Judith Teall

	The World Health Report 2013 argues that universal health coverage cannot be achieved without the evidence from scientific research, and in order to better manage healthcare, clinical research needs to keep up-to-date and advance in line with society in general. Without clinical research, global health would falter and decline, but perhaps the importance of this relationship is not well recognized.

	Two-way movement of information is critical and underpins both clinical research and healthcare. Better engagement leads to more informed and empowered patients, and ultimately improves patient outcomes. An opportunity, therefore, exists to truly embrace the mobile and digital revolution, and utilize its full potential in 21st century clinical trials.

	As insufficient people are aware of clinical trials, could there be a greater commitment to engage people about clinical research-prior to any medical need arising? The science curriculums in our basic education systems don't adequately introduce this critical topic. Hence, we're missing out on the starting point in the healthcare communications chain-an opportunity to influence new ways of thinking, and establish a new generation of trial participants and future influencers.

	Complicated medical language has long prevented easy access to healthcare, engendering an aura of "respect" and "reverence" to physicians. However, patients are becoming increasingly confident in searching online and asking questions-mobile and digital technology is enabling more digestible content (making medicine less exclusive, and healthcare more accessible for the masses).

	The medical community is still learning to routinely embrace mobile and digital technology, although healthcare professionals (HCPs) are increasingly accessible through online "virtual" consulting. This may create new opportunities for clinical research awareness.

	Today's youth has grown up in an information-loaded, technology-rich world, with data instantaneously accessible through the portable medium of their (smart) mobile phone. But what do patients really understand about mobile and digital capabilities in healthcare? Does the average person know that scale data can be collected via mobile, and the results viewed in real time by the HCP? Or that asthma sufferers can blow into a Bluetooth (to mobile) paired spirometry device, to help track their condition? I suspect that the public are largely unaware of how, where, and why mobile and digital technology is being used in clinical research and healthcare management, and what options are available already.

	If popularized sufficiently through technology, could we anticipate greater understanding of clinical research, and generally improved healthcare management? With decreasing numbers of medically trained doctors, and a seemingly crisis-level escalation in some countries of chronic diseases, when it comes to health management, we need to embed a greater sense of ownership in everyone. We need to help ourselves, and that's where "mHealth" can put control into the patient's hands (e.g., digital access to public health campaigns, online interactive support programs, or mobile data collection for trials).

	Just how far the mobile and digital health revolution can take us is unclear. It could reveal previously unknown facts through sheer data volume, or we may find that clinical research is changed through greater honesty, convenience, or control between HCPs and patients. Endless possibilities emerge. Imagine if all chronic sufferers were to give a health status on a given "World Mobile Health Day"; how powerful that "snapshot" would be.

	Clinical research is just a building block in health management. But if we could "mobilize," educate, and engage everyone, then the bigger picture would be clear. Let's tell the patients.

 Director of Clinical Excellence, Exco InTouch E-mail: 

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The World Health Report 2013 argues that universal health coverage cannot be achieved without the evidence from scientific research, and in order to better manage healthcare, clinical research needs to keep up-to-date and advance in line with society in general.

Exposing Patients to the Bigger Mobile and Digital Health Picture

To understand just how far mobile and digital technology can truly influence progress in global healthcare, we first need to form the foundation of the discussion with a few rudimentary facts. 

Clinical research ("a branch of medical science in human beings") is critical to healthcare.

All stakeholders are current or potential patients.

All stakeholders therefore have a vested interest in progression of healthcare.

Our current healthcare model is evolving, slowly but surely. How this progression is defined, and how mobile and digital technology can help to speed this along, will be explored in this article.

Clinical research is conducted with the aim of further enhancing the health of humans via a number of different pathways. Increasing the knowledge surrounding an existing drug, device, medical procedure, or disease state, or investigating the potential of an innovative compound (IP, Investigational Product) all form the foundation for advancing global healthcare. The world health report 2013 "Research for universal health coverage" argues that universal health coverage—with full access to high-quality services for prevention, treatment and financial risk protection—cannot be achieved without the evidence provided by scientific research.

In order to better manage or prevent the healthcare problems that can emerge (through antibiotic resistance, climate change, challenging economies, wars, and a growing and aging population—to name but a few), clinical research needs to keep up-to-date, and advance at the same pace as society in general. It cannot be allowed to stagnate, because without clinical research global health would no doubt falter and decline. It’s that simple—but perhaps the connectivity and criticality of this is not recognized by the general public. 

Movement of information regarding education, support and guidance, and of course data capture is critical and underpins all progress in both clinical research and healthcare in general. It stands to reason that better engagement leads to more informed and empowered patients, and that is ultimately what leads to improved patient outcomes. An opportunity therefore exists to truly embrace the mobile and digital revolution that has swept the globe, and utilize the popularity of this communication method to its full potential to help deliver clinical trials fit for the 21st century healthcare needs. 

We are constantly told that patient recruitment is still the single biggest limiting factor in clinical research,

 which has caused people to ask the question as to why this continues to be so difficult. It has been proven through multiple surveys

 that insufficient numbers of people are aware of clinical trials—either because they are completely unfamiliar with what they are, or just not conscious of trials that they could join. It should also be acknowledged that there are many trials that are not of a suitable design for those looking to enroll, which is a frequent "gripe" of patient representation at conferences. Could there perhaps be more of a commitment from everyone to engage people from the outset about clinical research—prior to any medical need arising? The science curriculums in our basic education systems do not adequately introduce the critically important topic of clinical research. It seems we’re missing out on not only a very important link in the healthcare communications chain (i.e. the starting point), but also a significant opportunity to influence new ways of thinking and establish a new generation of clinical trial participants (and future influencers).

The role of healthcare professionals (HCPs)

For many years, healthcare has been managed in a language that prevents easy access. Long and complicated medical terminology has engendered an aura of ‘respect’ and ‘reverence’ from patient to physician. However, in this online information era, it seems that things are changing; patients are becoming increasingly confident in asking questions and searching for information, the mystique and complexity of medicine is being lifted, and it’s being brought down a level by mobile and digital technology—enabling the information to be more digestible for patients. Essentially, technology is making medicine less exclusive, and enabling better access to healthcare for the masses.

The role of the HCP is therefore changing too. The medical community is learning to embrace mobile and digital technology and understand how best it fits into their day-to-day practices, whether that’s for data collection as part of a clinical trial experience, or through direct interface with patients to monitor, educate, motivate, or track their health. How exactly these newly captured data (individual or ‘big’) are used is specific to the environment and situation (the clinical trial objectives or the questions and gaps that exist in that medical field). It’s fair to say that it’s not always without challenges (such as integration of data with the hospital’s EHR system), but the stronger the rationale for use of the technology, the more likely the solutions will flow and embed.

It’s also interesting to see the increasing ‘accessibility’ of HCPs through online Q&A and consulting opportunities. Approximately 1 in 6 doctor visits in the US will be virtual this year.

 The media of an online consultation offers different opportunities for health advice and guidance packages to be provided, and potentially greater openings for discussion about clinical research potential—with the patient being directed more easily (through established workflows) to relevant materials that could be considered. 

All of these small steps are changing the dynamics of HCP-patient interactions, and as a result, the role of clinicians is changing in both research and practice. Consequently, a new healthcare model is being defined by the advancing technology era.

The role of mobile and digital technology

Today’s youth has grown up in a technologically rich world, with mobile and digital communications reaching all corners of the globe. From their very first monetary transaction they have always known about internet banking. They have been brought up in a fast-paced and information loaded environment, with data available instantaneously for educational or social purposes. And now everything is accessible through an even more personal and portable medium on their [smart] mobile phone. 

But what do patients really understand in terms of how mobile and digital capabilities are being introduced into the world of health? Whilst many might have heard of personal gadgets such as pedometers and how they are being used in tracking or improving fitness (often in those who are well, and interested in increasing their wellness status), it seems likely that the awareness of the link between health and mobile and digital technology stops there. Does the average person know that data can be collected via a mobile phone from clinical trial participants on how they feel by ranking themselves on an anxiety scale, and from there the results of those rankings viewed in real-time by the HCP in their hospital office to monitor efficacy and safety within that clinical trial? Do they know that asthma sufferers can blow into a spirometry device that has been paired via Bluetooth with a mobile phone, as part of a broader support package alongside their medication which helps them in tracking their own condition more accurately? I suspect that the public are largely unaware of how, where, and why mobile and digital technology is being used in clinical research and healthcare management, who can use it, when it can be used, and what options are available right now. Who is telling the public that we are now on a mobile and digital healthcare super-highway, and that they are allowed to join the journey? For example, the infographic in figure 1 could be used to convey the message simply and clearly in doctor’s offices, clinical sites and through general social media sites such as Facebook and Pinterest.

If popularized sufficiently through mobile and digital technology, could we anticipate a greater level of interest in and understanding of both clinical research and improved management of healthcare in general? Will it help to further engage and shape the thinking of our patients of today and tomorrow? There is much discussion ongoing about how technology is becoming increasingly important in the world of health, such that expanding internet access is now being considered as one of the drivers of health disparities.

 It seems that internet access is fast becoming one of our basic human rights to enable wellbeing.

The important questions we should ask ourselves are … Who owns our health, and whose responsibility is it? Does it belong to us as individuals? Does it belong to our Governments? Or is it a joint responsibility? Clearly, the answers to those questions are dependent upon where an individual lives, the national economic model, and the healthcare system that is in place. What is clear though is that with decreasing numbers of medically trained doctors per headcount (global population is now >7billion), and a seemingly crisis-level escalation in some countries of chronic diseases such as diabetes mellitus, when it comes to management of health, we need to embed a greater sense of ownership in everyone. Expanding on the first of those drivers for change, the density of physicians per 1,000 population is a stark reminder of the practical challenges and of the disparity in delivering healthcare globally; with fewer than 0.03/1,000 in countries like Sierra Leone and Liberia—where the Ebola virus is currently taking hold, through to the relative luxury of >6/1,000 in places such as Monaco and Qatar. Perhaps surprisingly, the US and UK have relatively modest rates of 2.45 and 2.79/1,000 respectively.

 It’s simple math, sometimes we need to help ourselves. Society therefore needs to wake up and take charge of this growing issue, and that’s where ‘mHealth’ can put that control back into the patient’s hands—whether that be in the form of digital access to a public health campaign regarding a quarantine zone, a web-based interactive neo-natal support program, or mobile data collection for a cystic fibrosis trial. 

Just how far the mobile and digital revolution can take us in discovering otherwise unknown facts about health, is unclear. It could potentially reveal previously hidden secrets, through the power of the sheer volume of data that could be collected from patients or healthy subjects. We may well find that clinical research is changed through there being a greater level of honesty between HCPs and patients (or at least a greater convenience and control), and the ‘Parking Lot’ syndrome of last minute PRO (Patient Reported Outcomes) will be finally over. Perhaps we will see a greater ability to look at healthcare through a different ‘wide-angled’ lens. Imagine, if all chronic health sufferers were to give a health status on a given ‘WORLD MOBILE HEALTH DAY’, what a powerful and impactful ‘snapshot-in-time’ that would provide.

Clinical research is just a building block in the greater scheme of health management. But if we could ‘mobilize’ the population, and engage from the youth upwards, through education, then we have the potential to ease the patient recruitment problems in trials, and enable everyone to contribute to a much larger picture than we might have thought possible. We just need to let the patients know.

Judith Teall, Director of Clinical Excellence, Exco InTouch

World Health Organization, “Research for universal health coverage: World health report 2013”, 

http://apps.who.int/iris/bitstream/10665/85761/2/9789240690837_eng.pdf?ua=1

A.M. McDonald, R.C. Knight, M.K. Campbell, V.A. Entwistle, A.M. Grant, J.A. Cook, D.R. Elbourne, D. Francis, J. Garcia, I. Roberts, C. Snowdon, “What influences recruitment to randomised controlled trials? A review of trials funded by two UK funding agencies.”, (2006) 

I.S. Mackenzie, L. Wei, D. Rutherford, E.A. Findlay, W. Saywood, M.K. Campbell, T.M. MacDonald, “Promoting public awareness of randomised clinical trials using the media: the ‘Get Randomised’ campaign”, (2010), 

S. Baum, “How often do consumers use digital health tools? This graph will show you”, (2014), 

http://medcitynews.com/2014/08/often-consumers-use-digital-health-tools-graph-will-show/#ixzz3Ak1kavJ6

L. Mearian, “Almost one in six doctor visits will be virtual this year”, (2014), 

http://www.computerworld.com/s/article/9250262/Almost_one_in_six_doctor_visits_will_be_virtual_this_year?pageNumber=1&taxonomyId=132&utm_content=7438870&utm_medium=social&utm_source=twitter

J. Bresnick, “How can expanding internet access address health disparities?”, (2014), 

http://healthitanalytics.com/2014/07/23/how-can-expanding-internet-access-address-health-disparities/

http://gamapserver.who.int/gho/interactive_charts/health_workforce/PhysiciansDensity_Total/atlas.html

To understand just how far mobile and digital technology can truly influence progress in global healthcare, we first need to form the foundation of the discussion with a few rudimentary facts.

Judith Teall

Articles

Exposing Patients to the Bigger Mobile and Digital Health Picture

Exposing Patients to the Bigger Mobile and Digital Health Picture - Did We Forget to Tell Them?