Richard Ashdown, Amplia Group; Catherine Skobe, Pfizer; Simon Fry, Springer Healthcare
The impact of the COVID-19 global pandemic on healthcare systems, colleagues, friends, and loved ones has been unprecedented and, in many cases, tragic. In thinking about digital innovation and the future, the effect of this pandemic will perhaps change our society forever in how we communicate in a variety of ways. Indeed, the speed, response, and efforts in tackling the ongoing crisis are testimony to the concerted effort of global human endeavor in the face of adversity. The breadth is extraordinary and includes:
- the early alerts system in Singapore used for COVID-19 notifications1,
- the Cytokine Storm research of Dr Fajgenbaum2, who suffers from Castleman’s disease
- the unified clapping for carers3,
- the extended internal and external collaborations and research responses by Amazon4,
- the unique track and trace technology partnership of Apple and Google5.
As much as digital innovation, in a broad sense, remains crucial in overcoming the challenges faced on divergent national and global scales, our industry also has a part to play. A report from the Global Web Index6 revealed how the pandemic has changed media consumption7. It took a pandemic to force the hand in digital communication growth in the medical communications sector that has been on a long, slow, and steady climb. Change and innovation is happening at both macro and micro levels, and this article aims to illustrate where these will have an impact on medical communications.
Technology’s Potential Impact on Peer Review and Preprints
Increasingly, as the more combative arguments about “track” and “trace” for COVID-19 show us, there remains an ongoing challenge about trust, specifically about trust in scientific and medical research as well as data ownership. If an aspect of the medical publishing world was ever in the spotlight, it must surely be the process of peer review. Concerns raised by government bodies8 may have been validated with recent high-profile COVID-19 publication retractions in the New England Journal of Medicine (NEJM) and The Lancet9. The traditional peer review model is again under pressure. Will innovation in collaboration drive change here? Is open peer review the answer? Perhaps the use and advocation of a blockchain as per Tim Mackey’s model presented at ISMPP West 2019, or the Digital Science and Katalysis project on blockchain10, would go some way to addressing the concerns expressed about peer review and data integrity11. And if there was ever a moment for blockchain to become mainstream, surely it is now? Could preprint servers with blockchain oversight resolve issues of trust?
The Chan Zuckerberg’s Foundation’s involvement in the preprint space12, with funding for medRxiv and bioRxiv, might suggest the technology corporations, through their not-for-profit arms, have an interest in accelerating research and supporting “Open Science” as an innovative agenda. The OpenAthens initiative13 and others are, again, attempts to remove barriers and connect people to research. Such innovation is perhaps more silent than the arrival of a new piece of hardware or software platforms but, nevertheless, remains fundamentally important in advancing research, understanding, and engagement.
The Societal Move to Work-from-Home
In the most obvious manifestation of change, many people are working from home and may continue to do so into the foreseeable future. This is a huge shift, not least in the pressure on secure information technology (IT) infrastructures allowing greater collaboration. It cannot be underestimated how sudden an action this was for many people and how the necessity to make the change may have galvanized organizations to adjust to a more flexible understanding of how and when we work. Some agencies are already ahead of this curve in accepting a better work-life balance for writers and researchers, so this change wasn’t too disruptive. It has also spawned software and apps to measure home time productivity14. At the National Health Service (NHS), the largest employer in the UK and the fifth largest globally, use of Microsoft Teams has surged by 800% according to NHS Digital’s figures.
Other than measuring productivity, perhaps agencies and companies will begin shifting to more dedicated collaborative writing tools such as Etherpad15 where the onus is on real-time functionality. It is worth visiting the various blogs16 to sense-check specific software. Commentators, however, are now beginning to talk about the downside of this new world17. Meanwhile, a clear advantage of using collaborative authoring tools is to solve the age-old problem of validating ICMJE authorship criteria 2 and eradicating guest authorship by holding authors accountable for their contributions.
New Digital Innovations in Health Care
Among the recently deployed digital innovations, the most obvious is the rise in telehealth (both in remote medical monitoring of patients and in company engagement with clinicians). Using artificial intelligence (AI) is no longer a distant fiction with the US Food and Drug Administration (FDA) having already opened the discussion with its proposed Regulatory Framework for Modifications to AI/machine learning (ML)-based Software as a Medical Device18. Notably, a leading proponent of teleheath, Babylon Health, used a study on causal machine learning19 to support its argument that AI can be used to improve diagnosis and, ultimately, patient outcomes. Although currently unavailable to the public, this is a clear step towards the integration of AI into medical practice. It will be vital for medical communication professionals to not only understand the mechanism of action of a drug, safety, and efficacy reporting, but also have general knowledge about medical-digital technology practices.
From a medical writing perspective, as discussed at recent ISMPP meetings, perhaps the greatest acceleration and direct impact on the profession will result from the use of Natural Language Processing in Scientometrics20. From an information gathering perspective, writers can already use services like Amazon’s Comprehend Medical21 to support research.
Data collection is ubiquitous in the digital age. Indeed, the idea of the intuitive health tracking wearable has existed since Apple announced its “health kits” back in 2014. Further, Dr. David Feinberg, Head of Google Health, believes Google is already a health company22. If further convincing is needed of the importance of health data collection and analysis, simply look at the big projects and sometimes subtle changes that the tech platforms have developed, anything from Google’s Project Baseline23, an “initiative to make it easy and engaging for people to contribute to the map of human health and participate in clinical research,” through to Apple’s watchOS being able to monitor hand washing24.
Perhaps less obvious is the slower public revelation of Amazon’s health strategy. Its health-care venture with Berkshire Hathaway and JP Morgan has indicated a clear business focus on what Amazon does best – supply chain dynamics. It will be interesting to see if and when “Prime Health,” short-hand for their branded approach to a health subscription service, is launched – connecting their different services and disrupting the traditional health landscape25. Amazon’s interest isn’t just in distribution, however. Alexa presents an opportunity for the use of voice technology in patient support, and Amazon is involved with projects focused on Diabetes26. Check out this Saturday Night Live comedy sketch27, which was perhaps more on point than they realized. Furthermore, at a Klick Health event, for the first time, Amazon VP Babak Parviz spoke publicly about the rising issue of loneliness28, suggesting this may be an ongoing focus. It will be interesting to see how Amazon’s foray into healthcare develops and when Alexa moves from a HIPPA-eligible to HIPPA-compliant device; in other words, dealing with the challenge of keeping privacy data secure. For the medical communications professional, validating these data and ensuring the rigor in which it is analyzed and reported will be vital for truthful reporting and for instilling trust.
As the macro forces of technology platforms have galvanized around us, often unseen29, the interface between these platforms and ourselves herald more obvious innovations30. The internet is, essentially, a “global system of inter-connected computers – which serve users information.” At its core, however, lies written, visual, or audio-based content; even an Alexa needs a writer. And remember, Google’s core user experience – and business model – is built around access to, and the consumption of, content31. This not only necessitates the need for content of rigorous scientific integrity to be accessible, and for the written form to work within the technology without reduction (the long form vs short form argument), it also opens the door for “citizen science”32 in which public participation and contribution to research encourages “democratization of knowledge production.” Our responsibility as participants in Open Science has never been more important. In many ways, the current public health crisis has shone a bright light on the question of science as a public conversation; social media discourse, in particular, focuses on plagiarism and fraudulent research33, and there are an increasing number of tools to help34 in the guardianship of content.
The Challenge of Change
As much as we might deploy systems and software to enhance experience in the “new normal” by improving collaboration and research, the permanency of these changes is still uncertain. At a granular level, there are tools that will help drive research and collaboration. At a macro level, the ever-increasing dominance of the technology platforms will eventually change the industry. Even so, it can be argued that there is a wider responsibility and opportunity to drive access to evidence-based content, whether generated by a machine or not. Perhaps it is here, almost subliminally, that the medical publications profession is actually taking the lead ̶ ensuring that accurate, authoritative content is delivered where and when needed most. In the immediacy of the pandemic, it is at this point of intersection with the digital ecosystem ̶ whether through device or web, through infographic, video, or in text ̶ that a population devoid of answers to the crisis look to be better informed. In the domain of “.health,” the need and strength of our profession has never been greater.