By Sarianne Gruber
Twitter: @subtleimpact
Having been successful for decades maintaining a traditional product-driven model, pharmaceutical companies are feeling their way toward a new business model: patient-centricity. Hospitals, providers, payers and other health organizations have transitioned towards outcomes rather than products and services for several years now. Pharma’s comparatively recent patient-focused approach has cultivated a strategic shift from brand to disease. This cultural change has spurred on partnerships and collaboration testing new models for patient services, payer engagement, and pharmacy engagement. A suggested read on this subject is Heidrick & Struggles’s whitepaper ‘Walking the Talk’ in Patient-Centric Pharma.
At the World Congress on EHR and E-Prescribing Summit, Dr. Usman Iqbal discussed how EHRs have created a tremendous value for the pharma industry as they work towards patient-centricity. As the Senior Medical Affairs Leader at AstraZeneca, he shared his own experience and spoke to the audience on how the concept of patient centricity gets translated into meaningful practice. For the pharma ecosystem to succeed, three key areas must be addressed:
- An entity needs to be in place that synthesizes the EHR database of patient information and translates data to support actual decision making.
- Identification of barriers to care in order to proactively spot opportunities and build solutions around a target product profile.
- Most important is the strategy. The plan is to then apply it to chemical or commercial decision support systems or a patient access programs.
Patient Journey Detailed in EHRs
Dr. Iqbal deems these three aspects (listed above) as the fundamentals to truly deliver patient centricity to the pharma ecosystem. Intricate to this process is access to patient EHR data, and at this juncture, the concept of the patient journey comes into play. Historically, pharma has opted for high-level patient assessments, which are extracted from primary research, market research, and focus groups. In today’s environment, a plethora of tangible and detailed information actually enables a level of decision confidence to define a commercial strategy or define a development strategy. Over the last few years working on this concept of patient journey, pharma has tried to pull together 5 key stages of the patient journey. The five key stages include:
- Screening
- Diagnosis
- Understanding the treatment landscape
- Disease management
- Experience in health outcomes
Patient screening and diagnosis require knowing the barriers to access that impact a patient’s ability to get screened. Fortunately, Big Data and EHRs are a significant help in capturing this information. Dr. Iqbal contends that knowing the actual epidemiology of a disease is useful for making a diagnosis and fully understanding all the patient touch points. “Much of the time the patient journey starts with treatment but 50% of the time 50% of the population doesn’t get diagnosed or may be missed diagnosed. You are losing a lot of your focus by starting with treatment. You need to start with awareness, screening and assessing the diagnosis landscape. And that takes a lot of variable details and that is where EHRs are very helpful,” expressed Dr. Iqbal.
EHRs are providing pharma with the whole 30,000-foot view of the treatment landscape and disease management, which is a very important piece to understand. The information helps to address questions such as: What is the standard of care in today’s world? What are the unmet needs? How can we position the unmet needs towards a target product profile that correctly addresses those needs? Dr. Iqbal asserted, “All of this information along with a patient segmentation, and most importantly what the prescribing practices are, can be gleaned systematically from EHRs and positioned towards clinical, commercial and medical care strategy.”
Patient Centricity Needs Real World Outcomes
If you are truly patient-centric, you need to know what the outcomes are as well as their differences in terms of clinical trials versus real world outcomes. When you are talking about clinical trials the measurements are marked by clinical endpoints. However, Real World outcomes cover economic endpoints, patient medication adherence, the patient-reported outcomes and health-related quality of life. EHRs detail the full picture at the time the patient gets access to the drug. “You can have an approved drug but in the end, someone has to pay for it. And those payers are putting in all those prior options in the background. Behind those prior options, you need to have to effectiveness data. How does your drug compare to the competition? Unless you have this information on the treatment landscape and disease management, it is really hard to keep up against the competition. If you have this information all along, it won’t empower the patient. But within the institution, it will help you establish better patient-centric designs that have the right information, the right population, the right endpoints, and the right competitors. So you won’t get rejected when you try to get access,” pointed out Dr. Iqbal.
Fit for Purpose Databases: Links Patient Centricity
EHRs only provide information on episodic care. Accessing several different types of databases to track patients across all sorts of care, opens channels to more knowledge and information on patient experience and provides a complete picture of the patient journey. Linking unique patient identifiers is where all the advancement is happening in Big Data. In the pharma world, companies are joining with cutting edge data providers to create, customized “fit for purpose” databases. The goal is to have the ability to link all of these disparate datasets and make sense of them in order to track the actual patient experiences. “What Pharma is investing in, is actually the partnering with data providers to create fit for purpose databases, which is geared for one disease or even one indication. It requires a lot of investment but it provides you with a complete view of the patient. From diagnosis to treatment, outcomes to genetics, depending on whatever data you need and you can build it, “described Dr. Iqbal. An excellent example of a fit for purpose database is the Oncology Services Comprehensive Electronic Records database, also referred to as OSCER. Learn more about the OSCER database. More about the work and background of Dr. Usman Iqbal.