Digital Health: Letting human nature drive design
End users are increasingly important partners in developing digital health solutions, to the benefit of all
The next generation of digital therapeutics (DTx) and other digital health solutions are being developed in partnership with a key party: the end user.
An increasing number of developers are working with patients and other end users to co-create digital tools. The aim is to give users greater engagement with the digital health tools, a stronger sense of agency and, ultimately, promote better health outcomes.
The value of digital health solutions for patients, the largest and most important group of end users, depends on their usability and how well they suit patients’ preferences and lifestyles. “Co-developing with the users and the patients helps us to make sure that we are relevant and that we are offering the right support for their needs,” Yacine Hadjiat, Global Head of Biogen Digital Health Solutions.
Organizations including Sanofi, Biogen Digital Health and Vicore Pharma are working with patients throughout the development cycle to identify and capture patient insights and nuances they can apply to the product.
Patients are more than just their disease
Involving patients in the process enables pharma to develop solutions that address the whole patient, addressing behavioral and physical health together. This whole-patient health approach, recognising that the mind and body are both key to wellness, can be a powerful combination in a well-designed health solution.
Sanofi is one such pioneer taking a holistic approach. It is building a whole health solution for patients with diabetes and cardiovascular disease with its DTx partner, DarioHealth to address the diverse needs of individuals that they confront throughout their health journey.
“We really want to solve for the whole health needs of people living with chronic disease,” says Alex Condoleon, Sanofi’s Head of Digital Healthcare for US General Medicines. “And that means solving for disease specific needs. It means solving for physical well-being, mental well-being, and it means being highly attuned to the social factors that are driving health determinants and health outcomes.”
Vicore Pharma is also addressing the mental health of patients with chronic disease. The company is developing a DTx that applies psychology, cognitive science and behavior-based therapies. This fully automated medical device software will deliver evidence-based clinical interventions to patients suffering from anxiety associated with idiopathic pulmonary fibrosis (IPF), says Jessica Shull, Director of Digital Therapeutics at Vicore Pharma. “The product is a 12-week therapy based in interactive sessions with the software, utilizing cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) methodologies, tailor-made for this population.”
Direct input places patients at the heart of design
While quantitative data continues to inform development, qualitative data keeps patients at the heart of the design. Methods of gathering patient data are plentiful and include patient focus groups, one-on-one interviews, input from patient advocacy groups and advisory councils, patient level market research and social listening.
This is where patient needs are identified. “It starts with empathy, listening and hearing. We listen to the needs of the patient in their care journey and their pain points,” says Hadjiat. “Then we develop, we gather additional feedback, and we iterate. That's a user-centric design that we have as a core principle. It is really at the heart of what we do in this co-creation process.”
This patient-centric design approach includes not only patient input into the health solution, but also a say on the prototype. Patients have input into every content piece, from colour choices to the positioning of buttons. This inevitably improves patient engagement and retention on the platform as every aspect of the design is deliberate in serving and supporting the patient.
Shull agrees, “The only way to understand what patients want to see, what resonates with them, what obstacles they face, and what will help them cope, is to speak with them. The psychology team at Alex Therapeutic, our partner in building this DTx, held more than 25 interviews and dozens of user testing sessions in order to ensure the voice, the content, the font…everything was appropriate.”
Iteration is fundamental to this development cycle as it allows for continuous adaptation to patient needs and solutions that continue to offer value over time. Incorporating patient input into the product allows the software to communicate with patients in a way that helps them adopt the right health choices.
A flexible and adaptable platform is essential to adjusting solutions quickly to fit patients’ evolving needs so they can benefit fully and stay engaged in their treatment. “You want them to have the right behaviors. You want them to be adherent to the treatments and have the right persistency, and if the solution is not adapted to the patient, you miss it,” says Olivier Bogillot, Head of US General Medicines at Sanofi.
“You've got to move from understanding a need that you want to solve for to understanding what is the journey that I can take someone on in order to help them make better choices on that journey, because digital interventions are not about a single point in time. They're not about take a drug at this time. They're about the life in between,” says Condoleon.
Patients are involved in every phase of the development process from the beginning, and this is an ongoing process. There essentially is no finish line. “I don't even call the solutions a finished product at all in their lifecycle,” says Hadjiat. “Those solutions, in a way, cannot be a finished product. It has to evolve. It is a V1 V.1, V2, V3 and so on. This user-centric design and this feedback loop is at the heart of the technology and the solution. It has no end.”
Translating the data
Capturing patient insights and translating them to a therapeutic application takes special care. At Biogen Digital Health, an organisation developing digital therapies in neuroscience, a unit of more than 15 people is dedicated solely to patient insights and design translation, says Hadjiat.
It is important to make certain that these insights are understood and applied. Developers at the division work to continually refine and improve solutions. “It’s back to this core principle, where we co-create, we co-design, we go with a user-centric design as part of our DNA. Innovating with digital solutions is an iterative, fast-paced learning experience,” says Condoleon.
“Many of us are going to be adopting agile and design thinking methodologies.
We want to understand the journey that someone would like to be taken on and all of the variants of that journey, because digital lets you personalise the journey to different people.”
Where developers gather insights from also matters to the quality of the solutions being developed. Patient advisors at Sanofi are comprised of not just external sources such as advocacy groups, but also include employees from within the organisation who experience chronic conditions. Their contribution of ideas, critiques and feedback provides valuable enrichment to digital products and a high level of empathy.
Getting to scale faster through partnership
Successfully getting to scale can be accelerated by collaboration with the right tech partner. There is a learning curve in DTx, so if you can synergize with a mature platform, you can impact the success of digital health solutions and the speed at which they get to market, says Condoleon. “I think there's a lot of value to partnering and to leveraging competencies in order to get to market and to learn quickly.”
In building out Sanofi’s digital infrastructure, the foundations Dario has already built can be supplemented and enriched. “They have built up their AI algorithms so that we don't need to be talking about what are your generic determinants of health, we can start thinking about what are your personal determinants of health.”
Working with a partner that has a direct-to-consumer market also allows you to test other products in development. “We're able to test in the direct-to-consumer population that they've got and work out what gets to the critical standard that we want, and then bring that across the fence into the products that we're launching into the health plan and employer market,” adds Condoleon.
However, limitations to fully scaling digital products remain. Regulatory bodies and payers have not yet caught up to the fast pace at which digital health solutions are moving, often hindering the adoption of these technologies. “Payers need to understand these kinds of products better and decide on parameters for evaluating them as valid for reimbursement. The future is already here,” says Shull.
Challenge remains then, says Hadjiat, “but with the users at the core, we tend to overcome most of it. And that's the beauty of it. Otherwise, we wouldn’t be talking about innovation.”