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Digital Therapeutics in the NHS: the Rise of Digital Therapies & The Digital Therapeutics in the NHS: The rise of digital therapies & the evidence that proves they work In partnership with #DHLCOLLABORATE digitalhealth.london #Digitaltherapeutics DigitalHealth.London Contents 04 Fear over pragmatism? Have we reached the tipping point for evidence and digital therapies? 07 DigitalHealth.London: a pan-London partnership 08 The UK could become a leader in digital health by rolling out a turnkey solution for Digital Therapeutics research 10 Infographic: the digital medicine cabinet is coming of age 12 The balancing act of Digital Therapeutics: how should the NHS bring global innovation in the clinical validation of apps home? 14 Let’s move on from the evidence challenge to explaining what good looks like 16 Evidence is crucial but context can be king in ensuring innovation spread 18 How real world data could be used to generate evidence for digital health 02 Digital Therapeutics in the NHS Foreword The past decade has seen rapid development and adoption of technologies that change the way we live in many areas of day to day life. Digital and connected technologies continue to stake their claim in the health and care industries. In the last few years we have seen the rise of a new type of health technology product — one that promises measurable health outcomes: Digital Therapeutics. It’s clear that Digital Therapeutics holds Our health and care sector continues great promise to enhance patient care, to face difficult challenges. We need to create treatment efficiencies, and ensure universal access to any benefits improve clinical outcomes. However, delivered via innovation through the NHS, the complexities of our current research preventing the system from being left and development system, coupled with amidst a vibrant and growing consumer the costs associated with running robust market. Furthermore, we must make it William Smart clinical trial and studies, has historically easier for providers, commissioners and Chief Information Officer curtailed the development of a validated patients to leverage and benefit from the NHS suite of digital interventions that could rich health information these technologies confidently be adopted or prescribed can deliver. by healthcare providers. Fortunately, the emerging body of evidence suggests a So, I invite you, our NHS colleagues and positive and fertile landscape to start to industry to be part of the conversation on encourage in earnest the use of Digital the future of Digital Therapeutics. Let us Therapeutics in conjunction with existing engage with digital health companies from and more traditional therapeutic options. around the world with best in class clinical evidence and learn what the current At this year’s annual DigitalHealth.London/ evidence is telling us right now about Collaborate event, which is being hosted in clinical effectiveness. As a collective, let collaboration with NHS England, IQVIA and us commit to taking the steps to ensuring The Digital Therapeutics Alliance, we will evidence does get into real-world clinical explore the process for getting the most practice for Digital Therapeutics. out of proven digital therapeutic solutions, focussing on the evidence base, what we Let us continue to embrace new know right now, what good looks like, and technologies like these, which present how this should be informing how we make new opportunities for our health and care decisions around which digital solutions to system, improving the lives of our patients adopt and use. and citizens. 03 The rise of digital therapies & the evidence that proves they work DigitalHealth.London Fear over pragmatism? Have we reached the tipping point for evidence and digital therapies? DigitalHealth.London Amy Galea, Deputy Director, Transforming Firstly, what are ‘Digital Therapeutics’ – Health Systems, NHS England, recently here’s a definition: have been debating stated at the HIMSS executive leadership the growing value of summit, that currently seven pence in every “Digital Therapeutics are something pound is being spent on chronic condition that is digital or software by nature, that Digital Therapeutics in management. Despite 70% of funds going engages a patient, and by virtue of the the United Kingdom and towards this, it is not necessarily reflected mechanics of the software can by itself or in the health outcomes being achieved. in combination with something else lead engaging with many Ruth Robertson, The King’s Fund, showed to clinical outcomes,” says Eddie Martucci, stakeholders both inside how the increased demand for health care CEO, Akili Interactive Labs. services is having a negative impact on and outside of the NHS. the quality of care being delivered. Martucci goes on to say, “there are The July 2017 Healthcare System various forms and approaches that Performance Rankings, published by Digital Therapeutics take, whether that be The Commonwealth Fund, ranks the digitally-enabled drug delivery, software- UK first for care process and equity, driven behaviour modification or disease but 10th (out of 11 countries) for health management, or stand-alone digital care outcomes. products that directly activate physiology to achieve outcomes.” There are many contributing factors driving the quality of health outcomes. We at DigitalHealth.London have been But one emerging question that is debating the growing value of Digital gaining traction and profile is, canDigital Therapeutics in the United Kingdom and Therapeutics play a role in improving engaging with many stakeholders both health outcomes, and what is the inside and outside of the NHS on its evidence to suggest they can? potential to improve patient experience and impact clinical outcomes. Some examples of digital therapeutic innovations that you may have come across include: Akili; Quit Genius; Omada Health; Pear Therapeutics, Propeller Health, myCOPD, WellDoc, Voluntis; Yinka Makinde Programme Director Sleepio; Vida Health; Oviva; Changing DigitalHealth.London Health; OurPath, and more besides. 04 Digital Therapeutics in the NHS A recent report on 571 published efficacy Recently, three of our UK grown studies and 234 randomised controlled innovators; OurPath; Oviva and Changing trials of the quantitative value of digital Health (current and previous DigitalHealth. health apps and connected devices on London Accelerator companies) delivered important metrics like weight loss, blood impressive outcomes following a four sugar control, depression scales, and month real world evidence trial led by hospitalisations, concluded that the vast Dr Tony Willis, Clinical Lead for Diabetes, majority of these efficacy studies have North West London Collaboration of CCGs shown statistically significant benefits on where more than 400 Type-2 diabetes health outcomes. patients from 18 GP practices in North West London were offered one of the The July 2017 Healthcare Few of these published clinical studies three digital therapeutic interventions. and results however, had been generated System Performance by digital therapeutic innovations But what is the quantitative value of digital Rankings ranks the developed outside the UK. I believe there health? Do apps and connected devices UK first for care process is a reason for this. In the UK we currently really improve patient outcomes? Will and equity, but 10th for have four challenges affecting the prolific digital health create cost savings that the generation of clinical evidence to support NHS can count on? And most importantly, health care outcomes digital clinical interventions: what is growing body of ‘evidence’ that currently exists – whether randomised 1 Lack of clear standards defining what controlled trials or real-world evidence? good looks like – so that innovators These questions and others are the focus know the bar to aim for of the debate at this years’ DigitalHealth. 2 Insufficient trial sites to conduct the London/Collaborate 2018 Summit. clinical studies 3 Borrowed (from life sciences clinical Thank you for attending this important trials) infrastructure, rigid approaches event. This year DigitalHealth.London is and a legacy culture that drives up a delighted to host its 2018 Collaborate cost of conducting clinical studies that Summit in partnership with NHS England, is out of reach for the average digital IQVIA and The Digital Therapeutics health innovator Alliance. This Summit is aimed at a 4 Poor visibility of and access to national and international audience. the growing body ‘evidence’ that currently exists – whether randomised controlled trials or real-world evidence 05 The rise of digital therapies & the evidence that proves they work DigitalHealth.London The title of the event is: ‘Digital Joshi, Digital Health and AI Clinical Lead, and Therapeutics in the NHS: The rise of backs the need for clear standards defining digital therapies & the evidence that what good looks like, so that innovators proves they work’ and offers senior know the bar to aim for. Through a multi stakeholders in the NHS insight into stakeholder steering and working group, the evidence that exists right now, the group aims to deliver a set of NICE supporting the clinical effectiveness endorsed guidance for digital innovation, of digital therapies. It aims to provide for commissioners and innovators. delegates with the opportunity to see real examples of innovations and interrogate We are optimistic that by engaging the evidence, and to start to co-produce Recently, three of our in more activity like this, led by the a toolkit for commissioning and adopting UK
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