New medical challenge together with the “telemedicine tech venture”
Take on a new medical challenge together with an “telemedicine” tech venture to deliver reliable and continuous treatment to COPD patients who are concerned about the risk of infection
- A validation program for telemedicine for COPD patients using MICIN’s telemedicine service “curon”
- COPD is one of the underlying diseases with high risk of severe COVID-19
- It was expected that the high risk would make it difficult to continue treatment, including hospital visits
- Some elderly patients are not familiar with digital technology and there are challenges in selecting solutions
- There is certainly a sense of anxiety about visiting hospitals and a need for telemedicine
- Some younger patients are eager to have a telemedicine environment
A new coronavirus infection (COVID-19) spread worldwide in 2020. Since the beginning of the pandemic, it has been believed that underlying diseases are more likely to cause severe illness, and one of the diseases with a particularly high risk is chronic obstructive pulmonary disease (COPD).
In order to create an environment where COPD patients who need long-term symptom control through continuous treatment can continue their treatment safely even in the midst of a COVID-19 pandemic, AstraZeneca and MICIN, Inc. (MICIN), which provides telemedicine service “curon”, have joined forces.
We interviewed Ryoichi Kusama, Senior Vice President of MICIN, and Liu Lei, AstraZeneca i2.JP Director.
Invisible anxiety about hospital visits: Possibilities found in COPD patients x telemedicine
——First of all, could you give us an overview of the project and what AstraZeneca and MICIN have been working on?
Liu Lei (Liu)：What we have been working on with MICIN is a validation program for “telemedicine” for COPD patients.
We planned and promoted a validation experiment to create an environment where patients and their families can receive medical examinations online without having to visit a hospital, and where doctors can provide continuous support to patients through the telemedicine service “curon”.
——What was the background to this project?
Liu：The COVID-19 pandemic is one of the reasons why we promoted the project focusing on COPD patients.
The first wave of the COVID-19 pandemic began in Japan, and it was found that people with underlying diseases were more likely to become seriously ill. Among them, those with respiratory diseases, especially COPD patients, were positioned in the segment with the highest risk of severe disease.
COPD patients intrinsically require long-term symptom control through continuous treatment, but due to the high risk of infection, it was assumed that patients would refrain from coming to the hospital or discontinue treatment on their own judgment, resulting in a delay in treatment. As we put patient-centricity into practice, we thought that there is an unmet need for patients.
AstraZeneca has been focusing on the respiratory therapy area, including COPD. However, if patients are not able to continue treatment and medication properly under the guidance of HCPs, they will not be able to achieve the expected outcome.
We wondered what we could do to achieve sustainable treatment while avoiding the risk of infection.
After a series of discussions with the marketing team responsible for the target drug, we reached to a solution: telemedicine.
By providing telemedicine for COPD patients, we hoped to eliminate the barrier of hospital visits and create an environment where patients can continue their treatment safely, as well as achieve stable and long-term symptom control.
By combining AstraZeneca’s accumulated knowledge of COPD and MICIN’s platform, we launched a project for comprehensive patient support.
A shared vision for the future of medicine
——Why did AstraZeneca and MICIN decide to collaborate to solve the problems for COPD patients? Can you tell us the story before the project was launched?
Ryoichi Kusama (Kusama)：My first contact with Mr. Liu was when the first wave of the COVID-19 pandemic broke out in Japan. I asked him if we could work together to realize better healthcare, not only for this project.
I talked to him because we have a telemedicine platform, but we don’t have medicines necessary to cure patients’ diseases.
Only when doctors are able to properly diagnose and select medications can they provide the medical care that patients need. Telemedicine is just one piece of the puzzle. If we really wanted to change patient experience, we thought that collaboration with pharmaceutical companies would be essential.
It was AstraZeneca, “i2.JP”, and Mr. Liu that opened the door for us.
Liu：Actually, in order to find the best partner for this project, we talked to almost all the companies that provide telemedicine services. Among them, MICINE was the one that resonated with me when we discussed our visions for the future of medicine.
MICINE and Mr. Kusama’s desire to “use telemedicine as a starting point to expand a healthcare system that is close to patients” overlaps with AstraZeneca’s patient centricity in many ways, and we decided to work together.
——After that, how exactly did the project turn out?
Kusama：Mr. Liu acted as a bridge between the marketing team of the target drug at AstraZeneca and us at MICIN, and we began by proposing to the marketing team a solution and possible usage scenarios.
After several rounds of proposals, we finally decided on a joint validation program that would provide “a series of telemedicine services for COPD patients, including medical appointments, consultations with doctors, and payments to medical institutions, using telephone and smartphone applications,” and evaluate its usefulness “through qualitative research in clinical settings.”
The project started with 10 to 15 patients and a period of about 3 months.
It often takes a long time for such projects to be planned and implemented, and there are many cases where a start-up like us and a large company like AstraZeneca require a different speed when implementing projects. For this project, however, the marketing team had a strong desire to support patients, and I feel that we were able to build a cooperative structure and start the project relatively smoothly.
Direction change in three weeks, opinions voiced by patients fighting the risk of infection
——You are finally starting the validation. Did the project go smoothly?
Kusama：We quickly found doctors and medical institutions that were willing to cooperate in the validation, saying, “This is an interesting concept, let’s work together.“ However, we had a difficult time finding COPD patients who would cooperate with us.
Liu：Since many COPD patients are elderly men, it would have been a beautiful story if we could have created a proof of concept of “a 75-year-old male patient using telemedicine to avoid risks and maintain treatment”.
In reality, however, it was more difficult for such patients than expected to master how to use smartphones and apps, and there was a huge barrier to overcome in order to maintain treatment through active digital use. It was about three weeks into the project that we discovered that the initial validation itself was not viable.
Kusama：We knew from the beginning that there was a discrepancy between the age group with the largest number of COPD patients and the age group that utilizes telemedicine. The users of curon are mainly in their 60s or younger, but COPD has the highest prevalence in people over 70.
However, we were thinking that the COVID-19 pandemic would change the mindset of patients and their families, and that they would become more willing to use digital applications. That assumption was out of sync with the actual situation.
In the course of our survey, we found that, for example, in the case of patients who were accompanied by their family members to a clinic about a 10-minute walk from their homes, “anxiety about visiting the clinic” and “willingness to use telemedicine service” were not as high.
This finding reminded us how important the process of understanding the differences in the needs of each patient is.
——What did you do with the project after it turned out to be difficult to validate?
Kusama：We changed the direction of the project from validation in the clinical setting to an interview survey. We recruited more than 20 COPD patients additionally and guided them through a series of telemedicine processes. Afterwards, we interviewed them about their impressions of using the service and their needs.
What was striking in the interview was that a patient said, “I am afraid of going to the hospital. If I could avoid it, I would.” This was the assumption we had before the interview.We found out that there are definitely patients who feel anxious about going to the hospital, and we were able to clarify their issues.
Liu：Another thing that impressed me was that in an interview with a female patient in her thirties who uses a smartphone on a daily basis, she said, “If it were available, I would use it right away”.
Although this is a rare case in COPD, where the majority of patients are elderly and male, it was an opportunity to reaffirm the importance of delivering the right product to those who need it and its effectiveness in the future.
New sprouts emerge from failure, ongoing partnership for the future
——The project has been completed as of December 2020. How do you reflect on the whole project?
Liu：At this point, we have concluded that it is difficult for elderly COPD patients to utilize telemedicine alone without the support of someone else.
However, in the long run, it is certain that the generation that is exposed to digital technology will age, so there will definitely be opportunities for telemedicine to be accepted as a matter of course in the future.
We would like to continue to study how to make telemedicine easy to use even for today’s elderly patients while keeping an eye on the coming future. In addition, we hope to apply this learning to disease areas where there are many younger patients.
Kusama：There are many diseases, not limited to COPD, which we focused on this project, where there is a gap between the age of the patients with the disease and the users who utilize telemedicine services.
How can we bridge this gap? It gave us a clue to reconsider new solutions for patients who are not used to digital devices.
In fact, MICIN has created solutions that are close to people who are not familiar with digital technology, such as providing a service that allows telemedicine via cable TV and enabling telemedicine via web browsers.
While working with AstraZeneca, we are also collaborating with the team in charge of other disease areas and are in the process of consulting with them for new projects.
Although the project was not a success based on the assumptions made at the start of the validation, it was a big learning step that will lead to the future, for changing the future of medicine.
——The lessons learned from this project have already led you to new challenges. Finally, can tell us about your future plans?
Kusama：Startups like ours are driven by a strong sense of discomfort with the current situation and an unfounded conviction that the future will definitely be the one we envision.
In today’s healthcare system, it is commonplace to go to a hospital and wait for two hours, only to be seen by a doctor for three minutes. From the patient’s point of view, this is not necessarily a good service. However, I believe that there must be a form of medical service that is optimal for all stakeholders.
In order to bring about change in the healthcare system, it is absolutely necessary to change the mindset of everyone involved, but there is a limit to the power of a small start-up. We really need a reassuring partner like AstraZeneca.
However, it is also true that it is not easy for a startup to approach a large company, and I am really grateful for the existence of “i2.JP” that provided us with this opportunity.
I am very grateful that we were able to take on this challenge together in the midst of an uncertain future, and I hope that we can continue to work together as we aim for the same goal.
Liu：We are also trying to realize “patient-centered medicine,” but we recognize that it is a very challenging task.
However, if you look outside Japan, you will see that patient-centered healthcare, including telemedicine, is rapidly being realized. This means that it is definitely possible in Japan as well.
As Mr. Kusama said, in order to promote this, it is necessary for each and every one of us to change our mindset, and I believe that cross-boundary collaboration will drive this forward. i2.JP aims to be just such an ecosystem.
We would like to increase the number of connections between large companies and startups, and as a bridge between them, I am always open to seeking partners. If you share our vision of i2.JP, please feel free to contact us.
- Ryoichi Kusama
- Senior Vice President
Worked in McKinsey’s Tokyo and New Jersey offices and has extensive experience in the healthcare sector, primarily in pharmaceuticals and medical devices. Co-founded MICIN in 2015.
- Liu Lei
- Innovation Partnerships & i2.JP Director
Engaged in medical device R&D at GE Healthcare Japan, and worked in consulting, startups, and life insurance companies before joining AstraZeneca. Leads Innovation Infusion Japan (i2.JP), an open innovation network.
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