When discussing Mobile Health (mhealth) it can be a challenge to ensure we all interpret this by the same parameters, so all stakeholders feel engaged in a common space.
mHealth, digital health, telehealth – all these terms are regularly referenced but misinterpretation or defining the scope can be an issue, both professionally and in patient circles, leading to uncertainty, alienation or a feeling of inaccessibility around the approach.
However, clarity around the language of opportunities will become increasingly important as trials and healthcare provision further decentralize and as an industry we are challenged by ever more remote demands.
Do not dehumanise mhealth
For mdgroup, mobile health is viewed within the context of serving patient. All stakeholders – from patients, Sponsors, CROs, sites, to researchers themselves, can feel challenged by the concept of mhealth or digital health. For all parties there are challenges and uncertainties regarding how mhealth may impact the outcome, and their sphere of operation.
But when the approach is not dehumanised to components such as recruitment, engagement, data collection, and endpoints, and where a clear distinction and understanding of the value of holistic patient servicing is made, which can really add value and ensure the best quality outcome, the picture becomes less alienating for all.
Mobile health services may involve medically trained healthcare professionals visiting a patient’s home to perform an assessment needed in the protocol. If you look at what is needed in the protocol, unless there are blood draws or complex assessments/evaluations that need to be done by a person actually being in the house, there are cases when an in-person visit may not be needed.
In this context, digital health, telemedicine and digital technology come to the fore as a sub-set of mhealth. These act as an enabler, through tools like electronic questionnaires, remote ECG monitoring and wearable devices. However, each of these enablers still need managing by people, and to be fully understood and embraced by people, across the health ecosystem.
And here, the value of the human angle cannot be underestimated.
Interpretation of data as it applies to people, insight, experience, understanding around the human interaction with technology all demand, or benefit exponentially, from a personalised approach. As it ‘says on the tin,’ the importance of the person cannot be taken out of the equation as personalised medicine and patient centricity gather force, no matter what terminology, technology or trend is to the fore.
How far can mhealth take us?
We have had components of mobile health supporting clinical trials for years before COVID. But some aspects, such as home visits, were really only used on trials for certain indications. For example, rare diseases where patients were located significant distances from sites, and you may only have had five or ten doctors that treated those diseases globally.
Covid has changed all that. We better understand the anxieties and complexities all populations face in diverse clinical and healthcare situations. Protecting patients through trials, allowing them to continue on studies without always needing to visit the clinic and managing the intense anxieties associated with trials and healthcare provision is now much more widely understood. The argument for patient servicing to support many aspects of enabling trial participation and aiding retention, by bringing patients to trials in distant locations, and bringing trial protocols to distant patients – is much more valued, and yet so much can be done.
Sites and sponsors can be supported by logistical systems and medical distributions centres to make remote care possible.
Researchers can be aided by better communication with patients – interpreting with patients the languages of data, endpoints and scientific thinking to better engage with diverse patient populations.
Trial design, protocols, and risk profiling across the various phases of research can all benefit from quality patient servicing, alongside more closely monitoring wellbeing with patient sentiment analysis technology platforms.
It all begs the question, what more can we do through mhealth and patient servicing to support diverse populations, and why do we not do this for more patients?
Case Study – Out Back but Not Out Done
Australia’s isolation through COVID-19 has created a unique environment for its healthcare workers and patients. And with the remote environments of the country, mhealth visits require real commitment from healthcare providers (HCPs), as well as technological and logistical support of the highest calibre for the sites and sponsors.
Mdgroup’s patient servicing in some of the remotest regions of Australia, as well as in urban areas, support diverse patient populations while removing the need for trial participants to commute to COVID-19 hotspots in Australia.
Clinical Manager Isabelle Ibrahim, who has worked in scientific laboratory settings, clinical research project management and as a critical care nurse specializing in intensive care, is only too familiar with all the complexities for stakeholders engaged in mhealth. She is committed to supporting patients at all stages of the trial and helping minimise the number of patients going to site.
This empathy with patients and passion to provide outstanding patient-centred clinical trials services, not only for the patients and their families but in support of skilled patient-facing clinicians, is the differentiator that underpins holistic patient servicing and mhealth as we interpret this.
“It’s a real positive of the role to offer a solution which saves the patients from commuting to distant clinical trial site locations in COVID-19 hotspot zones, especially whilst major cities in South-eastern Australia navigate challenges associated with the current Delta outbreak,” explains Isabelle.
“The feedback from the patients we have supported has been overwhelmingly positive,” she added.
And this is the mhealth story we are seeing more and more from HCPs who, supported by digitisation, can now extend their services and skills to support even wider and more remote communities.
Isabelle’s experiences also make her quick to express a gratitude – many of us in the clinical services sector feel – towards clinical trial participants, for their valued role in facilitating new therapy discoveries and improving health outcomes for future generations.
Like many HCPs, she has at times felt restricted by the resources available to her to provide truly patient-centred care. She explains,
“In my experience working in the clinical research field, I have often felt disappointment and frustration at the resource constraints faced as a member of clinical trial site staff.
“With the present Australian clinical landscape, especially in response to the onset of the COVID-19 pandemic, the mHealth opportunities enabling me to work creatively to overcome the various associated challenges we face in the field, have given me a renewed passion for my work.”
Working on a global scale
This Australian case is just one example of how mhealth can reach those parts ‘others cannot reach’ and where holistic patient servicing is improving outcomes for researchers, healthcare professionals and patients. Clients are now more open to mobile health components due to experiences with COVID, but there is no reason not to deploy the same strategies in areas where COVID is not so much of a challenge – as an active patient management strategy to remove some of the barriers to participation/retention.
Patients feel more engaged and supported, sponsors and sites have quality field support and are more assured of accessing quality data in real time, and healthcare practitioners are more engaged and better informed about study details.
Without barriers from geography, technology, communication challenges or service capabilities, the potential to create truly global healthcare solutions with patients at the heart of the transformation should be the goal of all stakeholders.
By Caroline Jackson, Executive Vice President, Patient Services, mdgroup