Healthcare – Time is Ripe to Drop the “I” in Patient - Aventure – Volume 10 / Issue 3 / July 2020

JGI JAIN – Aventure – Volume 10 / Issue 3 / July 2020

Healthcare – Time is Ripe to Drop the “I” in Patient

An unwavering focus on patient well-being should form the bedrock and the quintessence of all developmental efforts by healthcare professionals and the industry at large. In today’s healthcare ecosystem, it is time to drop the “I– Illness” in patient and focus on “Patent” to create a new paradigm in the value chain spanning many sub-vertical players such as pharmaceutical companies, hospitals, insurance companies, laboratories, etc. It calls for a new collaborative approach in an industry that has seen the entry of many players engaged in delivering value-based outcomes – the right care at optimal quality and at a lower cost for better health - “Wellness” of the population. An ideal balance between quality service offering and cost is the need of the hour and this can undoubtedly be achieved by harnessing technological advancements that have also furthered the progression of players.

We are right now grappling with the massive spread of Coronavirus across the globe that has mandated the World Health Organisation (WHO) to tag it a ‘pandemic.’ An unprecedented situation, it has challenged the healthcare delivery system as much in advanced countries as in developing countries, where, of course, the stress on the system is far more evident. In the absence of a vaccine or a drug, innovators are accelerating research studies in labs and on animal models, and just stepping into human-based trials of a hitherto unknown SARS (Severe Acute Respiratory Syndrome) virus. The race among the many players to the finish line is to crunch an average 10-year development lifecycle into a meagre 10-12 months.

Global healthcare spend is slated to increase by leaps and bounds – at an annual rate of 4.1% in the 2017-2021 period as compared to 1.3% in the 2012-2016 period. Under the current situation, will the industry repurpose its dollar-spend or pour in additional amounts is something only time will tell.

The ecosystem has today become dynamic and complex because it has access to large amounts of personal health data generated from personal health monitoring systems/gadgets and health apps.

The movement ‘from Illness to Wellness’ should be the Healthcare mantra, especially during such turbulent times. The confused patient left with a hodgepodge of options searches on Google for the right answers, only to be confused further and fires a barrage of questions to the caregiver, and many a times causes more self-harm. It indeed is a perfect storm situation – what are the timeline options and who are the players ready to take the big step in this direction, given that baby steps like digitisation, digital adoption, newer players accelerating the pace etc. are already in place. However, what we are waiting for with bated breath is the coming together of the forces to provide the best care to the patient.

Developments in the Healthcare System

Population Health – Dispensing with the one-size-fits-all notion, the system proactively focuses on the risk factors of subgroups within a population and analyses their susceptibility to a disease condition and the treatments. For instance, epidemics, outbreaks, and localised patterns can be identified and treated.

Precision Medicine – Advancements in pharmacology, genomics, proteomics, bioinformatics, etc., help map the individual gene make-up to deliver customised medicine for better results. For instance, cancer diagnosis and treatment with gene-sequencing and gene therapy is entering into mainstream therapy.

Patient Engagement – The patient is a ‘connected’ individual, who needs to be continuously engaged by the eco-system to impart better education and awareness, sustain patient interest, and deliver desired outcomes. Pharmaceutical companies have endeavoured to monitor patient progress and treatment path by sharing education material, webinars, chatbots, informational videos, online conversations, KOL (Key Opinion Leader) platform for knowledge-share, etc. Hospitals and clinics are striving to reduce wait-time by leveraging digital scheduling models and tools, to make their operations transparent. The goal of a better-engaged model is to enhance patient experience.

Prescription Adherence – Compliance to the prescribed medication and dosage is crucial to achieve intended outcome. The lack of adherence gravitates to a grim situation with spiralling healthcare costs and receding patient wellbeing. Every player in the system has his pulse here to ensure 100% adherence through digital means.

Digitized Clinical Trials – Collecting clinical trial data using digital tools is a necessity where multi-site centres around the world help to orchestrate better collaboration. The pandemic has made this an absolute requirement and of prime importance.

Technological Advancements in Healthcare

Developments in the industry, aided by innovative technologies have the potential to make a difference between life-and-death, provide the most efficacious options, in terms of awareness and treatments.

Blockchain – Blockchain, through its decentralised approach, records a digital footprint of the assets or blocks created, as it transacts and changes hands using cryptography. Clinical trials of the Pharma industry stand to benefit enormously due to its multi-country, multi-ethnicity coverage, as well as among healthcare providers for quick and easy exchange of data.

Artificial Intelligence – AI aided computer systems can iteratively program themselves upwards from self-learning and build on its vast experience gained through continuous transactions. Greater the data fed, more insightful are the outcomes. Chatbots are just one example of a bridge between doctors and patients. Image analytics to sift through thousands of MRI/X-Ray/CT scans to connect with patterns of previously known cases, for instance cancer growth is an immediate area to explore.

Mobility – Smartphones with advanced features, processor speeds, etc. have connected people around the globe and opened new possibilities. They can help monitor and record many basic health parameters.

Cloud and IoT – Internet of Things (in simple terms, physical devices embedded with electronics, software, sensors, and network connectivity which enables them to collect and exchange data) is here to stay and the question that technology players are betting big to answer is likely via ‘co-opetition’ (cooperative competition) with the domain players and other eco-system actors. Cloud solutions to store patient data for easy access and quick retrieval at the pointof-care have enticed numerous players. Bed-side access to case studies around the world enriches the doctors’ knowledge. Privacy and data security aspects are addressed, albeit a few sporadic instances. Better response time to emergencies, remote patient monitoring, proactive management in dealing with mental disorders, fall detection in seniors are a few areas that will benefit. A simple discipline of hand-sanitization in a hospital environment to help arrest the infection-spread is an example to illustrate this technology.

Virtual / Augmented Reality – If reality can be brought closer virtually, or if the experience can be further enhanced, then healthcare is waiting to embrace this technology. Medical education and training of professionals through these technologies is a new wave in the healthcare industry and has found numerous takers. Post-traumatic stress disorders among military personnel have been addressed remarkably through this technology.

Tele-health –Telecommunication technologies provide enhanced access to rural areas to deliver healthcare, education for awareness, and increase the reach in urban areas. The transportation of immune-compromised patients during the COVID crisis is a further strain on the system. The model of a ‘connected patient’ in a remote monitoring paradigm is ideal in the context of the skewed doctor-to-patient ratio. Enhanced security protocols are essential for patient data confidentiality.

Wearable gadgets – Belts and patches to monitor temperature, sugar levels, even sleep and breathing patterns, are also programmed to inject medicine with micro-needles and are fast gaining acceptance. Even wound management techniques using flexible electronic sensors integrated with woven bandages are now mainstream in developed countries, and a matter of time before it hits the rest of the world markets. Fall detection sensors as wearable belts or devices help elderly patients within the precincts of their own homes.

Analytics – Huge quantities of patient data is generated 24x7 with the advent of umpteen tools discussed above. This data become useful only with easy data collection, easy access, quick analysis, generation of insights and trends, and the final derivation of results.

Progression of Players in the Ecosystem

Traditional players are being pushed to their performance limits with the advent of new players or fringe players who are expanding the gamut of their service offerings.

Insurance companies have leveraged technology to get better insights into patient behaviour. They use analytics to control and reduce fraudulent claims, better understand patient journey on the medical path, gain insights into patients’ drug-switching and drug-substitute decisions.

Hospitals, having adopted patient-centric healthcare delivery models, engage Progression of Players in the Ecosystem with other players to deliver enhanced post-operative care, to convert patients into repeat customers.

Pharmaceutical companies are now channelling their funds towards drug discovery and development, optimal manufacturing methods and digitising the value chain. They have outsourced peripheral activity along the value chain to reduce costs. With technology, they get better insights into patient population and can monitor sentiments that would impact their overall ‘brand reputation’ through extensive use of social media.

Contract Research / Manufacturing Organisations offer end-to-end services to pharmaceutical companies in drug research and development and operationalise the costs incurred. They have progressed from clinical trial centres to key enablers offering scientific might along with use of digital tools.

Infomediaries collect volumes of prescription and drug usage data from insurance companies and hospitals, based on which they analyse, model and profile the purchase and usage patterns of the patient population. Based on this valuable data, pharma companies align their R&D and marketing and advertising strategies. In the Indian context, this link in the value chain still needs to transform into organised sector.

EHR/EMR Entities help capture and manage electronic health/medical records to create a mammoth medical bank and a potential single repository of patient health records. Hospitals were benefited from the analytics derived from this data. However, the big blow came when due to inter-operability issues, several instances got created. Another discussion that is still open-ended is who would be the keeper/ owner of the records; and about granting these rights to the patient.

Laboratories generate volumes of clinical data of patients from various tests. Use of instrumentation and ICTs has necessitated better ways to handle this data and derive useful patient longitudinal insights. Network of laboratories owned by corporate entities has enabled the movement and exchange of data.

Technology players like Apple, Microsoft, Samsung, and Google have taken the onus to enhance the overall experience of the net-resultant forces in the eco-system via their technology and service offerings.

Entities like NGOs, university researchers, domiciliary care-providers, online pharmacies, prescription delivery outfits, organised caregivers, venture capitalists, etc. have driven the discussions in the direction of an empowered patient, and have directed the investment funds to ride the crest of research work.

The chain is as much broken as there are efforts to keep it integrated with the immense challenge of keeping an end-to-end view of patient data. There is an imminent need for newer partnership models to meet the needs of a smarter patient - all this for a cost-effective, future-proofed, and sustainable healthcare to improve community wellness, rather than be drowned in reactive treatment methods.

Illness to Wellness

Dropping the “I” in patient, we have ‘Patent’ which implies that the focus should shift towards research and development, innovation, out-of-the-box methods to solve healthcare problems. Whether to help identify brand new drugs for new methods of treatment or cures for uncured diseases or pulling better outcomes for the tough disease conditions that help improve patient quality of life or to find newer less-invasive methods to treat chronic illnesses, the race is towards a ‘gravity-defying’ collaborative approach.

The journey from ‘Illness to Wellness’ must be carefully manoeuvred to reach the patient’s desired destination in an informed, intellectual, and ethical manner. The ecosystem right now is resting on fertile ground that is ready to take the ‘sow’ and deliver the ‘harvest.’

The patient community has been long waiting for a brand-new world of healthcare, which gives the drug, the service, the treatment, or the workflow or even the synergy a new shape for a marked difference in the overall health. Patients have waited to receive a new kind of care that is palatable and promises aspired outcomes. The healthcare industry is at a true inflection point that would point towards the removal of illness from the patient and create patentable artefacts for people’s wellness and the society at large, a win-win situation.