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In pursuit of personalised digital care

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Dr Bipin Patel, CEO and founder of electronRx, on how advancements in disease management are paving the way for personalised digital medicine.

Healthcare is by its nature a deeply personal issue, though that has not always been reflected in how it is delivered.

There is currently an industry-wide shift occurring in how we define exceptional healthcare, driven by the pressing need to find sustainable methods of delivering care to an ageing population showing exponential growth in chronic and complex care requirements.

The nature of this shift is reflected in the NHS Long Term Plan that was released in 2019 to define its key ambitions for the service over the next 10 years, which include a move towards delivering more personalised care and ensuring digitally-enabled primary and outpatient care becomes mainstream.

Little did we know that progress towards these goals would be accelerated by a global pandemic in which we were forced to explore new models of care. This helped to remove the various barriers that were previously impeding innovation as the benefits of harnessing virtual and hybrid care in disease management quickly became apparent.

We find ourselves presented with a golden opportunity to replace necessity with patient-centricity as the primary driver behind healthcare’s digital transformation.

If successful, we can redefine the boundaries of medicine in a way that will secure the sustainability of our healthcare systems by not only improving the quality of chronic care but also enabling preventative care to stem the growth of chronic diseases.

The question now is how exactly advancements in disease management should be configured if we are to seize this opportunity.

The current state of disease management

Chronic diseases are already the number one consumer of healthcare resources globally, and their growth in prevalence shows no signs of abating.

From 2000 to 2019, the number of ICD-defined chronic diseases in the world’s top 10 causes of death rose from 4 to 7.

Cardiovascular disease (CVD) is the most prevalent, responsible for a quarter (160,000) of all UK deaths per year.

At the same time, 7.6 million people are living with a CVD in the UK. The costs of CVD alone to the UK economy is estimated at £30 billion per year, with 60 per cent of these costs, i.e. £18bn, relating to healthcare.

As the prevalence of these conditions grows, so too will the costs of care to unsustainable levels as our healthcare systems currently have no means of effectively managing chronic disease.

They are unequipped to deliver the frequent monitoring and intervention required by these long-term conditions from the day of diagnosis to the end of a patient’s life.

Physicians are fighting a losing battle with one hand tied behind their back, while patients are being overwhelmed with the management of their condition.

Treatment for heart failure patients, for example, requires aggressive titration of medication based on blood pressure, symptoms, and laboratory results to keep patients out of hospital and provide them with the highest quality of life possible.

For physicians, the difficulty presently lies in obtaining all of the required insights into a patient’s health, both physical and patient reported, on a reliable and regular enough basis to enable timely interventions which limit deterioration and reduce readmission rates.

For patients, this need has traditionally resulted in huge burdens on their day-to-day life, requiring them to frequently travel to in-person monitoring appointments, remember to take their medications, regularly measure their vital signs using medical devices such as ambulatory blood pressure monitors, and keep records of their readings, symptoms, activity, nutrition, or any other information relevant to their condition.

These complex treatment plans have led to extremely low levels of patient compliance, with 40-50 per cent of chronic disease patients on average not adhering to treatment.

The culminating result of ineffective disease management is high readmission rates; skyrocketing overall costs of care and creating a severe lack of capacity in healthcare services.

In the NHS, heart failure accounts for 1 million bed days per year, with 50 per cent of the 920,000 UK patients diagnosed with heart failure experiencing hospital readmissions; contributing to the well-documented problem of overcrowding in emergency care facilities.

On both sides, high levels of effort are generating low levels of reward. This explains why advancements in remote and hybrid chronic care models that occurred during the pandemic were so well-received.

As the adoption of virtual care technologies soared and the boundaries of care were extended beyond the clinical environment further than ever before, there quickly arose a new found understanding of the benefits that this can bring to both patients and physicians.

By May 2020, a mere 2 months after Covid-19 had hit with full force, McKinsey reported that 76 per cent of consumers already reported interest in using telehealth going forward, and 57 per cent of providers reported viewing telehealth more favourably than before.

Advancements in remote patient monitoring in the form of connected devices such as wearables (smartwatches, rings, skin patches, digestibles, harnesses) and at-home medical exam kits (e.g. TytoCare) are empowering patients with the ability to integrate the collection and transfer of biometric data more seamlessly into their day-to-day lives, while also giving care providers more up-to-date, comprehensive and digestible insights into a patient’s health over time.

Physician workloads are being streamlined through automated alerts systems that allow for more timely and informed interventions to reduce readmissions and improve patient outcomes.

By harnessing smartphone applications which also facilitate the capture of patient reported information on symptoms, lifestyle, and more, recent digital health innovations have indeed been found to have a significant impact on patient outcomes, reducing the risk of readmission within 30 days by 52% in heart attack patients.

Paving the way for personalised digital medicine

So, it’s clear that, by meeting patients where they are, advancements in digital healthcare are enabling more effective chronic disease management. However, we are just scratching the surface of their potential to enable a proactive, personalised approach to healthcare.

As we continue to build out hybrid care management plans in which the interface through which a patient engages with their care is increasingly their smartphone rather than their doctor’s office, we open the door to harnessing the power of this readily available infrastructure to expand access to a hitherto unavailable depth and breadth of health insights.

Digital therapeutics (DTx), for instance, are utilising highly-engaging user experiences to augment or replace existing treatments, boost engagement and uncover insights into health-related behaviours that can in turn be used to tailor treatment to the individual and further improve the likelihood of treatment adherence.

The first to receive FDA approval was Pear Therapeutics in 2017, and Insider Intelligence forecasts DTx to be a US$56bn global opportunity by 2025.

Most excitingly, though, recent innovations have applied machine learning algorithms to extract vital signs and other physiological parameters from smartphone sensor data alone; without the need for additional devices.

By placing the power to accurately measure physical health metrics into the hands of over 6 billion smartphone users worldwide, we can not only provide widespread access to digital companions that learn an individual’s baseline and over time become increasingly effective at spotting deviations that can inform real-time personalised therapeutic interventions, but we can also enable population-wide health initiatives that take a proactive, preventive approach to turning the tide on the chronic disease epidemic.

By building this technology into digital therapeutics, the physiological digital biomarkers that will be established will also have implications across pharmaceutical drug discovery and development, the efficacy of drug administration and our understanding of the pathophysiology of diseases.

It’s still early days, and a number of barriers surrounding regulations, reimbursement, usability, and more, are yet to be cleared.

This bold vision will require organisations from across the entire healthcare ecosystem to work together to shape the processes that will facilitate this shift to n=1 personalised digital medicine.

However, in doing so, this will realise a system-wide move to proactive, value-based care and improve the lives of millions across the globe. So, it’s worth a try!

Dr Bipin Patel is CEO and founder of electronRx, a deep tech company of scientists and engineers leading the development of novel chronic disease management solutions that pave the way for personalised digital medicine.

 

 

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