COVID-19 has made healthcare radically more digital, with many of the services that previously needed clinicians and patients to be in the same room moving online. Changes that normally involve years of hearings, debate and red tape are unfolding in mere days – the speed of this transformation is astounding. For instance, the Chinese government transitioned 50% of its healthcare tasks online during the epidemic, the NHS selected 11 suppliers to provide video consultations for primary care after a 48-hour tender, and some healthcare providers are doing more virtual visits in a day than they did in all of 2019.
Digital solutions can improve the reach and effectiveness of modern healthcare systems and reduce their cost. There is the risk that they may also increase the ‘digital divide’ in healthcare, leaving those without internet access or know-how behind, and leading to both doctors and patients becoming overwhelmed and frustrated. So, how do we draw positives out of the crisis and use the current momentum towards digital solutions to improve patient outcomes long term?
A lot of the focus has been on quickly deploying telehealth, home healthcare and remote patient monitoring solutions. However, while the ‘digital triage’ ushered in by COVID-19 has served us well so far, we need to move on to more carefully designed solutions that fully meet patients’ and clinicians’ needs. Beyond improving existing digital touchpoints, the pandemic-induced reset offers opportunities to revisit the potential of digital health and therapeutics, and to unbundle healthcare services to increase care outcomes and efficiency.
As many nations approach and/or pass their peaks in the pandemic, everybody is reeling from the knock-on effects of lockdown measures. The vastly accelerated roll-out of telehealth and remote patient monitoring during the crisis is a form of digital triage – an impressive response to a crisis, but by itself not a sustainable digital health solution.
While many mild conditions can be diagnosed remotely, a telehealth solution cannot replace a thorough physical exam and complex doctor-patient consultations. A trusting relationship is not easily formed online. Many doctors and nurses that have found themselves in extensive video conferences during the COVID-19 lockdown are reporting fatigue and burnout.
It is also clear that patients are not satisfied with the self-testing tools currently available for COVID-19 and other conditions, as a recent survey fielded by Forrester Research revealed. Only 36% of online US adults are confident that self-screening tools provide accurate results or recommendations. However, 90% of users (n=119) that participated in the UX study reported they would use a similar tool again for other types of symptoms. Users want more guidance, sharper capabilities, and reliable information from the available tools.
Good design practices can help. As the Forrester Research article elaborates, the best digital testing tools reduce information overload for users, set clear expectations of where they are in a process, and signpost what to do next. It’s critical to take a systems view in the design process, testing both with clinicians and patients to ensure the resulting service meets their needs in a fair, user-friendly and mutually rewarding way.
The future of home healthcare and telehealth
One of the central opportunities for a ‘radically digital’ healthcare – a delivery system that uses digital, contactless solutions by default rather than as a stop-gap – is to enable patients to do much more than they previously thought possible. In the future, patients will be able to do more testing and therapeutic intervention from home, from simple tests that might require a urine sample to more complex procedures such as home haemodialysis. A physical therapist can watch a patient who lives in a remote area do his or her exercises after a knee replacement, improving aftercare and eliminating the need to travel. Pharma companies may find effective digital solutions to increase medication adherence. Telemedicine also offers a virtual window into the patient’s living situation and can uncover important connections between the patient’s environment and his or her medical condition.
To truly enable patients to run tests or perform simple procedures themselves, we need to strip complexity out of clinical workflows. To make it safe and effective for people to treat themselves, we must make self-care advice straightforward to understand and easy to follow. Effective telehealth will have to be so much more than a video call, and include asynchronous information exchange such as texting, the sharing of pictures and videos, data retrieved from sensors attached to the body, and even patients’ mood and pain tracking. Concerns around the privacy and security of patient data and regulatory compliance will have to be addressed.
Digital health and therapeutics after COVID-19
Beyond communication and telehealth, COVID-19 may provide a boost to the digital health and therapeutics industry. In 2019, many pharma companies reduced their investments in digital health. For example, Novartis ended its partnership with Pear Therapeutics, and Otsuka announced it would not commit to additional investment into Proteus Digital Health. Investing now would maximise on the exponential progress made recently – in terms of what we’re learning from the triage services and people’s ability and willingness to seek medical help digitally.
The increased digital acceleration set in motion by COVID-19 – from telemedicine to contact tracking apps – has lowered the regulatory thresholds for digital health and increased patients’ familiarity and comfort level with health apps. Digital apps can generate specific patient-level data from mobile devices, wearables and sensors to enable personalised medicine. This data provides an opportunity for pharma companies to deploy targeted digital health innovations focused on individual behaviours and contexts rather than the disease in general. The flip side, however, is that it also makes it easier to see when a therapy is underperforming, so companies will need to be prepared for such transparency and scrutiny.
Digital health solutions remain a promising tool for pharma companies to create and maintain meaningful engagement with patients over time – a problem the industry has long struggled with. Companion apps to complement new drug launches may improve adherence over time. So many of the chronic conditions of our time have a behavioural dimension that digital solutions can both track and attempt to change. In some of our work on digital health solutions, we carefully introduced ‘gaming’ elements to boost patient engagement, and achieved twice the retention rate than standard health and wellness apps.
The great unbundling
A ‘new normal’ for healthcare is emerging: a world that is radically digital, designed for digital, contactless solutions by default rather than as an alternative to physical interactions. Across many industries, digitisation has rarely played out as a 1:1 translation of processes and interactions. As the tech analyst and Stratechery columnist Ben Thompson points out: “When the Internet digitises what used to be analogue assets, we often find out that jobs that were once done together end up in radically different places.”
The healthcare industry has been debating the unbundling of services for quite some time. For example, many of the services currently provided by a large hospital network from testing to procedures may become disintermediated as a result of radical digitisation. Already, we can see a vibrant ecosystem of start-ups jumping at the opportunity to provide new, digital-first solutions for primary care, telehealth, home health, testing, and remote patient monitoring. This should lead to lower prices and new nested relationships between patients and care providers.
For pharma companies, the ‘great unbundling’ that may be upon us presents opportunities and threats, as control, pricing power and patient/clinician engagement will become more distributed and dispersed. Surviving and thriving in a digital-first, contactless world may require significant changes to the prevailing pharmaceutical delivery and engagement model.
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