in everyone’s minds. Some companies are trying to bridge the gap. They are actively researching digital solutions and mapping new external stakeholders who might get involved.

However, many in the industry seem to think that there’s a long way to go on communications for digital change and using digital channels.

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Q.1

2. https://richmondgroupofcharities.org.uk/taskforce-multiple-conditions

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Industry has to raise its game in key areas

It needs to have more activities that talk to patients and equip them to make the most of access to healthcare that doesn’t involve a face-to-face meeting with their GP. With greater preparedness, big pharma will be in pole position to help lift patient engagement to the next phase, which some have dubbed Health 5.0. This will employ the latest digital tools to boost the personalisation of care. It recognises the core role of patients as customers – going well beyond patient-centric healthcare towards customer-centric wellbeing services.

EQUIPPING PATIENTS FOR

Patients are increasingly digitally adept, embracing new technology to engage with personalised treatment plans. Making patients strategic partners in their health is fundamental to a new level of engagement, better enabling them to navigate the fast, disruptive changes that are shaping the new healthcare environment.

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“PARTNERSHIPS ARE THE KEY.

I DON’T BELIEVE THAT PHARMA CAN DO IT ON ITS OWN.”

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What is the solution to bridging the ‘digital divide’ to help prevent those with limited access becoming further marginalised?

Will the divide between the technophiles and technophobes – separated on the basis of age, socio-economic class or simply inclination – limit the spread of these benefits? This raises another pertinent question: how will we give patients the skills – or even ensure the degree of social involvement – they need to make the most of digital healthcare? It’s back to reaching beyond the engaged patient. People who welcome digital healthcare – or even those who tend to get involved in related trials – are more digitally savvy; in other words, a self-selecting audience.

But what does the industry actually know about customers and patients? And is it in the position to bridge the information technology gap in healthcare? Big companies might have 20 to 30 people talking to clinicians every day; in future they are likely to get their insights from digital routes and tools.

New players will enter the market. It is now easier for tech giants to enter digital healthcare by piggybacking on a smaller existing health organisation, thanks to their existing scale and infrastructure. In the not so distant future we are likely to see digital health platforms

by tech giants such as Apple or Amazon which will integrate all types of healthcare data – and help consumers through predictive and preventive care models.

There will always be a role for pharmaceutical companies in developing new medicines. Regulation will be a huge issue for the industry. Many stakeholders still have to get to grips with the notion of NHS and social care working together. But there will need to be big changes, particularly in regulation if the pharma industry is to play its part in boosting public health in the digital age. The burgeoning market in health apps underlines this. Several informants referred to the “wild west”

“IT’S ALL VERY WELL HAVING AN OFFICIAL

MISSION STATEMENT TO MAKE PATIENTS’ LIVES BETTER. BUT IF WE’RE GOING TO MOVE INTO THE DIGITAL SPHERE

AND SUPPORT DECISION MAKING TOOLS, WE HAVE WORK TO DO.”

of half a million or so apps, with many of the popular ones lacking an evidence base, in comparison to the high burden of proof for the effectiveness of new medicines.

Q.2

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DIGITAL DIVIDEDIGITAL DIVIDEDIGITAL DIVDEDIGITAL DIVDEDIGITAL DIVDEDIGITAL DIVDEDIGITAL DIVDEDIGITAL DIVDEThe industry can currently only communicate with “other relevant decision makers”

But in the new world who are “relevant” decision makers? Personalised medicine will thrust this role onto patients. Yet industry representatives can’t promote medicine directly to the public, or interact with social care – an area that is increasingly seen as indivisible from healthcare. It may well be time to relax or revamp those rules.

We can’t really predict what changes will have occurred in 20 years’ time. But the industry can and should be proactive – and adapt to shape the future for the benefit of all. The importance of personalised care needs to be considered right at the beginning of the development of a new treatment.

Pharma can and does engage patients in the drug development process with everything from scientific discovery and drug development, to disease management and patient education. But additional questions will need to be asked as a matter of routine. How is this treatment going to be delivered to the patients? Is it the type of medicine that will fit into an algorithm? And in this case, how do we design our clinical trials to accommodate this?

There is much for the industry to be positive about: it has a fantastic history of public health campaigns with patient groups and charities in helping provide the expertise and funds to make people aware of things they might otherwise not be.

But to take this to the next level, in the digital age, the industry will have to champion digital tech for patients, and let them know how it can help them. Pharma reps might not need to see 200 GPs because an algorithm will tell them what to prescribe. Instead, we could see reps taking public health campaigns to much larger consumer audiences – for example, via football grounds.

The Topol Review calls for programmes to engage and educate the public on digital healthcare technologies. To do this, the NHS will have to develop national industry exchange networks, as well as opportunities for clinicians to partner with academia and the health tech industry.

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BETTER AND SAFER PERSONALISED

TREATMENTSTTREATMENTSTREATMENTSTREATMENTSTREATMENTSTREATMENTSTREATMENTSRARE DISEASESRARE DISEASESWhere can the greatest benefit be gained from the application of new technologies such as genomics, digital medicine, artificial intelligence and robotics?

Advances in everything from earlier diagnosis to better and safer personalised treatments promise to revolutionise healthcare. Breakthroughs in genomics, computing and diagnostics will allow clinicians to deliver personalised, precision care to patients.

Artificial intelligence – the branch of computer science dealing with the simulation of intelligent behaviour in computers – is already beginning to play a big role. A handful of companies have developed algorithms that are able to learn and evolve as they gather information. In April 2018, in a real first, the Food and Drug Administration approved IDx-DR, an imaging tool driven by AI that detects diabetic retinopathy. Trials for the automation of breast screening are already underway. Wearable technologies will allow patients – and clinicians – to monitor a range of vital signs, including glucose levels, away from the clinic.

The Topol Review’s emphasis on preventive medicine requires genomics to play an ever-larger role. But the rise of genomics could leave a long ‘tail’ of rare genetic conditions – and patients – at risk

of being forgotten. It’s relatively easy designing personalised care for vascular disease or diabetes. Common diseases have engaged sizeable patient organisations, from which you can get input or members of a steering group. There is a challenge to do this for rare diseases.

Financial dilemnas do exist and these must be considered when looking to maximise the benefits of technological advances. The crucial economic question: Is it the industry’s job to pursue medical research for the 1%, those who don’t respond to existing treatments, the long epidemiological ‘tail’?

Everyone agrees that someone should do it. But, for this to be financially viable, there will need to be a fundamental change in our approach to healthcare economics. The benefits from digital technology should provide the incentive.

Technological advancements could provide direct benefits for industry; it might provide even more focused R&D with greater efficiency and savings. Digitalisation would see pharma companies specialise more; concentrating on doing fewer things but doing them better.

Q.3

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The expert patient is on the rise

And when it comes to digital transformation, as with everything else touched upon in the roundtable discussion, patients need to be included.

There is a fundamental need for the industry to be involved in digitalisation policy. The Topol Review sought little or no industry input and just one pharmacist was involved in the whole report. Even though the community pharmacist is a key figure in patient access to healthcare there was no discussion in the report about their role and how technological changes would affect them. The ABPI hinted at this disappointing lack of inclusion by pointedly noting that digital healthcare challenges would be “most effectively addressed through collaboration across NHS, academia and industry”.

It is essential to ensure the right new partnerships are forged with other stakeholders (while acknowledging that different companies have different priorities and concerns). It will be interesting to see what the new NHS unit designed to oversee digital transformation of the health service, NHSX, will bring to the table³.

Rethinking our approach to clinical trials in an era of personalised medicines is unavoidable. This will require a redesign of trial methodology and reporting and an increased reliance on open data and evidence. This could bring benefits in terms of increased public trust.

Clear guidance on what standards should apply to new technologies would also be welcome - the Topol Review appeared to suggest that different rules might apply in future. It may well be time to adjust or revamp those rules.

And finally, digital transformation will require embedding tech skills throughout the pharma workforce. The Topol Review cleverly models future careers in healthcare showing how our current roles will change over the next decades; and we can fully expect to see roles in pharma changing too.

“PHARMA MUST ALWAYS LISTEN TO PATIENTS. WHEREVER THINGS WE’VE DONE HAVE

BEEN WELL RECEIVED, IT’S BEEN BECAUSE

WE PUT THE PATIENT AT THE CENTRE – AND

WHEN WE DO THAT AND WHEN WE DO IT WELL, EVERYONE BENEFITS.”

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3. https://www.gov.uk/government/news/nhsx-new-joint-organisation-for-digital-data-and-technology

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Contact Alison Dunlop, Managing Director, Health at MSL

and join the conversation.

alison.dunlop@mslgroup.com +44 (0)20 3219 8700

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