A good friend of mine, a physician, once told me “healthcare would be great, if it weren’t for the patients.” She’s a remarkable physician, well respected in her field, caring, compassionate, and clinically brilliant. There’s a reality, however, that as we go from bench to in vivo trials to full scale clinical deployment, outcomes are more and more a confusing function of multiple factors, including the most mysterious and confusing of all . . . people!What my friend meant was that in the translation from clinical research to clinical practice, to reliably produce the best outcomes, we need a much more expansive view of what constitutes “best care,” in a way that accommodates environment, social support, behavior, habits, and the myriad factors that influence the effectiveness of a selected course of treatment.
As I write this article, I am sitting on a terrace in Cambridge, overlooking the Charles River. Google is three blocks away. Pivotal is six blocks away. And almost every major pharmaceutical company in the world has a major commercial center or technology outpost, either right here or within a 30 minute drive. Why?
I would argue that our focus has shifted from the microscopic to the macroscopic. Genomics and advanced diagnostic technologies have enabled personalized medicine that offer the right treatment to the right patient at the right time. Yet, there is still an immense opportunity for transparent communication with patients to enable holistic treatment approaches. Patient support and engagement models create avenues for a quantum leap in treatment effectiveness for therapies.
We expect to see a fundamental shift in our relationship with clinicians, patients, and insurers, in which the focus shifts from the molecule and its performance in research to the total patient care solution and its performance in practice.
What drives this shift in thinking, and enables us to approach our partners, patients, and customers in a new way is the innovation that you, as the healthcare informatics community, have participated in and driven, dating back to Larry Weed and Clem McDonald. Using the power of the computer to store, organize, retrieve, connect, mine, interpret, and predict, along with the power of the network to transmit, and innovations in devices and mobile communications to monitor and engage, you have created the information environment for vastly improved patient monitoring and support. Mobile and patient wearables now support monitoring the patient at home and on-the-go, and even offer digital therapies beyond the clinic. We can see a path forward where we can and should expand the support we provide to physicians and patients as an integrated care team, working together to ensure the patient receives maximum benefit from their course of treatment.
"Usually, our insistence on data interoperability actually means ‘create commercial opportunity for me, a technology vendor"
In a sense, this is simply a logical progression of the support we provide patients, today. Many patient treatments, especially in the chronic disease therapeutic space, include integrated nursing call center support, in which we actively engage with the patient for ongoing monitoring, coaching, advice, and feedback to the patients’ physician. In many cases, our patient support teams have developed deeply personal and lasting care relationships with these patients, and operate as a seamless, if invisible, part of the care team. It’s time for us to do more, though, and to build off the good work you have done to provide support where, when, and how it can be most meaningful and impactful for the patient.
How can we truly get organized around and more fully support the patients’ needs, and what role can pharma play in that support model? The first and most obvious opportunity is with smart devices and technology for drug delivery, both for orals and injectables. Whether it’s process and technology in supply chain and tracking, technology-enabled packaging, automation in drug injection, or tracking at disposal, clinicians want to know their patients are receiving the right drug at the right time in the right dose. This has been done with closed-loop order management, dispensing, and administration in inpatient and clinic settings, and we can help in home-based administration and tracking.
The second opportunity is thru digitally-enhanced patient support programs: extending our patient programs to capture and present information when and how it’s most convenient to the patient. At this point, it’s a foregone conclusion to say this means engaging patients online and on mobile. We are providing services that fill in the gaps between clinical encounters, and to be truly meaningful, we need to be more flexible in how we provide those services.
Lastly, we need to get connected. Everyone wants to engage patients, and everyone is happy to come up with another reason why the physician and patient care team needs to use another system or capture another data-set or provide another report or track another set of indicators. We are slowly killing our physicians with administrative, data, and technology overload. Usually, our insistence on data interoperability actually means “create commercial opportunity for me, a technology vendor.” What we really need to do is be working to bring together patient monitoring/device technologies, care and treatment systems, data exchanges, and patient support programs to simplify the effort of the care team, and the patient, to ensure that the treatment plan has the best opportunity for success.
In some ways, I see this as the next “blockbuster drug.” Let’s get wired and get connected. Let’s provide meaningful and timely support to put the patient in charge. Let’s close the medication loop in the home. The impact in real-world outcomes can be massive.
Technology has done remarkable things for early detection and diagnosis. It has enabled far better and more timely care coordination. It can do much more for disease prevention. It absolutely HAS to do more to optimize treatment outcomes. Pharmaceutical innovation only counts where it really counts – out in the field, with real patients, and all of the confusing, complicated, messy realities that my friend, the doctor, has to deal with every day. This is a great time to be dealing with messy realities.