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HLTH Content Director, Jody Tropeano interviews Manisha Gulati, Chief Operating Officer, Clarify Health and Bhash Parasuraman, Vice President and BU Lead, Rare Disease Patient &amp; Health Impact, Pfizer . They both recently presented on a HLTH GoLIVE series webinar called “Rearchitecting the drug launch model.” The discussion zeroed in on the incentives of regulators, payers, providers, and patients, which are often at odds with each other when it comes to drug launches.

Rearchitecting the Drug Launch Model

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Global Smart Health Solution Leader

The power of linked data in care transitions from hospital to home is fundamental to improving the health of individuals, as well as that of health systems. EY’s new insights paper, titled <a href="https://www.ey.com/en_gl/health" target="_blank">How innovative infrastructure can power the purpose of integrated care systems</a>, looks at the information architecture backbone necessary to join up the many threads of health, social and community services that keep people and populations healthier, independent and at home. The paper discusses integrated care systems (ICSs), which are presently being introduced in England’s NHS. However, the insights are relevant for any health system that is contemplating better coordinating care between health, social, third-sector and local government delivery channels. Joining up services is a long overdue recognition that, working together, rather than in fragmented silos, achieves better outcomes. And ICSs tick all the right boxes, ideally providing equitable, well-connected and coordinated care across all aspects of a person’s health and social needs for healthier populations and more sustainable systems.  Infostructures, or information systems that can create, connect and share data, leveraging a semantic standard, at scale, are key to modernizing health systems. As data becomes the core asset of health and care, it will be used by thousands of people for different purposes across time and space. Unlocking the power of ICSs as coordinated and collaborative ecosystems requires a new approach to health information architecture. This is one that not only spans the health and social dimensions of an individual’s life journey, but also realizes the immense value of health data availability in accelerating novel approaches for better and more efficient health and care.  Joined-up care means working differently  The richness and variability of health and social care encounters demand information infrastructures that are sufficiently agile to accommodate the heterogeneity of many different existing systems. Such infrastructures also need to act as platforms of exchange. This means allowing the easy flow of data within and between systems and analytics capabilities that support the use of data for local needs, safely and securely.  At a minimum, modernizing the operating environment should integrate the vast amount of health-related information about an individual into an integrated shared care record. Spanning complex care pathways across many different organizations, this should drive interorganizational information exchanges that prevent errors, avoid inefficiencies arising from duplication, and support primary care and health at home care models. As organizations such as the NHS move toward integrated care systems, there is a timely opportunity to build an information backbone with the entire system in mind. In the paper, we discuss why an open platform environment would allow sufficient flexibility to benefit from emerging technologies (e.g., artificial intelligence, augmented and virtual reality, hyper automation, decentralized identities and digital twins) and to deliver digital-first consumer and workforce experiences.  As major investments, health information systems need to stand the test of time. For decision-makers, this means not being constrained by elements that hold back system modernization and taking steps to avoid future burden from technical debt. Although the NHS points ICS decision-makers toward consolidation and enhancement of existing EPR assets, we have suggested in the paper that an alternative approach warrants consideration. This includes weighing whether existing monolithic EPRs in use in the acute health system can extend to satisfactorily meet the information needs of the community, mental health and social care domains, as well as in providing an experience desired by both the individual and the clinician.  Infostructure: The essential foundation for new models of care  Sharing organized and complete data to generate insights for better health outcomes is the driving force behind joined-up care in ICSs. This demands an information architecture that supports a longitudinal health and care record, shared services between different resources and the easy exchange of structured data across systems.  Health systems need to plan with a long-term view of the future. Beyond immediate need, strategic considerations must revolve around the vision for a modernized health system. Technology enablement is key to modernization, and the primacy of data liquidity is beyond question. The tools to deliver such liquidity must enhance, not impede, the permissioned sharing of complete data that gives rise to service model and operations innovations for better health outcomes. ICSs are a perfect example of the importance of considering the needs of all information users and ensure that a sufficiently agile system underpins the model.  Open platform systems will produce significant value as a result of seamless data flow across the entire health and care value chain – from primary and community care through to hospital systems. Integrated shareable care records replete with good-quality data are the backbone for any future health and care system. This is too important to get wrong. In this early stage of transition to ICSs, opportunity exists to weigh alternatives carefully. If information infrastructure is viewed through a different lens, that of open platforms and systemic design, the building blocks of a truly transformational change become clear.

As Health, Social & Community Care Systems Embrace a Common Ground in Integrated Care Systems, an Agile Information Infrastructure is Called For

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Managing Director, Technology

Sports technology is experiencing a rip-roaring boom. According to Emergen Research, the global sports technology market is <a href="https://www.einnews.com/pr_news/586687516/sports-technology-market-facts-future-scenarios-growth-analytical-insights-and-forecast-to-2028" target="_blank">expected to reach $40.22 billion by 2028</a> and register a double-digit CAGR over the next few years. The sector claims the vanguard in both <a href="https://www.cnn.com/2022/01/18/sport/gallery/sports-wearable-tech-spc-intl/index.htmlhttps:/www.cnn.com/2022/01/18/sport/gallery/sports-wearable-tech-spc-intl/index.htmlhttps:/www.cnn.com/2022/01/18/sport/gallery/sports-wearable-tech-spc-intl/index.html" target="_blank">wearable innovation</a> and <a href="https://fivethirtyeight.com/features/the-nba-is-turning-to-wearable-sensors-to-prevent-player-injuries/" target="_blank">advanced data analytics</a> for actionable health applications such as injury prevention and performance enhancement. Such wonders are immensely attractive to serious athletes, professional sports organizations, and the average weekend warrior — hence the thriving market. It’s an exciting space, but it is also relatively insignificant compared to the colossal opportunities it enables. Beyond protecting <a href="https://www.washingtonpost.com/sports/2022/03/18/stephen-curry-injury-left-foot-sprain/" target="_blank">Steph Curry’s ankles</a> or helping smartwatch owners <a href="https://www.9news.com.au/technology/samsung-galaxy-watch-5-pro-price-specification-samsung-unpacked-new-york/df2a1779-8a42-4a57-bf21-f8b232ed21c9" target="_blank">get a good night’s sleep</a>, the real prize is leveraging wearable sports-tech innovation and the valuable data it produces to transform population health and advance systemic improvement in medical understanding and application. Continuous Monitoring Data is Healthcare Gold Like many advancements in our age of digitalization, data is core to modern sports-tech innovation. The explosive development and adoption of wearable devices supply massive streams of continuous health monitoring data used for a plethora of personalized health and wellness-related applications. Those streams of data fuel all the fancy algorithms and AI-powered insight engines that support new sports and health services from companies ranging from Apple and Abbott to XSens and Xiaomi. Adapting and synthesizing that type of data and its related technologies to transform the larger healthcare ecosystem will unleash previously unimaginable capabilities — and it’s already starting. Radical Impact Consider just one example: pharmaceutical development. As outlined in a <a href="https://hbr.org/2019/05/the-future-of-drug-trials-is-better-data-and-continuous-monitoring" target="_blank">Harvard Business Review</a> article on “continuomics,” the same technologies consumers now use to increase daily activity or lose weight can be used in “radically new designs for clinical trials — with more targeted interventions, shorter duration, and fewer participants — thus lowering costs, increasing efficiencies, and potentially bringing important new therapies to market faster.” How radical? In a recent podcast interview on the use of wearable data and <a href="https://podcasts.apple.com/us/podcast/continuously-measured-digital-biomarkers-bringing-functional/id1542679453?i=1000567260517" target="_blank">continuously measured digital biomarkers</a>, Dr. Art Combs, President of FutureTech Strategies, illustrated with the example of researchers <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138095" target="_blank">obtaining a statistically significant sample size for a study</a> on cognitive decline in the elderly: “With normal technology, which is using surveys and many mental status exams and physician visits, the study was powered with 2,000 patients, and it required four years.” But with unobtrusive, continuous digital monitoring of activity that correlates with cognitive ability (in this case, walking), “the number of patients was reduced by a factor of 10 — meaning only 200.” And with continuous monitoring of walking activity and computer usage combined, “you need only 26 patients and three months.”  A Bigger and Better Picture Beyond clinical trial transformation, Dr. Combs noted that as a physician, exploring this kind of data is already reshaping his understanding of medicine: “I’ve been able to measure things that I previously couldn’t measure and didn’t even know it might be interesting to measure…what I’ve learned through digital medicine is that you cannot have a disease — pick one, Parkinson’s disease, diabetes, heart failure, sleep apnea, I don’t care what you pick — you cannot have that disease and not have the whole rest of your body notice.” Technologies pioneered for sports applications can paint a more holistic portrait of an individual’s health. Moreover, they can supply a more robust understanding of population health. A recent multinational <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826148/" target="_blank">JMIR mHealth and uHealth</a> scoping review on “The Impact of Wearable Technologies in Health Research” found:<ul><li>Big data extracted from wearables may potentially transform the understanding of population health dynamics and the ability to forecast health trends</li><li>Overall, wearable-generated big data sets might decrease biased data because measurements are objectively taken in the natural environment of numerous and diverse individuals</li></ul> The authors concluded, “We see growing uptake of wearables in health research and a trend to use wearables for large-scale, population-based studies…in diverse health fields including COVID-19 prediction, fertility awareness, geriatrics, atrial fibrillation (AF) detection, evaluation of methods, drug effects, psychological interventions, and patient-reported outcomes.” Bridging the gap The confluence of all these new streams of data for wearable sports-tech and traditional healthcare is worth noticing. Notably, new health applications for Apple Watch Series 8 are expected to dominate <a href="https://www.youtube.com/watch?v=ux6zXguiqxM" target="_blank">Apple’s Live Event</a> tomorrow. Fitbit’s <a href="https://www.fiercehealthcare.com/tech/what-fitbit-s-new-product-and-services-say-about-company-s-health-ambitions" target="_blank">Health Solutions business</a> works with 100 health plans, including Humana, UnitedHealthcare, and Blue Cross Blue Shield, and the company <a href="https://healthsolutions.fitbit.com/whyfitbit/" target="_blank">claims</a> that “over 2.6M Fitbit users have connected their data to a population health platform.”  In April this year, the US Food and Drug Administration <a href="https://www.zdnet.com/article/fitbits-afib-detection-algorithm-gets-fda-approval/" target="_blank">approved</a> Fitbit’s photoplethysmography (PPG) algorithm to identify user atrial fibrillation (AFib) from heart rhythm readings passively collected throughout the day. The <a href="https://www.fiercebiotech.com/medtech/fitbits-afib-detection-algorithm-makes-its-debut-new-health-tracking-smartwatch" target="_blank">technology is already embedded</a> in Fitbit’s Sense 2 smartwatch, which starts shipping at the end of September. Such innovation demonstrates how increasingly sophisticated health diagnostics are spilling over to consumer availability at a breakneck pace. Spilling into the traditional healthcare system is another story. While some medically prescribed continuous monitoring technology is fairly common for remote glucose or electrocardiography (ECG) devices — we’re still far from having anything like those Fitbit Sense 2 readings flowing seamlessly into a healthcare provider’s EHR.  Issues surrounding regulation, patient privacy, medical-grade data quality, and the capacity of healthcare IT infrastructure to accommodate or utilize vast swaths of continuous biometric information remain vexing hurdles, as do debates around potential cost and payment models. And there are massive cybersecurity concerns about what could happen if such data (or control of its streams) were used for nefarious purposes or wound up in the wrong hands. These are formidable challenges. But formidable challenges present enormous opportunities for solutions that surmount them. It’s not for nothing that Google ponied up <a href="https://www.theverge.com/2019/11/1/20943318/google-fitbit-acquisition-fitness-tracker-announcement" target="_blank">$2+ billion</a> to purchase Fitbit or that <a href="https://www.bloomberg.com/news/articles/2022-07-20/apple-argues-it-s-now-a-major-force-in-the-health-care-world" target="_blank">Apple released a 50+ page report this year</a> “outlining all its health features and partnerships with medical institutions, arguing that such offerings are key to the tech giant’s future,” or that <a href="https://www.morningbrew.com/daily/stories/2021/08/30/fitness-wearable-company-whoop-raises-200-million-36-billion-valuation" target="_blank">impressive investment is drawn to the field</a>. The quest to safely integrate the cutting-edge capabilities of the sports-tech world into the broader healthcare sector will revolutionize both.

Pioneering Opportunities for Wearable Sportstech Data in Healthcare

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Senior Vice President Clinical Innovation

Discover key connections to your mission and community Advancing diversity, equity and inclusion across every community is an urgent and imperative goal for many organizations. It’s essential to connect advocacy groups to health organizations, health employees to the mission of health, and consumers to services that have historically been out of reach.  To shape a more equitable health picture, leaders can collaborate with community groups to improve data collection, pinpoint local needs and take action. They can also project the impact that social determinants of health and bias within the community have on their organization. Pairing with community-based organizations  Health organizations are thinking about health equity in new ways. They’re working with community partners to share data, build whole health consumer profiles, create value-based care avenues that address inequities, and assess performance metrics. Leaders should identify local community groups that are strong potential partners. By building trusted relationships with these entities, health leaders can assist them with the support they need to implement solutions and scale. To that end, the community may already have developed possible solutions that haven’t yet been explored at a broader level. Together, health and community-based organizations can work together to finally empower the scaling of community-originated ideas.  There are many ways to approach cementing these community-based partnerships. Health organizations can financially support nonprofits. Health leaders can also serve on their boards. Additionally, they can invest in programs that serve the community needs around food, transportation, housing and other basic life needs. It can be more cost-effective for health organizations to support community work that is already serving their members through a whole-system approach. Health foundations and Medicaid health plans are also channels to fulfill members’ holistic health needs. Half the battle lies in some of the basics. Using technology to address social determinants of health Technology is an indisputable asset in supporting a patient’s health journey. It empowers a person to have more information at their fingertips, allowing them to better take charge of and manage their condition around their life, rather than their life around their condition. Technology also adds value to the greater health care ecosystem by combining important contextual information from an electronic health record — such as a patient’s health history, medications, allergies and social determinants of health — with a computerized version of best practice clinical guidelines. As a result, a more complete health picture allows providers to offer a more personalized recommendation, and that can lead to a more equitable outcome. Technology supports value-based care management through remote monitoring, patient mobile apps, artificial intelligence, automated scheduling and more. These tools also help overcome transportation- and cost-related challenges to improve access to the physical and behavioral health services people need.  Digital therapeutics further personalize the health experience by pulling together a person’s background, preferences and mental health symptoms and then matching them to an app that would fit them best.  However, it’s important to keep in mind that technology will not solve health equity on its own. For instance, access to technology itself is a social determinant of health. Those living in rural areas may not have internet or mobile service coverage that is powerful enough to enable a person to use electronic technologies for digital health. They may also lack the funds to afford these services.  Charting health equity with outcomes in mind  To identify people who are affected most by health disparities, organizations can construct a data-driven map of communities at risk. Connecting data points also provides insight into the ways social determinants, health literacy, bias and other inequities affect health outcomes. For example, a person experiencing homelessness may be driving high health care utilization rates, yet the data point that they are unhoused may not be recorded anywhere in the patient’s records. If information from multiple sectors connects these facts, then the community, public health system, homeless shelters and health organizations may be able to combine forces to assist the person in securing housing. The same structure applies to other SDOH, such as food and transportation. Health care is a major part of a community and of an ecosystem, yet there are other vital factors at play too. In fact, medical care contributes to just 20% of a person’s health outcomes, while where one lives, works and ages can have more impact on their health than any other factor. Ensuring products and services serve consumer needs Racial, ethnic and language diversity often isn’t reflected in products and service offerings. There’s no clearer business case for growth than increasing the access of products and services. Improving and simplifying readability for people with low literacy is one example of supporting an approach of diversity and inclusion. Other aspects to consider are whether your products and services can be delivered in rural areas, what your consumers’ needs are for communicating, whether a population’s primary language is English, whether products meet their needs, and if your customers understand how to use them. Serving every person, everywhere, through technology is the best business case. By thoughtfully determining how you can weave health equity into every aspect of your business, you can reach all the different dimensions of the American consumer. Listen here to explore more strategies for reducing disparities and improving health equity.

Health Equity Paves New Pathways for Integration

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