ERT, a global data and technology company dedicated to improving health outcomes through innovative drug development and patient support solutions, and Foundry³, a creative, science and innovation consultancy, recently announced a partnership to create tailored digital health programs that improve clinical outcomes by providing support to patients throughout their healthcare journeys.
The partnership brings together the expertise of two organisations with distinct capabilities in driving digital health program success. Foundry³ adds its unique approach to uncovering the challenges and motivators that impact patient behaviours and how they can be interpreted into a cogent digital health strategy to ERT’s global expertise in delivering regulatory-compliant drug development and patient support solutions for the pharmaceutical industry.
We spoke to Tim Davis, Vice President, Digital Patient at ERT and Alex Butler, Co-founder of Foundry³, to discover how, through this collaboration, they will deliver rich, adaptive digital health programs ─ based on substantiated patient needs ─ to help patients better manage their conditions and ultimately improve health outcomes.
Q: How would you say digital health programs have changed over recent years?
Alex: “Most initial digital health programs were based on a number of assumptions that really didn’t have any evidence, or validity, behind them. Often they were designed to support what the organisation, i.e., the pharmaceutical company or healthcare provider, believed would work, or, what they wanted to work because of how they wanted patients to behave. As we know from various aspects of our daily lives, people want to have control over how they engage with technology; they don’t want to be told how and when to interact, and they expect real value as a result of their interactions. Therefore, we need to provide tools and services that take these factors into consideration in order to genuinely help patients improve their lives.
This applies whether a digital program is intended to improve quality of life, make a difference to the way that patients understand their illness, or to facilitate better conversations with their healthcare providers. For example, patients can use technology to record events that happen in between visits with healthcare professionals, such as stress levels, sleep tracking and even automatic 6-minute walking distance tests. There are so many different ways that digital health programs can deliver real patient value.
Today’s technologies also enable us to incorporate validated tools to understand and track patient improvements. There are simple, validated, questionnaires that can help us understand what it’s like to live with a condition and as a result provide better patient information and support, but traditionally these were rarely used in clinical practice. There are a whole host of patient reported outcomes (PRO) tools that could not only help patients and HCPs, but also help pharma to understand the impact of medicines and other interventions in the real world.”
Tim: “From the tech side, what has changed is the technology to support these processes. Traditionally, digital health programs required patients to first enter the medications they were taking and how often they were taking them. For some this data entry could take 10-20 minutes before finally getting to something of value, so many patients would just walk away at that stage. Some organisations still want to capture this information, so it’s very important for solutions to be flexible and give patients choices. We have learnt that when patients can choose which elements they want to engage with rather than being forced to respond to a cascade of questionnaires, they are a lot more open and willing to continue their interactions with the technology.”
Q: When you look to design a patient support program, what are the key starting points?
Alex: “The key starting point is the patient. Implementing patient-centric programs in the real-world requires organisations to truly and rigorously look at patients’ lives and discover what they actually want. We have a simple model that looks to understand what the clinical intervention should be, which includes working out where the evidence base is for what people can do, or interventions that can be accomplished. We then look at what type of behaviour can be supported. This can get a little tricky, because although it may seem like we’re trying to modify the way that people think, we’re actually trying to enable interventions that can support behaviours that have been proven to enhance outcomes.
Historically, the use of behavioural science in pharma programs was about getting experts to talk about different theory models, whereas now we are focused on using behavioural theory to direct how to present information, give patients choices and enable them to take action.
The final consideration is what actual value the patient is going to get out of the interaction. If they’re not focused on reminding themselves to take their medicine, but they have to plough through 15 minutes of a set-up process that purely focusses on that, then it is unlikely to add value to the patient. Patients’ daily lives are already busy, so if a digital health program makes the chronic condition management more complex and time consuming than it was previously — and does not add any great value — it’s not likely to be something that they will use.”
Q: Personalisation has become a major factor in delivering these types of programs. What tools and techniques work best for creating adaptive solutions that can be tailored to individual users?
Tim: “Often the organisations we work with are focused on continually refining a solution before launching it, whereas we are much keener on getting solutions out there relatively quickly to see how they work and learn from this experience. We find this to be the best approach to creating adaptive solutions. We release new digital solutions with some of the key functions and then look at the implementation of additional features going forward. But we always reflect back to understand what those core objectives are. That way, when we introduce enhancements we can ensure that they are based upon learnings from the initial launch.”
Alex: “Pharmaceutical companies have always been comfortable with segmentation models; however, these can be problematic when it comes to patient support design. The models often become organisationally defined and based on binary risk evaluation models that then define the patient interventions. We should enable organisations to personalise programs down to the individual. We can then use technology to build programs around individual attitudes and beliefs, thereby meeting real goals and needs. This enables us to develop services that support people in the context of their own lives, rather than trying to segment them into specific groups that may not really represent their needs.”
Q: How do you see current tech trends (conversation interfaces, artificial intelligence, etc.) impacting the design and delivery of these types of interventions?
Tim: “I think that it is really easy to throw everything at these type of programs from a technology perspective so that you have various ways to interact, rather than asking ‘what can we do that would make patients’ lives better and give us a path forward to engage with them on a longer-term basis?’
On the flip side of this, some technologies can actually have a significant impact. For example, with artificial intelligence (AI), where we can mimic natural conversation, we get a useful level of personalisation that something like an app doesn’t provide. Essentially, it’s still like entering a question into Google, but it provides a much more natural interaction that some patients really like.
At ERT we have done some work with voice interfaces, which research has shown to work quite well with elderly populations. When it is appropriate, we will incorporate these types of technologies, but at the core we will always ask ‘what value will it add for the patient?’”
Alex: “The key factors are ‘simplicity’ and ‘what you are trying to improve?’ when it comes to clinical outcomes. If you start from a technology point of view, often you make the wrong decisions based upon whatever biases you have. Actually, the simplicity side of things is what excites me about technology. If you can just type a question into a solution, in natural language, and get genuine help and responses –also in natural language and in real-time — then that is a massive improvement for many patients trying to manage chronic diseases.
The challenge is for pharmaceutical companies to provide information that is genuinely easy to understand. A lot of content that is currently produced for people with health conditions doesn’t work when put in the context of an actual conversation, which shows just how unreadable and unhelpful it is from a health literacy point of view. AI’s capacity to help solve these problems is going to be really powerful for patient support programs. The irony is that a voice interface probably has the most benefit among patients who are not able to get support through other current technologies, e.g., those living with Alzheimer’s, early onset of dementia and other such diseases. It is exciting, but I believe you should never lead with the actual technology.”
Q: How do you see this collaboration adding value to the solutions you develop?
Tim: “We want to create better, more relevant and highly sustainable patient support programs. We think that there are two aspects to achieve this. The first is helping pharma to work with patients so that we can make something tangible that will make a real difference in their lives. The second aspect is around the delivery. These days, digital health programs are so much more complex than just a standard app. They require greater in-depth experience in multi-country roll-outs, changing regulatory environments and data privacy considerations, as well as an overall understanding of how to manage these programs for the long-term and not just for an initial product launch.
Speaking for ERT, we recognise the experience and the strength that Alex and his team has when it comes to really getting to the crux of understanding the key performance indicators and relating those to every day patient experiences. This means that we can design patient support programs that have a positive impact on behavioural change and offer true value in their lives.”
Alex: “Foundry3 has a long history of helping pharma to innovate when it comes to improving clinical and patient outcomes. I think that if you combine insight, strategy and an understanding of how to apply technology to improve patients’ lives and outcomes with the capacity to manage all of the complexities of data privacy — and you deliver that type of innovation at scale, which ERT has repeatedly done — then you have something that is really exciting.”
