While digital health investment rockets on in areas such as telehealth, online pharmacies, weight loss and diabetes, one broadly defined therapeutic area has thus far been remarkably underserved by the digital revolution: immune mediated inflammatory diseases (IMIDs). At Healthskouts we think this is a tremendous opportunity. We are convinced that digital health solutions can and will play a significant role in improving the lives of people with IMIDs. That’s because the unmet needs in this area are exactly the types of challenges where digital solutions can make a real difference.
Immune IMIDs are a group of clinically diverse diseases that have common inflammatory pathways and dysregulation of the normal immune response. IMIDs include various diseases such as COPD, asthma, axSpA, psoriasis, psoriatic arthritis, rheumatoid arthritis, inflammatory bowel disease as well as some cardiovascular, neuromuscular and infectious diseases.
IMIDs are an escalating health threat globally and are associated with significant diagnostic delay, morbidity, mortality and compromised quality of life. The incidence of IMIDs in Western society approximates 5–7% and appears to be increasing.
The unmet needs in these therapeutic area are significant:
- Many IMIDs are notoriously difficult to diagnose, especially in their crucial early stages, due to a lack of differentiated symptomatology and reliable biomarkers.
- The treatment of IMIDs is too often based on a trial & error strategy, leaving patients exposed to unnecessary side effects and long delays before finding relief. Many of the best treatments are also very expensive, meaning that it is crucial that the right treatment decisions are made early on.
- Disease progression & treatment response is often influenced by lifestyle factors such as smoking, diet, stress and physical exercise, but these tend to be poorly understood and managed.
- There is a lack of reliable biomarkers and tools for monitoring disease progression and treatment response in most IMIDs, making treatment optimization difficult.
In summary, healthcare professionals and their IMID patients too often lack the data or signals to make timely, precise medical decisions. That is exactly where digital health tools can come into play, to ultimately create a holistic, longitudinal ‘cockpit’ view of the patient’s condition and thereby enable a more precise and holistic approach to the treatment and management of the patient.
In our work for clients, we scout for digital (and non-digital) innovations that could address such challenges across the entire patient journey. We look both for pragmatic solutions that can be implemented immediately and emerging technologies that could radically improve patient’s lives in the mid to long term. To give you a sense of where things are going in this field, here’s a selection of promising innovations that are having an impact in various phases of the patient journey.
Accelerating diagnosis with AI
It seems counterintuitive in this digital age that so many IMID patients are poorly diagnosed. For example, many patients with Axial Spondyloarthritis (axSpA – a chronic, inflammatory rheumatic disease that affects the axial skeleton, causing severe pain, stiffness and fatigue) are burdened with a diagnostic delay of between 5-8 years and some are never properly diagnosed and treated. Mainly that’s because diseases such as axSpA have symptomatology that is very similar to very common medical conditions (i.e. unspecified back pain) and because primary care doctors don’t have the time or knowledge to ask the right questions and order the right tests.
Already today, however, I can consult online AI-driven symptom checkers such as ADA, Symptoma, Infermedica and Buoy to help me and my physician get to a diagnosis faster. Most of the leading telehealth services also have symptom checking built-in as a front door feature. E.g. Babylon Health, 98point6, K-Health. Most of these constantly learning systems will ‘interview’ me in a personalised manner and generate probabilities for relevant diagnoses that are based on the analysis of millions of data points, including medical records. All before I’ve seen my first doctor.
Looking further ahead, we envisage a scenario where such AI software is built in common virtual assistants such as Siri, Google and Alexa. The power of such diagnostic AI will also increase significantly once we link our existing medical records and even personal health data (such as activity tracking and smartwatch based monitoring of cardiovascular parameters) to such AI software. For example, AI software can, by means of activity trackers, already detect flare-ups in rheumatoid arthritis based on mobility patterns. Through such longitudinal surveillance, I may one day get a call from my GP or health insurance company to come in for a few tests, before I even experienced a first symptom. Privacy is a key obstacle here off course, but in Europe at least we are seeing government initiatives to create data utilities and related platforms (e.g. We Are platform in Flanders) that should enable secure data sharing to service providers.
Precise, non-invasive diagnostic tests
Instead of undergoing expensive MRI or CT scans, and doctors prodding and poking my painful, swollen joints, in the years to come patients will likely have access to very convenient, hassle-free diagnostic tests, again before they’ve had their first doctor consult.
Medical kiosks in supermarkets or other convenient locations could take my blood and perform non-invasive imaging of my swollen hand joints. Today we already see companies like Kroger pursuing this strategy by offering basic medical exams at health kiosks located in its supermarkets through a partnership with Higi.
To address inflammatory diseases, we expect future blood tests to check not only for common inflammation markers but also conduct gene profiling leading to accurate diagnosis and better treatment decisions. Already companies such as Scipher Medicine and DxTerity offer precision medicine tests for IMIDs – and are building data troves for drug discovery.
For conditions like psoriasis, a blood test may not even be needed. Mindera Health, for example, is developing a skin patch for minimally invasive RNA collection.
A next step is to combine such test data with data from other sources to generate ever more precise and predictive diagnoses and treatment advice. IMIDomics is pursuing that vision by integrating and analysing clinical data, real world data, patient samples and biomolecular data, all with the aim to develop more effective precision treatments for IMIDs.
Our kiosk in the supermarket could also incorporate Fluorescence Optical Imaging technology (e.g. as developed by Xiralite) that scans your joints in minutes, with an accuracy that has comparable utility to an MRI.
Treatment monitoring and self-management
So finally I will get to see a rheumatologist, dermatologist or gastrointestinal specialist – and this after a medical interview driven by the collective intelligence of thousands of previous cases, an all-in precision medicine blood test, the non-invasive imaging of my swollen joints and the AI-powered analysis of my cardiovascular health and mobility.
Furthermore, as a patient I’ll be in control of these data flows, being able to give my rheumatologist – and dermatologist, GP, dietist and physiotherapist – access to these multiple data sources. In time, we expect such data to feed into intelligent dashboards for healthcare professionals (similar to the NAVIFY® Decision Support platform in oncology), so that my multidisciplinary care professionals can together define a proper treatment plan.
Crucially, such data will enable my physician to make a more precise diagnosis and treatment decision. Instead of cycling, trial and error style, through a series of increasingly expensive drugs, my physician will send me home with a prescription for a biological that, according to the AI crunching my data, is most likely to deliver a good response with least side effects.
Instead of returning every 3-4 months for a follow-up consult, for more prodding of my joints and completing archaic disease severity questionnaires, I will receive a regular blood test or skin patch in the mail that monitors my unique immune system activity (e.g. a next generation of DxTerity’s MIP Test).
While I won’t see my rheumatologist in the flesh very often, I will have a virtual version of her with me along the entire treatment path. In fact, not just my physician, but also the department’s physiotherapist and psychologist. Together they’ll be expressed in a Digital Therapeutic that helps me with treatment adherence, physical exercise and stress management.
With a tool like MyMee, I’ll be able to identify the factors that trigger my autoimmunity issues in real time and the online coach will help me manage those triggers to prevent flares in the first place. I may even make use of a small Nēsos earbud that targets my autonomic nervous system’s control of the immune response, helping me live a near symptom free life. Nēsos was just recently granted Breakthrough Device Designation by the FDA to its digital therapeutic for patients with rheumatoid arthritis (RA) who have had an inadequate response or intolerance to disease-modifying anti-rheumatic drugs (DMARDs).
Lets build this future today
Some of these ideas may seem a long way off yet, but they ought not to be, if we consider some of the existing solutions and studies cited in this article. We can make a real difference to patient’s lives, also in the short term, if we pragmatically stitch together and implement some of the best of breed solutions out there and available today. We would be honoured to help you with that!
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