Pharma’s isolated islands of innovation
The relentless pace of technological innovation in healthcare means we’re witnessing a Cambrian explosion of connected data-enabled medical devices. Electronic patient health records are becoming the norm. Interaction is moving beyond the computer and phone and into distributed voice-activated services such as Alexa. Artificial intelligence and big data sets are all set to revolutionise the way we diagnose, manage and treat conditions - with record amounts of funding pouring into start-ups and established players alike.
But it seems there’s a widening gulf between the promises of healthcare technology innovation tomorrow, and its application to the improvement of people’s lives in the here and now. And especially so for those managing long-term or chronic conditions.
Within the pharma industry, this has been evidenced by so-called ‘beyond the pill’ services providing a thin veneer of patient utility by focusing almost exclusively on drug-related support programmes, rather than services providing patients with a technology-enabled, data-driven understanding of, and element of control over, their condition.
The development of these pharma services have traditionally been ‘tacked on’ to an existing product, driven by a need to market said product - rather than developed as a core component of the product itself. The internet is subsequently cluttered with pharmaceutical ‘support programmes’ named after drugs, and offering the same standard set of ‘one-size-fits-all’ basic services: access to phone lines, online resources and tips, medication reminder apps, mindfulness tools, help with pre-screening/application processes and financing, savings cards, and even daily crossword puzzles and games.
Historically, it would seem pharmaceutical companies have not been well suited to the development of user-centred services. By definition, their businesses are geared towards lengthy R&D-driven scientific product development processes, not creative, agile, service design methodologies. Service design is not part of their core business.
And on a broader level, data and digitally-enabled service design by traditional healthcare providers, medical device manufacturers and health insurers has so far largely resulted in isolated islands of innovation that remain unconnected from the average patient’s perspective. Virtual consultations, repeat online prescription deliveries, online health assessments and mail-order blood tests are all available. Separately.
But usefulness and utility is only truly delivered for patients with long-term conditions when these services are joined up. But the task of joining up ever larger and more disparate amounts of data, on ever more devices and services, across ever more outdated legacy systems, is becoming harder and harder.
A single organisation in a particular sector or industry attempting to join data, devices and services so they work optimally for a patient faces some pretty tough challenges.
By way of example, let us take the simple hypothetical case of a patient undergoing a common surgical procedure in a private hospital. Let us suppose that following this particular procedure, the patient is prescribed a series of drugs and physiotherapy. It’s been proven that this particular combination is the most effective in aiding recovery, but that over- or under-exercising in the first six weeks following the procedure has a detrimental effect on outcomes.
Using technology to aid patients in their recovery would seem a simple matter of tracking their activity using a device, and sending them an alert when their activity levels were under or over recommended levels. Less like big data - more like just a little bit of data.
Yet these types of data-enabled feedback loops simply aren’t commonly available. The reason is that designing the service isn’t difficult. But initiating, funding, developing and operationalising it is staggeringly difficult.
In our basic example, the health insurer, private hospital, operating surgeon, pharma company, physiotherapist and patient all have a vested interest in improving and tracking the patient’s outcome. The development of a simple technology-enabled service with the ability to improve said outcome should be a no-brainer for all of them.
But one needs to ask why an upstream insurer or pharma company should develop a solution that would need to be administered and monitored downstream by a physiotherapist. How would that even work? Which systems would they use? Which other systems would they need to integrate with? Where would the data be stored? Who would own it? Who’d be able to access it and when, and under what circumstances? Who’d be responsible for it? Who’d own the patient relationship? How would revenue or costs be shared? The list of reasons as to why it’s not going to get off the drawing board just goes on and on.
So even in our brutally and artificially simple example, we’re not designing around the patient at all. Instead, we’re skirting around the issue. And as an industry, pharma will continue to do so unless it is able to truly focus on providing patients with meaningful data they can use to change their behaviour or manage their environment. Our hypothetical example uses but a simple fitness tracker. The range of data-enabled medical devices currently and soon-to-be available is quite staggering.
Gathering, storing, sharing, analysing and using all the data these devices produce will be tremendously difficult, but that is what’s required if we’re to use technology to improve services for patients, and ultimately improve patient outcomes.
This is something that organisations close to, or indeed representing, people with long-term conditions are already acutely aware of, as Janet Allen, Director of Research at Cystic Fibrosis Trust, speaking recently with Elly Aylwin-Foster, one of Friday’s experience design strategists, explained:
“Empowerment is a central tenet of remote monitoring, and indeed every aspect of the research we do; it’s about providing people with cystic fibrosis the tools they need as individuals to manage their condition. Those needs will vary from person to person, but a variety of tools should be available to help people manage their condition to the best of their ability.”
So the role of service design and technology must increasingly be to facilitate the flow of real-time actionable data that has context and meaning, and can be acted upon by the patient. Which requires an understanding of, and response to, the fact that patient outcomes are likely to be best improved within the context of a very complex ecosystem.
Modern service design approaches in pharma are thus likely to be more successful if they focus less on what the next app should be, and more on how to offer services and data in expectation that they’re likely to be incorporated and subsumed in other company’s service platforms.
This necessitates pharma being active in defining the data-sharing and integration protocols and standards that will allow for more useful-joined-up-ness between services for health and well-being, patient management, condition management, insurance funding and healthcare logistics. This is a service platform approach, with pharma leading in the standards definition for data and technology interoperability.
Which requires a fundamental shift in perspective and capability.
It means developing services with the expectation that you’ll need to partner, share and develop collaboration standards.
The winners will be the innovators, the collaborators, the true patient-centred designers: those that lead the way in developing standards of intra-industry protocols, governance and revenue sharing.