Digital technology has gradually become embedded in medicine over the last 50 years. Walk into any hospital and it is pervasive. Everything is wired. Most of these wired technologies address standard patient care concerns such as patient records and patient monitoring (heart monitors, blood pressure, and others.) The typical hospital room looks as if bowls of spaghetti have been thrown about.
However, wireless reliability, security, and range have rapidly improved over past five years. As a result, we have seen wired replaced and a rapid merging of wireless technology and medicine. In addition to wireless, other technology innovations such as cloud computing are contributing to the accelerating convergence of technology and medicine.
Advancements in genomics and biomarker are creating new possibilities in preventative care and the diagnosis and treatment of chronic disease. These advancements, combined with real-world patient data, are allowing life sciences companies to develop more personalized medicines.
Eric J. Topol, MD, director of the Scripps Translational Science Institute, professor of Translational Genomics at The Scripps Research Institute, predicts that wireless phenotyping will allow us to understand human biology at the genomic and physiological level. This will allow an understanding of each individual at the granular level, and enable prevention and optimal management in a precise and efficient manner. (John M. Bue, 2011)
Social Media and the Internet
Patients are becoming more technology savvy and unafraid to take their health concerns into their own hands. Patients have an expanding set of resources at their fingertips. They want to be educated and be part of the decision-making process of their health. The expanding universe of health information on the internet along with social media and changing attitudes around privacy allows patients to find their voice in the conversations about their care.
WebMD is a great example of this. WebMD educates patients and caregivers on a variety of health issues and diseases and has been around for over a decade. 72% of online U.S. adults have looked for health information online in the past year1. Patientslikeme.com provides patients with the resources to compare treatments, symptoms, and experiences with people like them and take control of their own healthcare.
As these types of sites on the internet became available, patients and caregivers wanted more. When this occurred, the old paradigm of medicine characterized by “diagnose and treat” and the physician as the master is becoming a thing of the past.
Advances in wireless technology are making it possible to monitor patients inside and outside clinical settings. Companies are developing wearables. Wearables are Wi-Fi-enabled sensors that detect vital information relay it to patients or physician in real time. Advances in the area of nanotechnology and ‘nanomanufacturing’ are contributing to the development of smaller and more convenient wearable or implanted sensors. The application of sensors is wide ranging:
- Check Patient Vitals: Once patients affix Preventice’s BodyGuardian sensor, it collects a wealth of data — pulse, respiration rate, activity levels. It alerts a doctor if anything is off base.
- Assess Impact: A helmet sensor developed by Reebok and tech firm MC10 analyzes head impacts during sports play. It flashes a light when players get hit too hard, so they will know to take a break.
- Track Medicine: Proteus Digital Health is developing a grain-of-sand-sized sensor powered by stomach fluid that could be swallowed as a pill. The sensor would then relay information to a smartphone about the effects of a particular drug.
- Improve Athletic Performance: Another MC10 sensor, stuck on like a Band-Aid, sends real-time hydration levels to athletes’ smartphones so they know exactly when and how much they should drink.
- Nurse Patient Wounds: John Rogers, a researcher at the University of Illinois, is developing tiny, dissolvable sensors that can generate heat near surgical incisions to prevent infection.
- Keep Skin Healthy: A translucent sensor developed by MC10 can be stuck on to check users’ UV-exposure levels while they sleep and recommend the best moisturizers.
- Managing Adherence: Pharmaceutical companies are experimenting with embedding sensors in tablets (Proteus Digital Medicines) or with smart pill boxes like Vitality GloCaps® that can collect data on timely pill usage. The use of approved sensors makes it possible for Life Sciences companies to capture feedback from patients about potential adverse events and outcomes. The FDA recently approved its first remote monitoring drug trial (Greg Slabodkin, 2013).
As the use of wireless sensors gains traction, we see a shift in the paradigm. Health data is no longer a “system of record” but a “system of engagement” that enables stakeholders to do more than simply “record” it. What is the implication for the pharmaceutical industry? They will have the ability to generate more real-time insight through digital technology. This will improve patient safety and reduce costs of running clinical trials.
Health Care Apps
The IMS Institute for Healthcare Informatics recently conducted a survey of that included a study of 40,000+ apps available for download from the U.S. Apple iTunes app store. Their study included an assessment of the potential value they provide throughout a patient’s journey. According to IMS, “This (study) clearly demonstrates that to date most efforts in app development have been in the overall wellness category, with diet and exercise apps accounting for the majority available. Further, an assessment of the functionality of today’s available apps finds that they have both limited and simple functionality, the majority do little more than provide information.” (IMS Institute for Healthcare Informatics, 2013) The study reports that there is a significant skew in download volume for healthcare apps. More than 50% of available apps achieve fewer than 500 downloads. Conversely, 5 apps account for 15% of all downloads in the healthcare category.
The study also found that the ratio of apps is disconnected from the greatest areas spend. “apps developed to date do not fit well with the greatest areas of spend in healthcare – those patients facing multiple chronic diseases and typically over the age of 65. These patients are likely to be among the top healthcare spenders but smartphone penetration is lowest among this group, with only 18% of the U.S. population using them, compared to 55% of those aged 45-54 year”
This disparity may be a result of market research that focuses on the 65 years and younger market. It is possible that because of such misleading research, most product development seems to focus on the tech-savvy boomers and their interests in fitness and self, rather than on the 65+ seniors. In addition, less than 100 of the 40,000 apps have been proven to produce positive outcomes by completing clinical trials. This is a big gap in health care and digital medicine.
Information Technology and Cloud Computing
R&D requirements for large datasets and associated computing capacity—as well as collaboration across entities—makes R&D a prime candidate for cloud applications. Some of these demands stem from the enormous amount of data generated from areas such as bioinformatics, gene sequencing and molecular imaging and modeling. In these cases, the cloud offers a scalable, cost- effective and high-performance computing environment. In fact, Amazon Web Service (AWS) now offers an entire Life Sciences cloud stack designed to get such research platforms up and running quickly. This not only provides access to relevant and essential public data but also the tools necessary to analyze data quickly.
As in Medical Advancements, it is difficult to separate Cultural Advancements from technology. Setting aside the debate on whether the Internet and the social networking capabilities it gave birth to have created social decline instead of social advancement, the Internet, websites, blogs, pixels, megabytes, gigabytes, URLs, apps, etc. are pervasive in our modern lexicon.
What the Internet has done is provide a mechanism that enables people to fulfill their need to be connected. Some argue that the real value of the Internet has not been the “Information Super Highway” but the ability to form spontaneous online communities of people with common interests. These communities cover almost every conceivable activity and concern.
Most important to this discussion are those communities that address people’s health concerns and medical care. A Google search can find thousands of sites dedicated to Obesity, ALS, Fibro Myalgia, Cancer, Diabetes, etc. What is striking is the number of people who are willing to share their stories and gain insights from others about their disease. This openness would have been taboo 20 years ago.
Millions of people around the world live with life-changing and chronic diseases. They often have specific questions about their treatment options and about what to expect. They wonder – “Is what I’m experiencing normal?” or “Is there is anyone out there like me? An online patient network, PatientsLikeMe, is “where people find the answers to those questions, and connect with others who know firsthand what they are going through.” Today, members have reported their real-world experiences on more than 2,000 diseases. Diseases include everything from rare diseases like ALS to more prevalent diseases like depression, fibromyalgia, multiple sclerosis, and psoriasis.
Through health profiles, members monitor how they’re doing between doctor and hospital visits. They also document the severity of their symptoms, identify triggers, note how they are responding to new treatments, and track side effects. They learn from the aggregated data of others with the same experiences and see, often for the first time, just how they are really doing. They also get and give support from others that will help them live better day to day.” (PatientsLikeMe, 2014) A survey of by PatientsLikeMe (PatientsLikeMe, 2014) of 2,125 members in the U.S. says that adult social media users with health conditions embrace the idea of sharing their health data online if it helps clinicians improve care, helps other patients, or advances medical research.
- An overwhelming majority would be willing to share health data if it could help others in some way. 94% would be willing to share to help doctors improve care. 94% would be willing to help other patients like them. 92% would be willing to share to help researchers learn more about their disease.
- Four out of five respondents (84%) would be willing to share their health information with drug companies to help them make safer products. And 78% would do so to let drug companies learn more about their disease.
- 94% believe that their health data should be used to improve the care of future patients.
A for-profit founded on a philosophy of “openness”, PatientsLikeMe aggregates the data, analyzes them and shares the results with health care and life science companies. This accelerates research and develops more effective treatments. However, Pharmaceutical companies have been slow to adopt the social media channels as a way to reach patients and to garner patient insights from the kind of interactions like the ones taking place on PatientsLikeMe. Tapping into these patient stories and understanding the patient’s experience can help to improve product design and create better patient outcomes.
These cultural changes are creating bold strides in medicine. But, is that collective intelligence asking for more cool apps? The danger is that the force of the technologies, brainpower, money, assumptions of value, may be rushing in the opposite direction, to cloud-based analytics interpreting biometric and other data elements captured from the device-o-sphere.
Defining Digital Medicine
We have seen how the convergence of Medical, Technological and Social Advancements has shifted the discourse around the practice of medicine. In our opinion, you cannot have a discussion about most aspects of modern medicine without a discussion of digital technology and the patient. This convergence has the potential to create a networked, highly connected health ecosystem that enables patients, doctors, pharmaceutical companies and other providers to dynamically engage with health data rather than simply record it.
“Digital technology has the potential to make the practice of medicine more precise, more effective, more experimental, more widely distributed, and more egalitarian and more patient centric than current medical practice. The data will engage us…we go from measuring, storing and using health information from a “single point of time” (SPOT measure) to a continuous stream of health information. We can think of this as analogous to the shift in financial services from a SPOT measure of a stock price to streaming stock prices. Way past digital health, and right around the corner from connected heath, is the construct of a stream of health information; health indices, and eventually the last generation of mankind capable of successfully using the excuse “I did not know”. Richie Etwaru, Group Vice President Digital Innovation, Cegedim
I began writing this blog with the intention of answering the question “what is digital medicine?” As with most questions, seeking answers can sometimes spawn more questions, such as:
- Is a hand-held ultrasound device digital medicine?
- Is a sensor for monitoring blood glucose for a diabetic considered digital medicine or a sensor on a pill cap bottle? Are RFIDs that track patients and assets digital medicine?
- How about a mobile app that allows you to track your diet and exercise?
- What about a device for arrhythmia monitoring?
- What about sensors on pills?
- And is there a difference between digital health, mHealth, digital medicine, telemedicine, etc. We hear all of these terms and how do they relate?
From a pragmatic perspective, digital medicine is not any one “thing.” Whether it is wired or wireless, it can be all of the above as long as it addresses the basic human concern for better health in a way that enhances the delivery of care in a way that is not harmful. From a philosophical perspective, if we remove the “things” from the equation, digital medicine is more likely an ongoing conversation around health that includes medicine, technology, sociology, community and finance.
As Unity Stokes puts it: We are in a Creative Destruction moment in healthcare but it’s incredibly early. We’ve seen a lot of incremental movements forward and experimentation with what’s possible. Amazing entrepreneurs and money are starting to pour in and a budding digital health ecosystem is emerging. The past year proved that many pieces are in place (investment and incentives, reform, talent, desire, market demand, etc.) to set us up for a much more radical transformation in healthcare as every aspect of our health and wellness is beginning to be reimagined. There’s now a rapidly growing global community who understands that change is not only possible, but inevitable, and best of all many are taking action. Unity Stokes, Co-Founder and President, StartUp Health
In my next blog, I will be writing about digital medicine and what it means to the pharmaceutical industry. Healthcare, in general, has been adopting digital medicine but pharma has been slow to react and adopt in the few instances digital medicine has been pursued…this must change. Patients need digital medicine.
Greg Slabodkin. (2013, January 1). Retrieved from FierceMobileHealthCare: http://www.fiercemobilehealthcare.com/story/fda-approves-first-remote-monitoring-drug-trial/2013-01-01#ixzz2HHl9mWK4 IMS Institute for Healthcare Informatics. (2013). Patient Apps for Improved Healthcare: From Novelty to Mainstream. John M. Bue. (2011, Jan). The Digital Medicine Revolution in Healthcare. Healthcare Executive ache.org. Nosta, John. (2014, Jan 2). Digital Health In 2014: The Imperative Of Connectivity. Retrieved from Forbes.com. PatientsLikeMe. (2014, January 23). PatientsLikeMe Survey Shows Vast Majority of People With Health Conditions Are Willing To Share Their Health Data.