From an early age, I understood that the doctors and nurses in the emergency room were helping me live a fuller life. I think that’s why I always wanted to become a doctor one day.
It wasn’t until I learned about the CRO industry and got to see firsthand how the work could truly impact patients in need, that I realized I was meant to help people in a different way.
In clinical research, as long as you have an internet connection, you can help patients access new treatments and bring life-changing drugs to market from anywhere in the world.
Instead of going to residency after medical school, I decided to do just that and accepted an offer to help get a site management organization (SMO) up and running in Brazil.
While working in Brazil, I saw how inefficient and broken other healthcare systems and research processes are.
In Brazil, citizens are separated into five classes—the As, Bs, Cs, Ds, and Es. If you’re in the A, B, or C tiers, you get a corporate paycheck and corporate healthcare. Those in the D and E tiers are known to the government as the “Invisibles.” They get paid under the table for their work and receive universal healthcare from the government which, in Brazil, is limiting.
The healthcare system in Brazil is overburdened, especially for the individuals with universal healthcare. In the areas of most extreme poverty, each district only has one primary care doctor to triage patients. That’s about two doctors for every 1,000 patients. Often, the wrong treatments are given to patients—some may receive a certain medical treatment when what they really need to survive and live a better life is surgery. Many people there say they’re waiting in line to die for healthcare.
Fortunately for these individuals, doctors with their own private practices still have to put in a certain number of hours at universal healthcare clinics each month. One of the cardiologists I worked with explained to me how he would recruit patients into his trials from the universal healthcare clinic. Not only did this provide the patients with an opportunity for new potential treatments, it also ensured they received better medical attention. Patients from the universal clinics were more than happy to participate in research because they received service from this cardiologist’s commercial clinic, as well as all of the additional touchpoints included in the clinical trial.
After about a year and a half working with the SMO, I was ready to use what I had learned in Brazil to help more people. I wanted to form a concierge medical group that would allow doctors to have a truly one-on-one relationship with their patients. With fewer patients in their portfolios, they would be able to give better attention to the patients they managed and provide consultations from their homes or places of work. I moved to San Diego and enrolled in business school to see my vision through. But when I got back, there was an even bigger opportunity waiting for me.
It was 2008 when I got back to the states and everyone had an iPhone. When I'd left for Brazil, people still had flip and candy bar phones and texting was a relatively new technology. All of a sudden, everyone had these internet-connected devices in the palm of their hands.
At the time, there weren’t any medical apps or workflows—just some really simple apps and games. A couple years later, when I saw the iPad release, the idea hit me over the head.
This technology could change the way patients access healthcare in a very real way—especially patients who rely on underdeveloped and inefficient healthcare systems like those in Brazil.
Think about it. If a patient in a clinic or doctor’s office needed a knee replacement or their appendix taken out, a doctor could simply hand them a tablet with all the information and tools they needed to really understand the procedure and informed consent process. We could deliver all of that information to the patient in an educational and interactive experience.
I knew this was going to be something big.
Access to healthcare options should never be based on your economic status in life, but unfortunately this is commonplace in Brazil and many other areas around the world.
Those in a lower socioeconomic tier usually have more restrictions and limited opportunities for their health, among other things.
In the US, where many people already have solid healthcare options, clinical research is often taken for granted. But in many developing countries, participating in research is one of the few ways for patients to receive the care they need—and technology can literally offer a lifeline to these patients. Using internet-connected devices and social media to help recruit people into studies seemed like the perfect way to start bringing these underserved patients into the clinical research process.
Healthcare clinics could give a patient an iPad to view available trials and sign up for a patient registry. Patients could learn more about the trials available and opportunities to participate and easily share those trials with others that could benefit. Ultimately, we could improve recruitment for studies and help patients receive better treatment than they might have otherwise.
Using these new technologies to bring patients into clinical research became the basis for my startup, nPruv, which focused on clinical trial patient matching and recruitment here in the US. While the US healthcare system is very different than in Brazil, I knew that this technology could also help reach patients here who may not have other options—patients without health insurance, patients who didn’t know clinical research was an option, and patients who may be interested in participating in a trial but didn’t have the time for traditional research.
By placing tablets in participating clinics, we were able to access every patient that went through and those patients could also share that information with someone else who might be interested—for instance, a family member or friend. This allowed us to reach even more people who needed care and provide them with options that could improve their health.
Since founding nPruv, a lot of new technologies have entered the healthcare space. In 2016, nPruv was acquired by Parallel6. I joined their executive team as Chief Medical Officer and helped innovate their platform to record patient reported outcomes (PROs), incorporate connected devices data, and support virtual visits. That technology served as the foundation for what we now know as PRA’s Mobile Health Platform (MHP).
It’s been amazing to see healthcare and clinical research evolve right before my own eyes. Today, we don’t just have the ability to find and recruit patients remotely—we can run entire studies virtually. This alone has changed the way so many patients are accessing healthcare—from their own homes and devices, and on their own time.
For patients with limited healthcare options, this is life changing. Today, these patients who were used to waiting in never-ending lines to receive inadequate care can speak to a doctor at any time of the day. They can access new drugs and treatments that were unavailable to them just a few short years ago. And, perhaps most importantly, they can start to take control of their own health in ways they may never have thought possible.
Christina Fawcett, Senior Director of Real World Solutions, Digital Health
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