The pharma world is now looking to digital tools to help facilitate everything from patient adherence to decentralized clinical trials. AstraZeneca has been in the digital game for some time. The life science giant recently teamed up with health system Mass General Brigham to help create and clinically validate patient-centric digital health solutions. 

The collaboration used the pharma company’s new tool, dubbed AMAZE, a disease management platform, to study heart failure and asthma management. 

MobiHealthNews sat down with AstraZeneca Chief Commercial Digital Officer and Global VP Karan Arora to talk about provider partnerships, how COVID-19 changed digital and what’s next for the future.

This interview has been edited for length and clarity. 

MobiHealthNews: I know AstraZeneca has had a lot of news this year, but what are you thinking about in terms of digital, or can you give me a little overview of where you're at with digital?

Arora: We probably, unlike many other pharma companies, dabbled in the digital space. I would say five years ago, you would find a lot of pilots, you would find a lot of random partnerships. When I joined two and a half years, three years ago, I came in in the role on the commercial side with the chief commercial digital hat. My objective was, how do we build scalable digital health solutions that really bring tangible [benefits] to pharma, or AstraZeneca in this case?

In order to do that, we had to really identify what were the use cases that we must focus on. The first thing we did was look at what we are solving for that brings value, and think about what is the technology or digital angle that can be used to solve it. 

There are five things: The first one is about patient identification. How do you get patients that are probably undiagnosed, or not severe, or not aware to know about their disease or their risk of disease?

The second bucket was around, once they identify themselves, and they are speaking to the clinician, how does the clinician know what is the most appropriate therapy for them to get them to outcomes in the fastest way possible? So it’s about guideline directive therapy use, it’s about incorporating new innovation as quickly into the regiment, etc.

The third one is around adherence and compliance. I think that remains an issue, because about 50% of patients don’t remain adherent, and about 30% don’t remain compliant, which means they use the drug differently from how it is prescribed.

"Then finally the fourth level emerging is about real-world data. It’s about figuring out, as part of the clinical pathways, how disease progresses – everything from acute to chronic. We don’t know that very well.

We know from a clinical perspective when someone is diagnosed. But we don’t know what happens post discharge. Ninety percent of patients live out their care in a nonclinical setting.

There is a gap in understanding disease progression. The fifth one is in R&D, which is focused around clinical trials and decentralized clinical trials. It’s about faster recruitment of patients. It’s about molecule identification.

So when we look at these use cases on the basis of that, we started investing in digital capabilities to really start trying to solve this. 

MobiHealthNews: I’m really curious about this build versus buy question. How do you look at that in terms of partnering with startups, versus this is something we could create on our own?

Arora: I think it depends. So the earlier experience with startups, what we learned was they still lacked a lot of capability in terms of regulatory compliance, legal and project management skills. We had to bring a lot of that to the table. We had to say, "All right, what are we extracting from the partnership that is of value?"

One of the things we brought in-house was this whole concept of experience design. So we have our own experience design team now, and we map out the solution, and find opportunities where it makes sense to partner and where it makes sense to do it ourselves.

I think in broad brush I would say clinical expertise is something we prefer doing ourselves because we just know how to do it and work in a constructive environment that we’re used to. That environment hasn’t changed for us whether it is digital health or therapies. When the FDA looks at AstraZeneca submitting something, they look at us in the same light. …

I think the user experience is something we would also own: things like clinical workflow as we really understand the clinical workflow, how things are prescribed, how clinicians use it, they understand the provider landscape really well. ...

The actual build from a technology standpoint, that’s not core competency. That’s something we are able to outsource or partner. We are also happy to outsource and partner with pure infrastructure stacks. [A] similar example is BrightInsight, who we partnered with.

They have a regulated cloud environment. For us to replicate and create a regulated cloud for digital health tech is a massive undertaking that is unnecessary. 

We’re better off focusing on clinical use, on the workflow, on the design and really partnering with the players who have the design and build expertise and have the environments on which they can host it when it’s commercialized. 

MobiHealthNews: I’m interested in this idea where tech moves super-fast. Pharma moves slowly. How do you balance that, and what does that look like culturally? How do you balance those elements?

Arora: In terms of innovation, we’re probably as, if not more, innovative now than any tech startup. We have that mentality. We’re quite entrepreneurial as a pharma company. … 

I think what we struggle with is digital health. [It's] still new for us. So we have to build competencies, and say, "How we do this at scale?" So we have to build that discipline of use case, and make sure there is clinical utility, and then use our commercial engine to scale it.

Once we put it in that language where it is similar to a drug, and it’s the same process as a drug, except a 10 year window – not think of it as an 18 month window. So I think once that gets ingrained, and we’re using some of the same check boxes as you are in clinical phase 1, 2, 3, then let’s go commercialize, it becomes easier for us to incorporate this in our daily routine. 

With digital startups, one of the things we’ve learned from them is about discipline and agility and the iteration process. So they have taught us you have to be quick at adaptation, you have to be quick at learning, you have to be agile. Part of it is investing in those capabilities in our teams and bringing in people with that mindset. …

MobiHealthNews: I’m interested in this element of clinical trials. Whether it is real-world data or decentralized clinical trials. What does it look like in practice?

Arora: We’re talking about the AMAZE digital partner in large AMCs [academic medical centers] is Mass Gen Brigham. We announced our partnership about a year ago. What it is, is a full bi-directionally integrated platform. It’s a chronic disease management platform. 

I qualify bidirectionally. There are a lot of platforms, but they sit outside of the EMR. What we were finding was there was a big challenge in adoption and use by the clinicians because it was sitting outside the EMR. Because they didn’t want to read data and then put it in the EMR. They wanted it to be workflow-efficient and not add more burden to their daily workflow routine. 

From a patient perspective, they didn’t want to deal with a lot of pointed solutions. So they didn’t want a diabetes app, or an asthma app. I want one app that deals with my chronic conditions. Four out of 10 patients are comorbid patients. 

So in that regard, what we thought about is: OK, if we truly want longitudinal data, and we want it to be sustainable, we have to invest in the platform from a clinical efficacy standpoint. So we invested in Mass General Brigham, and we really focused on, OK, what will it take for the clinicians to use it?

How will we make sure the patients actually adhere and start putting data in, so it’s valuable? How do we build a partnership where it is above brand, at a partnership level where we can start to see de-identified data that gives us a longitudinal view of disease progress, which goes into real-world data?

It’s continuous and sustainable, where providers want to use it and patients want to use it. It was that constant view of data, and we didn’t find that anywhere else with the point solution. 

Now we are scaling it with other providers. 

MobiHealthNews: What lessons did you learn from going through that pilot?

Arora: Partnering with providers is hard. Scaling anything in a B2B environment takes a lot of time. Part of the lesson is, how do you contract around data and liability, what is the compliance you have to follow, what is the regulatory you have to follow? Not only do you have it at a macro FDA level, but you also have it varying at a provider level.

MGH has different protocols from Stanford. You have to be flexible to work within those. It was important to establish what’s really important. 

The good thing is we established a North Star. We both wanted to deliver better outcomes for patients. If that is the North Star, how do we get that? We need transparency of data. We need good adherence from patients to actually want to record data. We need clinicians wanting to look at the data and intervene before it becomes chronic.

We’ve seen some really good readouts. We’re seen adherence rates almost two to three times higher at 90 days than typical digital health platforms out there ...

It gives us a lot of promise that if you include the clinician, and they are the focal point of driving digital tech, you will get good adherence, and you’ll start to see the results and the adoption. I think that is the biggest learning. You can’t disintermediate the clinician as part of your digital health. 

MobiHealthNews: What has changed in terms of digital during the pandemic? Or how has digital been implemented during the pandemic?

Arora: My five year plan became the one year plan. That's the best way I can say it. And I think definitely, at the board level, there was just a renewed appetite to focus on digital with a heightened sense of urgency. So for me, what changed personally was I got more gray hair. And then professionally, we've had to really think about, OK, what are our priorities?

Where are we seeing value, and how can we drive massive focus where we see value in scaling? Because this is an opportunity to do so. I think in many ways we've actually gone from, let's say, a portfolio of 20 things and said, let's narrow that down to five, but really put a lot of investment in research to try and scale those five things.

So it's helped us prioritize much quicker. We have really broad endorsement from leadership, and I think the sense of urgency and willingness and an ecosystem level, even within partners, has just increased for the adoption of digital.

MobiHealthNews: Looking down the road next five years, what are you most excited about?

Arora: I'm really excited about digital therapeutics and digital biomarkers, and I'm excited about that, because I truly think that combined with therapy will drive better intervention for patients. There's been a whole push on devices.

I honestly think devices are a commodity, right? I'm not a fan of them, only because I think it's a burden for the patient. It's hard. Most of the patients we are dealing with are elderly. This whole connectivity, from a Bluetooth standpoint, WiFi standpoint, it's too many variables to deal with

I just think of my own parents, right? I mean, like them trying to figure out how to get something connected to is just difficult. So I think passive collection of data to digital biosensors, I'm excited about that, where you already have a phone. Everything should be collected on the phone.

They're not the point clinically where that data can be used, but they're getting there. So I'm excited about that. And digital therapeutics in combination with product, I think would drive better adherence and really get to micro segments of populations to say, "How do I focus on, let's say, for rare disease, or oncology, or specialty drugs, you know, and get to the right patients who have the best outcome with my therapies?" I think those are the two areas I'm quite excited about.