Unprecedented Technological Trends Push the Envelope in Life Sciences

Unprecedented Technological Trends Push the Envelope in Life Sciences

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  Unprecedented Technological Trends Push the Envelopein Life Sciences A preview of five pivotal technology trends remaking the life sciences industry: AI and automation, human augmentation, edge analytics/ processing, data ownership and protection, and the intermingling of products and services. Executive Summary A group of emerging technologies is rapidly cre- ating numerous opportunities for life sciences companies to improve productivity, enhance patient care and ensure regulatory compliance. These technologies include robotic process auto- mation (RPA), artificial intelligence (AI), machine learning (ML), blockchain, the Internet of Things (IoT), 3-D printing and augmented reality/virtual reality (AR/VR). This white paper, built from an earlier report, “Unexpected: Five Ways Tech- nology Will Challenge Conventions,” explores five themes 1 encompassing key technological advances and evolving business models that are transforming the life sciences industry. Our first theme, Blur, uncovers how medicinal products are being combined with value-added services such as patient engagement, education and compliance tools, to generate data and thus provide greater insights on patient lifestyle and user experience. We also examine value-based healthcare, a new business model that supports this product-plus-service paradigm and focuses on patient outcomes. Value-based is emerging and replacing the old volume-based model of healthcare. Cognizant 20-20 Insights | May 2018 COGNIZANT 20-20 INSIGHTS
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  Cognizant 20-20 Insights UnprecedentedTechnological Trends Push the Envelope in Life Sciences | 2 In Know Me, Forget Me, we explore how freely we give up our personal data, expecting that doing so will be to our advantage. But our data could also be used without our knowledge, monetized without our approval or even used against us. We must become more aware of how our personal information is used, and take control by ensur- ing that it will be “forgotten” once it no longer benefits us. Excellence at the Edge is about extracting the value of data while it is freshest and most rel- evant. Data collected at the network’s edge by IoT devices, wearables and mobile apps can be processed, analyzed and acted upon in real time — enabling life sciences companies to work smarter, respond faster and be better informed in making vital decisions. As automation and AI become increasingly mainstream, life sciences companies have an opportunity to differentiate themselves from the competition by being early adopters. Automa- tion at Work explores the opportunities created in the areas of patient care, drug discovery and business process automation by emerging auto- mation and AI technologies. In Augmented Humanity, we see how technol- ogy is helping those afflicted with serious injury, hereditary disease or disability to walk, see or express themselves. With these advances, digital- ly-augmented humans are living fuller lives and increasing their lifespans.
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  Cognizant 20-20 Insights UnprecedentedTechnological Trends Push the Envelope in Life Sciences | 3 BLUR A pill used to treat a condition can now self-re- port that it’s reached your stomach. 2 A watch worn to display time can now monitor your sleep patterns and vital signs, and transmit them via Bluetooth to your smartphone and then to your care provider (with your consent), who can then review in real time and recommend a course of action or treatment. As healthcare costs skyrocket, the industry has begun to shift toward value-based care. This, combined with rising consumerism and increased adoption of digital technology, is pushing phar- maceuticals companies to deliver support and services directly to the consumer. This gradual shift has given rise to new paradigms such as patient-centricity, “beyond the pill” and “around the pill,” where medicinal products are com- bined with value-added digital services enabled through emerging technologies. As such, life sciences companies are pivoting from being purely product-based entities to product/ services players that improve patient outcomes. Product Plus Digital Service: The New Paradigm Pharma companies are embracing more patient- centric approaches by engaging directly with patients to better understand their needs and the challenges that they face, and in turn by provid- ing patients with better information and support. Digitization has helped pharma companies augment products by creating patient engage- ment services that inform, engage and support patients in the care journey. This is upending the traditional business model of volume-based care, and replacing it with value-based care. 3 A few examples of services that pharma com- panies have begun to provide patients that go “beyond the pill” include patient engagement solutions that enable quick and efficient onboard- ing, assistance with reimbursements, outreach and personalized services (including guidance on treatment programs), adherence reminders/ alerts, and support systems in case of adverse side effects or reactions to a drug. For instance, one leading pharmaceuticals com- pany selling a rheumatoid arthritis drug found 1 Product Plus Digital Service: The New Paradigm Services Products PATIENT Bundle Options + + + Figure 1
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  Cognizant 20-20 Insights UnprecedentedTechnological Trends Push the Envelope in Life Sciences | 4 Digitization has helped pharma companies augment products by creating patient engagement services that inform, engage and support patients in the care journey. This is upending the traditional business model of volume-based care, and replacing it with value-based care.
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  Cognizant 20-20 Insights UnprecedentedTechnological Trends Push the Envelope in Life Sciences | 5 through surveys and discussions that patients were often anxious upon receiving a prescription for its Rx, since obtaining and administering the drug presented several challenges. There was often a delay in receiving the drug; it came with a high out-of-pocket expense; patients often feared injecting the drug; and many were concerned with its potential adverse side effects. To respond to these challenges, the company adopted a “beyond the pill” approach. It created an ecosystem of patient-centric services that included a more efficient onboarding process and direct training from nurses on how to take the injectable. It also extended to a one-touch sup- port system that was made available to patients who experienced adverse side effects or reac- tions to the drug. Other “around the pill” digital services include physician-prescribed clinical apps encompass- ing a variety of companion health applications and devices that serve as digital therapy. Apart from providing a mechanism to treat patients, they also collect patient health metrics and help care professionals “close the loop” with their patients. 4 One example of such a clinical app is BlueStar, which is prescribed by a healthcare provider (HCP) to support the management of type 2 dia- betes. Cleared by the FDA in 2013, the app was the first mobile prescription therapy in the U.S.; the FDA approved its non-prescription version in 2017. 5 Developed for adults living with type 2 dia- betes, BlueStar analyzes diabetes data entered by the patient (including blood glucose levels), compares trends, delivers summarized curated data and suggests a plan for self-management. KNOW ME, FORGET ME Patients’ lives are being made easier already by devices such as wearables and IoT medical sensors. One day, your watch may wake and alert you to high blood sugar levels. You’ll then use a smartphone app to instantaneously book an appointment with your physician. When you arrive at your doctor’s office, your tests will already be scheduled and performed on the spot. By the time you get home, your phone is vibrat- ing with a notification that your test results are ready. After dinner, you jump on a video call with your HCP to review the results and discuss treat- ment options (see Figure 2). Know Me, Forget Me ALERT Your blood suger level is above 170.1 2 3 4 5 171 Appointment confirmed. Test results: Your blood tests are scheduled. Let’s discuss your treatment options. Figure 2
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  Unprecedented Technological TrendsPush the Envelope in Life Sciences | 6 As such, Know Me, Forget Me reveals patients’ acceptance that it’s OK to monitor them and collect their data in order to provide an immer- sive experience. The critical factor here is that patients expect to be forgotten on their terms, typically once they no longer believe they are receiving value in return. What’s key is that they expect their providers to make sure their data is safeguarded from falling into the wrong hands. The issue of data privacy and security is very important in life sciences, as pharma companies collect volumes of highly sensitive patient data including protected health information (PHI). This data is collected during clinical trials and post-marketing surveillance for safe and effec- tive treatment, and it needs to be secured. As part of patient engagement, pharma com- panies now capture and monitor information related to lifestyle, vital signs and medical his- tory. This raises serious questions and concerns about data privacy. The success of pharma companies depends upon their ability to leverage the huge treasure trove of patient and healthy individual data in a transparent and secure manner that does not compromise the individual’s privacy and security in any manner. Giving Control Advanced technologies such as wearables, sen- sors and mobile apps are empowering patients to take control of their health. A collaborative and consent-based approach that apprises patients well in advance of the use of their PHI collected at trials helps ensure both transparency and their active participation. At the same time, patients need to take responsibility for their personal data which means taking the necessary precautions and using judgement before sharing such data on social media and mobile apps. Regulatory and governmental bodies have been at the forefront of data privacy, protection and security in life sciences. The Healthcare Insurance Portability and Accountability Act (HIPAA) pro- tects the privacy and security of an individual’s PHI and ensures it cannot be disclosed without the individual’s consent. But the threat to patient privacy and data security has increased expo- nentially since HIPAA was passed in 1996 due to digitization and the advent of cloud, mobile, social and wearables. According to healthcare statistics published by HIPAA Journal, data breaches have soared over the past nine years, with 2017 seeing more data breaches reported than any other year. 6 Technological advances are creating new ways to share and protect data. For example, sharing of genomic and clinical trial data is now possible by using blockchain technology. 7 With blockchain, sensitive patient data can be concealed while at the same time be used for studies and shared across companies without compromising patient privacy. A collaborative and consent-based approach that apprises patients well in advance of the use of their PHI collected at trials helps ensure both transparency and their active participation.
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  Cognizant 20-20 Insights UnprecedentedTechnological Trends Push the Envelope in Life Sciences | 7 EXCELLENCE AT THE EDGE Various forms of data, whether structured or unstructured, historical or real-time, hold great significance in any industry. In life sciences, data has the potential to completely change the way treatment is provided to patients. Imagine a scenario where a robot diagnoses a disease and prescribes a personalized medicine on the basis of the patient’s genetic make-up (genome sequence) and past medical history. The patient uses a 3-D printer at his or her home to create the medicine. 8 The chip in the medicine tracks when the pill is taken through the patient’s smart phone and the smart watch tracks vital signs post medication, sending real-time updates to the vir- tual patient assistant throughout the treatment journey. Advances in analytics and cloud adoption, cou- pled with data collected by wearables, devices and mobile apps, are making huge amounts of patient data available in real time, enabling pharma companies to improve patient care and safety. Excellence at the network’s edge is all about collecting, processing and analyzing data as close as possible to its source, processing in the cloud to gain valuable business insights and acting upon those insights in real time. Remote Patient Monitoring Numerous wearable devices and sensors are available today that allow continuous, real-time monitoring of key patient vital signs such as heartbeat, temperature and blood pressure. They enable HCPs to remotely monitor and assess patients’ condition. The evolution of edible sensors and chips has enabled the development of smart pills. Smart pills are currently being used to track drug inges- tion and activity levels. 9 In the near future, pills with miniature chips will help monitor human organs and vital signs such as blood sugar levels, body temperature, blood pressure and pH levels, and transmit such data, in real time, to the care provider. Data Monetization Life sciences is a data-intensive industry, and pharma organizations have an enormous amount of historical scientific and research data col- lected over many years. This real asset presents an opportunity to find new drug candidates and repurpose existing drugs. Sensing the magnitude of opportunity, many leading pharma organi- zations share clinical trial data with the public, allowing researchers to combine data from multiple sponsors/organizations to innovate and accelerate clinical research. For example, GlaxoSmithKline has been sharing information about clinical research with the public as part of its data transparency initiative. Another area of focus is to identify new treat- ments tailored to an individual’s genetic makeup, environment and lifestyle. Advances in genom- ics research, coupled with data sciences, AI and advanced analytics, are enabling further scien- tific and medical research in the area of precision/ personalized medicine. Organizations in the U.S. and UK have launched initiatives to collect human genome data for the advancement of research into better diagnostics and personalized care. Excellence at the network’s edge is all about collecting, processing and analyzing data as close as possible to its source, processing in the cloud to gain valuable business insights and acting upon those insights in real time.
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  Cognizant 20-20 Insights UnprecedentedTechnological Trends Push the Envelope in Life Sciences | 8 Business Insights Apart from data monetization, advances in ana- lytics and data sciences are driving prescriptive and predictive insights that help assess the effec- tiveness, safety and economic outcome of drugs, improve clinical trials efficiency, streamline the supply chain and increase sales force effective- ness. Business scenarios where these techniques are applied to derive real time, meaningful insights include: • R&D: Clinical trial status, patient safety, patient recruitment, site identification and optimal trial design. • Manufacturing and supply chain: Enhanced production planning based on demand pro- jection; complex supply chain management, including predicting supply risk based on vendor performance. • Commercial: Sales force planning and align- ment, market access and contracting strategy. To make the most of this opportunity, companies must acquire skills in advanced analytics and data sciences and build functional data lakes. AUTOMATION AT WORK Automation and AI are emerging agents of change that are rippling across all industries, from autonomous cars and robots on the factory floor through digital assistants in the office and software bots. In the life sciences industry, automation and AI provide the opportunity to transform the patient or user experience thorough conversational chat bots, speed up drug discovery by applying AI and automate standard, repeatable, rules-based busi- ness processes. Transform User Experience Voice is the new user interface, and AI-based conversational bots are being embraced by life sciences companies to enhance experience for patients, healthcare professionals and inter- nal users. These bots take the form of digital or virtual assistants for users such as patient assistants (voice-based bots that guide patients through the treatment journey) or lab assistants (conversational bots that help scientists in labs to perform experiments). A number of voice-based chat bots have been deployed by life sciences companies. For example, we developed a voice- based chat bot that interacts with end users and helps to resolve IT issues. Digital Patient Assistants What can I help you with? Text message Voice-based botsHome devices Figure 3
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  Cognizant 20-20 Insights UnprecedentedTechnological Trends Push the Envelope in Life Sciences | 9 Augmented and virtual reality technology, which provides immersive experiences by simulating real-world environments through headsets, is being adopted to create educational, training and promotional material for both patients and HCPs. For example, we have developed an AR/ VR-based training solution that illustrates how insulin behaves when injected into the human body (see Figure 4). Reimagine the Process While there has been plenty of computer sys- tem-based automation over the years, an abundance of business activity is still carried out manually, resulting from a lack of integra- tion among systems and data extraction from source documents. Advances in RPA technology coupled with natural language processing (NLP) now provide the capability to automate standard, repeatable and rule-based business activities. Numerous business functions such as pro- curement, finance and accounting, talent management, clinical data management and pharmacovigilance require routine manual activ- ities and human intervention before higher-level thinking and action can begin. By automating these manual process end to end, pharma com- panies can free up resources (both financial and human) for more productive activities. Pharmacovigilance, 10 for example, is a highly manual and resource-intensive process involv- ing safety case intake, receipt, registration, data entry, quality check, medical review and submis- sion. Adverse events are reported across the globe in multiple languages and formats and in structured, unstructured and handwritten docu- ments from affiliates, partners and distributors. While there are IT systems and applications that automate case processing and reporting activi- ties, the overall process still requires much human intervention and manual effort, especially in the areas of case intake and data entry. The complete process, from case receipt to reporting, can now be automated using RPA and NLP, thereby limit- ing the amount of human intervention needed for exception handling, quality checks and reviews. AI-Based Drug Discovery Strong forms of AI such as machine learning (ML) have the potential to transform drug discov- ery. Pharma companies are using AI to identify potential new drug candidates, find new uses for previously identified compounds, predict the performance of drugs during testing and develop personalized medicine based on genetic markers. Some pharma companies are aligning with AI giants and start-ups to unlock the potential of AI in drug discovery; for example, GlaxoSmithKline recently signed a deal with Exscientia. 11 Insulin Molecule Journey Education via immersive experiences Figure 4
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  Cognizant 20-20 Insights UnprecedentedTechnological Trends Push the Envelope in Life Sciences | 10 AUGMENTED HUMANITY Advances in medical science coupled with technologies such as 3-D manufacturing, smart- phones, wearables and sensors are creating new opportunities for improved human capabilities. These smart technologies are either embedded in, worn or carried by people, and they provide significant potential for life sciences. Augmented humanity refers to the use of technology to augment and enhance human attributes. The term was coined by ex-Google CEO Eric Schmidt in 2010. 12 In life sciences, aug- mentation can be used to help HCPs in diagnosis and provide better and novel approaches for treating patients. Augmented Diagnosis Mobile apps that allow users to search and find drug information and interactions, calculate body mass index (BMI) or check basic symptoms have been available for quite some time. Now, more advanced solutions for disease diagnosis are being built for areas such as oncology. These solutions incorporate advanced AI and machine learning algorithms that are trained using patient data collected over the years. A smartphone app can today analyze a photo of a rash, mole or coloration and augment the availability and capability of a dermatologist to detect cancer. Similarly, an app can augment the capabilities of ophthalmologists, particularly in underdeveloped areas of the world, by rapidly screening for diabetic retinopathy using fundus photographs of patients’ retinas (see Figure 5). 13 Augmented Patient Prosthetics and exoskeletons help those who have been paralyzed or have lost limbs to stand and move again. 14 Advances in neuro-technol- ogy continue to improve the lives of those who have suffered a brain injury or have a debilitat- ing disease such as Alzheimer’s or Parkinson’s. This technology is also being applied to improve memory, sharpen cognitive skills and accelerate learning. Brain-computer interfaces (BCIs) link the commands of our thoughts to devices that take action and have the potential to correct dis- abilities, enhance communications and augment normal human brainpower. For example, in 2009 Mattel partnered with Neu- roSky to develop one of the first commercial brain wearables. The device was an EEG headset that could be used to play a game called Mindflex, Diabetic Retinopathy Detection Using Deep Learning Algorithms Figure 5
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  Unprecedented Technological TrendsPush the Envelope in Life Sciences | 11 Cognizant 20-20 Insights in which users move a ball around a small obsta- cle course using their “brainpower.” 15 Eventually, 3-D printers will create customized organs, tissues and various body parts to replace defective or deteriorating ones. Smart lenses will further help the blind and those with impaired vision to see again or see more clearly. Hearables will allow us to hear the faintest sounds, or trans- late foreign languages in real time. Implanted chips and digital tattoos will store our personal details and keep them safe. THE WAY FORWARD Emerging digital technologies are fueling innova- tion and transforming the life sciences industry by introducing new business models, products and services and enhancing patient experience. As always, these technologies are unlocking great opportunities as well as enormous risks. Life sciences companies will need to speed deci- sion-making before adopting new technology to keep pace with more nimble, fast-paced, dig- ital-savvy players who are beginning to pose a threat by introducing technology-enabled new business models. Pharma and medical devices companies must establish a formal innovation group and framework for identifying disruptive technologies within and outside of the life sci- ences industry, analyzing the potential business impacts and prioritize adoption. From there, we believe this type of collaboration would be instru- mental in building an ecosystem of academia, vendors and start-ups to help accelerate new technology adoption. This framework is critical for the survival and sustenance of business in the digital world. Pharma, med-tech and digital companies must continue to team up, combine their strengths and make investments in innovative products that blur the line between drug, device and digital ser- vice, allow patients to be known or forgotten on demand, provide real-time insights at the edge of the network, free scarce knowledge workers to focus on the highest level of thinking and aug- ment the weaknesses of the human condition. Pharma, med-tech and digital companies must continue to team up, combine their strengths and make investments in innovative products that blur the line between drug, device and digital service, allow patients to be known or forgotten on demand, provide real-time insights at the edge of the network, free scarce knowledge workers to focus on the highest level of thinking and augment the weaknesses of the human condition.
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  Cognizant 20-20 Insights UnprecedentedTechnological Trends Push the Envelope in Life Sciences | 12 FOOTNOTES 1 “Unexpected: Five Ways Technology Will Challenge Conventions,” Cognizant Technology Solutions, December 2017; www. cognizant.com/whitepapers/unexpected-five-ways-technology-will-challenge-conventions-codex3122.pdf. 2 Luke Dormehl, “This chip will reveal to doctors exactly where smart pills are in the human body,” Digitaltrends, September 2017; www.digitaltrends.com/cool-tech/caltech-chip-smart-pill/. 3 “Outcome-Based Contracts in Life Sciences – An Age-Old Idea Taking a New Avatar | Sherpas in Blue Shirts,” Everest Group, August 2017; www.everestgrp.com/2017-08-outcome-based-contracts-life-sciences-sherpas-blue-shirts-41400.html/. 4 Heather Mack, “FDA clears WellDoc’s non-RX version of BlueStar,” MobiHealthNews, January 2017; www.mobihealthnews. com/content/fda-clears-welldocs-non-rx-version-bluestar-its-mobile-diabetes-management-tool. 5 Pratik Maroo, “The Frontier Within (Part 1): Digitizing the Human Body,” Digitally Cognizant, August 2017; https://digitally. cognizant.com/the-frontier-within-digitizing-the-human-body-codex2718/. 6 Healthcare Data Breach Statistics, HIPPA Journal; www.hipaajournal.com/healthcare-data-breach-statistics/. 7 “Lester Coleman, “Blockchain Brings Privacy to Genomic Data,” Cryptocoinsnews, June 11, 2017; www.ccn.com/block- chain-solution-ensures-privacy-of-genomic-data-while-granting-access-for-medical-research/. 8 Robert Service, “You could soon be manufacturing your own drugs—thanks to 3-D printing,” ScienceMag, January 2018; www. sciencemag.org/news/2018/01/you-could-soon-be-manufacturing-your-own-drugs-thanks-3d-printing. 9 “FDA approves pill with sensor that digitally tracks if patients have ingested their medication,” FDA, November 2017; www. fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm584933.htm. 10 Harpreet Kanwar, “Transforming Pharmacovigilance with Intelligent Automation,” Digitally Cognizant, December 2017; https://digitally.cognizant.com/transforming-pharmacovigilance-intelligent-automation-codex3160/. 11 Amirah Al Idrus, “GlaxoSmithKline, Exscientia ink AI-based drug discovery deal worth up to $42M,” FierceBiotech, July 5, 2017; www.fiercebiotech.com/medtech/gsk-exscientia-ink-ai-based-drug-discovery-deal-worth-up-to-42m. 12 Liz Gannes, “Welcome to the Age of Augmented Humanity,” GIGAOM, September 2010; https://gigaom.com/2010/09/07/eric- schmidt-welcome-to-the-age-of-augmented-humanity/. 13 “How AI Enhances Accelerates Diabetic Retinopathy Detection,” Cognizant Technology Solutions, February 2018; www. cognizant.com/whitepapers/how-ai-enhances-and-accelerates-diabetic-retinopathy-detection-codex2972.pdf. 14 Anamika P, “Medical Bionic Implants and Exoskeletons Market Will Exhibit a Steady 7.5% CAGR by 2027,” Theglobalhealthnews, September 2017; https://theglobalhealthnews.com/medical-bionic-implants-and-exoskeletons-mar- ket-will-exhibit-a-steady-7-5-cagr-by-2027/. 15 “10 Real-Life Examples Of BCI Devices that You Can Control with Your Thoughts,” Analytics India Magazine, September 2107; https://analyticsindiamag.com/infographic-10-real-life-examples-bci-devices-can-control-thoughts/. ACKNOWLEDGMENTS The author would like to express appreciation to and thank Jill Notte, from the life sciences marketing team, and the Cognizant Global Technology Office Vision Team, including Prabhakaran Sabhapathy, Murali Sundaram, Uma Ramachandran, Revathi Murali, Aravind Elangovan and Ann Stocks for their ideating, brainstorming, researching, writing and reviewing content, as well as coordi- nating with cross-organization stakeholders.
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  Cognizant 20-20 Insights UnprecedentedTechnological Trends Push the Envelope in Life Sciences | 13 ABOUT THE AUTHOR Harpreet Kanwar Chief Technology Officer, Cognizant Life Sciences Harpreet Kanwar is Chief Technology Officer within Cognizant’s Life Sciences business unit. He is responsible for driving innova- tion, emerging technology adoption, architecture enablement and governance. Harpreet currently focuses on helping life sci- ences companies adopt automation, AI/ML/NLP/deep learning and blockchain technologies. He has over 25 years of IT industry expe- rience covering consulting, pre-sales and delivery. Harpreet can be reached at Harpreet.Kanwar@cognizant.com.
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  World Headquarters 500 FrankW. Burr Blvd. Teaneck, NJ 07666 USA Phone: +1 201 801 0233 Fax: +1 201 801 0243 Toll Free: +1 888 937 3277 European Headquarters 1 Kingdom Street Paddington Central London W2 6BD England Phone: +44 (0) 20 7297 7600 Fax: +44 (0) 20 7121 0102 India Operations Headquarters #5/535 Old Mahabalipuram Road Okkiyam Pettai, Thoraipakkam Chennai, 600 096 India Phone: +91 (0) 44 4209 6000 Fax: +91 (0) 44 4209 6060 © Copyright 2018, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means,electronic, mechan- ical, photocopying, recording, or otherwise, without the express written permission from Cognizant. The information contained herein is subject to change without notice. All other trademarks mentioned herein are the property of their respective owners. TL Codex 3456 ABOUT COGNIZANT Cognizant (Nasdaq-100: CTSH) is one of the world’s leading professional services companies, transforming clients’ business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innova- tive and efficient businesses. Headquartered in the U.S., Cognizant is ranked 205 on the Fortune 500 and is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com or follow us @Cognizant.