Digital platforms will be a driving force behind the move to patient-centred care, providing the means to improve the collection, analysis and use of data of all kinds.
For Peteris Zilgalvis, Head of Unit, Health and Well-Being, DG Connect, European Commission, who is currently shaping the EU’s approach to mHealth, the potential is very great. There is the opportunity to empower patients, promote prevention measures and improve access to healthcare, whilst at the same time creating growth and jobs.
The EU approach to mHealth encompasses three perspectives:
- apps used in healthcare systems to deliver services such as ePrescriptions and appointments;
- apps that support social innovation and health literacy, helping patients and consumers to manage their health and wellbeing in the way they want;
- consideration of how commercial sector apps can be validated and the issues of trust and data protection can be overcome, allowing mHealth apps to become an asset in the move towards personalised healthcare.
Of the current catalogue of 120,000 mHealth apps, a few are regulated as medical devices. A few hundred others have been validated in some way, for example by patients groups or health systems. However, with most apps attracting and losing users within three months, there is a fast turnover. “It’s a market that is evolving rapidly so we have to address it in a way that does not hamper the development of the technology or the benefits, but addresses any negative impacts,” Mr Zilgalvis said.
Following on from the Green Paper on mHealth and the responses received, the EU is taking three steps to support evolution of the market:
- assisting industry in drawing up a voluntary code on privacy and security;
- convening a stakeholder meeting on the quality and reliability of mHealth apps;
- creating a pro-innovation framework for non-embedded software.
There will also be follow-up actions to support mHealth under Horizon 2020, in digital health literacy, big data for public health, digital security, and evidence gathering and exchange of best practice.
Zoltán Kaló, Professor of Health Economics and CEO of the Syreon Research Institute, told the conference big data platforms should be deployed to inform decisions about how to make the best use of healthcare resources and to monitor the impact of these decisions.
In Hungary for example, increasing expenditure on cancer drugs has had no impact on mortality rates. “Is that because the drugs are no good, or because the patient pathway is blocked? We don’t know,” Mr Kaló said. He believes the problem is caused by slow access rather than ineffective treatments and is hoping big data will unpick this.
“Currently, the financial decision makers are not impressed by the return on investment in health, so we need to show [investment] is generating health,” said Mr Kaló “Big data can show where the problems are and where to intervene to make better use of resources.”
For the pharmaceutical industry big data will underpin a shift towards its products being valued in terms of the outcomes they deliver, said Elizabeth Kuiper, Director of European Affairs at EFPIA.
One example is in the Innovative Medicines Initiative project ROADS (Roads to outcomes of Alzheimer’s Disease), which will build understanding of how to measure outcomes in the neurodegenerative disease. This will involve working in collaboration with national health authorities and health technology assessment bodies and pooling evidence of real world outcomes. “The impact should be better patient care from the early stages and better understanding of the natural history of the disease,” Mrs Kuiper said. “The goal is to support evolution towards outcomes-focussed and sustainable healthcare.”
Alignment on the outcomes that matter in Alzheimer’s Disease, and that as a result will be consistently measured and evaluated, will in turn promote faster access to innovation.
Mark Pearson, Deputy Director, Employment, Labour and Social Affairs at OECD, agreed that thus far big data has largely been a solution in search of an answer in the healthcare sphere. “It has been technology driven. There was not enough health input and focus on outcomes,” he said.
But while applications of big data in healthcare are still scratching the surface, there is some evidence of positive impacts in areas including better clinical decision-making, governance, care coordination, waste reduction, and in research.
There are also negative examples, such as a pilot in the UK that used big data to perform risk assessments in Accident and Emergency Departments. Although the quality of care improved, there were no cost savings, Mr Pearson observed. The big breakthrough in terms of healthcare will come when big data can be used at the patient/clinician interface, in the same way as interactions in other sectors, such as banking, are informed by the availability of personal data.
It was suggested that moves to make big data a standard tool for assessing healthcare issues must include looking at incentives and addressing cultural barriers to implementation. Currently, providers are paid for seeing patients in healthcare facilities. New payment mechanisms are needed to incentivise the use of digital platforms in which care is delivered remotely.
In addition, it is important that mHealth and other technologies do not create another divide, in which the digitally literate have improved access and people with no internet access who are really sick, cannot get the personal care they need.
Standards and interoperability remain as obstacles to the deployment of digital platforms, and this applies as much in different departments of the same hospital as between different levels of healthcare provision.
There are also issues of governance and accountability to be dealt with. In mHealth, for example, people will expect that if they take a measurement, the data submitted to healthcare professionals will be used. This raises questions of who will be responsible for data governance and deciding who is allowed to use patient-generated information.
Similarly, there is little point in conducting big data analyses if there no one is accountable for taking action on the basis of the findings.
Data protection is central to the application of digital platforms in health. After long debate, consultation and deliberation, health data has been enshrined as a separate category in the EU Data Protection Regulation, which is now in the final stages of approval. This will allow health data to be used for the benefit of the patient and to be applied in an ethical way for research, but will ensure access is controlled, information is anonymised and health data is protected.