The word telemedicine conjures up images of a patient consulting a doctor who is at another location, through videoconferencing. This is the core of telemedicine.
However, telemedicine has since evolved along many paths with new and innovative applications and roles emerging constantly. Imagine a radiologist based in India analysing an emergent CT scan performed on a patient in an emergency room in the US and discussing the findings with a physician across the globe!
At the heart of advances in medical science lies drug discovery, the process by which new medications are discovered. The process of drug discovery involves conducting clinical trials or research studies that validate the safety and efficacy of a new treatment. This is both expensive (a 2014 study estimates the cost at $2.4 billion per drug) and time consuming (up to 10 years in some cases).
Pharma and biotech companies which are involved in drug development today, therefore, face major challenges. Telemedicine offers some innovative solutions to such challenges, which address both the time and cost components of clinical trials.
For example, clinical trial recruitment or the process of enrolling patients for clinical trials has proved to be a significant challenge for pharma companies and is viewed as one of the costliest aspects of drug development. This is particularly important in a condition where the patients are not able to be present in a healthcare centre or lab (for example, stroke, heart attack and other such acute conditions).
Utilising telemedicine for patient recruitment in such situations is beneficial to sponsors as well as CROs (clinical research organisations) which are the entities that coordinate clinical trials. In emergency and time sensitive conditions, such as an acute stroke, the use of telemedicine can help with patient enrolment into a clinical trial.
For instance, a patient suffering from an acute stroke in a rural hospital, can benefit from the latest investigational treatment protocols, facilitated by a telemedicine interaction between the general practitioner at the rural site and the neurologist and trial coordinator in the tertiary care centre, such as a university teaching hospital.
Another area where telemedicine plays an important role is in patient coordination and monitoring. For example, a trial known as REMOTE being conducted by the pharma major Pfizer to investigate a new treatment for overactive bladders relies on telemedicine technology to connect patients with a trial investigator over an online platform.
Additionally, many patients who are enrolled in clinical trials can be monitored while at home using home healthcare monitoring techniques which are an extension of telemedicine, as the parameters that are measured such as blood pressure and blood sugar may be remotely uploaded to a central database server. This has the potential to reduce trial costs as the patient does not need to be brought to a medical centre simply for the purpose of monitoring vital signs or other basic parameters.
An interesting space that has opened up in the last decade or so is in the area of imaging in clinical trials. Drug discovery today is to an extent dependent on medical imaging. For example, the efficacy of most anti-cancer treatments is determined based on whether the CT, MRI or PET scan shows a decrease in tumour size, referred to as response. The science of drug discovery is therefore tied with the science of medical imaging.
This has in turn led to the creation of Image Core Lab — an entity that uses teleradiology to transfer images from diagnostic centres to a centralised facility where specialist radiologists analyse these images using defined protocols such as Response Evaluation Criteria In Solid Tumours (RECIST).
Teleradiology further allows the image data to be stored for the duration of the trial subject to the strict security guidelines that regulatory agencies impose on such patient data. The Image Core Lab model provides a high quality analysis of the imaging data by imaging specialists with specific expertise in the area of clinical research.
In an era of severe radiologist shortages, the outsourced Core Lab model ensures timely analysis of the imaging data that helps reduce the duration of drug discovery cycle while providing a cost-effective solution. In the pharma/biotech industry’s ongoing quest to constantly bring new lifesaving treatments to the world, telemedicine offers the potential to be a long-standing and effective partner.
(The writer is MD, CEO and chief radiologist/pusher, Teleradiology Solutions)