Personalised, digital healthcare could be saving lives during the pandemic
From the earliest days of the crisis, doctors warned of the unintended consequences of social distancing – including people failing to seek the medical attention they need. By May, an investigation in northern Italy uncovered a 58 per cent increase in out-of-hospital cardiac arrests that coincided with the worst of the Covid-19 outbreaks. In Italian regions where the pandemic arrived earlier, the increase was as high as 187 per cent. In June, Cancer Research UK warned that an estimated 24,000 cases of cancer had gone undiagnosed after almost 2.5 million people failed to be screened, tested or treated.
There has always been a need for better remote, digital care to fill the gaps in the healthcare system. But Covid-19 has exposed the urgent need to bring the entire healthcare system up to date so that digital tools can have the greatest impact.
“The flywheel of remote care is beginning to turn,” says Pravene Nath, Global Head for Digital Health Strategy in Personalised Healthcare at Roche. “It’s like a call to action that allows us to launch more disruptive models of care. It won’t work for us only to build digital tools and expect that they will be adopted into existing clinical practices. We need to redesign the ecosystem.”
Nath has spent the majority of his career evolving that ecosystem. Having trained in clinical medicine, he was quickly struck by the often disjointed and archaic nature of medical record-keeping and decided to move into health IT roles. He became Chief Digital Officer of Stanford Healthcare before moving to the startup world. At Mindstrong, he helped people with serious mental illnesses such as schizophrenia and bipolar disorder access remote care through the company’s app and digital telehealth programme.
Throughout, Nath’s goal has always been the same: to use technology to connect with patients, provide value, and gain sustained adoption that broadens access to populations who may benefit the most.
“I’ve learned you have to be specific about the user and customer you are serving, and as crisp and narrow as you can be in the definition. Within that process, it’s about rapid, iterative learning,” says Nath. Roche’s team of developers rely on constant user feedback to design software and systems that people will use intuitively, and happily keep coming back to. “We build in analytics that allow us to test how a feature or use case will drive sustained engagement,” says Nath. “We do that quantitatively so all our decisions are data-driven. You really need the right kind of measurement systems to drive digital engagement. You also need the right partners, who are motivated to change the way that health care providers work.”
One such recent collaboration with Moorfields Eye Hospital was launched mid-pandemic as a pilot project to meet the urgent needs of vulnerable patients with retinal diseases. It’s estimated that by June 2020, 10,000 people missed out on care vital to their eyesight, while it was reported that 8,000 fewer people received injections for age-related macular degeneration. At-risk individuals used Roche’s Home Vision Monitor app to undergo a simple vision test that takes minutes. The data is shared with ophthalmologists who track patient progress or decline, triggering remote or in-person consultations if necessary. It’s the ideal example of saving healthcare time and resources, reserving interventions only for when they are necessary. “The current pandemic forced us into this quickly,” says Nath. “The app builds in comfort. Monitoring provides users with a sense of security, which is important during the pandemic and also as we develop new drugs that may reduce the need for frequent office visits.”
One of the key learnings from the pilot has been to build support programmes to help patients understand and use the app, as opposed to leaving it to physicians to provide this support. Digital literacy among physicians is just one of many hurdles healthcare providers need to cross to enable wide uptake of digital tools. And it needs to be wide, to make a difference. The more data providers have on a condition, or a particular individual, the better the care becomes. Ultimately, it will enable personalised and preventative remote care to one day become the norm, reducing the time and cost it takes to deliver superior care.
It might seem counterintuitive, but Nath suggests that communities where remote care and electronic health records are absent present the greatest opportunities for advancement. “We think of electronic health records as a prerequisite before building advanced digital solutions, and we do need that real-world clinical data to surface insights,” says Nath. “But electronic healthcare records can be a barrier to adoption of new technologies which are viewed as potentially overlapping. There are opportunities for digital to leapfrog in markets and ecosystems where electronic records have not penetrated. The result is smaller, more focused use cases for disease management where the digital tool is the primary mode of care.”
And the rest of the hurdles? “Solutions need to be culturally sensitive and aware; we have to overcome people’s concerns about where information goes; there’s the literacy problem; access; interoperability; the willingness of providers to share and operate with the same data…” The list goes on, adds Nath, with a chuckle – “it’s difficult, but I do feel optimistic.”
“I don’t think it has to be solved immediately at scale. I like the fact we’re seeing success among companies that have this viewpoint. There are redesigned clinical teams that use digital tools, and we’re seeing it in chronic disease management such as diabetes and in mental healthcare. I’m excited about that. In our lifetime we can expect to see that expand into more complex diseases, and eventually into a continuum of care.”
“As a patient and a person you will be constantly connected to the system that will care for you – passively through a device, and actively through trained professionals who use digital to work more efficiently. The ecosystem will be fully aware and activated all the time, throughout your entire life.”
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