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“Medication and Self-Management App” for cancer patients

"Personal Health Record" transforms the future of healthcare - Co-creation between AstraZeneca and Welby to address challenges surrounding cancer patients

Innovation Infusion Japan, i2.JP is a healthcare innovation engine that aims to realize a "patient-centric" business model. The Japanese subsidiary of global pharma AstraZeneca launched this open community in November last year with the belief that "there must be much more we can do beyond drug discovery”. Over 100 companies and organizations who share the vision participate in the community and the count continues to increase (as of August 2021).

TOMORUBA started feature articles titled "Challenges to Healthcare Innovation" to follow i2.JP initiatives. Through the voices of the founding members and partners of i2.JP, we will consider and deep dive into the future of healthcare at its best.

In this second article, we introduce a case study of co-creation between AstraZeneca and Welby, which formed a strategic partnership agreement. Welby aims to implement PHR (Personal Health Record*1) in society. It has a track record with as many as 30 joint projects including ones with pharmaceutical companies.

In June 2020, the two firms jointly released an app to support patients taking the anticancer drug developed and deployed by AstraZeneca and help them self-manage their medication status. In this interview, we asked the representatives of each company about the background and vision behind the development of the app, the co-creation process, the future outlook, as well as the current situation and issues surrounding PHR.

PHR plays an important role in realizing patient-centric care

——In June 2020, AstraZeneca and Welby signed a strategic partnership agreement. How did the two companies meet and what vision do you share leading to the partnership?

Kazuki Takashima(Takashima): In 2014, AZ and Welby jointly released "Maisapo", a wellness management app for lifestyle-related diseases. Since then, we have been working together for almost 7 years. Welby's mission is to "Empower the Patients". The firm’s focus is on achieving patient-centric care based on power of technology and data. AstraZeneca is also committed to "putting patients first" as stated in Our Value. So, we had the fundamentals in common.

Our goal has always been to promote proper use of pharmaceuticals by enhancing our services to patients and healthcare professionals. In that sense, I believe PHR (Personal Health Record) is one of the critical services.

Since Welby pioneered the field of PHR in Japan and we already had a business relationship with them, we decided to enter into a strategic partnership agreement in 2020.

——The term PHR has come up as a keyword. I would like to hear from Welby, the leader in this field in Japan. How do you feel about the current status of PHR?

Akihito Iokawa(Iokawa):PHR was introduced in the US and Nordic countries ahead of Japan. In order to implement this system in Japan, we founded Welby in 2011 and have been working on it since. I've been with Welby for six years now, and back then, smartphones weren't as popular as they are today. In addition, not much work had been done to support patients based on smartphones.

Against this backdrop, Welby started a partnership in 2014 and our first partner was AstraZeneca. We also released a wellness management application called "Maisapo", which was mentioned earlier. Since then, we successfully rolled out about 30 projects with various companies. I am under the impression that PHR is gradually taking root Japan.

I think there are two factors that improved penetration of PHR. One is expansion of smartphone users. The other is the trend in favor of patient-centric healthcare. I feel more pharma companies are discovering that ‘patients are the owner of care’.

——How would you see the status in Japan in comparison with early adopters such as the US? What could we improve, if any?

Iokawa: Japan is still far behind the US and other countries. The problem in Japan is slow penetration of electronic medical records. Medical records hold a large number of patient healthcare records, but there are still many medical institutions in Japan that hold medical records on paper.

Also, in the U.S., for example, electronic medical records are basically cloud-based, and hospitals are seamlessly connected to each other. On the other hand, Japanese medical institutions primarily use on-premise systems, which are difficult to connect to external networks. As a result, medical records are kept within the boundary of the hospital. This makes it difficult to take patient information out of the hospital, undermining data portability.

——What do you think is the fundamental reason for the current situation?

Iokawa:In my opinion, there was no leadership in Japan with a wholistic view of delivering the best for all. In the U.S., for example, the federal government took the lead in promoting the introduction of electronic medical records to improve efficiency with data-driven medical care. On the other hand, Japan had the concept of developing electronic medical records individually in each medical institution or company. This is why systems are different and fragmented across hospitals. They are disconnected, even if they are developed by the same IT vendor.

Later came the idea of connecting the independent medical records across. Japan faces a unique issue of making amendments to align with the direction that was changed midway. To the contrary, PHR is a system that embraces patient ownership of personal health records. Patients are able to carry and make better use of their records in treatment. This is the kind of thinking we're working with.

A story of co-creation behind developing ‘Medication and Self-Management App’

——In June 2020, AstraZeneca and Welby signed a strategic partnership agreement to promote use of digital based on PHR (https://welby.jp/category/news/200603160000.html) and jointly released ‘Medication and Self-Management App’ for patients taking the anticancer drug developed and marketed by AstraZeneca. Can you tell us what led to the development of this app?

Ryota Suehiro(Suehiro):When I first joined the company, we had the agenda to “support cancer patients and caregivers so that they can lead life as usual with hope, even after diagnosis”. I completely feel convinced about this. Currently, lung cancer drugs targeting patient genetic mutation types are being developed and introduced into clinical practice. This resulted in improvement of patient life expectancy and extension of the duration of treatment. It is important for patients to stay in treatment while reducing side effects to the minimum, especially when considering their desire to lead life as usual even under prolonged cancer treatment.

Of course, we had been working on this challenge for some time, but the starting point for the development of this app was the idea that we could do something by utilizing smartphones and digital technology. We attempted to promote patient engagement in treatment though the use of digital technology, to support early detection and intervention of side effects.

——How did you manage over the course of the project?

Suehiro:Let me take you through the development phase and implementation phase. First of all, we didn't have any experience in developing apps, so we finalized specifications based on the discussions with Welby.

One thing we kept in mind was the the app has to be introduced from HCP to patients, before it is ultimately passed onto the patients. Therefore, in the development phase, we consulted with patients and also HCP seeking their advice and input for better user retention, instead of simply delivering a service that is used once and never again.

In addition, since more than half of the patients taking the anticancer drug targeted by this app were over 75 years old, we were conscious of keeping data entry simple and ensuring great on-screen visibility rather than making it complicated and loaded with features. We perfected the app taking the best of both worlds: User-friendliness of an existing paper version of medication booklet and functions only an app can offer.

——What exactly do you mean by "functions only an app can offer"?

Suehiro:For example, patients can watch video contents on the app to teach themselves about self-care. The app also offers a function to keep photos of their symptoms of concern as well as medication reminders.

——Iokawa-san, did you have any difficulties in the development phase?

Iokawa:Our initial focus was to identify how medication guidance is given to patients and what pain points patients usually experience. Based on the understanding, we proposed use cases as we embarked on development. The most challenging part was to design the app in a way that introduces intended changes in the existing treatment.

——I would also like to ask you about the implementation phase.

Suehiro:From a regulatory point of view, we can't introduce this app directly to patients, so we have to get referrals through HCP. Most healthcare professionals are not familiar with using an app for treatment. In fact, many doctors we engaged held a misconception that an app is too difficult to manage, which was the first thing we tackled.

We explained patient benefits to physicians by sharing the contents of the app, showing how simple the screen design is and demonstrating the functions only achievable through an app. Over time, we were able to increase the number of physicians who turned positive about trying out this app.

——What is your view, Iokawa-san?

Iokawa:What Welby has to offer is insights generated from the past projects. We made a lot of mistakes in the past, so we shared with AstraZeneca common pitfalls that could stall our progress. We also made suggestions as to how to make counterarguments when physicians state the app is “too difficult to explain” to patients.

Transformation in patients and HCP through ‘Medication and Self-Management App’

——It's been about a year since the app was released. What kind of feedback have you received from patients?

Suehiro:We conducted interviews with patients/app users and identified four key points. First, adding and reviewing data is easier on a smartphone. Conventional paper-based booklets are inconvenient in many ways such that it takes more time to enter information, needs storage space to keep used booklets, which may go missing during storage. However, with a smartphone, entering and reviewing data can be done easily any time. Many users shared positive feedback about using their smartphones.

The second is a peace of mind that the patients can get with the self-care contents. Patients are generally well informed about the side effects of our anticancer drug at the care facility, yet they still have some concerns. This app has contents that help the patients learn deeply how to cope should side effects occur. They said that this has given them a sense of assurance.

The third point is better communication between HCP and patients. This app has a feature that allows user to take and save a picture of symptoms. Let’s say, a female patient wants to share her symptoms with her doctor who is a male. She would hesitate to physically expose the area affected in the examination room. In that case, the patient can take a picture beforehand and simply present it to communicate her current conditions. In this way, the app seems to help in terms of communication as well.

The fourth point is support for routine medical examination. In some areas, there is a lack of HCP manpower. Informing patients on treatments and guiding them on self-care may be of secondary importance in communication. Some people suggested that this app is a useful tool to support patient care in place of HCP.

——I see. What are your thoughts on the future development of ‘Medication and Self-Management App’?

Suehiro:Ultimately, as a treatment outcome, we hope to contribute to patients in a way that maximizes survival and time to disease progression. Since our anticancer drug is a tablet, even if it is prescribed at a hospital for the first time, it is often prescribed at a dispensing pharmacy for the second and subsequent times. Therefore, for the purpose of information sharing, we would like to expand our reach to cover pharmacists at dispensing pharmacies and construct database of patient adherence and adverse events.

Also, many of the patients on the anticancer drug for which this app is intended are 75 years old or older, and some of them are not positive about using this app. However, in many cases family members are engaged in supporting patient care. In fact, for about half of age 75+ users of this app, the direct user is not the patient but family members. I would like to add improvements with that in mind.

——I would also like to ask about the future development of Welby as a company.

Iokawa:First of all, we hope to empower patients with this app to have better communication with doctors. Using the accumulated data, we would like to visualize patients' pain points and leakage points and develop this into a better service. Hopefully, we can develop a system that feeds our findings to doctors.

Beyond that, we are aiming to interface with electronic health records and other services, which may streamline HCP work and improve their productivity. We believe that the key to our success lies in our ability to create products that make patients happy and lift burdens on HCP.

——What is AstraZeneca's vision for PHR?

Takashima:With the recent rise of telemedicine offering the ease of data sharing between patients and HCP, people will start to expect better and more connected healthcare services. I believe that PHR can bridge the gap. So, we would like to work with Welby in oncology and beyond.

Also, while making the most of patient-enabled data including one captured with sensor devices, we would like to step up our efforts to empower patients so they can share lab results and health exam data during a consultation with a doctor. In addition to PHR, we would like to consider interface with EHR (Electronic Health Record) and EMR (Electronic Medical Record).

i2.JP, a healthcare innovation engine aims to achieve patient centricity

——Finally, please tell us about the benefits of participating in i2.JP and give a message to those who are considering membership.

Iokawa:There are benefits to joining i2.JP: We can advertise our strengths and share our vision. What we can do on our own is limited. Through i2.JP, we can communicate our assets while considering various partnering options. In the future, by combining our PHR technology with assets offered by i2.JP members, we hope to create an opportunity to provide better services for both companies and ultimately better services for patients.

——What are the characteristics of AstraZeneca as a co-creation partner?

Iokawa:What stands out at me is the spirit of challenge. The first company to implement our PHR service was AstraZeneca. At the time, PHR and in-hospital apps were obscure concepts for the most part. However, AstraZeneca was excited about our concept and was willing to take on the challenge. That was a major turning point for our business. We are thankful for the strategic partnership as our desire has been to collaborate cross-functionally across the board, instead of limiting it to one project.

——Suehiro-san and Takashima-san, please give us a message for companies that are considering participating in i2.JP.

Suehiro:We see an increase in types and sources of information that we can utilize, such as patient data and electronic health records. These information are putting spotlights on various patient needs. When trying to meet these needs, it has become increasingly difficult to solve them internally. I see i2.JP as a place to go in such circumstances.

The pharmaceutical industry is heavily regulated, but I think there are many areas that are changing. This is the first time for me to be involved in the ambitious project with a motive to transform the entire healthcare system. Through this project, I feel inspired and educated. We are looking forward to future developments and hope that many companies and organizations will join i2.JP.

Takashima:We are working to build patient-centric communication and promote support for treatment and side effect management. If you have a technology or solution that leads to patient’s wellbeing, we would like to work with you. Some companies may think they are completely unrelated to what we do at first, but please contact us if you are interested, because various ideas may develop by having direct dialogues.

Postscript

i2.JP embarks on building an ecosystem to transform the entire industry toward realization of patient centricity. As referred to in the interview, the efforts to "transform the entire healthcare system" is likely unprecedented in Japan. i2.JP launched in November last year is now attracting close to 100 members. We will continue to follow the progress of i2.JP to see how it leads to healthcare reform.

Also, i2.JP is recruiting partners. Medical and research institutions are welcome, but it also encourages digital startups and others to participate, even if their link to healthcare industry appears weak at first. There is no obligation or fee associated with the membership. Interested parties should contact from the inquiry form below.
(Editor: Kogo Sanada, Writer: Wakako Hayashi, Photographer: Yuji Yamazaki)

Ryota Suehiro
Ryota Suehiro
Associate Brand Manager, Lung Cancer (EGFR) Marketing, Oncology Business Unit, AstraZeneca K.K.

Joined AZKK in 2007. Developed experience as Oncology MR (sales rep). Assigned to the Lung Cancer specialist team in 2016. As part of LC marketing team, responsible for MR action strategic planning and execution support. Led the development and deployment of this app. Certified pharmacist.

Kazuki Takashima
Kazuki Takashima
Manager, Business Partner, Customer Engagement Transformation, Commercial Excellence, AstraZeneca K.K.

Joined a securities company after graduating from college. He then moved to a medical device manufacturer, where he was in charge of sales as well as launch of digital marketing. Joined AZKK in September 2019, taking charge of omnichannel promotion in Oncology. Managed the strategic partnership contracting process with Welby and promotion of the co-creation project.

Akihito Iokawa
Akihito Iokawa
Executive Officer and General Manager, Welby Inc.

Joined Eisai Co., Ltd. and worked as MR after graduating from college. Moved to SMS Co., Ltd. and engaged in development of pharmacist-facing business. Joined Welby in September 2015. Appointed as Executive Officer and Business Manager, Disease Solutions Division in January 2018. Current role since July 2021. Led joint development of PHR services with partners including pharmaceutical companies. Certified pharmacist.

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