Are You Ready for the Telemedicine Revolution?

Telemedicine has been promised for more than a decade yet has never really taken off as a serious alternative to in-person visits. COVID-19 has instantly accelerated the acceptance and widespread adoption. Medical professionals and patients of all ages now actively pursue digital consultations and overall digital care beyond the therapeutic applications where telemedicine originally was adopted.

Telemedicine is embraced by physicians and patients alike

During the pandemic, patients have been highly reluctant to visit physicians, clinics and hospitals. As many as 80% of Americans now say that they are concerned about contracting the coronavirus from visiting the emergency room.^[1] Patients who, before coronavirus, were reluctant to use telemedicine due to their desire to maintain close relationships with their physicians or their discomfort with technology, have, as a result of COVID-19, stepped up their digital know-how and rapidly moved to incorporate technology in their health management. 

“Telemedicine, in a matter of weeks, jumped ahead to where we thought it would be in 10 years.” 
PW Singer^[2]

Patients’ embracement of telemedicine is reflected in the number of online consultation sessions. Over a four-week period, leading telemedicine platform Doctolib witnessed video consultations leap in France from 1,000 to 100,000 per day, with 2.5 million consultations booked by the end of April. Sweden’s Kry International experienced a 163% jump, and in the United States, top provider Teladoc witnessed a 92% jump to 2 million online consultations in Q1 alone. 

Patients now see how convenient and effective telemedicine can be, particularly for rudimentary day-to-day health management issues, symptom screening, and, in some instances, diagnosis. In two notable examples, 94% of diabetes patients at a Cleveland clinic were cared for virtually and the Mayo Clinic delivered hundreds of thousands virtual visits across a broad range of conditions. ^[3]

Telemedicine is here to stay 

This recent spike in digital care will likely have an impact on physician behaviour beyond treating patients. As physicians become increasingly at ease utilizing digital tools within a treatment paradigm, there is a very good chance that they will be more accepting of digital tools in other areas of their workflow (e.g., e-detailing readiness, remote access to clinical data, clinical decision support, and use of remote monitoring).

It is expected that this evolution will expand as the threat of COVID-19 lingers and telemedicine becomes more readily available through government support and new entrepreneurial launches. For example, Japan’s Health Ministry recently announced that 10,000 clinics now offer telemedicine, and popular app providers Site Navi and Line have announced upcoming telemedicine expansions or launches. With more than 80M monthly active users, Line’s telemedicine offering will have a deep reach throughout Japanese society. 

Telemedicine is quickly becoming easily accessible by anyone. Tomorrow, not visiting your GP in person will be the new normal.

A transformed patient journey

Evolving patient and physician attitudes, the likely longevity of the pandemic, and the reality of an increasingly stressed and costly healthcare delivery environment are converging to not only transform the patient journey itself, but also entrench the role of telemedicine in healthcare. Digital physician-patient interactions will continue to grow going forward, eventually becoming a regular and permanent component of healthcare delivery. Nevertheless, this shift raises various questions about how this phenomenon will evolve:  

●      How is the patient journey likely to evolve in the post-COVID-19 era? 

●      How will a broader set of digital solutions, used in conjunction with telemedicine, optimize a transformed patient journey? 

●      How will this shift change physician behavior? 

●      What opportunities are there for healthcare companies, and, in particular, pharmaceutical and medical device (MD) manufacturers, within this new paradigm?
 

One can think of COVID-19 as a change accelerator in the healthcare space: many of the trends that we have witnessed in recent years will only accelerate in a post-COVID-19 era, irrespective of the therapeutic area or healthcare delivery scenario. Although there will undoubtedly be differences by country or region, telemedicine and digital care will drive changes in patient and physician behaviours and will transform the patient journey in a way that will transcend markets. 

The patient journey is transforming. There is real risk to laggards who do not quickly adapt. 

Let’s take, for example, a patient journey within the cardiovascular therapeutic area, and look at the impact that COVID-19 and other digital enablers are having at different stages of the journey.

Table 1

Click to enlarge.

Click to enlarge

The impact of a more extended use of telemedicine on the Cardiovascular (CVD) patient journey, illustrated in Table 1, will undoubtedly bring a number of favourable outcomes to the management of cardiological conditions, including:

●      Better and more prompt follow-up appointments and communications.

●      Prevention of clinical changes, stimulation of condition self-management and the resulting improved quality of life and reduction of re-hospitalization costs – thanks to a more extensive use of wearable devices and remote data transmission, this will allow better monitoring and early identification of changes in condition parameters or of device-related issues.

●      Quicker treatment in case of cardiac emergencies – thanks to direct connection to emergency numbers, ambulances, hospital system and faster transmission of patients’ ECG and clinical parameters while transferring to the hospital.

A simpler disease management process and the use of AI-supported decision making will also leave more time for physician and patient interactions, with a positive impact on their overall satisfaction.

Extensive use of wearable devices and sensors will enable hospital-quality monitoring to be performed continuously. This will result in an increased quantity of patient-specific data upon which to base decisions, positively affecting early diagnosis,^[4] treatment precision and speed, as well as an expected improvement of treatment outcomes. 

Finally, how physicians gather information and make decisions regarding treatment options for their patients will also evolve as e-detailing becomes more widely adopted.

This example from CVD is simply one example. This transformed landscape for healthcare can deliver benefits to physicians and other HCPs, patients, and careers, irrespective of therapeutic area or condition severity. Although these changes will affect many sectors, pharmaceutical and medical device companies in particular will need to consider the impact on their business and adapt the way they interact with their customers and patients in response to these changes.

Which digital technologies may be adopted to optimize the patient journey?

As physicians and patients embrace the benefits and learn to navigate the pitfalls of telemedicine, we look at a few areas where digital adoption is influencing the patient journey, giving us an indication of the new reality that pharmaceutical and medical device companies need to respond to.

Expansion of touchpoints and reach in the physician-patient interaction

Telemedicine will optimize the use of the physician’s time. Doctors can use empty slots in their diary to field telemedicine consultations and move effectively from one patient consultation to the next. Physicians can expand the radius of service, as there are no longer physical barriers for the consultation, and, in principle, see more patients. Patient files can be automatically pulled up and any time waste reduced. Automated notes taking, speech-to-text software and machine learning can be used to improve case analysis and identify insights that may have been missed.

Accuracy of diagnosis 

Compared to in-person visits, telemedicine may carry a higher risk to miss patient signals leading to inaccuratediagnosis. On the other side, AI can provide the physician with suggestions on diagnosis and treatment. In addition, telemedicine will increase the frequency of interactions. Follow-up appointments and conversations can be shorter than the initial visit, and, in several cases, be executed fully digitally.

Improved patient compliance

In its most simple form, a CRM system can reach out to patients and suggest new appointment times for follow-up consultations, with reminders to take medication, complete an at-home blood test, or encourage the patient to finish the treatment. 

In a more advance form, CRM can work proactively. For instance, recommend a preventive test based on age, family history or prior disease or issues.

Although there might be some danger with applying sales practices to medicine, in most instances the benefit of better and earlier diagnostics outweighs the possible negative consequences. 

Patients are ready for the change

Patients are ready to embrace this new reality. In a report from Canada, 84% of patients expressed interest in the ability to access all of their health information from one platform. The majority believes that technology is improving their healthcare experience.^[5]

Recent work on using the ongoing patient data provided by Apple watch & Fitbit to predict, before the onset of symptoms, when a patient is infected with coronavirus⁴, is an example of how many of us will be willing to share our data for the benefit of early diagnosis combined with an offer of early treatment. The benefit? A higher chance to live.

Transforming the COVID-19 threat into an opportunity for pharmaceutical and medical device companies 

Although pharmaceutical and medical device companies have been one of the less-affected industries by the economic fall-out from COVID-19, the foreseeable financial crisis and higher unemployment levels are likely to affect patient spending capabilities and limit their access to healthcare insurance, thus impacting demand with a shift to less-expensive treatment solutions and possibly a higher weight placed on generics.

Another important impact of COVID-19 has been a significantly reduced frequency of HCP visits by pharmaceutical companies, thus influencing top-of-mind recollection and physicians’ likelihoods to recommend specific brands. 

On the other side, the new environment offers pharmaceutical and medical device companies opportunities to leapfrog competitors and sustain sales even beyond the COVID-19 crisis. Telemedicine can bolster demand by offering new ways to reach patients, both in a context of social distancing and beyond, and by accelerating the time to diagnosis and increasing treatment adherence.

Furthermore, increased overall patient and physician satisfaction, supported by an intelligent use of digital tools, is likely to sustain sales over time. 

To continue to win, pharmaceutical and medical device companies must learn how to transform their strategies and operational processes to respond to the new environment that is emerging from the pandemic.

From vision to reality: A five-step approach for pharma and medical device companies to uncover opportunities and implement changes.

How can healthcare companies leverage technology to stay ahead of competition and capitalize on opportunities created by changed market conditions? 

The path to success will differ depending on the patient journey, location, brand and company reality. One tangible way to sketch the right path is by following a five-step process to identify and develop the most appropriate digital solutions to take full advantage of emerging new spaces.

Table 2

Click to enlarge

Delving into each of the five steps, here are the main points to consider and actions to take:

1.  Analyse the patient/HCP journeys
Map carefully the patient and HCP journeys to identify where the patient or physician risk to drop out and the HCP’s drivers and barriers to the prescription of the therapy class or brand.

2.  Find the leverage points that can be triggered with the usage of digital technology
Identify the specific changes in behaviour that should take place in the patient and HCP journey to lead to more satisfactory outcomes & outline digital opportunities. 

3.  Develop and pilot digital solutions  
Ideation should start from a clear understanding of the “ideal” journey, targeted interactions, and pain points to be addressed.

4.  Plan the launch of the new solutions and rollout
A launch plan that ensures customer awareness is raised, adoption quickly ramps up and internal personnel are trained.

5.  Monitor, track KPIs, and adjust
A set of KPIs should be designed to track the adoption of the new solutions and their impacts on the customer journey.

Companies that intend to lead will need to stay ahead of changes in the marketplace, capturing opportunities offered by evolving physician and patient behavior and, ultimately, developing a revised go-to-market model with a more extended use of e-detailing. In other words, they’ll need a new working paradigm for the commercial organization.

Conclusion

The COVID-19 pandemic has shortened patient, physician, and government adoption of telemedicine from years to months. Similar to how working from home and video business meetings are here to stay, we expect that telemedicine is the new normal. 

As governments, doctors, and hospitals seek to future-proof society for the next pandemic, and entrepreneurial companies roll-out new telemedicine solutions, making virtual doctor visits more easily accessible, we expect fundamental changes to occur with regard to the patient journey.

In combination with trends in ongoing health monitoring, AI analysis of user health data and yet-to-come unknown device developments, we believe the patient journey, as well as the patient and physician relationship, are in for rapid, continuous change.  

Even post-crisis, social distancing behaviors are likely to remain in the mid-term. Consequently, companies will need to find compelling and meaningful ways to engage with physicians remotely.

Companies must ready their brands, operations, and people to deal with the new reality. By taking a five-step approach to analyzing the impact of these changes on their businesses and developing and testing possible solutions, organizations can make more informed decisions regarding any required actions they should take-either now or in the future-to effectively service physicians and patients for years to come. 

Trista Bridges is Partner, Edge+ Management Consulting Marketing; Gilda Sala is Founding Partner, Edge+ Management Consulting; and Rune Sølvsteen is Managing Partner, Defacto Partners Limited.

[1] Poll by American College of Emergency Physicians and Morning Consult.

[2] “Coronavirus is automatic the world even faster,” Quartz, May 29,2020. Note: Singer is a strategist at the New America Foundation who warned early on of the COVID-19 pandemic and offered predictions on its long-term impact.

[3] New York times June 11, 2020 “Don’t avoid your doctor any longer” written by Tomislav Mihaljevic CEO & President of Cleveland Clinic and Gianrico Farrugia CEO & President of Mayo Clinic.

[4] We are now seeing tests if wearables can predict coronavirus in patients, before the onset of symptoms.https://www.usatoday.com/story/tech/2020/05/27/coronavirus-tracking-apple-watch-fitbit-studies-aim-detect-covid-19/5270949002/

[5] The future of connected retail. August 2019  A CMA/Ipsos collaboration.