Digital therapeutics and their impact on society

Head of Customer Experience Elisa del Galdo explores how healthcare technology can help chronic disease patients and asks what makes a good digital therapeutic?

In the 20th century, research, technology, and new novel treatments have enabled us to increase the average lifespan by 25 years, but our healthspan has not increased accordingly. We live longer, but not necessarily better – unfortunately, our quality of life has not improved throughout these added years. This is in part due to the explosive, bordering on unmanageable, increase in chronic diseases, such as cardiovascular disease, diabetes, Alzheimer’s disease, obesity, and asthma.

Often these conditions are not experienced in isolation, resulting in many patients managing two or more comorbidities, leading to complex health problems that are more difficult to monitor and manage.

The World Health Organisation reports that by 2020 chronic diseases will account for three-quarters of all deaths worldwide and will reduce the quality of life for patients and their caregivers. With the average cost of managing comorbid chronic patients in the UK estimated to be eight times that of a relatively healthy patient, the economic impact of these illnesses on healthcare systems is immense.

To solve this problem, our systems must be more efficient and more effective in the management and prevention of chronic diseases.

Digital therapeutics, such as smartphone apps and wearable technology, can be used to relieve some of the pressure. They can be used in a multitude of ways to support the effective delivery of healthcare.

This includes monitoring, motivating, changing behavior, facilitating communication, and helping to manage processes, all while collecting valuable data. When done well, these tools can facilitate more meaningful interactions between patients and healthcare professionals.

What are digital therapeutics?

Digital therapeutics are digital, evidence-based therapeutic interventions for the prevention, management or treatment of a medical condition. They are used independently or in combination with other treatments to track symptoms, to deliver content and facilitate communications with healthcare professionals.

These tools are designed to optimize outcomes for patients and support their providers in delivering healthcare. The technology can give patients more independence, but it can also provide healthcare professionals with real-time insights and evidence-based data on the patient’s condition, enabling more connected and effective treatment, leading to a more collaborative approach.

Digital therapeutics are not created to replace the physician, instead, they are aids designed to help them be efficient and more effective, improving the experience for all stakeholders.

The benefits are far-reaching and cross a multitude of therapy areas, with one recent report on 571 efficacy studies and 234 randomized controlled trials showing statistically significant results in five chronic disease areas – diabetes prevention, diabetes, asthma, cardiac and pulmonary rehabilitation. These studies investigated the quantitative value of digital health apps and connected devices and include metrics such as weight, blood sugar control, depression scales and hospitalizations. The authors concluded that the vast majority of these studies have shown statistically significant benefits for health outcomes.

Tool for personalized care

Traditionally, healthcare has been delivered through a one-to-one model in which patients visit the doctor and receive treatment. However, these short appointments rarely give doctors an insight into the reality of the patient’s experience, their behavior and how these factors are impacting their condition and quality of life.

In these sessions, healthcare professionals rely on the patient’s memory and their perception of the important symptoms, rather than more nuanced factors impacting their health or the success of their treatment.

This one-to-one model of delivering healthcare in a very short space of time is not sustainable. Industry and healthcare systems are striving to develop a personalized patient care model that can serve and account for the variability in stakeholders’ needs and capabilities. For this new way of treating patients to succeed, we need technology to not only track, but more importantly to inform, and influence behavior for better outcomes.

Additionally, we need a system that supports healthcare professionals to do what they do best – use their judgment, emotional intelligence and provide attention to detail.

While digital therapeutics can support the one-to-one model by making the conversations between the doctor and patient more productive, the technology can also provide ‘treatment’ for the patient at the most effective time, which is rarely during a 10-minute doctor’s appointment.

Understanding the things that make a patient unique – their environment, behavior, needs and the genetic basis of their disease over time – is essential. Digital therapeutics can collect this information about the patient outside of the clinic, to ensure the doctor has a continuous view and care can be delivered when needed. When designed well, this enables healthcare professionals to efficiently understand the nuanced factors that impact a patient, their illness and their quality of life.

Two recent examples are Medisafe – an app that uses artificial intelligence (AI) to improve patient adherence – and Medopad, a modular app for remote patient monitoring.

Medisafe is a personalized medication management platform for tracking adherence. In the US, 700,000 people a year will either over or underdose, resulting in 125,000 deaths. Medisafe looks to solve this problem by using AI to enable the personalization of medication management. The technology uses algorithms and micro-segmentation to analyze the causes of non-adherence and then identify what will motivate adherence, all powered by machine learning.

Medopad’s technology is focused on providing bespoke patient monitoring across multiple disease states and geographies. Using a combination of artificial intelligence, data analysis and a strong understanding of user experience, the company has developed a platform for creating modular apps that can be personalized across numerous patient types. The platform is comprised of more than 100 modules designed to capture different types of data and can be linked to wearable devices and retain test results. The modular nature of the technology allows healthcare organizations to create a tailored patient solution that addresses specific needs and challenges.

The underlying foundation of almost all digital therapeutics is the ability to track and collect data, but it isn’t just about what is tracked and collected. More important is what is done with the data and how it is used to modify patient behavior, communicate longitudinal patient evidence, and inform treatment decisions to deliver better outcomes and experience.

For a digital therapeutic to be successful, it has to be fit for purpose. This means reducing the burden of care, delivering healthcare effectively and efficiently, and improving the patient’s quality of life. It also means catering to the variety of individuals who will be using the tool, from the patient and caregiver to the various healthcare professionals interacting with the patient, and the relevant stakeholders working across the healthcare system.

In 2017, the US Food and Drug Administration (FDA) approved the first digital pill. What makes technology innovation is not the pill’s groundbreaking ingestible sensor system. Instead, it’s the application of the technology to successfully meet a substantial unmet need.

In the US alone, just 25% – 50% of patients worldwide take their medications properly. Proteus’ digital pill was designed to solve this challenge by using cutting-edge technology to track patient adherence to medication and its impact on their outcomes.

The pill contains a sensor, which is about the size of a grain of sand. This sends information to a small wearable patch worn on the abdomen. The data is then transmitted to an application on a mobile device and a provider portal. Importantly, objective data is not just provided to physicians to help them measure treatment effectiveness and optimize therapies, the patient can also authorize other individuals to see the information. This means a carer for a patient with a condition such as schizophrenia or bipolar disorder can be alerted if the patient does not take their medication. Additionally, the pill can be used across the industry to facilitate more accurate clinical trials.

Since the approval of the pill, the organization has proven that the technology can be used across chronic diseases, including cardiovascular disease, diabetes, and HIV, and now the company is moving into the oncology space.

The smart pill’s success lies not just in its novel technology, but in the organization’s in-depth understanding of its stakeholders’ journeys and the needs that they reveal, from the patient and carer to the healthcare professionals and the clinical trial designers.

The underlying foundation of almost all digital therapeutics is the ability to track and collect data, but it isn’t just about what is tracked and collected. More important is what is done with the data and how it is used to modify patient behavior, communicate longitudinal patient evidence, and inform treatment decisions to deliver better outcomes and experience.

For a digital therapeutic to be successful, it has to be fit for purpose. This means reducing the burden of care, delivering healthcare effectively and efficiently, and improving the patient’s quality of life. It also means catering to the variety of individuals who will be using the tool, from the patient and caregiver to the various healthcare professionals interacting with the patient, and the relevant stakeholders working across the healthcare system.

In 2017, the US Food and Drug Administration (FDA) approved the first digital pill. What makes technology innovation is not the pill’s groundbreaking ingestible sensor system. Instead, it’s the application of the technology to successfully meet a substantial unmet need.

In the US alone, just 25% – 50% of patients worldwide take their medications properly.5, 6 Proteus’ digital pill was designed to solve this challenge by using cutting-edge technology to track patient adherence to medication and its impact on their outcomes.

The pill contains a sensor, which is about the size of a grain of sand. This sends information to a small wearable patch worn on the abdomen. The data is then transmitted to an application on a mobile device and a provider portal. Importantly, objective data is not just provided to physicians to help them measure treatment effectiveness and optimize therapies, the patient can also authorize other individuals to see the information. This means a carer for a patient with a condition such as schizophrenia or bipolar disorder can be alerted if the patient does not take their medication. Additionally, the pill can be used across the industry to facilitate more accurate clinical trials.

Since the approval of the pill, the organization has proven that the technology can be used across chronic diseases, including cardiovascular disease, diabetes, and HIV, and now the company is moving into the oncology space.

The smart pill’s success lies not just in its novel technology, but in the organization’s in-depth understanding of its stakeholders’ journeys and the needs that they reveal, from the patient and carer to the healthcare professionals and the clinical trial designers.

The secret behind true innovation

There is no one-size-fits-all solution for healthcare – age, gender, socioeconomic status, culture, condition, and health literacy are all factors that need to be considered in the design of digital therapeutics.

It is important that designers clearly understand the problems they can solve from the perspective of all the individuals that interact with the technology. This means speaking to a complex network of stakeholders across the healthcare system to clearly understand their needs and challenges and translate them into the design of systems and tools that are fit for purpose.

New technology is not always the answer, and innovation is not just about new technology. Usability and user experience design are key, but these principles must go hand-in-hand with a solution that provides validated clinical outcomes. All of this needs to be encompassed in a digital ecosystem that reaches all stakeholders and can be individualized to a patient’s needs. Importantly, this ecosystem must support healthcare professionals in delivering what they have been trained to do, provide excellent healthcare.

By Elisa del Galdo