Vodafone is calling for the healthcare industry to embrace IoT technology as a way to tackle the single biggest problem that it currently faces – the cost of patients not complying with their prescribed medications, both in terms of wasted assets, but also future care costs. All the extra data involved is a huge opportunity for the likes of Vodafone, acting as a conduit but also potentially a service provider, but the healthcare industry could be poised to reinvest the savings on new IoT ventures.
The figures that the report has found are pretty staggering. In the US, poor adherence costs an estimated $290bn each year, according to the New England Healthcare Institute, with the UK’s National Institute for Health and Care Excellence (NICE) estimating that around one-third of all long-term prescribed medications are not taken as recommended.
In the US, lack of adherence is believed to account for 125,000 deaths per year, and account for 69% of all medical related hospital admittance. In the EU, the paper says that 194,500 deaths each year are due to incorrect dosage and non-compliance of prescribed medicine. The cost of EU non-compliance is estimated to stand at around €125bn each year. In the US, the paper says that improved diabetes adherence would help avoid 1m emergency visits, for around $8.3bn in savings.
When patients do not follow the prescription, they often extend the duration that they require treatment for – turning what could have been a small problem into a larger and more expensive one. In that kind of scenario, a healthcare provider has a clear motive to ensure that a patient follows a course of antibiotics or anti-inflammatories, for example, as it cuts the cost of caring for that patient in the long-term – as compliance might help the hospital having to perform a small operation.
For conditions like diabetes, long-term compliance can save the healthcare provider huge amounts in treatments, and significantly improve the patient’s quality of life. Unnecessary amputations are the most striking outcome of poor compliance in diabetes patients, but loss of eyesight can also have a debilitating impact on them.
The paper notes that low-tech solutions have helped with compliance – ranging from labeled pill boxes to help make taking medication less confusing, and SMS or email alerts to prompt compliance. But Vodafone says that the healthcare providers are failing to realize the opportunity that more advanced technologies have here.
Noting that the reasons patients don’t follow their prescriptions and treatments are complex, the paper says that once usage data can be collected from these devices, to measure compliance, and then shared with patients and healthcare professionals, it can really start to change behaviors and improve outcomes. An example would be enlightening a patient that they are using their asthma pumps a lot less often than they think, or that a doctor can find out why a patient isn’t using the sleep apnea monitor and face mask but still reporting problems.
As such, it calls for “an evolution in the way medical adherence is tackled. In today’s hyper-connected society, why are we still relying on 20th-century techniques to try to ensure people take their drugs correctly?”
Thankfully for the industry, connected packaging has come a long way in the last ten years, with advances in low-power sensors able to create a pill bottle that can report when it has been opened, or in-home monitoring equipment that can upload its findings to a cloud application that lets a doctor make sure that a treatment plan doesn’t require an intervention. In conjunction, the growth of tele-health means that doctors can hold consultations with patients from the comfort of their own homes, which can boost their productivity and help less mobile patients.
We dived into more detail in a conversation with Vodafone’s Jon Lee-Davey, Head of Healthcare and IoT Vertical Market Development in Vodafone Group Services, and Prof. Bernard Vrijens, University of Liege and managing director of the European Society for Patient Adherence, Compliance, and Persistence (ESPACOMP).
Lee-Davey said that it was time to drive mass adoption, as the technology is not a barrier now. We asked whether Vodafone was considering setting up a dedicated service offering for this stack, and were told that it could be the case. Lee-Davey noted that such a move would follow the trend of carriers moving into more and more service offerings, and healthcare data exchanges or brokering could be one of those. He noted that the model wasn’t clear yet, and that he looks forward to grappling with it in coming years.
We asked Vrijens about the complexities of adherence. He noted that around half of patients are non-compliant with the instructions, but that there is often a good reason for this – such as side effects. However, if they patient doesn’t report that experience the drug’s developer and the hospital practitioner have no idea that this is a problem.
As such, Vrijens argues, usage data would be a very useful thing for the pharmaceutical companies to collect, and once enough data is collected, the doctors may be able to give much more personalized prescriptions for specific patients – as the drugs won’t be being developed for the average patient, rather for a much more tailored experience.
As for models, we asked if a B2C approach would appear – something that Vrijens was fairly dismissive of, because of the evidence that shows self-reporting is not reliable. People misremember what they have taken, and when they took it, mostly due to a recall bias. He added that the main problems seen in the self-reporting studies were patients who never began the prescription (about 20%), and patients who stop taking their medicine, and often don’t tell their carer about that (leading to problems in future diagnosis and treatment).
Vrijens adds that smart packaging would be of huge benefit during drug trials too, as only around 1% of tests currently use adherence-measuring devices – opening up the tests to the same aforementioned problems in compliance. Vrijens argues that the bigger question surrounds how to share the data from trials and the field throughout the healthcare ecosystem.
On the basis that adherence is the biggest single problem in that ecosystem, due to its presence in so many separate systems, the sharing of this data would enable existing drugs to be put to use in a more accurate manner – instead of trying to develop entirely new formulas. With the amount of money that could potentially be saved through ensuring patients follow their prescriptions, there should be a lot of freed up cash to spend on digitizing the industry, and adding new technologies to the mix – such as AI-based diagnostic tools, or predictive analytics systems for better understanding epidemics or breakouts.