Healthcare forms a complex ecosystem where hospitals, payers, professionals and industry are only loosely tied together, working with siloed systems and data. They follow their own agendas, and the role of the patient shifts constantly. AstraZeneca executives Alexander Bedenkov, Ryan Walton, Carmen Moreno and Timothy Geldard write that the priorities of these varied stakeholders will need to become interoperable, with collaboration centred around real-world data.

‘The patient is king’. A familiar expression in healthcare, that in the past has often been seen as little more than a platitude or sign of positive intent. But times are changing, and so are the views of healthcare stakeholders. Has the time finally come for the patient to take centre-stage?

It’s unfortunately the case that, while we have been on a crusade for patient-centred care for decades, and irrespective of the progress made, the patient remains part of a complex ecosystem, but rarely the focus.

One key reason for this is that stakeholders – including payers, hospitals, healthcare professionals and industry – are only loosely tied together, working with siloed systems and siloed data. As a consequence, they follow their own agendas, perspectives and goals – and the role of the patient shifts and drifts from player to player and fiscal year to fiscal year.

In the future, if we’re to see the creation of a truly patient-centred ecosystem that integrates well-being and healthcare to deliver optimal care, the priorities of these varied stakeholders will need to become interoperable, with collaboration centred around health data. And the associated mindset shift will be the biggest challenge of all.

Pharmaceutical industry’s role

For many years the industry has been moving from a traditional “pill” to a “platform” (pill + data + software + service) model, with the aim of delivering value beyond treating illness, to facilitate population wellness.

Today, in the face of immense strain on healthcare systems and their ability to deliver quality, guideline-led care, we need to take this one step further – employing our unique expertise as an industry to drive a fundamental and sustainable transformation of clinical practice – partnering with the wider clinical, healthcare, and patient communities, for the benefit of patients.

We will only be successful in this endeavour if we can forge long-term partnerships with organisations and individuals who share the same values and objectives for advancing equitable access to affordable, high-quality, and innovative healthcare solutions – those who are increasingly contributing to disease prevention, risk awareness, post-treatment, and wellness within broader health systems.

Our ultimate ambition should be to become a trusted, go-to partner for both traditional collaborators (patients, healthcare practitioners, governments, policymakers, and academia) and new entrants (tech, fintech, IT/digital, ecosystem builders, investors, entrepreneurs) in establishing data-driven, fully integrated, partner-based and patient-centred ecosystems.

A data- and partner-driven revolution

The secondary use of medical data is at the forefront of the ongoing healthcare revolution, given its potential and capability to advance medical science and improve patient experiences and clinical outcomes.

Sources of real-world data (RWD) have evolved and expanded from the traditional electronic health records (EHRs), medical and pharmacy claims, disease and medical product registries, and observational clinical study data to include unstructured data sources such as physician notes processed by natural language processing, novel data types like genomics data and diagnostic imaging, and patient/individual-generated data from wearable devices and social media.

The pharmaceutical and tech industries have a longstanding and sustained interest in RWD: not only for post-launch surveillance of their products, but increasingly also for R&D, label extensions, and service solutions for healthcare.

Historically, many collaborations between healthcare systems and industry tended to be transient and on an as-needed basis, with short-term funding and engagement commitments. Study-specific access to government data holdings is one example. As a result, these collaborations have not supported long-term, sustainable, mutually beneficial partnerships.

Short-term focus still represents a significant barrier to unlocking the unique value of RWD for patient outcomes.

New partnership models are therefore required that ensure long-term commitment, transparency, and joint ownership of insights – keeping patients at the centre throughout. This would also facilitate sustained integration of the best available data from all partners to solve common problems through transparent public-private partnerships or multi-stakeholder alliances. The good news is there are more and more exemplars of such long-term partnerships, like DARWIN EU, EHDEN or DRIVE projects.

Among the most recent examples of how we as an industry are walking the talk and coming together with partners to foster a patient-centric healthcare ecosystem, improving experiences, and ensuring better patient outcomes are the Global Evidence Powerhub (GEP) project in China, and OPERA project in Scotland.

In China, the concept of real-world evidence (RWE) arose in the early 2000s from awareness of the limitations of traditional clinical trials and the need for additional evidence to inform healthcare practice and policy decisions.

Several challenges still remain in the generation of RWE, including but not limited to data accessibility and sharing. Moreover, concerns exist about confidentiality and how researchers and partners may use the data. One of the strategies to improve the quality and usefulness of RWE is a call for public and private research foundations to support research that can improve data infrastructure and develop new technologies and methods.

Addressing this call for action, the GEP in China was established earlier this year to uplift capabilities, develop people and talents, design and execute practice-defining studies that will broaden understanding of clinical unmet needs in the Chinese population, and ultimately enable even more patients in China to access innovative medicines and solutions. In addition, it will support the building of new RWD technologies in partnership with healthcare systems, as we seek to engage and expand partnerships with current and prospective collaborators.

Figure 1. The GEP project aims to reimagine evidence generation and transform healthcare delivery in China

Note: Copyright © AstraZeneca

To support this commitment, GEP China recently established a strategic long-term collaboration with Chengdu Wuhou District Health Bureau to improve public health and chronic disease management. Partners within this collaboration have a shared vision to transform the future of healthcare and unlock the power of RWD to improve patient outcomes. They are utilising an RWD visualisation platform and extensive expertise in the field of chronic diseases, to analyse the current clinical practices and treatment, in a bid to provide valuable insights into clinical unmet clinical needs. Moreover, we have joined forces with our partners across various of domains, including public health and chronic disease management research, evidence-based medical practice, and public education initiatives on chronic disease management.

The second example is the Optimised Pathway for Early Identification of Heart Failure in the Community (OPERA) project in Scotland. The OPERA project dramatically reduced waiting times for patients with suspected heart failure from 12 months to under six weeks, allowing earlier diagnosis and treatment to optimise future outcomes. It is an excellent example of how public-private partnership work can deliver innovative solutions to drive clinical practice change and provide equitable access to high-quality care.

To conclude, the lines between healthcare sectors in RWD are blurry and more and more overlaps are becoming apparent. A new patient-centred ecosystem is on the rise, and there are good reasons to partner with pharmaceutical companies on RWD and leverage their unique capabilities, experience, and connections in this field if they share the same values and objectives, as well as meet certain conditions like respecting data privacy requirements, ethical standards and acting in accordance with the public’s interest in health benefits.

If we’re ever to truly put the patient centre-stage, we need grab the opportunity in front of us with both hands, including the potential of RWD partnerships to improve patient experiences and clinical outcomes.

• This blog post represents the views of its authors, not the position of LSE Business Review or the London School of Economics.
• Featured image provided by Shutterstock
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