Revolutionizing Patient Care with Digital Technology

SCIENCE FICTION IS becoming more of a reality as medical technologies accelerate to levels people could only dream of a few years ago. From robots and artificial intelligence in practices and devices that help physicians gather patients’ health data, such tools, and many other highly technological instruments, are increasingly coming to fruition. Indeed, products are revolutionizing doctor offices and patient health. As technology progresses at breakneck speed, healthcare providers may occasionally feel outmoded. Today, even modern practices and industries must step up their game simply to remain proficient. To help providers stay apace, here is a glimpse at various developments.

Improving Anatomy Classes

Patient well-being begins with educating healthcare providers more effectively. A common problem among surgeons in training, for example, is shifting from the 2-D images of a textbook to a 3-D surgical environment. To address this, among other needs, 3D4Medical is developing Project Esper, an artificial intelligence textbook and a mixed-reality anatomy project. According to Irene Walsh, head of design at the Dublin-based medical tech company, “You can work with it in a really intuitive way with a 3-D representation of the body — just right there in front of your eyes, reach out and touch it. And it would be a breathing model, a living creature that can offer so much more than a cadaver in a lab.”¹

The company hopes its immersive, highly detailed and accurate anatomical models will eventually offer students and healthcare providers more mobility, allowing them to simulate dissections and possibly procedures, even from a dorm room or office. Such technology will also help patients understand their own physiology and health conditions, allowing them to visualize how their bodies should work, as opposed to how various illnesses cause damaging effects.²

Medical Activism…of a Sort

In 2016, Apple released a software update to its iPhone health information app installed on every smartphone with a feature to register as a donor with Donate Life. Apple CEO Tim Cook said he was inspired to add the feature by former-CEO Steve Jobs’ “excruciating” wait for a donated liver in 2009, with the goal of addressing the organ donor shortage. 3 Donation advocates hope younger generations who use their smartphones for virtually everything will use the app. “Younger Americans are not registering [for donation] at the same rate as they have in the past,” said David Fleming, chief executive of Donate Life America.³

Facebook has also implemented organ donation sign-up features. In 2012, the social media giant made it possible for users to display they are registered organ donors. In a single day, there was a 21-fold increase in donors, Johns Hopkins researchers found.⁴

Improving Clinical Trials

Platforms such as Apple’s ResearchKit and other wireless, mobile-health (mhealth) devices could eliminate the tedious, paper-laden, visit-based treatment processes that sometimes produce more frustration than quality clinical research. And, pharmaceutical companies, among others, are teaming up with various organizations to conduct clinical trials using the technology.

Pfizer recently joined a clinical trial with the Lupus Research Alliance using ResearchKit as a platform to enable patients to connect with their healthcare providers through their iPhones. 5 “Traditional patient assessments in lupus are unfortunately done in a very arcane way; [they] require the patient to come to the clinic and complete a paper form,” said Albert Roy, executive director of the Lupus Clinical Investigators Network. “Lupus patients don’t come to the clinic every week unless they are very sick, so they have to recall weeks and weeks of how they felt and address the question in the most accurate way. We wanted to reduce this burden on the patients and see if we could translate all these instruments from paper into an electronic format. Running the mobile app is an opportunity for patients to do the assessment on their own, in the comfort of their homes and on a smartphone. We could get more accurate data since they would be able to answer these questions once or twice a week versus once a month.”⁵

According to Kenneth M. Farber, co-CEO and co-president of the Lupus Research Alliance, “This is an important step in demonstrating that mobile technology can improve how and what patients report to their care teams about subjective but serious symptoms of lupus such as debilitating fatigue. This app may enable more frequent and consistent reporting from patients, thus providing better information for care teams and empowering patients to take a larger role in developing future therapies.”⁵

Parexel and Sanofi are using ResearchKit as well for a clinical trial they call the patient sensor solution — but with the addition of a wearable device that gathers patient data. In an ongoing single-site study, data is being collected remotely via multiple devices patients wear. Not only can wearables potentially improve a trial’s execution by increasing patient participation and engagement, they provide decentralized trial sites. Parexel and Sanofi are striving to determine how wearables can further drug development and boost study performance, since data from devices could potentially be simplified into a single, scalable data system that could help pharmaceutical development.⁶

“Our objective is to demonstrate the relevance of data collected remotely and the overall feasibility of utilizing wearables in clinical trials,” said Lionel Bascles, global head of clinical sciences and operations at Sanofi. “Wearables are a core component of Sanofi’s digital trials strategy, and represent an important approach to automate patient processes using the latest technologies to bring new therapies to patients sooner.”6 According to Xavier Flinois, Parexel Informatics president, “We believe the use of wearables to collect data from trial participants represents a breakthrough in the digital transformation within the industry. Working with Sanofi, we believe we have a strong opportunity to streamline and automate data collection from multiple devices, collect high-quality data remotely and generate meaningful results, all while reducing burden on patients and sites, as well as lowering costs.”⁶

GlaxoSmithKline (GSK) has also ventured into using new medical technologies. It launched its PARADE (Patient Rheumatoid Arthritis Data from the Real World) study in 2016 using Apple ResearchKit for its clinical study. GSK’s chief medical officer, Murray Stewart, says the company made the technology easily downloadable for patients through the App Store. “Within 48 hours, we had over 200 downloads,” he said. “Our hope was that we would not just receive data but insightful information from patients.”⁷

The app and its instructions are simple. First, users are asked whether they have rheumatoid arthritis. If they say yes, they are asked if they would be willing to use the app. Those who agree are then asked to do several things, including putting their phone in their pocket and walking with it, and holding their phone and moving it to monitor wrist movement. The app also asks them several additional questions.⁷

Moses Zonana, CEO of Compliance Meds Technologies (CMT), a startup medical tech company that focuses on patient adherence, believes clinical trials could benefit greatly from such technology by helping patients communicate with healthcare providers and researchers. “Pharmaceutical companies don’t have a good way of correlating use patterns of patients to efficacy,” he says. “So many medications might have been rejected because patients, during the course of the research, did not take them the way they were supposed to be taken. Many times, the medication could have been efficacious had the patients remained on track. While research statistics adjust somehow for those errors, it’s not perfect.”⁸

A device that encourages patient adherence such as CMT’s CleverCap, which records dates and times of bottle access, among other data, could help researchers gauge efficacy much more efficiently and accurately. CleverCap and its various iterations could also aid in the opioid crisis by acting as a deterrent. “One of the features of our technologies is it can control and dissect when an overdose occurs, before it’s too late,” explains Zonana. “There are technologies to deter abuse, to monitor it and to curb it. We need to create awareness about that.”⁸

Patient Adherence

Perhaps one of the biggest problems that can be addressed with medical technology is patient adherence. As many healthcare providers are aware, people are not always compliant with treatment plans. Indeed, more than 40 percent of patients sustain significant risks by misunderstanding, forgetting or ignoring physicians’ healthcare advice.⁹ Their inattentiveness to medical instructions, in fact, causes at least 125,000 preventable deaths per year and can cause significant economic burden as well.¹⁰ The yearly cost of poor compliance to the pharmaceutical industry alone is $250 billion. And $300 billion each year is wasted in hospital admissions, avoidable emergency room visits, additional physician visits, etc.¹¹ With increasing costs ravaged by a broken healthcare system, the country is taking notice of patient nonadherence. Forbes went so far as to call it “one of the greatest cost drivers in healthcare,” claiming that patient noncompliance costs an additional $300 billion in healthcare expenses since people who do not follow treatment plans often need emergency room visits or hospital stays.¹²

Medical tech companies such as CMT are addressing these problems. They have developed and continue to create easy-to-use solutions that help doctors care for patients more effectively — and help patients live healthier by allowing them to participate in, even if passively, their own care. “These devices provide visual or audio cues to patients to remind them to take their medication,” explains Zonana. “The patients can also utilize our app to stay connected with their provider with different engagement tools. All of the dosing information is recorded, real time, and uploaded into our cloud-based analytic system. The information is made available to providers that care about ensuring patients get better outcomes. The idea behind all of our solutions is to connect different stakeholders in the continuum of care with one goal in mind: Help patients stay on track with their therapies.”⁸

Helping patients follow instructions is a tremendous factor in treatment efficacy, of course, and Zonana explains how his company’s technology can make doctors’ and patients’ lives easier: “One of the issues with some medications is that they have side-effect profiles or they have certain characteristics that patients might [cause them to] drift away from a proper adherence pattern. In some cases, it may have to do with having a complex regimen or the medication creating a particular side effect. By the information being captured real-time in the outpatient setting, where people dispense their drugs on a daily basis, then the medical provider, being either the prescriber or the pharmacist, can anticipate if a patient is drifting into low adherence or anticipate some erratic potential patterns of use that might create a clinical complication. And by anticipating such problems, they can reach out to the patient to help them remain on therapy as they should to get the proper outcomes.”⁸

Besides this benefit, Zonana says such technology also helps ensure a medication is given a fair chance, so to speak. “Many medical professionals today are pretty much in the blind sometimes, trusting what the patient says. Typically, the patient doesn’t really remember details, so there’s a high level of overstatement — patients saying they’re taking their medications better than they are,” he says. “Often, the doctor relies on that information and thinks that a particular treatment is not being efficacious on that basis. Then, he or she may overprescribe by resorting to a second-line therapy instead, or a third-line therapy instead. In many cases, the first-line therapy would have been as effective if the patient had taken it as prescribed. So, it may be creating toxicity or it may be creating additional problems by not having a better understanding of those patterns of utilization. While using our devices might cause a few more minutes of work for a doctor on the front end, they save many additional hours of work and cost down the road by keeping patients safe.”⁸

Growing in Efficacy and Efficiency

Keeping patients safe and keeping providers better informed are the two biggest goals for much of the latest medical technology. While no one device or system can ensure patient compliance, comprehensively train a medical student or flawlessly record every single byte of trial data, medical technology is steadily growing in its efficacy and efficiency. Hopefully, it will eliminate currently labored processes and streamline data, and increasingly educate both providers and patients. And someday, perhaps soon, it will all seem less foreign than it does to many patients and providers now. The medical technology industry is growing so fast that in 10 years, the healthcare community will look back on today’s most cutting-edge products and wonder how they ever managed.