The merging of biology with digital technology is personalising health

27th May, 2015

Digital platforms are underpinning the move to patient-centred care. Across the spectrum, from drug discovery to diagnosis and treatment, staffing and skills development, to facilities management, the key to better health systems lies in the improved collection, analysis and deployment of data of all kinds

Recent commitments by leading technology companies including IBM, Apple and Google, underline the unstoppable momentum behind the movement to digitise healthcare. This will give exquisite control over all types of data, providing the potential to transform every single element of health and care, allowing for better use of resources, and making for more responsive and sustainable health systems.

The potential is clear, but the current position is complex. For a start there is a confusing array of terms and approaches that may or may not mean the same thing, or rest on the same technology base. The lexicon starts with big data, eHealth, telehealth, mHealth and assisted living, and moves on to stratified medicine, personalised medicine and precision medicine.

Alongside all the confusing terminology and competing technologies, there is much to be done at a policy and a practical level to pull all the strands together and provide the framework for the deployment of digital platforms.

The European Commission is working to set out guidelines and promote the development of standards to underpin the market. Measures including implementation of the new clinical trials regulation, and delivering the final versions of the data protection and the devices and diagnostics regulations that are both currently in the legislative works, will also be significant in the deployment of digital platforms.

Demonstrators light the way

While much is still up in the air, a number of pilot projects and live implementations are pointing the way and acting as demonstrators to show how digital technologies can productively be applied to:

• Improve drug discovery and development, reducing attrition and getting treatments to patients sooner;
• Capture patient data to speed diagnosis and the tailoring of subsequent care;
• Support a move from episodic care to continuous monitoring, putting patients in control and making it possible to anticipate exacerbations of chronic disease;
• Increase the productivity of healthcare staff by streamlining processes and providing clinical experts with decision support;
• Improve the management and responsiveness of health systems.

One of the most powerful drivers is the rise of mobile health, which is allowing patients to monitor their own conditions, and moving their care from regular outpatient or general practitioner appointments, to evidence-driven care.

There is evidence from various projects and pilots that putting patients with chronic diseases in control, allowing them to monitor symptoms, whilst knowing they can get attention if required, reduces the number of times they visit their doctor.

The logical conclusion, as summed up in the title of US physician, Eric Topol’s recent book, ‘The Patient Will See You Now: The Future of Medicine is in Your Hands’, is that health systems are re-oriented and care begins in the home.

Digital silos

There are great opportunities to develop new products and services and deliver them via smartphone. But there is a gulf to be bridged, in that mHealth is largely a bottom-up phenomenon that has been sparked by freely available healthcare apps. Data that individuals collect with the huge number of health, wellbeing and fitness apps sits in a separate silo from their medical records.

One of the biggest challenges is not only to allow the interaction of these repositories, but also to structure health systems so they are responsive to patient-collected data – and thus more accessible.

Another critical issue lies in opening the way for the secondary applications of anonymised data – whether collected on smartphones or sitting in conventional records systems – for use in healthcare planning, epidemiological studies, to inform public health initiatives, provide the evidence base for care pathways and commissioning, assess the feasibility of clinical study designs and speed patient recruitment into trials.

There may be a feeling that the term patient-centred care is fashionable jargon or meaningless lip service. But in fact it is the route to unlocking the value that is inherent in data. Patient-centred systems that give individuals control of their own data are the way forward. This is evident in registries set up by rare diseases patients’ groups, which make it possible to track the natural history of a disease, can be used to identify patients for clinical studies, to power trials and collate patient-reported outcomes.

Implementation of digital platforms

In parallel with its work to push forward on the legal and regulatory fronts, the Commission is funding research and development (R&D) to promote the application of digital platforms. For example, the €306 million ‘Personalising Health and Social Care’ project is funding pilots to demonstrate the potential of personalised medicine to address chronic disease management, improving outcomes and contributing to sustainability.

Another example is the programme, ‘Self-Management of Health and Disease and Decision Support Systems Based on Predictive Computer Modelling Used by the Patient Him- or Herself’, which reflects the fact that many medical problems could be prevented or better monitored and managed with the participation of the patient.

As outcomes from this it is hoped to:

• Improve participation of the patient in the care process;
• Improve the management of a disease by reducing the number of severe episodes and complications;
• Increase the importance of the prevention;
• Boost the development of personal devices for self-management of health;
• Improve individual control of health and disease prevention.

Boosting productivity of R&D

Pharmaceutical companies investing a combined total of €30 billion per annum in research and development in Europe are looking to digital platforms to boost productivity in discovery and development, speed the delivery of new medicines, and improve access and affordability.

The European Federation of Pharmaceutical Industries and Associations has put its weight behind regulatory initiatives including Medicines Adaptive Pathways to Patients, the European Medicines Agency’s Adaptive Pathways pilot and the UK Early Access to Medicines scheme. Working within the current regulatory framework, these initiatives are using digital platforms to feed in real world evidence to reduce risk, shorten development timelines and support pricing, reimbursement and commissioning discussions.

The industry is also involved in specific projects in the €3.2 billion Innovative Medicines Initiative 2 – the largest public-private partnership in the EU’s Horizon 2020 research programme – that have the aim of bringing the power of digital platforms to the discovery and development of new medicines.

A notable example is the GetReal project, which has the aim of factoring real world data into drug development. It is hoped that this will improve decision-making and reduce costs: Compounds that are going nowhere will be dropped sooner, while those that make it through to approval will arrive backed by real world data providing insights into how effective a drug will be in clinical practice.

Rather than basing reimbursement and commissioning decisions on phase III efficacy data, agencies will have a sense of how well a drug will perform in the context of individual healthcare systems.

A related IMI project, the European Medical Information Framework, aims to develop a common framework of patient-level data to link-up and provide easier access to medical and research data.

A brief perusal of any other sector confirms the potential of digitisation. While healthcare as a sector has been slow to join, there is now momentum around the introduction of digital platforms. Much remains to be done and the Riga conference “Universal health: Investing in Health and Wellbeing for All” will put a spotlight on the need for effective data collection, sharing, integration and use across the piece.