To launch our new DTx Circle podcast, Wellthy’s Karine Soulat was joined by Maneesh Juneja, a Digital Health Futurist who explores the convergence of emerging technologies to see how they can make the world a healthier and happier place.
Ranked 7th most influential person in Digital Health in 2016 and the 10th most influential in Wearable Technology in 2015, Maneesh has been supporting and advising organisations since he left the security of his career at GlaxoSmithKline, to immerse himself in the new world of Digital Health in 2012.
Karine and Maneesh covered a range of topics, from how healthtech can stay relevant to the needs of the population over the coming decades to how other industries can help to shape the future of healthcare delivery.
The products and services with the biggest impact will come from outside healthcare.
Having analysed real-world data sets in the pharmaceutical industry for over a decade, Juneja believes there is a huge amount of data that’s generated but not necessarily captured.
He cites the example of a patient who has two appointments six months apart, during which time their condition worsens. Is this solely due to their treatment plan? Or are other factors at play? Perhaps they stopped exercising in that period for example. Much of this data is generated, but not captured by healthcare services. To build a 360-degree view of a patient’s health, systems need to integrate this data into patients’ records.
What role do you think DTx plays in the current shift in thinking?
Juneja notes that healthcare and pharma are not sustainable in their current guises. Increasing the workforce numbers, or the number of scripts written is not the long term solution. Healthcare systems have to look at being preventative, rather than responsive; working to fix population health issues.
For DTx to thrive, healthcare systems should be looking at incentivising new forms of value. If a product, DTx or otherwise, can help to prevent disease in a patient’s lifetime, this is of more value than the treatment. Healthcare Beyond the Pill must find a way for these types of DTx solutions to be incentivised in order to improve population health.
Paying for prevention is, of course, something of a contradiction. Until the end of a patient’s life, it’s impossible to tell whether or not that preemptive intervention was necessary. Lowering risk factors using digital solutions though, Juneja notes, should be incentivized.
How should pharma elevate DTx solution providers?
In order to fully appreciate the value of DTx, Juneja states that healthcare systems should go beyond traditional measures of evidence, and look at new forms – patient experience, patient outcomes, and integration. These will drive both innovation and population health.
There’s also a huge opportunity for DTx to help drive the Net Zero targets of healthcare organisations. The NHS has committed to Net Zero by 20401, and certain DTx products, with their emphasis on healhcare in place, rather than in person visits, can massively reduce carbon footprints. As planetary health becomes more intertwined with human health, DTx providers can stand out in the drive to Net Zero.
What solution will be the biggest driver of personalised care?
It all comes to health outside the hospital – any solution that can provide a 360 view of healthcare in real time will be the biggest driver. If we can link the data from DTx, wearables, and any other validated data inputs a patient has, to the electronic patient record we can see when, where, and how the patient’s health is changing. Even within a healthcare system, tech systems rarely talk to one another.
At present it’s often a struggle to link data sets from wearables to electronic patient records. The organisation that solves this link will be the one that will drive the biggest change, whether it’s an existing global tech giant, or a new entity.
If you invented a DTx solution in healthcare what would it be?
For Juneja, it would be fall prevention. Almost 700,000 fatal falls occur every year, making it the second leading cause of unintended injury death after road traffic. 80% happen in low and middle income countries according to a World Health Organisation report2.
DTx can be used in many ways to help prevent this, like smart home technology, to help people age in place.
With a lot of digital solutions, they’re a lot better at picking up signals than we have been before, so we can alert clinicians to risk much earlier. One of the concerns healthcare professionals (HCPs) have shared with Juneja is around resources – with more data than ever before, how can HCPs match the potential for increased demand?
How do you think HCPs perceive digital solutions?
Of the hundreds of clinicians Juneja has spoken to, there’s a spectrum, dependent on both experience and speciality.
Many clinicians are passionate about digital solutions but frustrated about getting them into the delivery of healthcare. There is also frustration that some patients aren’t digitally literate enough to utilise digital solutions, and this must be addressed by the solution providers.
The final frustrations come from clinicians and patients who feel that they weren’t consulted in the process of DTx creation, particularly around integration and their workflows. To flourish, digital solutions must have clinician and patient input from the start.
For those HCPs who do embrace digital solutions, what is the feedback?
Juneja shared a personal example, from his COVID-19 diagnosis in April 2020, which developed into Long COVID. Unable to see a GP in the UK due to COVID-19 restrictions, Juneja was able to utilise wearables like smart rings, sleep monitors and smartwatches to provide his GP with data, such as an ECG, to help him diagnose Long COVID. This was then put into his medical record, to be used in future treatments, a huge change from the past, where clinicians may have been reluctant to utilise patient-generated data, which can not only improve clinical outcomes, but also the clinical workflow.
What role does trust play in digital solutions?
In terms of improving it, Juneja believes in a gold standard for digital solutions that is just as rigorous as those for new pharmaceuticals or vaccines. In order to do this, digital solutions need to have patients and HCPs involved from design all the way through to deployment.
In addition, integration is also key. How can we make the experience for both patients and HCPs as seemless as possible?
What’s the human relation between HCPs and patients in a digitally enabled world?
For Juneja this is very much dependent on the patient and the situation. In extremely personal areas of healthcare – sexual health or mental health – patients may be more comfortable with digital solutions. But for other areas, for example joint pain, patients may not be able to utilise DTx solutions, and would prefer to be in the physical presence of an HCP.
In addition, removing a one-size-fits-all approach, and having a wide variety of tools for patients to utilise is important.
Can digital solutions help broker trust between pharma and HCPs?
There have in the past been moments where pharma has lost the trust of HCPs, whether over an individual incident or otherwise. The key things that DTx can bring are value and transparency.
How do new solutions offer new forms of value to HCPs and the system as a whole? If they can ensure they’re not going to cause HCPs a headache in terms of how the do their jobs, or how they get reimbursed, they can bring real value?
In terms of transparency and fairness, how can digital solutions be transparent about, for example, the accuracy of algorithms trained on a caucasian population in use in other ethnicities? If the pharma companies can be fully transparent, then they can utilise DTx to broker trust.