Even before Covid-19, the expectations of the modern patient were undergoing a paradigm change. There is a growing desire to take control of one’s own healthcare and with this, a growing acceptance of digital solutions.
Badri Wadawadigi, chief digital officer of Pharmanovia, believes more effort needs to be focused on digital investment. Whilst companies across the world traditionally spend billions on developing new medicines, Badri believes digital solutions are a better investment choice, both for the patient, and the business itself.
Pharmanovia is a fast-growing international pharmaceutical company with a portfolio of over 20 brands across more than 140 markets with offices in the UK, Denmark, Netherlands, Switzerland, UAE, India, Singapore, Italy and South Korea. Its therapeutic areas include Cardiovascular, Oncology, Endocrinology and Neurology.
HMi caught up with Wadawadigi to discuss his view that digital solutions hold the key to improving patient outcomes.
The following transcript of HMi’s interview with Badri Wadawadigi has been edited for brevity and clarity.
HMi: What is driving the shift to digital solutions?
Badri Wadawadigi: I think it’s several things. There’s growing clinical evidence that medicines are not the only answer to improving disease outcomes, particularly chronic diseases ‒ diseases that patients live with for a very long time. Digital intervention can also be impactful in those sorts of situations.
In the past, we’ve attacked every problem with a new chemical or biological intervention. Billions of dollars of R&D are spent trying to improve medicines and to come up with new ones that are better than the current offering. But there is more and more evidence that other factors can also influence disease outcomes. It’s not just about medication, it’s also about whether you have the right diet, the right lifestyle, the right exercise regime, etc.
It used to be believed that lifestyle influences would only be impactful for conditions such as diabetes or diseases directly related to weight, but we’re seeing increasing evidence that you have better outcomes across a larger range of diseases if you improve your lifestyle.
If you’ve ever looked after a loved one suffering from a chronic disease, you’ll know how difficult the situation is. There’s so much going on in your life: you’re trying to figure out your financial situation, for instance, it impacts your work and family relationships, and it causes a lot of confusion, anxiety and isolation. It’s in this space, that digital interventions can help patients navigate the bit that isn’t just about the size of your tumour, but the one that impacts your entire life.
HMi: Digital interventions promise a more holistic approach to disease. Where else is interesting?
BW: The crossover between the two approaches to treatment is an interesting area. In clinical trials, where people take drugs in a very controlled setting, you might come up with a perfect result for how impactful a particular biological or chemical medicine is.
That’s not how real life works. In real life, people have jobs, families and many other distractions, and what actually happens is a lot of patients don’t adhere to their medicine very well.
This is particularly the case for diseases that are largely asymptomatic ‒ like hypertension ‒ where you can feel more or less well even if you don’t take your medication, up until the point you have a heart attack. Or osteoporosis, where if you don’t take your medicine properly, you feel well until you have a bone fracture. In those sorts of situations in particular, patients often drop off medications. This is a natural response to stress, side effects, and other issues that arise during the course of medication.
That’s where digital reminders, digital engagement, getting them a bit more involved in understanding why they’re on medications and what is happening with their body, can help patients adhere to their prescriptions for longer. They have better outcomes, and they’re less likely to have negative events.
HMi: What impact did Covid have on digital health?
BW: The pandemic provided a shock to the system.
Prior to the onset of Covid, although there were some interesting innovative digital ideas being developed, there was limited adoption, or rollout at scale, because of the inherent and understandable inertia in the healthcare system.
Healthcare is a risk-based system. Every decision made is qualified by the risk to the patient and so new ideas don’t necessarily find fertile ground for wide adoption. The pandemic forced a physical separation between doctor and patient. It also forced a change in approach to treating many chronic diseases as these were exactly the patients that might have been immunocompromised.
You don’t want such patients going into a high infection-risk hospital environment, especially when there’s Covid patients in the very same hospital.
It raised the question of how to manage the care of these patients, how to give them some level of support and how medical professionals could interact with them under Covid conditions. And that’s where technology made an impact. With telehealth, providing care at a distance suddenly became a possibility.
Medical professionals are now primed to the benefits of technology, and the healthcare system is now primed to operate in this new environment. It has been forced to.
Living through the pandemic has broken down a lot of barriers for digital health. In fact, it has accelerated a lot of developments and new technologies that are still yet to reach their full potential. It’s done the same thing in the vaccine space as well.
HMi: Do you still see the rate of adoption being maintained or will the industry revert to old habits?
BW: In the past, there were particular ways of doing things and now there are multiple solutions.
There will always be a place for in-person consultations but that doesn’t mean there isn’t space for consultations that are remote conversation based or for illnesses that require long-term monitoring. There’s no reason that some of these patient solutions should not stay in the digital realm.
What we’re going to see, just as with the workforce’s return to the office, is a lot of hybrid solutions. The next challenge for the healthcare industry is to work out what can be done digitally and what should be done in person. It needs to work out how to make the patient journey seamless: having an online consultation one time followed by an in-person visit and maybe another one on-line later. The challenge is how to use all the possible care delivery routes available to make the process work better but without disrupting the patient experience.
HMi: What part of the healthcare sector do you think digital healthcare solutions are most relevant and have the greatest potential?
BW: I’m particularly interested in management of long-term disease. It’s a sector where you must acknowledge the funding pressures being experienced by public care systems; they are constantly being asked to do more with fewer resources.
With long-term disease, you typically need periodic interventions but what’s happening now is that those interventions are becoming less frequent due to budget constraints. Digital solutions can help provide a companion to treatment and can help monitor in between those periodic interventions. They can provide a bit of reassurance when it comes to addressing minor questions – e.g. is my insomnia due to the medication, the disease itself, or the stress of living with the disease, for instance?
At Pharmanovia, we’re looking very closely at digital chronic disease companions that provide long term support to patients.
You also need to remember that a patient is a biological system. It’s constantly changing so readings you take at a doctor’s appointment aren’t necessarily reflective of your steady state. In fact, in hypertension, there’s a well-documented white coat effect where your blood pressure rises simply because you are in a clinical setting.
Things like at-home-monitoring, diagnostics and at-home companions can provide ways of interacting with the healthcare system without physically going to a hospital or clinic. There’s a huge opportunity in this last-mile where the healthcare system interacts with the patient, particularly where a patient has a long-term disease.
HMi: Are there any other contexts where digital opportunities are particularly exciting?
BW: There’s a couple of different models being developed in digital care.
One is where they provide a safe space for ailments that may be difficult to speak up about – things like erectile dysfunction, women’s health issues and diseases that might be, for cultural reasons, taboo. For these conditions, if you can get the same quality of medical advice or intervention remotely while sitting safely behind a computer screen, then you’re more likely to do it. There are loads of problems that go undiagnosed due to a reticence to talk openly and digital solutions would help better address them.
Another constraint is physical geography. There is an inherent ‘postcode lottery’ with health services. If you happen to live next door to a highly ranked teaching institution hospital, then you’re more likely to get a better standard of care than if you live in a rural area with fewer available clinics. That is particularly pertinent for emerging markets where distances can be large, transport infrastructure more challenging, and we are seeing here that online adoption is growing fast. We’ve seen massive growth in telemedicine in many Asia Pacific markets, for example, where people might not have the same ease of access to hospitals and clinics.
HMi: What could hinder the wider adoption of digital solutions.
BW: One thing that’s not really focused on enough is usability.
We’ve got to stop thinking that healthcare digital platforms are something fundamentally different to other digital tools. From a user experience, digital healthcare is the same as any other type of digital interaction. Patients are using well designed, easy to use apps and websites in many other aspects of their lives, and this sets a certain expectation on ease of use and intuitive navigation. When we think about designing digital health propositions, we must focus more than we have done in the past, on usability. You can have the most amazing, impactful medical outcome but if the patient isn’t comfortable with the app, it’s not going to get used. Surveys have shown that in the perception of patients, usability is equally important to the actual outcome.
We need to put the patient experience at the centre of everything we’re doing. Digital is just a tool. It’s not an end to itself, but it is a very good tool for trying to enhance the patient experience.