GAFAMS, STARTUPS & INNOVATION IN HEALTHCARE by PHARMAGEEK

As digital health continues to extend into the mainstream, continuous glucose monitor (CGM) manufacturer Dexcom took advantage of the 2015 Consumer Electronics Show (CES) to unveil a simulated Apple Watch displaying live demo glucose readings from a Dexcom CGM.

As pictured on the right, the Apple Watch display is fairly similar to the current Dexcom receiver’s. It displays the current blood sugar reading, a graph of recent blood sugars, and  a trend arrow (telling the user whether their glucose trend is sharply upwards, upwards, flat, downwards, or sharply downwards). From the demo, there is no indication if the Apple Watch app will have any other features such as alarms, calibration, etc.

I believe this is the first time any diabetes device manufacturer has publicly shown any demonstration of continuous glucose data being transmitted wirelessly to a smartwatch.  The closest demonstration would be Medtronic live streaming glucose readings from their CGM to an iPhone display this past Fall.

Currently, there are no official solutions that stream glucose data to smart watches.  For the tech-savvy, a NightScout community exists that helps users “hack” their CGM’s into streaming glucose data to the cloud. In comparison, out-of-the-box synchronization to mobile devices would be a huge step for continuous glucose monitors, and the recent demos by Dexcom and Medtronic suggest that the FDA approval landscape for diabetes technology is loosening.

In a CES Digital Health session titled “Winning the War on Diabetes”, Dexcom’s Steve Pacelli (pictured second to left), Executive Vice President of Strategy and Corporate Development, announced that “[Dexcom's] 5th generation system will transfer data from the sensor to the phone.”

This would represent a significant upgrade over current G4 solutions that require a separate product (the recently approved Dexcom Share) to serve as an intermediary device between the smartphone and Dexcom receiver. Dexcom’s 5th gen release would eliminate the need for a Share-like receiver and could potentially even eliminate the receiver.

With respect to the Dexcom booth’s Apple Watch demo, it was unclear if the Apple Watch integration is coming for the Dexcom Share (and therefore current G4 systems) or for the future G5 release. However, it’s worth noting that the demo was running inside Apple’s developer kit, which means that the display was running actual software code and not just a mockup.

Furthermore, unlike Medtronic which has officially gone on record stating that Apple HealthKit integration is not part of initial plans for their upcoming smartphone systems, Dexcom’s booth prominently featured Apple Watch and Apple HealthKit in their signage.

Time to step up or step out of the way?

The digital health movement is growing rapidly. Almost everyday we hear of new technology, apps and ideas that bring the promise of improved medical care, health and wellness. From hand-held ultrasound devices to smart phone arrhythmia monitoring, the digital health movement isn’t only about expensive pedometers and the ‘gym elite’ but about key areas in health and wellness that will have a direct impact on medical care. Pharma–for better or worse–has a seat at this table.

Concept and Illustration: Peter Zamiska

Yet there seems to be a bit of a disconnect between pharma and many of the innovations that are emerging. Perhaps it’s the very nature of these innovations that conflicts with the conservative pharmaceutical industry. Perhaps it’s still a period of ‘watchful waiting’. Or even, it could be yesterday’s brand managers, sales reps and administrators who, while caressing the piles of pills that define an industry, are just missing what many define as the next revolution since the personal computer.

Whatever the case, there are many compelling reasons for pharma to embrace digital health. If not for today, certainly in the not so distant future.

The future of medical practice and pharmaceutical selling

The pressures on the practice of medicine are numerous. From healthcare reform to the tsunami of clinical information and data, today’s providers are looking for ways to care and to cope. Technology is an essential part of the solution. And digital health is a central part of this equation. The touch points for pharma are numerous and represent areas for engagement and support. On demand information and analytics will shift the focus from bed side ‘rote memorization’ to “augmented digital expression” where a differential diagnosis and interventions come with the aid of a hand-held computer screen. Further, the looming role of the electronic medical record will also set into motion a transformation from paper to electrons will catalyze the digital health movement and accelerate adoption. Many of these changes are happening now as a new generation of medical students begin to use their smart phones at bedside as a diagnostic and therapeutic tool with the same zeal as yesterday’s physicians who clung to their stethoscopes as validation of their clinical acumen.

The traditional role of the sales rep must also change. The consultative nature of the brand detail will shift in parallel with the technology-driven changes in practice. Pressing the flesh will transform to clinking a link and clinicians will adopt the conventions of today’s consumers and seek information in a controlled on-line setting. But perhaps more importantly, the days of typical case studies and efficacy charts will be replaced with a richer and more compelling presentation that are consistent with what this ‘techno’ generational will simply expect. And the experts themselves will change too–the standard practice of expert professorial engagement and peer to peer influence may be enhanced by none other than IBM IBM +1.92%‘s Watson and other ‘electronic’ thought-leaders.

Patients and caregivers will play an important role in the evolution of healthcare and digital health. The emergence of “citizen scientists” who are empowered by increasingly focused and filtered information will act–alone and with like-minded people–to take greater control of care. Self-advocacy will change ‘population-based’ treatment guidelines to more personalized care. And the pandering “ask your doctor” headlines of DTC advertisements will shift to data-based claims that empower the patient and make a much stronger and direct link between the pharmaceutical industry and the true end-user, not the physician.

Maybe it’s digital narcolepsy?

Whatever the cause, pharma needs to take notice. The cases studies and talking points that drive a traditional brand detail must be rethought and redefined in the context of tomorrow’s clinical reality. A reality that’s actually happening today.