an emerging world of digital medicines: a multi-episode study

Delivering Digital Drugs

Delivering Digital Drugs: A project funded by Research Councils UK (RCUK/EPSRC) ‘New Economic Models in the Digital Economy’ programme

An emerging world of digital medicines: a multi-episode study

Tony Cornford1 & Valentina Lichtner2

Kings Fund Digital, 5 July 2016 1 Department of Management, London School of Economics2 School of Healthcare, University of Leeds

ConclusionThe StudyBackground Methods Findings

An emerging world of digital medicines: a multi-episode study

www.digital-drugs.org

Point of Departure

Digital materiality: The nature of things (e.g. medicines) as they become (more) digital and more active/connected (with digital agency)

Medicines as hybrids – part chemical, part physical, part informational, part digital (with agency)

Technology in practice: Technology as revealed in the doing (e.g. technology of medicines) (Orlikowski 2000)

Methods Findings ConclusionThe StudyBackground Methods Findings

Point of Departure

Digitalization

“Simply put, digitalization refers to the encoding of analog information into a digital format and the possible subsequent reconfigurations of the socio-technical context of production and consumption of [..] products and services.

Digitalization can happen [to] three broad types of artifacts, physical objects, routines, representations.”

(Yoo, 2012)

Methods Findings ConclusionThe StudyBackground Methods Findings

Aims and scope

• Digitalization is often seen to promise making the supply and use of medicines more effective, safe and efficient, and as a way to better healthcare (?perhaps cheaper healthcare?)

• This is predicated on task oriented software, new devices and new digital representations and data infrastructures

• Trials, Pilots, Assessments and Evaluations usually focus on digital interventions for specific tasks: e.g. DSS in prescribing, administration with bar codes, adherence with smart phones

• Our aim is to investigate the digitalisation of medicines themselves within and across the overall system, and proposing active roles for digital medicines (their digital agency)

Methods Findings ConclusionThe StudyBackground

Presenter

Presentation Notes

The digitalisation of medicines supply and use --------focus on medicines, rather than technology or tasks New technology is introduced to make supply and use of medicines more effective, safe and efficient, and produce better healthcare (generate ‘value’).

Methods

An Exploratory study

Qualitative/interpretative approach

Interviews, Observation, Documentation

Purposive sampling of ‘Episodes' in the life of a digital medicine – from factory gate through clinical settings to bodies and then data points

“Follow the drug” (not the task/workflow, the patient or the disease)

Using Tracer drugs

Making and re-making maps as elicitation devices

Methods Findings ConclusionThe StudyBackground

Presenter

Presentation Notes

This is the project 2 years…

Study design: follow-the-drug in a multi-episode study

5 Episodesregions where digitalisation (reconfigurations) occur

• Supply Medicines• Hospital Medicines• Patient Medicines• Research Medicines• Pharmacovigilance Medicines

( plus Community Medicines)

Methods FindingsBackground ConclusionThe Study

Presenter

Presentation Notes

Our research design has two main distinctive elements: five studies of the phenomenon of digitalisation of medicines (as we explain below, we call these episodes ), and three medicines followed across the five studies (we call these exemplar drugs). We planned our investigation as a ‘multi-case study design’ where each of the five cases represents an episode of the digitalisation of medicines along the chain of supply and consumption.

Patient Medicines

Drug discovery

Trial

Approval

ManufacturingSupply Chain

Retail

Prescribe

Administer Patient

Research Medicines

Pharmacovigiliant Medicines

Supply MedicinesHospital Medicines

GP / Community


Dispense

‘Follow the Drug’;

Presenter

Presentation Notes

The 5 cases

‘Follow the drug’ - tracer approach3 Exemplar medicines: selected tracer drugs followed across the five episodes –

– pain killers – anticoagulants – antibiotics

Tracers: Objects to follow through the organisation to investigate processes across times and stakeholders, to gather information about the whole (Combey 1980)Used as “both a source of data and as a means of sampling key participants” (Hornby and Symon 1994)


Presenter

Presentation Notes

In tracer studies of organisations, individual tasks or objects are followed through the organisation to investigate processes across times and stakeholders, as a way of gathering information about the whole of the organisation (Combey 1980). As such, data is not collected exclusively about these tracers – e.g. about the 3 drugs selected for our project. Rather, they are the starting point for expanding and connecting the investigation – e.g. to other drugs where digitalisation adds value in specific episodes. As tracers, the exemplar drugs are used as “both a source of data and as a means of sampling key participants” (Hornby and Symon 1994). Thus, the chosen drugs are not our exclusive unit of analysis within each episode, but they do provide a sort of ‘minimum dataset’ that should facilitate mapping across the episodes along the chain of supply and consumption.

Patient Medicines

Drug discovery

Trial

Approval

ManufacturingSupply Chain

Retail

Prescribe

Administer Patient

Research Medicines

Pharmacovigiliant Medicines

Supply MedicinesHospital Medicines

GP / Community


Dispense

Tracers across five episodes

Presenter

Presentation Notes

The 5 cases

New worlds,New maps

Mappa Mundi, Hereford Cathedral, circa 1300

See:http://www.herefordcathedral.org/visit-us/mappa-mundi-1

Methods Findings ConclusionThe StudyBackground Methods FindingsBackground ConclusionThe Study

http://www.herefordcathedral.org/visit-us/mappa-mundi-1


Hospital medicines


electronic prescribing

GS1

mobile apps as reminders for patients

decision support for

precise dosingdm&d

decision support for pharmacogenomics

electronic discharge

summaries

robotic dispensing

barcode scanning for

administration of medicines

data - for patient care, audits, research, …

Hospital medicines

mobile apps as reminders

for HCPs

Integration/communication

Digital medicine hybrids are often fragmented, constituted by multiple digital resources (e.g. databases, evidence summaries, protocols, DSS etc)

This fragmentation is for both good and bad reasons

The hybrid ‘identity’ is more often tied to task, than to episode or the wider system.

Integration or unification per se is (probably) not the answer.

Background Methods ConclusionFindingsThe Study

Digital value

The digital agency of medicines has potential to directly generate value by enabling:

1) control 2) efficiency (automation) and 3) precision

Each implies some “reconfigurations of the socio-technical context”

Broader impacts may emerge from

1) access to information, 2) stronger system feedback, 3) more active patients.


Conclusion

• Medicines are central to contemporary health care.• New medicines offer hopes for improvement in care

delivery, • So too can ‘digital enhancement’ of those we already

have. • So far, this field has been predominantly concerned

with digital initiatives based around tasks. • Understanding medicines as hybrids (‘digital

medicines’) that generate value across contexts offers a valuable lens to help practitioners and policy makers work for improvement goals.

• Our work contributes necessary andcomplimentaryfocus on the medicine itself.


Acknowledgements

RCUK as funders

Dr Tony CornfordDr Ela Klecun Dr Will Venters Dr Ralph HibberdDr Jane Dickson

London School of Economics and Political Science

Professor Bryony Dean Franklin

UCL/Imperial College Healthcare NHS Trust

Dr Paul Taylor UCL

Ann Jacklin

Dr Simon Taylor Brunel University

Professor Nick Barber The Health Foundation


Presenter

Presentation Notes

The funders and the team

References• Lichtner, V, Hibberd, R, Cornford, T. (2016) Networking Hospital ePrescribing: A

Systemic View of Digitalization of Medicines’ Use in England, 13th International Congress in Nursing Informatics, (NI2016) Geneva– June 25 to 29 2016

• Combey, P. (1980). A tracer approach to the study of organizations. Journal of Management Studies 17(1): 96-126.

• Cornford, T. and Lichtner, V (2014) Digital Drugs: An anatomy of new medicines. In: Doolin, B, Lamprou, E, Mitev, N, McLeod, L, (eds.) Information Systems and Global Assemblages: (Re)configuring Actors, Artefacts, Organizations. IFIP Advances in Information and Communication Technology, (Vol. 4). Springer, 149-162.

• Hornby, P. and G. Symon (1994). Tracer studies. Qualitative methods in organizational research: A practical guide. London, Sage: 167-186

• Orlikowski, W.J. Using Technology and Constituting Structures: A Practice Lens for Studying Technology in Organizations. Organization Science, 11, 4, 2000: 404-428.

• Yoo, Y.: Digital Materiality and the Emergence of an Evolutionary Science of the Artificial. In: Leonardi, P., Nardi, B., Kallinikos, J. (eds.) Materiality and Organizing: Social Interaction in a Technological World, pp. 134-154. Oxford University Press, Oxford (2012)


Tony CornfordDepartment of ManagementLondon School of Economics

[email protected]

www.digital-drugs.org

mailto:[email protected]

an emerging world of digital medicines: a multi-episode study

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