Tomorrow’s world, future of healthcare and a shift towards the prevention agenda

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Talking medicine cabinets, body monitoring implants, virtual health forecasts – this is the future of healthcare and a shift towards the prevention agenda. But how will pharma adapt?

In today’s world, just a touch of a keyboard is enough to access a wealth of general health information. Before long, however, specific information about what diseases we are predisposed to, what drugs we would most benefit from, even what time of day we should take our pills will also be available – and probably sent straight to our smartphone.

Indeed, a recent Ogilvy CommonHealth Worldwide report listed 20 ideas they say are likely to come to fruition in the next decade – and all are based on technology that is already at our fingertips. From evolving current services such as healthcare at home to the more futuristic, the report says these advances will revolutionise the way people live and think about health.

In an era where disease burden, growing populations, and financial pressures are choking healthcare systems, there is a natural shift in thinking to how prevention and self-care can cut costs and save money. And the potential technology can play is huge, says Jennifer Covich Bordenick, chief executive at US-based eHealth Initiative.
Using technology to monitor and manage patients from the home is just one example of how healthcare will change in the future, and headway is being made in these areas with numerous pilot schemes underway to demonstrate the financial advantages of keeping people out of hospital while simultaneously improving patient experience. In one small telemedicine pilot conducted in Northern Ireland, for example, 22 patients with chronic obstructive pulmonary disease were provided with a home monitoring device to measure various vital signs over a 12-week period. The information was transmitted to a secure server for nurses to review and take action if needed and the results showed an almost 12% reduction in hospital admissions, a 25% reduction in face-to-face visits with patients, 36 prevented hospital admissions – which in itself saved an estimated £83,000 – and a 25% improvement in patient quality of life scores. The trick for the future is to get these pilots rolled out on a nationwide basis.

Genetic profiling coupled with specific disease screening via diagnostics and imaging should also push the prevention agenda, the Ogilvy report reveals. And implants using radio frequency identification technology, currently employed in the medicines supply chain and counterfeit prevention, will be developed to monitor vital signs and transmit information to health services for diagnosis and speedy intervention; indeed, lab-on-chip systems are already being developed and could be small enough to fit under a temporary tattoo to measure nerve and muscle activity. These advances, coupled with developments in nanotechnology, personalised medicine, personalised polypharmacy (combination drugs) and next generation targeted therapies like stem cell technologies, gene therapy, cloning and regenerative medicine, offer up a powerful set of tools to monitor and directly treat future health and disease.
From a digital point of view, available technology is already making inroads in improving patient health and helping systems become more efficient. Text message reminders for medicines adherence are becoming commonplace, for example, while the number of medical smartphone apps for patients and healthcare professionals has jumped 78% in the past year, according to Ernst & Young.

Moving forward, geolocation and GPS tracking could detect patterns of infectious disease outbreaks, the Ogilvy report notes. And augmented reality – a computer-generated 3D graphic – could become the norm. Already Genzyme (agency Langland) has used the technology to show doctors the cardiovascular risks in chronic kidney disease patients that take calcium-based medications by producing a 3D image of a beating heart with calcium deposits.

Add into the mix the expectations for near-field communication – a way for mobile devices to wirelessly interact with other devices or objects that are in close proximity – and healthcare looks set to be transformed. This technology could be used in a plethora of ways – to track patients in hospitals, to improve medication compliance, and make drug prescribing more efficient. Meanwhile, digital display devices such as talking medicine cabinets or fridges that could remind us to take our medication or eat more healthily based on feedback loops from monitoring implants are on the horizon. And even more ‘sci-fi’ are brain-computer interfaces – using the power of thought to interact and communicate – which has huge potential for immobile and terminally ill patients.

The data cloud
Meanwhile, electronic health records are also expected to be important in the future. But it won’t just be a matter of past health information being stored in an easily accessible ether, future health scenarios will also be generated from large databases of information including lifestyle and genomic data, as well as medical intervention choices. Known scientifically as predictive analytics, this medical forecasting and patient profiling will become increasingly popular, believes Ian Gallifant, managing director at Zaptag, a UK-based personal health record company. “This means patients will have a personal future health profile, bespoke and individual to them, compiled from previous illnesses, family history and medications, which predicts their future health risks and creates a health forecast outlining steps for a healthier and longer life.”
Indeed, Sarah Gordon, associate director at OgilvyHealthPR, says widespread use of cloud-based electronic health records that can be accessed anywhere at any time will be the “tipping point of future progress”, and with smartphones playing a major role in realising this potential, she says they will be “the digital glue that will allow technological advances to interact with our bodies”. For example, adds Rohit Talwar, chief executive of futures research and consulting firm Fast Future, “I could scan the product bar code in the supermarket to tell me whether or not I should buy it – for example, rejecting foods with high sugar content if I’m a diabetic”. The future will see “individuals using their own genetic data to make healthy lifestyle choices, have deeper conversations with their healthcare provider and more actively participate in research”, notes Ashley Dombkowski, chief business officer at genetic profiling company 23andMe.

Patients are the drivers
So our destiny is gadget-led, but while technological advances increase capabilities and save financially, these are not the main forces behind this dramatic healthcare shift. Much comes back to the patient, their increased interest in health and in interacting with technology. “People are realising they have a choice and are gaining control and knowledge, thereby becoming more proactive rather than reactive to health issues,” says Gallifant. “The realisation of support and education from online technology and apps and their increasing availability is fuelling the opportunity, and drive, for improved health and care.”

Indeed, according to recent market research carried out by Novartis, 92% of patients and 84% of seniors said they were comfortable using technology overall and almost two-thirds of patients think technology is helping them to better manage their health. “Patients are showing an increased interest in managing their own care and research shows they understand how technology can help them improve their health and are embracing solutions to do so,” a Novartis spokesman says. As such, the firm’s portfolio already includes a variety of smartphone apps and an electronic medication bottle cap, called GlowCap, which notifies healthcare professionals if a transplant patient misses a medication dose. Novartis is also experimenting with ingestible microchips, a sensor-based technology that monitors whether patients are taking their medication, with success shown in early trials.
While some might think it seems like technology overload, the irony is for future preventative healthcare to materialise you need technology to enable it, says Michael Reilly, managing director at Triantan Solutions. Patients and consumers need to be empowered through access to information, which will allow greater independence and reduce the cost burden on healthcare, he says. It is, he adds, “irrefutable” that we need greater adoption of technologies to connect patients and consumers to the health system, while allowing independent living and, importantly, reduced cost of care through out-of-hospital treatment. “Patients and consumers are increasingly more demanding, they desire choice and are technically literate,” he says.

However, “the challenge”, warns Pamela Spence, UK and Ireland head of life sciences at Ernst & Young, “is how you encourage consumers to take charge of their own health rather than demand the right to get better when sick?” For example, she says, genomic data is “helpful” but it may be at the mercy of insurance companies, which means the genomic test acts as a disincentive. “There is no denying technology can help healthcare delivery and management but unless there is a benefit to the consumer why would they change their behaviour?”

Technology is not a panacea
So “technology in itself is not a panacea; it needs to be adopted and incorporated into our everyday behaviour” and information overload will have to be managed, Gordon notes. It is the “interface between technology and the person that is more important than the technology itself and that will be key to changing behaviour”. As such, public and individual patient communication will be important in unlocking the benefits of new technologies.

For example, computer-generated video documentaries of future health scenarios could help people understand the impact of their disease, potential future consequences and drive patients to make better decisions about their health.  “The challenge will be to use technology to bring to life future scenarios that are perceived to be real, not make-believe, that empower rather than frighten, so that people will actually apply the message and adopt recommended health behaviours,” Gordon notes.

However, as former Labour Health Secretary Alan Milburn noted at the recent Future Health and Care Expo: the potential for technology is “enormous” but there is a “mismatch between the services that are provided and what is needed”. Furthermore, some people adopt new technologies more quickly than others – and, says Dombkowski, many won’t always fit neatly into existing procedures and systems; it takes time to develop new or broader approaches that enable the effective application of new technologies.

What is pharma’s role?

Companies have to decide, says E&Y’s Spence, between enabling health outcomes or being famous for scientific innovation and medicines. However, Talwar believes the demarcation won’t be quite so distinct. “Industry boundaries will blur. Pharma will focus more on wellness and also get into lifestyle drugs, such as treatments to enhance mood, reduce stress, improve concentration,” he predicts. He also suggests companies may move to acquire providers of self-care and prevention tools, including greater tie-ups between the pharma and food industries.

Likewise, Gallifant doesn’t believe it’s an either/or situation for pharma. “Industry will continue to produce pharmaceuticals to treat illness and disease; however companies need a more patient-focused and supportive method to communicate with, and support, local communities and patients in prevention and self-care.” He also agrees with Talwar that pharma will increasingly make acquisitions in the prevention healthcare and technology space, but cautions:

“In this new era of prevention, pharmaceutical companies are in danger of alienating themselves further and gaining a worse reputation for being purely profit, rather than patient, focused.”

Novartis is all too aware of this, he says, adding that marketing should continue to be responsive to patients’ needs. “Our marketing efforts should also ensure proper integration of new technologies to reach these patients in new and effective ways.”

Drugs and cures won’t lose their place, says Gordon, but what companies invest in will need to be chosen wisely. The bling might capture our imagination but “we need to remind ourselves that the focus of future healthcare remains the individual”.

Pharmatimes : Senior Reporter: Katrina Megget. Edited by: Jenny Hone/Claire Bowie 

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