Internet of Things Becomes Greater Focus for Pharma

Large pharma players are approaching IoT to embrace what is happening in the digital health space.

As Thomas B. Cueni of the IFPMA recently stated, voluntary "technology transfer partnerships have been the cornerstone in the fight against COVID-19" in ways that offer new and exciting opportunities for pharma. The need for the adoption of connected technologies that was exacerbated by the pandemic is expected to complete a shared vision.

The vision is centered on using the Internet of Things (IoT), a concept coined several decades ago, to provide improved and personalized healthcare to patients. IoT describes a system of computing devices interconnected via the internet that enables sending and receiving data. The ongoing push for the IoT hype to become reality as part of the digitization of healthcare got a second wind after the pandemic began in 2020. Major pharma players are working to harness the potential of IoT for time and cost savings that ultimately benefit patients and providers.

IoT encompasses every organization from providers and payers to developers and vendors. But pharma is in an advantageous position to connect the dots across the entire life cycle of a medication. The advantages of IoT are focused not only on medical intervention and medication errors, but also personalized medicine.

What perhaps is the most interesting is the way that large pharma players are approaching IoT to embrace the entirety of what is happening in the digital space and through connected devices. Bayer, for example, has invested into a business unit that is focused on trying to create revenue out of this.

Johnson & Johnson, as another example, made a $2 billion IoT investment in 2016 and was named as the top IoT innovator in the pharma sector at the tail end of 2021. Meanwhile, Verily Life Sciences LLC, the research arm, of Google's parent Alphabet, and Sanofi also launched a $500 million joint venture in 2016 aimed at developing a comprehensive, data-driven connected diabetes management platform.

"The integration of multiple interventions, such as data-driven patient support and devices in addition to treatment, can help improve outcomes, which is important from the perspective of patients, healthcare professionals and the overall healthcare system," Peter Guenter, executive vice president, and head of global diabetes and cardiovascular business at Sanofi, said at the time.

"Our goal is to connect the dots for health care providers on the 'moments of truth' that happen outside of the clinical setting, and to help people manage diabetes on a daily basis," added Jessica Mega, MD, chief medical officer of Verily.

GlobalData Plc, a London-based data analytics and consulting company, tracks data points of IoT in pharma that include IoT deals in the pharma technology sector, the number of IoT patents in the pharma sector, top companies with IoT mentions in filings, and IoT influencer activity in the pharma sector today. It also monitors the top IoT related innovators in the pharma industry and in the clinical operations industry , with J&J topping both.

Additionally, GlobalData indicates the top IoT patent holders from 2001 through 2021.

Yet another research area that GlobalData records involves comparing IoT as a theme to the top five themes in pharma today. While IoT is at the bottom end of the spectrum of the top themes, following cybersecurity, data security, ecommerce, marketplace, and Big Data, the theme has been steadily trending upwards since 2019.

"We've seen with all things wireless, or wired, that the foundational technology has improved so much that, if you're not in it today, you're behind," Brian Drozdowicz, senior vice president of integrated care and digital health at Bayer Pharmaceuticals, told HealthLeaders of the IoT market. "So, we're well in it."

Wearables and electronic health records (EHR), among others, are some examples of patient health data providers in the real-world. Yet data can be captured from patients throughout the entire care continuum. Diabetes management has been used as a primary example of the potential for these data.

Greater adoption

In the earlier days of healthcare IT and digital health, where the connectivity, technology, and underlying foundation that make IoT possible was not as reliable, provider and patient adoption was low. The pandemic has accelerated the adoption of digital technologies in healthcare that have been around for a while. The improvement in the use of these technologies over the last two years has been primarily based on a larger sample size using them. Most people, for example, have had remote telehealth visits or remote diagnostic used over the past two years.

There has been greater adoption of these technologies in the past two years than the prior decade, and the preexisting challenges around accessing these technologies has improved in almost every case. The pandemic exacerbated the issues around access and forced people to consider models of care that had never been entertained before. Prior to the pandemic, primary care provider (PCP) visits were not widely expected through Teladoc, Amwell, or other telehealth providers through an iPad, smart phone, or computer. But adapting to this type of PCP visit has outweighed the perceived risk of being out in public with a pandemic that has had many unknown consequences in recent years.

From exploring the future of a decentralized clinical trial to specific post-drug launch digital companions to disease management solutions, Bayer has a variety of examples of what it's working on today when it comes to IoT. "It spans the entirety of our core drug portfolio," Drozdowicz said.

Drozdowicz's work leading the function of integrated care, includes the mandate to build a digital revenue stream through devices and digital solutions. An interesting concept that has gone into the formation of this business unit is looking beyond the things that core assets will benefit from.

"We don't want to limit ourselves," Drozdowicz said. "We see tremendous opportunity to potentially taking a leadership position in the market with some of the bigger things that are happening in digital health, and we have made some investments and relationships that support" these endeavors.

The company is working to strategically build business partners that it both invests into and has commercial and developmental relationships with to bring solutions to market that are transformative for healthcare as a whole and its core pharma business, in addition to building a revenue stream. Bayer sees "a tremendous opportunity in the [IoT] market today … and we see at it as a core part of our business going forward," Drozdowicz said, pointing to the efficiency-creating potential.

Strategizing

The efficiencies to be gained in the long term relate to obtaining results faster and more accurately. IoT can be used for improved recruitment of patients that are a better fit for a clinical trial. The speed, the precision around interoperable devices, the connectivity, and what all this can bring to a business are all efficiencies that give companies advantage over the traditional ways of capturing patient information.

There is a litany of challenges that go with moving toward connected devices, including integration challenges, data security, privacy challenges, and adoption challenges. "But it's here and it's now," and it's a core part of companies' pharma strategy all the way up to the highest-level, Drozdowicz said. Digital aspects of Bayer's strategy get "sharper and sharper each year and it's exciting to be in it."

On the digital therapeutics side, "the evolution in connected virtual reality and other devices that allow software to be the intervention have evolved toward clinically validating products and simplifying the onboarding process in healthcare as opposed to looking at the use of software in more of a 'mobile health' approach," Andy Molnar, CEO of Digital Therapeutics Alliance told HealthLeaders.

Yet IoT innovation has dropped among pharma companies in recent months. Figures compiled by GlobalData show the number of IoT patent applications in the pharma industry standing at 99 in the three months ending November, down from 181 over the same period in 2019. They also show patent grants related to IoT decreasing from 180 in the three months ending November 2021 to 101 as of January.

But the technology is expected to outpace any major policy change.

If the time it takes to conduct a trial and the data collection and evaluation of that trial can be done in a world where everything is electronic and integrated, that could rapidly speed up innovation in producing more timely and cost-effective therapies and be a massive disruption to the traditional path to market.

"I honestly think that the technology is going to move faster than the policy, and organizations like ours will adopt the technology because it's the right thing to do and because the patients live in a generation where it is now accepted," Drozdowicz said.

He said that the biggest advancements that will aid adoption and growth of the technology is going to be long-term consolidation of vendors, like what happened on the provider side with technology. Epic and Cerner own the EHR market today, with the former maintaining a 31% market share and the latter 25%. But a decade or so ago, these companies were small, and hospitals could have up to 30 best of breed systems that they stitched together and were loosely interoperable. The world of trials is expected to go in a similar path where there will be vendor consolidation that makes it easier for pharma companies to be more efficient in their processes.

Provider perspective

Stanford Health Care uses Epic, which "has many capabilities to advance further in its own existence as an EHR," within the EHR ecosystem, Deepak Sisodiya, director of pharmacy services at Stanford Health Care in California told HealthLeaders. "There's much ability for each system to have its own version of IoT," he said.

With many therapy types within pharmacy, there is some general guidance of what a medication order would be. But based on patient-specific nuances, providers may guide or advise for them to be slightly different. Providers, for example, may guide an intended order to be different for patient A than patient B based on the patient's individual health outcomes. This is one potential use case on the provider side.

When it comes to real-world data and personalized treatment, providers want to know how they can tap into information portals that may have already existed and ones that are not quite there yet.

Sisodiya compared a CVS or Walgreens information system to that of the Epic system that Stanford is using to share information. "We still aren't exactly perfect at having accurate medication history."

Sisodiya used cancer as an example of where better visibility can be obtained. Cancer is a slightly different category than diabetes, but the question is, "how do we get better determinations of what is the best treatment for a patient headed toward precision medicine?" Based on historic cancer treatments, a patient would be prescribed the type of dosing that are specific to a genotype and phenotype. A patient may get the same drug but dosed slightly differently, maybe more frequently.

The intent is to tie all healthcare advancements, genetics, and more personalized medication and therapy treatments together. For Sisodiya this means tying Stanford's Epic with the tools it uses such as certain levels of robotics and automation and then tie that to the external parties it partners with to receive medication, which include Stanford's wholesalers McKesson and Cardinal Health. This is intended to enable visibility of the system, of every single medication flowing through the entire life cycle, from its creation at the pharma level all the way to administration at the patient level," Sisodiya said.

Sisodiya also spoke to the long-standing issue in healthcare of medication errors. This is "unfortunately a reality of healthcare and our world today," he said. But IoT is an opportunity for Stanford to tackle medication errors, as well as track expired medications.

Sisodiya said that the hope for tracking medications is the radio-frequency identification (RFID) that can be used as a tool along with the labeling of medications, barcodes, and lot numbers to know where a medication is always. "There are many avenues through which medications are moved and opportunities for systems to continue to evolve in."