Prescription application. It is supposed to help in the treatment of opioid addiction [INTERVIEW]

Share on FacebookShare on Twitter - In December last year, the US Food and Drug Administration first approved a mobile application that had previously been subjected to the same assessment as drugs. It can only be used on the order of a doctor. - says in an interview with DGP Dr. Katarzyna Kolasa, head of the Department of Health Economics and Healthcare Management at Kozminski University, leader of the international Master's studies Health Economics and Big Data Analytics at Kozminski University. ReklamaDGPReklamaAmazon, Google, Facebook, Microsoft - the largest technological giants enter the medical services market. They will know not only what we are looking for online, but also what we are suffering from. Isn't that scary? NO. Anyway, we will not avoid the digital revolution in healthcare. Amazon has just signed an agreement with the National Health Service (NHS), the UK's public health service. Alexa, a virtual assistant, is to use NHS data and answer patients' health questions. This aroused controversy, because such sensitive information will be held by a private company. Why? Thanks to this agreement, the state will influence the development of digital health and digital health services. In the Amazon system, it looks like this: someone tells the phone that they have a migraine and asks what to do. Alexa, the voice of the AI, tells you what your options are. Importantly, the answers are provided on the basis of data collected and verified by academic centres. This is a guarantee of security, because this information is simply reliable.Dziennik Gazeta PrawnaReservations are raised by the fact that Amazon may create a user's health profile. And then, for example, send him advertisements - even migraine drugs, if someone often complains about headaches. Therefore, you have to be one step ahead of companies and before launching new digital health services, they should be checked - just like medicines - for safety and efficiency. Recently, the US Food and Drug Administration (FDA) for the first time approved a mobile application on the market, which had previously been subjected to the same assessment as medicines. And now the application is prescribed by prescription. This is the first digital therapy officially approved by the FDA. Helps? It is about the reSET-O application, which can only be obtained on the order of a doctor: to download it, you need to receive a code from the therapist. It is used to treat opioid addiction. Of course, it is an auxiliary measure, it will not replace drugs and outpatient treatment. In 2017, in the United States, 50,000 people died from overdoses of opioids, including painkillers, and heroin. This is a very serious and at the same time extremely costly problem for the American health service. Therefore, innovative therapies are sought, including digital ones. The clinical trial showed that the app helped keep the treatment going. How is it used? Thanks to reSET-O, patients have access to educational materials, videos and quizzes. These 15-20 minute "lessons" end with a test - you need to get a certain number of points to move on. To further motivate patients to make an effort, rewards are given in the form of congratulations or a digital gift. Patients learn how to refuse drugs by analyzing what they did well and what they did wrong. Thanks to the application, they can also find out in what circumstances they reached for opioids - where and how it happened, in what mood they were, were they with friends or alone. This way they can learn how to avoid the threat. Thanks to reSET-O, individual tools are developed for a given patient. And the information collected by the program is valuable knowledge for the therapist. Who financed the creation of the application? A pharmaceutical company. Isn't that a conflict of interest? No, because the application - like the medicine - has been evaluated for effectiveness. Anyway, this is not the only solution of this kind used in the treatment of addictions. For example, Twitter has joined the fight against cigarette addiction. Twitter? The method was also investigated, comparing traditional smoking cessation with one that was assisted by Tweet2Quite. The treatment lasted 100 days. Patients were included in 20-member closed "support" groups where they discussed quitting smoking. They were also sent information about research on addiction, new methods of quitting it, various types of incentives. The results of the treatment are promising - it is twice as effective as using anti-smoking patches or using websites with educational information. Here, at least, an algorithm was created that connected living people, but replacing a doctor with artificial intelligence seems more controversial. Yes, but in the case of mental illnesses or addictions, constant contact between the patient and the doctor is needed. This is not always possible.Therefore, when treating depression or schizophrenia, support for digital innovations is sought. Applications using artificial intelligence can answer questions, analyze data, suggest what can be done. And even monitor what websites are viewed - to send an alert to the doctor and the patient in the event of suicidal thoughts. Besides, it is a direction of change from which there is no escaping. Because one of the main problems of the health service, and not only in Poland, is the lack of staff. Will apps replace people? It will happen even sooner than we think. Taking into account the inefficiency of the public healthcare system - shortages of doctors, limited availability, queues - in a moment we will be dealing with the first examples of the widespread use of artificial intelligence in medicine. Even in Poland. The reason is simple - patients expect their needs to be met better and faster. Even via a mobile phone? It is faster and easier to create an algorithm, to write an application that facilitates the use of the health care system, than to educate a doctor, which takes over six years. In Poland, we slept through the moment when we had to prepare for a tsunami in the health service. If in five years time every third of us will be over 65, we are forced to look for modern solutions to ensure quick access to medical care. The second reason - apart from the aging society - is the growing expectations: we want to live a long, healthy life, and if we want to be treated, it is fast and outside the hospital. And what can meet our expectations? Digitization of health services. Countries like Sweden and the UK are already doing just that. It may sound strange to us, but the Prime Minister of New Zealand spent most of the budget on well-being. The country is moving away from spending money on standard areas supporting GDP growth - such as armaments or industry - in favor of social and health infrastructure. The budget is focused on spending to improve the quality of life. For this purpose, 61 indicators were defined, ranging from those reducing the feeling of loneliness to the quality of drinking water. The aim is to care for the physical and mental health and well-being of society. But the wealthy can afford it. Not necessarily. It's a matter of strategy and consciousness shift. There are many scientific studies that show how stress and dissatisfaction with living conditions correlate with an increased risk of stroke, heart attack or cancer. It is always cheaper to prevent than to cure. To act as the Prime Minister of New Zealand, you need to plan for the long term. In Poland, people think in terms of here and now. Especially when it comes to health. We have to change our mentality. The social contract of all political forces should be concluded on the topic of health. We need to start thinking in terms of improving health and life expectancy. Otherwise, we will not achieve success in other fields - economic or technological. What should we do? Digitization itself must be seen from the perspective of several levels. One of the pillars is big data, i.e. electronic patient records. Data collection will improve the work of doctors and medical staff. But the most important thing in the preparation of electronic registers is to provide access to them for health economics and public health analysts. This year, a study was published which shows that in the USA, thanks to data analytics, it was possible to identify a category of patients who may develop diabetes. Thanks to this, you can help them now. How? Researchers reviewed the data of 4 million patients and examined 42,000. various variables to check what are the symptoms that predict the possibility of diabetes - another 21 indications were detected, including chronic liver problems, high aminotransferase levels. And the insurance companies there already require this kind of research. In this regard, they cooperate with employers who want to be able to diagnose the risk of the disease as early as possible in order to intervene quickly and effectively. The National Health Fund also has a large amount of patient data. He also wants to analyze them to find patients at risk of strokes. The fund is already sending information to doctors about people to whom it may happen. But these are random actions, although it is good that they are undertaken. Thanks to this, we can carry out better diagnostics, which in turn allows us to take preventive actions faster. After all, diabetes itself is not a debilitating and expensive disease. These are the complications, i.e. cardiovascular diseases. So big data analytics is fun with large sets of numbers? The most important thing is to know what to look for. But equally important is the ability to use the knowledge you receive. In Israel, only one database contains information about 40,000. patients,who were admitted to hospital emergency departments. Thanks to the fact that doctors enter all the vital parameters of the admitted patients into it, it is possible to build algorithms that standardize the care processes for subsequent patients who, after examination, have the same vital parameters, blood test results, etc. This speeds up the operation - from admitting and verifying the patient to his departure from the hospital. It is primarily support for medical staff - by entering the patient's test results into the computer, the algorithm prompts what needs to be done. A similar system operates in Brazil. Here, in turn, Microsoft has come up with a special algorithm that helps triage patients. After entering the results and description of the patient's condition, the computer suggests what tests should be performed. And then it shows you how to proceed. This has improved the work in the departments where this solution has been introduced. Data analytics is one thing, but let's get back to what evokes so much emotion, i.e. eliminating people from the treatment process ... But people will always be needed. Let's take a look at telemedicine, or remote treatment. Artificial intelligence is very helpful here. A great example is a project that works in the UK. One company has partnered with the NHS to offer a mobile app called Babylon, which is already used by 20,000 people in London alone. people. The application de facto replaces the family doctor. The English equivalent of our National Health Fund pays about £80 per patient per year for this service. There is a doctor at the very end, but he only intervenes when he is really needed. We ask the virtual doctor about the fever. And what? The application user connects with an "artificial" doctor who asks simple questions - for example, do we have a headache. If we answer in the affirmative, he asks if we have paresis of the right hand or visual impairment. If we confirm, it automatically connects to the ambulance, because there is a risk of heart attack or stroke. The patient does not have to do anything other than wait patiently for help. What about liability? After all, even a digital doctor can make a mistake. The unreliability of the program was checked. The application had to pass the same exam as a family doctor. Artificial intelligence answered exactly the same questions as humans. It turned out that she achieved a better result than the average medic. Such an application is a way to reduce the costs of the healthcare system, shorter queues to specialists? Yes. In Sweden, it is the receptionist assisted by artificial intelligence who verifies whether the patient really needs contact, e.g. with a family doctor. The patient has no chance for a visit if he or she is not interviewed by telephone by properly trained staff or a digital assistant. When I lived in Sweden, I knew that the doctor wouldn't see me if I didn't pass the first "gate". It is not enough that someone has a fever - they must prove that it has lasted for three days and say what measures they have already taken. But will people always be needed? Yes. But the robots can be operated remotely: a UK doctor can perform the operation in Ireland. He sees what is happening on the monitor in his office and directs the robotic arm. It is also a way to deal with a situation where, for example, a hospital lacks a team. But there are also other solutions that help in medicine. For example, remotely monitoring whether patients are taking their medications. Cameras in the patient's home? Not necessarily. One of the main problems in the treatment of schizophrenia is not the lack of therapy, but the fact that patients do not take their medications. That's why they get tablets with a chip that activates when swallowed. And the information about it is automatically transferred to the doctor. Isn't that too much of an intrusion into the patient's privacy? What some schizophrenics fear is coming true. That they are being spied on…but it makes sense. As a result, schizophrenics are hospitalized less often. And at the same time it is possible to control them remotely. Such a system works in some places in the USA. There are many solutions using modern technologies. Therefore, you need to choose the ones that are effective. A scientific center for the digitization of health care should be established in Poland, which will assess and search for digital solutions most useful for our health problems. In order to fully diagnose the needs, a full data analysis is necessary, which is why I always encourage decision-makers to cooperate with scientists in this regard. In Poland, various attempts are made to use this data. Health maps of the National Health Fund have been prepared on the basis of partial information. The fact that we do not analyze data on diseases and treatments is a shame. I asked decision-makers why we don't do it. They replied that it was private data. It is obvious. Only why the payer in Great Britain is able to cooperate with academic centers in projects to assess the profitability of individual medical technologies,and in Poland it is not possible? Thanks to this, the English are already successfully reimbursing phone applications for patients and other solutions in the field of telemedicine. This gives measurable savings for the system and improvement of patient satisfaction. Two years ago, the National Health Fund introduced two applications: one for pregnant mothers with diabetes, the other - helping with cancer prevention. I don't even know their names. When the NHS introduced Babylon, everyone was talking about it. If a program were introduced in Poland that would combine the effects of using the application with data on the use of health services, it would have some chance of success. And yes, it's just another application. Health data is a tasty morsel, e.g. for insurance companies. What to do to prevent them from falling into the wrong hands? We have the GDPR, it is the first barrier to access to personal data. Moreover, they are owned by the patient. And it is he who decides for what purpose they can be used. But it is also the case that the GDPR allows for the reuse of health data for scientific and public purposes. It is therefore a matter of properly supporting public health, not pursuing commercial goals. Is that the only reason we don't do it? NO. It is rather a lack of knowledge about the existing possibilities. In every discussion, this issue comes up on a micro level. Not as strategic thinking. But something is starting to happen - an e-prescription, an e-referral comes in... It's not enough. We need to start looking for solutions and make them available for the benefit of patients in the form of reimbursed practices. Just like in the UK. This market is huge. There is a need for health economics specialists to verify the cost-effectiveness of adapting individual solutions. Because there is no problem with innovation, only with adaptation. Are you not afraid, however, that large corporations will collect data on our health? It's an unstoppable process. Therefore, it is necessary to involve the state in guaranteeing the safety of patients. The National Health Fund in the UK has made available on its website a list of over 70 approved mobile applications. Each of them has been properly tested before. Are we not in danger of dehumanizing the medical system? Now technology complements doctors, but in a moment it may replace them. The pace of change is so fast that before we know it, it will turn our way of thinking about medicine upside down. In Poland, the number of hospitals is being discussed, but new solutions may make such talks sterile. For me, a greater threat than the dehumanization of the healthcare system is the chaotic way of introducing technological solutions. Therefore, an institution must start operating that will assess the safety and cost-effectiveness of introducing existing innovations.