In this episode Gary Monk, independent consultant with over 25 years in the pharma and healthcare sectors where he worked in roles from R&D to business IT and strategic marketing, talks about the current state of digital therapeutics, remote patient monitoring, the potential of AI in healthcare, and the challenges with data integration. He also shares his personal insights on the use of wearables and their impact on health anxiety.
Key Discussion Points:
Digital Therapeutics and Integration Challenges
Fragmentation in the Space: Many digital therapeutics are siloed, with individual apps that do not integrate well with each other or broader healthcare systems.
Potential for Holistic Solutions: apps and digital therapeutics need to be more connected, for example, integrating with wearables or offering treatments.
Uncertain Future: While optimistic in the long term, Gary is cautious about short-term setbacks, noting that companies in this space may struggle without proper evidence and reimbursement models in place.
Remote Patient Monitoring and Virtual Care
Excitement Around Remote Monitoring: there are benefits of remote monitoring, especially for elderly and chronically ill patients, allowing them to stay home longer and safer.
Expanding Beyond Monitoring: Discussion expands on using technology not just for monitoring but also for providing interventions, such as reminders, voice support, and even predictive capabilities like fall prevention.
Wearables and Real-World Data
The Importance of Continuous Data: long-term, imperfect data may be more valuable than short-term, highly accurate clinical data in certain cases, such as tracking motor function.
Personal Experience with Wearables: Despite his enthusiasm for digital health, Gary admits he no longer uses wearables due to anxiety caused by over-monitoring and lack of actionable insights.
AI in Healthcare
Cautious Optimism: While excited about AI’s potential, AI needs to be integrated thoughtfully into healthcare workflows. He points out that many current AI solutions are useful but not yet integrated into clinical practice.
Ethical Questions Around AI: The conversation touches on whether AI should be used to predict diseases, especially if no treatment is available. This is particularly relevant in areas like Alzheimer’s research.
Integration as a Key Barrier
The Real Challenge: Both speakers agree that integration is one of the biggest hurdles in digital health today. As various apps and AI tools proliferate, getting them to work within existing systems, like clinical workflows, remains difficult.
Example from Clinical Trials
Even in areas like remote clinical trials, which are technically feasible, organizations are struggling to keep up due to complex internal processes and outdated systems.
www.facesofdigitalhealth.com
https://fodh.substack.com/p/ai-digital-health-pharma
[00:00:00] Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and how healthcare systems around the world adopt technology with me, Tjasa Zajc.
[00:00:12] Gary Monk is an independent consultant with over 25 years in the pharma and healthcare sector, where he worked in roles from R&D to business IT and strategic marketing.
[00:00:25] And now he's one of the people you really want to follow on LinkedIn to get the latest updates on all the trends and industry news that are making the news in digital health.
[00:00:39] I caught up with Gary in Boston at the Digital Health and AI Innovation Summit in October 2024 to just have a brief discussion around current trends, digital therapeutics and common sense when it comes to self-monitoring of your health and wellness.
[00:01:01] Enjoy the show.
[00:01:02] And if you haven't yet, check out our newsletter.
[00:01:05] You can find it at fodh.substack.com.
[00:01:09] That's fodh.substack.com.
[00:01:13] And you can read reports from various events such as the Digital Health and AI Innovation Summit, where I wrote a post on why pharma should be more ambitious when it comes to digital health.
[00:01:26] So go to fodh.substack.com and read that article for yourself.
[00:01:35] Now let's dive in the discussion with Gary.
[00:01:54] So, Gary, we actually met for the first time because we just knew each other over LinkedIn and the posts that we make.
[00:02:01] So what do you do in life apart from LinkedIn posts?
[00:02:04] Yeah, that's pretty much it, really.
[00:02:05] It keeps me busy.
[00:02:06] No, I try and keep myself immersed in digital health, which can mean a lot of things.
[00:02:11] But obviously tracking the space, the thought leadership on LinkedIn and then doing related projects for clients, but just diving into what they need.
[00:02:18] It could be understanding more about where they'd apply digital health and digital therapeutics for and depending on what therapy area they're involved in.
[00:02:26] So, yeah, that's the focus, really.
[00:02:27] Are there any trends that you are observing and are maybe not seen to most of the people that are following digital health?
[00:02:37] Like what's keeping you engaged?
[00:02:40] What do you find has a lot of potential?
[00:02:43] I've been thinking about this a lot recently and there's digital therapeutics is an example.
[00:02:51] And I'm not sure whether it's a bright, exciting trend.
[00:02:54] It's almost a sort of, not to get pessimistic, a kind of worrying trend because I see digital therapeutics and quite a lot of the focus is on apps, just siloed individual point solution apps.
[00:03:05] Whereas there's so much potential for those to be more connected, could be connected with wearable devices, even offering some kind of treatment.
[00:03:13] And I know people might say it's not a digital therapeutic, it's a medical device, but I'm not too worried about the definitions.
[00:03:18] But I'm starting to think to name drop med rhythms, for example, which I think might count as a digital therapeutic, but then they're actually treating disease through music.
[00:03:27] I think it's to do with stroke and then improving gait and walking.
[00:03:30] So without getting too technical.
[00:03:32] But yeah, I'm not saying digital therapeutics necessarily need to physically treat, but often they just seem to be apps that are disconnected.
[00:03:40] And also, I'm going to start a rant a little bit now, but if a patient's got, say, diabetes, high blood pressure, IBS, do they need three or four different apps or do they have one?
[00:03:52] So I think there's some really cool solutions, but they're not that well integrated.
[00:03:56] Yeah, it's not exactly holistic approach yet.
[00:04:00] If you've got, it's like doctors when you go to a specialist, but you're a patient with multi comorbidities.
[00:04:06] If you ask them about something else from their direct specialty, they're not going to want to answer on anything.
[00:04:12] Exactly.
[00:04:13] One of the things that kind of I find quite enlightening from the Digital Health and AI Innovation Summit was the explanation that CPT codes are designed to enable doctors to bill what they do.
[00:04:31] So what doctors do. And this is the reason that reimbursement codes, the CPT codes in the US for DTX are not there quite yet.
[00:04:40] It's really difficult to create them.
[00:04:42] And similarly for AI, if you create something that takes away the work for the physician, how do you then build that?
[00:04:48] So I thought that was super interesting, especially since I was thinking a lot around, should we give up on digital therapeutics given the trends that you've seen in the industry?
[00:04:58] And my conclusion on that was that not just yet.
[00:05:02] I think we are just figuring things out and it's not yet time to give up.
[00:05:07] What do you think?
[00:05:08] Yeah, I don't think it's time to give up.
[00:05:11] And I know there's issues with the codes and that's being addressed at some point, but slowly, not super fast, but I don't think it's time to give up.
[00:05:19] I'm optimistic in the medium to long term that digital therapeutics will be very successful, they'll be ubiquitous.
[00:05:26] But in the short term, pessimistic from the perspective we've seen other companies either go bankrupt, unfortunately, or downsize.
[00:05:33] And again, unfortunately, I think we'll see more of that still where the company's been set up on the old model of being super well funded, developing products with a degree of evidence, but not enough to satisfy payers and not addressing those issues that you've talked about in terms of reimbursement very well.
[00:05:48] So I think there will be some legacy companies or existing companies that will go down.
[00:05:52] That's the negative side.
[00:05:54] But the other side is, I think once we get through that, we will get to a really strong place with digital therapeutics where they'll be everywhere.
[00:06:02] One trend that is present in various markets is the remote patient monitoring, virtual wards, the expansion of at-home care to just decrease the burden on the hospital infrastructure.
[00:06:16] And I know that remote patient monitoring is also something that you are quite either excited or interested in.
[00:06:23] So tell me why.
[00:06:24] Yeah.
[00:06:25] Yeah. So very interested.
[00:06:27] I don't know where to start really, but the potential of it to thinking of the patients first, that they can be at home longer.
[00:06:35] They could have, whether it's, they've got say Alzheimer's or a chronic could be physical, mental health issues, aging.
[00:06:42] They could stay at home and be supported with the remote patient monitoring.
[00:06:46] I might be going a bit broader than what you're asking me about, but they've got the bit about actually monitoring the patients, making sure they're staying well, making sure they're staying safe.
[00:06:54] Also got the piece about predicting if they're going to, for example, fall over or have any issues.
[00:07:00] And then the bit I talked about broader is potentially even intervening and offering, offering support, could be voice support, could be medication reminders.
[00:07:07] But also, I think I mentioned a product last night, LEQ, that actually starts some talks to patients, can make jokes, jokes with them.
[00:07:15] So I think there's a whole ecosystem that can be done with patients that's probably broader than the monitoring you asked me about, but can really support patients' quality of life in the home, but help them stay in the home longer.
[00:07:26] And then another thing I'd add I was thinking about more was, I think that will evolve.
[00:07:30] I mentioned like elderly patients, but for everyone, this technology become ubiquitous, will all end up with some kind of remote monitoring to track if there's anything wrong.
[00:07:39] And I think we're seeing that with some of the wearables with which, again, is seeing if, again, it's more around diagnostics perhaps, but if we've got atrial fibrillation.
[00:07:47] So the presentation today about how many people have got undiagnosed atrial fibrillation, but starting to see that kind of develop and then monitoring that when it develops over time.
[00:07:55] And so I think that's just going to broaden that in terms of demographics that will benefit from that.
[00:08:00] Yes, but only if we actually have interventions and the capacity to just cater to all the data that's going to come out from all these devices.
[00:08:11] One of the discussions or dilemmas in the digital health wearables and data space is the quality of data.
[00:08:19] Real world data is not gathered for what it's used for.
[00:08:24] So you might have a smartphone that you just use on a regular basis.
[00:08:28] And there's already ads that can attract a lot of things like not just stamps, but how often you pick up the phone and things like that.
[00:08:35] And that data can be repurposed.
[00:08:38] What I find interesting in this case is that even though this data is messy for diseases such as decreased motor function, they can still be super informative.
[00:08:49] Because at the moment, if you just do the standard of care, which is coming to the clinic and doing the six and 10 minute walk test, it's really a snippet of everything.
[00:09:05] So that was one of the things that I thought was super interesting as well here.
[00:09:10] Yeah.
[00:09:10] Now, if I get what you're saying, then you're probably better off with data that's not perfect, but it's over a longer term or higher volume rather than maybe super accurate clinical data over a very short period of time.
[00:09:19] Yeah.
[00:09:20] Which is, yeah.
[00:09:21] As Amir Lahaw said it nicely, why have a trailer when you can have a whole movie or something like that?
[00:09:29] Yeah.
[00:09:29] And even a perfectly polished trailer.
[00:09:31] And you've got a movie that's maybe some of the editing in it's not perfect, but the storyline is great and you get to experience the whole thing versus a polished 30 seconds.
[00:09:38] Yeah.
[00:09:38] Because in the trailer, you're like, what is this movie about?
[00:09:41] And when you watch the whole thing, there's a story.
[00:09:44] Yeah.
[00:09:45] Yeah.
[00:09:46] Exactly.
[00:09:46] Yeah.
[00:09:46] What about AI?
[00:09:48] Everybody talks about AI and I'm going to again refer to the conference.
[00:09:52] I very much enjoyed the kind of realistic mindset around it and the fact that we should really think when AI should be used and is useful, not just use it for everything.
[00:10:07] Yeah.
[00:10:08] And also, we still need to figure out if there's any interventions that we can do if we uncover something with AI.
[00:10:16] Because if we can't cure a disease, should we tell a patient that he or she has that condition?
[00:10:24] Yeah.
[00:10:25] Yeah.
[00:10:25] No, that's a great point.
[00:10:26] So much to touch upon there.
[00:10:27] I mean, we saw around Alzheimer's and some of the technology can be very predictive, can be blood tests, can be AI, can be a combination of blood tests powered by AI.
[00:10:39] But yeah, I think that's an interesting ethical question.
[00:10:41] We're starting to see with some of these conditions, lifestyle can make a difference, but there is a question of patients.
[00:10:47] How much do patients want to know early on and then what can actually be done for them in a meaningful way?
[00:10:52] So I agree with that.
[00:10:54] And then the broader question about AI, I guess I'm struggling with it because we're starting to see lots of valuable point solutions, but not the integration of it into workflows.
[00:11:05] But then that could be potentially too early.
[00:11:08] I don't think we're there yet, this mass rollout for the reasons you said, mass rollout of AI.
[00:11:13] But I'm excited.
[00:11:13] I think I mentioned a technology last night, see the signs around cancer prediction in the UK,
[00:11:19] which actually helps doctors increase prediction of cancer amongst patients by 8%, which is actually very significant in terms of overall numbers.
[00:11:27] So I think we'll start to see things like that, which should fit nicely into doctors' workflows, get doctors trained, understanding it more, and then bring more solutions in.
[00:11:36] So I think it is, I love to say integration, fitting it all together, but we probably aren't there yet.
[00:11:42] We just need to get doctors familiar with it, have some different solutions.
[00:11:45] But then the problem you get to when you have multiple different apps, AI solutions, then how do you fit all that into a doctor's workflow and it gets super messy?
[00:11:54] An AI tool for that.
[00:11:55] I'm going to listen to my patient recording and summary there.
[00:11:58] AI test tool there.
[00:12:00] But I think that's the way we'll see it, like a jigsaw building together.
[00:12:05] Yeah, yeah.
[00:12:06] Integration is definitely a huge pain point in digital health.
[00:12:10] Yeah, I was going to say, sorry to interrupt you, because AI is evolving.
[00:12:13] We're not there yet.
[00:12:14] I'll speak to someone today about clinical trials.
[00:12:17] And we are there technically in terms of the technology that we've got available for remote clinical trials.
[00:12:22] So there's nothing really holding that back digitizing trials.
[00:12:27] But we saw about so many pharma companies with their internal processes, regulations, ways of doing things, that they have all these different systems in clinical trials, multiple laptops, computers that need to do technology.
[00:12:40] That's been around for quite a while and is not super new like AI or evolving as fast.
[00:12:48] Companies are struggling to keep up with that.
[00:12:50] So I think the AI will be another level of challenge to get that fully integrated.
[00:12:55] Yeah, for sure.
[00:12:56] Would you consider yourself a digital health enthusiast, skeptic?
[00:13:04] How would you define yourself?
[00:13:05] Yeah, I think quite balanced.
[00:13:08] People probably think I'm positive, but then I have posts that some people think are negative.
[00:13:11] So I like to call things out.
[00:13:14] The same is like digital therapeutics.
[00:13:15] So I think I'm an enthusiast overall, but I'm a skeptic in the short term that I think there's going to be pain.
[00:13:21] The reason I asked is because I can see that you don't have any wearables to monitor your wellness and well-being.
[00:13:27] Why?
[00:13:27] That's a good point.
[00:13:28] Are you faithful to the field?
[00:13:31] I am faithful to the field, but I'm a bit of a hypochondriac.
[00:13:33] I was an early adopter of wearables.
[00:13:35] I had Fitbits.
[00:13:37] I had an Apple Watch.
[00:13:38] Even before the Apple Watch, other wearables measuring heart rate basis band.
[00:13:42] I don't know if anyone remember those.
[00:13:44] Even some of the, I forgot the name of the clothing French company, Omo or something.
[00:13:49] So I had all these different wearables.
[00:13:51] And I found myself looking at my heart rate on all these wearables, wondering what was wrong.
[00:13:55] I'm standing up.
[00:13:56] My heart rate's 87.
[00:13:57] Is that normal?
[00:13:58] And I was starting to freak out by all this data.
[00:14:01] And I think I was telling you earlier, I ended up having an Apple Watch, but I just put it in airplane mode.
[00:14:04] But I think it would probably be a good time to evolve again.
[00:14:08] Because I think what I was struggling with, as well as those personal issues, was tied in with that.
[00:14:12] I was overwhelmed by data, but I wasn't getting any insights.
[00:14:15] It wasn't like a daily report of, okay, your heart rate was high.
[00:14:18] You should do this with your fitness or whatever, or what could be causing it.
[00:14:21] But I was like minutes to minute looking at it going, oh, is that right?
[00:14:24] I've just had a coffee and lunch, but I'm not doing much.
[00:14:27] My heart rate's 102.
[00:14:28] Have I got some tachycardia?
[00:14:30] Do I need to see a doctor?
[00:14:32] Is this an arrhythmia maybe?
[00:14:33] Maybe I've got AF.
[00:14:34] I'm overthinking it, where I wasn't getting any of those insights.
[00:14:37] So my paranoid mind was just going into overdrive.
[00:14:40] It's a great point.
[00:14:41] I remember once talking to a specialist for sleep and mental health.
[00:14:48] And basically she said that if somebody is anxious already or has sleeping issues, the last thing that helps them is just another device telling them that they're not sleeping very well.
[00:15:01] I think that's right.
[00:15:02] And it can, for me, when I've used devices around sleep, can be an issue sometimes dropping off to sleep.
[00:15:07] But I remember waking up in the morning, can I feel so good?
[00:15:11] I feel refreshed.
[00:15:12] Looked at my data and it told me how bad I slept.
[00:15:14] No, I can't be what I'm, no, I'm really tired actually.
[00:15:17] So yeah.
[00:15:18] So based on that, I think it's maybe better if you just stick to the general suggestions of be mindful that you sleep enough, don't drink too much caffeine, exercise.
[00:15:31] I think so.
[00:15:32] I think so.
[00:15:33] Or have a wearable that's very passive where it alerts me if there is a real problem.
[00:15:37] And then maybe I look at a monthly report or a quarterly report on it.
[00:15:41] But rather than, it's like the people who invest in stocks and you probably want to watch your finances.
[00:15:45] But do you want to watch your stocks go up and down in the market every 10 seconds going, God, that one's dropped, that one's gone up.
[00:15:51] Or do you want to just manage it over time and look at the trends versus obsession with the data?
[00:15:56] Thank you.