The document discusses a roundtable report on the implications of the Topol Review for the pharmaceutical industry. The Topol Review explored how to support digital healthcare technologies in the NHS. The roundtable addressed questions about ensuring personal care in a digital environment, bridging digital divides, and benefits of technologies like genomics and AI. Key points discussed included the need for patients to be partners, addressing skills and access issues, and the industry needing to adapt to remain relevant in a changing healthcare system focused on personalized care.
Is Technology Removing the ‘Care’ from Healthcare?
1. A roundtable report based on the Topol Review
HEALTH
CARE?CARE?CARE?
IS TECHNOLOGY REMOVING THE ‘CARE’ FROM
2. IS TECHNOLOGY REMOVING THE ‘CARE’ FROM HEALTHCARE? 2
Healthcare has entered
the digital age
The digital era is transforming
healthcare. All stakeholders,
including pharma, will need to
adapt, finding new solutions to
meet evolving challenges and
opportunities. February’s Topol
Review offers useful pointers.
The inquiry, led by US cardiologist,
geneticist, and digital medicine
expert, Dr Eric Topol, explored
how to support the deployment
of digital healthcare technologies
throughout the NHS.
There are wide-reaching
implications for the industry.
With healthcare at this crossroads,
MSL Health convened a roundtable
discussion, consulting industry
leaders, including communications
executives, digital transformation
experts, marketing chiefs and
clinicians/clinical scientists to look
ahead to the NHS’s digital future
and the role of pharma within it.
HEALTHCARE IS ENTERING THE
DIGITAL AGEDIGITAL AGEDIGITAL AGEDIGITAL AGEDIGITAL AGEDIGITAL AGEDIGITAL AGEDIGITAL AGEDIGITAL AGE
The healthcare workforce
needs expertise and
guidance to evaluate
new technologies, using
processes grounded in
real-world evidence.
Patients need to be
included as partners
and informed about
health technologies,
with a particular
focus on vulnerable/
marginalised groups to
ensure equitable access.
The gift of time:
wherever possible
the adoption of new
technologies should
enable staff to gain
more time to care,
promoting deeper
interaction with patients¹.
1. https://www.hee.nhs.uk/our-work/topol-review
The three principles proposed
by the Topol Review
3. IS TECHNOLOGY REMOVING THE ‘CARE’ FROM HEALTHCARE?
QQQ
IS TECHNOLOGY REMOVING THE ‘CARE’ FROM HEALTHCARE? 3
The Topol Review calls for patients to
be included as partners, with a particular
focus on providing the same access to
vulnerable and marginalised groups.
It says the healthcare workforce should
have the expertise to maximise the benefits
from these new technologies. And staff
should, as a result, have more time to
care for and interact with patients. But
the pursuit of these principles raises key
questions for the pharmaceutical industry
given its core role in developing new
treatments – and its conspicuous absence
among the large number of stakeholders
who contributed to the report.
The roundtable focused
on three critical questions
to guide the discussion
Q.1
How do stakeholders ensure that vital
personalised care is supported in an
environment where remote interactions
with healthcare professionals are
becoming the norm?
Q.2
What is the solution to bridging the
‘digital divide’ to help prevent those
with limited access becoming further
marginalised?
Q.3
Where can the greatest benefit be
gained from the application of new
technologies such as genomics,
digital medicine, artificial intelligence
and robotics?
4. How do stakeholders ensure
that vital personalised
care is supported in an
environment where remote
interactions with healthcare
professionals are becoming
the norm?
Personalised care means people
have choice and control over
the way their care is planned
and delivered. It is based on
‘what matters’ to them and their
individual strengths and needs.
Today’s increasingly digital savvy
patients appear willing to embrace
new technology. Patients may
welcome a quicker way to get
health advice rather than going
to see a GP for a face to face visit.
Direct consultations with healthcare
professionals are already being
supplemented with video and
phone consultations.
Up to 30 per cent of the population
lives with two or more long-term
conditions². The increasingly
complex nature of chronic disease
management will make it even
more important for stakeholders
to communicate effectively with
each other. Digital tools can allow
time to be used more effectively
and care to be customised. Digital
technology might free up more
time for those who need personal
interaction with their clinicians,
while others could use an algorithm
and self-prescribe. There is some
evidence that algorithms can offer
sound advice. Empathy, though,
is conveyed differently across a
machine interface. Patients are
changing: the next generation
may not need or even expect face
to face engagement. This could
change even further with artificial
intelligence.
But is the pharma industry paying
enough attention to skilling patients
in communication for this new
digital world, or giving sufficient
thought on how it’s going to
reach them? The aim is to make
FACE-TO-FACEFACE-TO-FACEFACE-TO-FACEFACE-TO-FACEFACE-TO-FACEFACE-TO-FACEFACE-TO-FACEFACE-TO-FACE-TO-FACEFACE-TO-FACEFACE-TO-FACEFACE-TO-FACE
DIGITALDIGITALDIGITALDIGITALDIGITALDIGITALDIGITALFACE-TO-DIGITALFACE-TO-FACEDIGITALFACE-TO-FACE
VS
companies digitally focused,
with patient engagement upper-
most in everyone’s minds. Some
companies are trying to bridge the
gap. They are actively researching
digital solutions and mapping new
external stakeholders who might
get involved.
However, many in the industry
seem to think that there’s a long
way to go on communications
for digital change and using
digital channels.
IS TECHNOLOGY REMOVING THE ‘CARE’ FROM HEALTHCARE? 4
Q.1
2. https://richmondgroupofcharities.org.uk/taskforce-multiple-conditions
5. IS TECHNOLOGY REMOVING THE ‘CARE’ FROM HEALTHCARE? 5
Industry has to raise
its game in key areas
It needs to have more activities
that talk to patients and equip
them to make the most of access
to healthcare that doesn’t involve
a face-to-face meeting with their
GP. With greater preparedness,
big pharma will be in pole position
to help lift patient engagement
to the next phase, which some
have dubbed Health 5.0. This will
employ the latest digital tools
to boost the personalisation of
care. It recognises the core role
of patients as customers – going
well beyond patient-centric
healthcare towards customer-
centric wellbeing services.
EQUIPPING PATIENTS FOR
Patients are increasingly digitally
adept, embracing new technology
to engage with personalised
treatment plans. Making patients
strategic partners in their health
is fundamental to a new level of
engagement, better enabling them
to navigate the fast, disruptive
changes that are shaping the new
healthcare environment.
DIGITAL CAREDIGITAL CAREDIGITAL CAREDIGITAL CAREDIGITAL CAREDIGITAL CAREDIGITAL CARE
DIGITAL CARE
DIGITAL CAREDIGITAL CAREDIGITAL CARE
“PARTNERSHIPS
ARE THE KEY.
I DON’T BELIEVE THAT
PHARMA CAN DO
IT ON ITS OWN.”
6. CHANGINGCHANGINGCHANGINGCHANGINGCHANGINGCHANGINGCHANGING
DIGITAL CARE
CHANGINGCHANGINGCHANGING
THE RULESTHE RULESTHE RULESTHE RULESTHE RULESTHE RULESTHE RULES
DIGITAL CARE
THE RULESTHE RULESTHE RULES
What is the solution to
bridging the ‘digital divide’
to help prevent those with
limited access becoming
further marginalised?
Will the divide between the
technophiles and technophobes
– separated on the basis of age,
socio-economic class or simply
inclination – limit the spread of
these benefits? This raises another
pertinent question: how will we give
patients the skills – or even ensure
the degree of social involvement
– they need to make the most
of digital healthcare? It’s back to
reaching beyond the engaged
patient. People who welcome
digital healthcare – or even those
who tend to get involved in related
trials – are more digitally savvy;
in other words, a self-selecting
audience.
But what does the industry actually
know about customers and patients?
And is it in the position to bridge
the information technology gap in
healthcare? Big companies might
have 20 to 30 people talking to
clinicians every day; in future they
are likely to get their insights from
digital routes and tools.
New players will enter the market.
It is now easier for tech giants
to enter digital healthcare by
piggybacking on a smaller existing
health organisation, thanks to their
existing scale and infrastructure.
In the not so distant future we are
likely to see digital health platforms
by tech giants such as Apple or
Amazon which will integrate all
types of healthcare data – and help
consumers through predictive and
preventive care models.
There will always be a role for
pharmaceutical companies in
developing new medicines.
Regulation will be a huge issue for
the industry. Many stakeholders still
have to get to grips with the notion
of NHS and social care working
together. But there will need to
be big changes, particularly in
regulation if the pharma industry
is to play its part in boosting
public health in the digital age.
The burgeoning market in health
apps underlines this. Several
informants referred to the “wild west”
“IT’S ALL VERY WELL
HAVING AN OFFICIAL
MISSION STATEMENT TO
MAKE PATIENTS’ LIVES
BETTER. BUT IF WE’RE
GOING TO MOVE INTO
THE DIGITAL SPHERE
AND SUPPORT DECISION
MAKING TOOLS, WE
HAVE WORK TO DO.”
of half a million or so apps, with
many of the popular ones lacking
an evidence base, in comparison
to the high burden of proof for the
effectiveness of new medicines.
Q.2
IS TECHNOLOGY REMOVING THE ‘CARE’ FROM HEALTHCARE? 6
7. DIGITAL DIVIDEDIGITAL DIVIDEDIGITAL DIVDEDIGITAL DIVDEDIGITAL DIVDEDIGITAL DIVDEDIGITAL DIVDEDIGITAL DIVDE
The industry can currently
only communicate
with “other relevant
decision makers”
But in the new world who are
“relevant” decision makers?
Personalised medicine will thrust
this role onto patients. Yet industry
representatives can’t promote
medicine directly to the public,
or interact with social care – an
area that is increasingly seen as
indivisible from healthcare. It may
well be time to relax or revamp
those rules.
We can’t really predict what changes
will have occurred in 20 years’ time.
But the industry can and should
be proactive – and adapt to shape
the future for the benefit of all.
The importance of personalised
care needs to be considered
right at the beginning of the
development of a new treatment.
Pharma can and does engage
patients in the drug development
process with everything from
scientific discovery and drug
development, to disease
management and patient
education. But additional questions
will need to be asked as a matter of
routine. How is this treatment going
to be delivered to the patients? Is it
the type of medicine that will fit into
an algorithm? And in this case, how
do we design our clinical trials to
accommodate this?
There is much for the industry to
be positive about: it has a fantastic
history of public health campaigns
with patient groups and charities
in helping provide the expertise
and funds to make people aware of
things they might otherwise not be.
But to take this to the next level,
in the digital age, the industry will
have to champion digital tech for
patients, and let them know how it
can help them. Pharma reps might
not need to see 200 GPs because
an algorithm will tell them what to
prescribe. Instead, we could see
reps taking public health campaigns
to much larger consumer audiences
– for example, via football grounds.
The Topol Review calls for
programmes to engage and
educate the public on digital
healthcare technologies. To do
this, the NHS will have to develop
national industry exchange networks,
as well as opportunities for
clinicians to partner with academia
and the health tech industry.
IS TECHNOLOGY REMOVING THE ‘CARE’ FROM HEALTHCARE?
DIGITAL DIVIDEDIGITAL DIVIDEDIGITAL DIVIDEDIGITAL DIVIDEDIGITAL DIVDEDIGITAL DIVDEDIGITAL DIVDEDIGITAL DIVIDEDIGITAL DIVIDEDIGITAL DIVIDE
7
8. BETTER AND SAFER PERSONALISED
TREATMENTSTTREATMENTSTREATMENTSTREATMENTSTREATMENTSTREATMENTSTREATMENTSRARE DISEASESRARE DISEASE
Where can the greatest
benefit be gained from
the application of new
technologies such as
genomics, digital medicine,
artificial intelligence and
robotics?
Advances in everything from
earlier diagnosis to better and
safer personalised treatments
promise to revolutionise healthcare.
Breakthroughs in genomics,
computing and diagnostics
will allow clinicians to deliver
personalised, precision care
to patients.
Artificial intelligence – the branch
of computer science dealing with the
simulation of intelligent behaviour
in computers – is already beginning
to play a big role. A handful of
companies have developed
algorithms that are able to learn and
evolve as they gather information.
In April 2018, in a real first, the Food
and Drug Administration approved
IDx-DR, an imaging tool driven by
AI that detects diabetic retinopathy.
Trials for the automation of breast
screening are already underway.
Wearable technologies will allow
patients – and clinicians – to monitor
a range of vital signs, including
glucose levels, away from the clinic.
The Topol Review’s emphasis
on preventive medicine requires
genomics to play an ever-larger
role. But the rise of genomics could
leave a long ‘tail’ of rare genetic
conditions – and patients – at risk
of being forgotten. It’s relatively
easy designing personalised care
for vascular disease or diabetes.
Common diseases have engaged
sizeable patient organisations,
from which you can get input
or members of a steering group.
There is a challenge to do this
for rare diseases.
Financial dilemnas do exist and
these must be considered when
looking to maximise the benefits
of technological advances. The
crucial economic question: Is it the
industry’s job to pursue medical
research for the 1%, those who don’t
respond to existing treatments, the
long epidemiological ‘tail’?
Everyone agrees that someone
should do it. But, for this to be
financially viable, there will need
to be a fundamental change
in our approach to healthcare
economics. The benefits from
digital technology should provide
the incentive.
Technological advancements could
provide direct benefits for industry;
it might provide even more focused
R&D with greater efficiency and
savings. Digitalisation would see
pharma companies specialise more;
concentrating on doing fewer
things but doing them better.
Q.3
IS TECHNOLOGY REMOVING THE 'CARE' FROM HEALTHCARE? 8
9. The expert patient
is on the rise
And when it comes to digital
transformation, as with everything
else touched upon in the
roundtable discussion, patients
need to be included.
There is a fundamental need for
the industry to be involved in
digitalisation policy. The Topol
Review sought little or no industry
input and just one pharmacist was
involved in the whole report. Even
though the community pharmacist
is a key figure in patient access to
healthcare there was no discussion
in the report about their role and
how technological changes would
affect them. The ABPI hinted at
this disappointing lack of inclusion
by pointedly noting that digital
healthcare challenges would
be “most effectively addressed
through collaboration across NHS,
academia and industry”.
It is essential to ensure the right new
partnerships are forged with other
stakeholders (while acknowledging
that different companies have
different priorities and concerns).
It will be interesting to see what the
new NHS unit designed to oversee
digital transformation of the health
service, NHSX, will bring to the table³.
Rethinking our approach to clinical
trials in an era of personalised
medicines is unavoidable. This
will require a redesign of trial
methodology and reporting and
an increased reliance on open data
and evidence. This could bring
benefits in terms of increased
public trust.
Clear guidance on what standards
should apply to new technologies
would also be welcome - the Topol
Review appeared to suggest that
different rules might apply in future.
It may well be time to adjust or
revamp those rules.
And finally, digital transformation
will require embedding tech skills
throughout the pharma workforce.
The Topol Review cleverly models
future careers in healthcare
showing how our current roles will
change over the next decades; and
we can fully expect to see roles in
pharma changing too.
“PHARMA MUST ALWAYS
LISTEN TO PATIENTS.
WHEREVER THINGS
WE’VE DONE HAVE
BEEN WELL RECEIVED,
IT’S BEEN BECAUSE
WE PUT THE PATIENT
AT THE CENTRE – AND
WHEN WE DO THAT AND
WHEN WE DO IT WELL,
EVERYONE BENEFITS.”
CONCLUSIONCONCLUSIONCONCLUSIONCONCLUSIONCONCLUSIONCONCLUSIONCONCLUSIONCONCLUSIONCONCLUSIONCONCLUSIONCONCLUSION
9IS TECHNOLOGY REMOVING THE ‘CARE’ FROM HEALTHCARE?
3. https://www.gov.uk/government/news/nhsx-new-joint-organisation-for-digital-data-and-technology
10. IS TECHNOLOGY REMOVING THE ‘CARE’ FROM HEALTHCARE? 10
Contact Alison Dunlop,
Managing Director, Health at MSL
and join the conversation.
alison.dunlop@mslgroup.com
+44 (0)20 3219 8700
We’re MSL, a creative
communications agency.
We build better brands,
reputations and businesses.
By uniting diverse people, skills, perspectives
and expertise we combine thoughtful insight
and stunning creativity to deliver stories, content
and experiences that transform the way people
think, feel and behave.