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From left: Dr. Cheryl Pegus of Walmart, Dr. Sachin Jain of SCAN Health Plan and Matt Holt of The Health Care Blog at HLTH 2022

The HLTH 2022 conference in its fifth year was more expansive than ever before. The conference at the Venetian Expo included drug developers, diagnostics and medtech companies, each with an assortment of health tech components. There was also a great deal of content on the consumer experience in healthcare, mindfulness and wellness both in the form of sessions as well as sponsors. It was also the first year HLTH presented the conference in an open plan setting, which worked surprisingly well.

The conference attracted 2,500 healthcare CEOs, with one-third of the estimated 9,000 attendees coming from the C-suite of their businesses. HLTH also made the splashy announcement that the event producer would debut a European version of HLTH in Amsterdam in 2024. 

Here’s a look at some of the themes of the event.

The clinician exodus in healthcare and what can be done to improve it

After years of consolidation, particularly health systems acquiring hospitals and physician practices, Sachin Jain, SCAN Group CEO, described the toll these deals have taken on physicians as part of a wider conversation with Walmart EVP Health and Wellness Dr. Cheryl Pegus.

“The job of being a front-line clinician is no longer what we imagined it to be in medical school – building meaningful relationships with patients that are long lasting and that produce great outcomes for patients…I would say that with the largest health systems, in many ways, their management infrastructures have not kept up with the needs that they have. We used to have health systems where doctors used to know each other, where they could just pick up the phone and get things done for their patients. We’ve added a lot of bureaucratic red tape as organizations have gotten bigger and bigger and bigger, so that the average physician in a large health system feels anonymous, invisible, and even lonely. They don’t necessarily feel like they have agency or mastery over their work anymore because it’s complex and it’s been made complex in ways that aren’t value-add for patients anymore.”

Pegus observed that last year, over 300,000 healthcare professionals left medicine – over 120,000 were doctors in many different areas.

“[They left] not just because there’s a lot to do. We’ve introduced two times the number of treatment modalities and have allowed no room for people to take that science and put it into practice. If you continue to push that innovation, which we’re all hoping for, into a very narrow funnel, something has to give.”

For Pegus, the solution is to add more clinicians to the care team to support physicians at Walmart. She pointed out that Walmart has come to be a place people in rural communities can rely on for their healthcare and reminded the audience of the role big box pharmacies like Walmart played in providing Covid-19 testing and vaccines. 

SCAN, which serves patients on Medicare Advantage plans, is expanding into new markets, such as Texas, driven by invitations from local health systems and medical groups who align with SCAN’s approach. It also has initiated a program to deliver care to homeless older adults called Healthcare in Action.

Hybrid approaches to care

There was also the recognition that even as they leave traditional hospital settings, physicians are still interested in practicing medicine. Virtual care companies such as Wheel and MD Integrations are providing a way for some of these physicians to continue to practice and set their own hours. Elsewhere at the conference, health tech companies presented refined approaches to natural language processing and clinical decision support tools with the goal of making the job of physicians easier, saving them time, and helping patients get healthier.

In a session discussing different forms of primary care, Zak Holdsworth, co-founder and CEO of Hint Health, acknowledged that the healthcare consolidation trend worries him.

“We are trying to make primary care a revenue generator rather than the heart of healthcare,” said Holdsworth. “We need to make payments predictable and avoid layering additional administrative burdens.”

Another aspect of the care delivery discussion that intersects with the consumerization of healthcare is a growing number of hybrid care models. One of the challenges is that only 40% of physicians feel equipped to do virtual care. The goal is to balance delivering primary care through telemedicine or other types of virtual care with the acknowledgement that in-person care should be a critical component of primary and specialized care.

Assure Health sits at the intersection of virtual care and remote patient monitoring, delivering virtual-first care and helping patients manage chronic conditions. The company recently closed a $8.7 million Seed round from strategic investors. There are not enough endocrinologists to meet diabetes patients in person, so the company enlists the support of nurse care managers who engage with patients.

In an interview at the conference, COO and co-founder Craig Bolz said the business is leveraging devices that rely on cellular connections (rather than bluetooth) around diabetes, hypertension, COPD, and congestive heart failure.

Assure Health has also launched a comprehensive diabetes program where it takes full ownership over the diabetes disease state and can prescribe lab tests.

Bolz said the business has a fee-for-service side and value-based care side. In 2023, it plans to expand its value-based care business, supported by the recent fundraise.

Redi Health co-founder Like Buchanan explained that his startup helps patients improve the way they manage their chronic conditions, in part, by identifying pharmaceutical company programs patients may not be aware they are eligible to participate. Its app enables pharma manufacturers, health systems, and payers to integrate their patient support programs directly into the application.

CEO and bioengineer Jane Zhang founded Remmie Health and developed the Home Ear Monitor / Otoscope as a way to better address her son’s chronic ear infections. as part of the Plug and Play pavilion. The device has two functions, according to Zhang. Embedded with a camera, it works as a monitor to capture ear, nose, and throat symptoms. There’s also an app that helps parents track symptoms, images, and videos, which can be shared with a physician through software plug-ins such as MyChart. Chief Commercial Officer Lorren Wyatt joined the company two years ago — HLTH marked the first time the two met in person.

Among the milestones Remmie Health achieved was a deal with Medtronic Labs last year to provide the device to underserved markets in Asia to treat non communicable diseases. It’s also working on a device to assess hearing loss from noise pollution in these markets.

Based in Seattle with offices in San Francisco, Los Angeles, London, Remmie won an SBIR grant last month. The $350,000 grant from the National Institutes of Health’s National Institute on Deafness and Other Communication Disorders will be used to support the development of a deep learning diagnosis assistance engine for ENT diseases.

Health equity

In a panel discussion on different approaches to primary care, Dr. Kyu Rhee, senior vice president and Aetna chief medical officer with CVS Health, talked about the importance of promoting “techquity” or using health tech to promote health equity. He also urged newcomers to the space to embrace these tenets.

  1. “Ensure that your workforce represents the people you serve. One thing I’m very proud of at CVS Health is that 40%-50% of pharmacists and pharmacy technicians represent the people they serve and have made a difference with vaccine delivery across the country by brokering that trust.
  2. You have to collect race, ethnicity, and language data. Aetna was the first to do this. You have to collect the data to show the inequities that exist.
  3.  You need to have a health equity dashboard as standard when you do assessments and contracts to reduce the disparities.
  4. Need to ensure AI is ethical and transparent.
  5. It’s not enough to know; you have to be prepared to act.”

Intersection of mind and body 

The connection between our state of mind and how we physically feel was also a significant theme at the conference as many of us try to reduce the stress and anxiety that exploded with the onset of the Covid-19 pandemic.

Calm, a company that promotes breathing and other mindfulness exercises to help people reduce stress and anxiety, shared its plans to expand from its d2c business through its app into the b2b world. Calm Health and Calm for Business serve self-insured employers, health systems and payers. CEO David Ko noted that a combined 400 million people have downloaded the app or visited its website.

Ko pointed out that the first set of customers who used Calm did it mainly for meditation. Then people came to the app because they had trouble sleeping. But during Covid-19 pandemic they’ve seen a spike in users arising from depression and loneliness. As more people return to the office after years of working remotely, anxiety is increasing.

The recent launch of Calm for work seeks to make employees happier and healthier in the workforce, Ko said.

“Three thousand employers are coming to us to help with their workforce and employees. We wanted to take what we’ve done with Calm and bring that to healthcare.”

Lucid is another company focused on the mind but uses music therapy to help users relax, energize, and sleep. Based in Toronto, Ontario, the company is also working with research institutions to use music to manage symptoms of Alzheimer’s disease and work with patients’ caregivers.

Making diagnostics more easily accessible 

Meeting patients/consumers where they are was a theme that permeated several areas, not just primary care delivery. In-home testing has been on the rise for years, whether it’s for genetic testing, STDs, or more recently, Covid-19. Pouria Sanae, ixlayer CEO and founder, offered an overview of the company, which provides lab testing services to people through CVS Health and health systems, as well as testing as part of clinical trial support for CROs.

“The goal is to be a new layer that lives on top of diagnostic testing that integrates many different services, to power remote testing — in-home and in-office testing,” Sanae said. “We focus on preventive care and consumerization of healthcare.”

In 2018 when ixlayer launched, its first test was a polygenic Alzheimer’s test for Alzheimer’s patients’ family members. Since then, it has rolled out testing services for people with chronic conditions, such as Type 2 diabetes. The Covid-19 pandemic led the company to rapidly expand its testing capabilities. Among its customers are DNA testing business PlumCare, Him & Hers, and the U.S. Coast Guard. Its board includes Paul Martino, co-founder and chief strategy officer of VillageMD, David Shulkin, a former Secretary of the U.S. Dept of Veterans Affairs, and Moncef Siaoul, chief adviser to Operation Warp Speed — the public-private partnership created to speed up the development, manufacturing and distribution of Covid-19 vaccines, therapeutics and testing.

Food as medicine

The acknowledgement that access to fresh, nutritious food is a social determinant of health and plays a critical role in helping people manage chronic conditions has led to the launch of healthcare startups focused on this niche as well as initiatives by healthcare organizations. A panel discussion on this topic led to some compelling insights from players in the space on how making access to fresh, nutritious food could reduce the need for some medications to manage chronic conditions, making such programs cost effective.

Sven Gierlinger, chief experience officer with Northwell Health, deplored the quality of food hospitals and health systems serve to patients. He discussed an initiative to change that on a few fronts. Gierlinger said the health system made a commitment five years ago to serve food with the best ingredients available prepared by a team of chefs. The health system also began offering cooking classes to physicians in training so that they could appreciate the benefits of preparing their own meals. Northwell also formed a partnership with a 400-acre farm in Queens, New York.

“Incentives need to be aligned better – the U.S. health system isn’t set up to incentivize a healthy population,” Gierlinger said. “The food industry has to change and that’s where I think the government and policy need to work together or it will never move forward.”

To address food insecurity, Gierlinger noted that the health system connects patients to resources and community-based organizations through the Unite Us app.

Ashley Tyrner, FarmboxRx founder and CEO, shared that the company, which started in 2014, is moving into its third year of being offered as a benefit by health plans supporting Medicaid, Medicare and Medicare Advantage programs. Its condition-specific food boxes are designed by a team of Registered Dietitian Nutritionists to support the wellness of those with certain health conditions.

Tyrner said a health plan that piloted its program reported that FarmboxRx was an effective care management tool to engage members in their health and to spur them to get their flu shot. She also emphasized that it’s important for providers to make patients aware of their eligibility for Farmbox Rx.

Photo: HLTH

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machine learning AI

The evolution of machine learning is still in its early stages, but at the HLTH 2022 conference this week, companies shared how they are working to fine tune their approaches to AI. Those efforts included everything from improving the quality of patient data that underpin the algorithms, which has been criticized for not reflecting a diverse enough patient population, to making it easier for healthcare organizations to validate their effectiveness. Health tech companies also highlighted different approaches they are taking to how they work with providers to pilot machine learning algorithms and market them.

Dr. John Halamka, president of Mayo Clinic Platform, used his talk at HLTH to highlight an initiative to assess and reduce bias in patient data to improve the effectiveness of machine learning algorithms. Launched three years ago, Mayo Clinic Platform built an ecosystem to coordinate collaborations with health tech companies to enable innovation in healthcare.

Halamka’s talk on the “algorithmically underserved” noted that currently, when healthcare organizations use an algorithm, they often have no idea whether it performs well or not. The goal of its AI validation platform, Mayo Clinic Platform _ Validate, is to provide clinical validation for machine learning algorithms.

Mayo Clinic Platform is also partnering with other healthcare organizations to set standards and reporting for models as part of The Coalition for Health AI. In addition to Mayo, other founding members include University of California Berkeley, Duke Health, Johns Hopkins University, MITRE, Stanford Medicine, and University of California San Francisco. Industry members include Change Healthcare, Google, Microsoft, and SAS.

Halamka announced that a webinar is planned for December 7, which will offer a preview of plans for a public-private partnership to create a national register to assess the usefulness of a variety of healthcare algorithms.

“We feel we need a national set of assurance standards for algorithms,” Halamka said. The registry will host the metadata for algorithms produced in healthcare.

AI marketplace

Health tech companies are also developing marketplaces to improve the way collaboration partners, such as providers, payers and research groups, select algorithms.

“Data may be the new oil but the data needs to be refined,” said Wavemaker Three-Sixty Health General Partner Jay Goss. One of its portfolio companies, Gradient Health, partners with medical data providers around the globe (generally hospitals and imaging centers) to curate annotated medical images for AI research labs and corporations, so that they don’t have to do one-off deals with hospitals to obtain the data. Companies can search through segmented and labeled studies, or request a custom dataset, spending less time tracking down data and more time developing new tools.

AI hubs

Ferrum Health developed a program to enable health systems to assess machine learning algorithms without exposing their de-identified patient data to a cloud or otherwise forcing them to centralize that data. The company, which is part of the United Healthcare Accelerator 2022 cohort, exhibited on the accelerator’s pavilion.  Ferrum’s approach enables these tests to be done on-premises, behind a firewall, an approach David Miller, Ferrum’s vice president of sales – West, said is designed to de-risk their business for hospitals and health systems. The algorithms in its marketplace are FDA approved.

“We run a test of the algorithms using the hospital’s de-identified patient data to show how they perform for them,” said West. “We let our clients try it before they buy it.”

The company’s four AI Hubs include: oncology, orthopedics, cardiovascular, and breast care.

Reducing physician burnout

DeepScribe exhibited as part of the Plug and Play accelerator’s footprint at the conference. Its automated physician natural language processing software automatically summarizes a physician’s conversation with their patient and auto-populates those notes into EMR fields. Among the EMR companies it works with are athenahealth, dr chrono, AdvancedMD and Claimpower.

Earlier this year, DeepScribe closed a $30 million Series A round to support the company’s growth. The business is designed to negate the need for an in-person medical scribe, saving clinicians money.

The validation approach to algorithms seems like a natural progression in machine learning, similar to the rise of digital health apps followed by the need to validate them to ensure adoption by healthcare organizations skeptical of overhyped tech. It’s a natural progression balancing the interest in machine learning with the recognition that healthcare algorithms are not created equal.

Photo: Hemera Technologies, Getty Images

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virtual care technology

Note: This article is part of a series exploring how to unlock the value of remote patient monitoring. The next article in the series explores how medical device companies are using RWE as part of submissions to regulatory bodies. We’ll explore how medical device companies are navigating this segment of the regulatory landscape.

Patient engagement is a critical component of remote patient monitoring. Part of real world evidence (RWE) collection involves patient-reported data. But if medtech companies are to build a collaborative relationship with patients, building trust is critical to get opt-in to share their data. If patients understand why their data is needed and how it will be used, they will be more likely to view this request in a positive light. They’ll see this as a way to help them manage their condition and not as a cynical transactional relationship.

As well as ensuring that accurate, timely data is collected from devices, capturing patient reported outcomes (for example, chronic pain) is also important to build a fuller view of the patient. In a recent webinar on remote patient monitoring and RWE, sponsored by Huma, panelists discussed how they are using patient engagement to trigger earlier interventions, support patients through their care journey and de-escalate the stress and anxiety often associated with managing acute and chronic conditions.

Earlier interventions

One of the exciting opportunities in leveraging RWE and data insights for patients and clinicians is they can lead to earlier interventions for high risk patients. This patient population may include patients with multiple chronic conditions as well as patients recovering from surgery.

AliveCor uses biosensors to convert a smartphone into an EKG to track arrhythmias. This heart condition can be tough to spot in the relatively short window of a physician appointment because they are unpredictable. That spurs the need for data collection over a long period of time when arrhythmias can be detected. The goal of the company is not only to make it easy for patients to collect and share data to avoid a fragmented care experience, but to enable earlier interventions to avoid hospitalizations.

Dr. Archana Dubey, chief clinical officer with AliveCor, shared that by adding remote patient monitoring, the company reduced emergency room visits by 56%. It was also able to cut hospitalization for patients with arrhythmia by 68%.

“That is powerful. That is important … for a primary care physician to better manage and better understand the patients when they’re at home or in the workplace,” Dubey said. “It’s also important for payers because they care about total cost of care reduction.”

In order to provide effective early intervention for the portion of orthopedic surgery patients experiencing complications with recovery, it’s important for that insight to come within one week of surgery. Patient reported data is essential within the week following this surgery, according to Paul Trueman,  global VP for health economics and market access at Smith and Nephew. By receiving patient feedback on pain, mobility, and satisfaction through medical device RWE platforms, surgeons are better positioned to respond in a timely manner and, if possible, deliver better outcomes for the patient.

Trueman noted that the medical device industry’s ability to collect and build big data sets based on patient-reported outcomes as they recover from procedures is where the medtech industry can prove the value and effectiveness of their devices in the long term. 

“That’s where we start to get signals about overarching product performance, rare [adverse] events. We know that’s occurred in orthopedics in the past where we haven’t had that wholesale data collection – we either missed it as an industry or we found it too late. I think as we start to get more and more data or we recruit more patients …. we’ll start to get those signals a lot earlier and correct [problems] earlier as well.” 

As valuable as earlier interventions are, for clinicians to receive and act on data insights for high risk patients, alerts need to be managed in such a way that they don’t create alarm fatigue or otherwise add to the overworked physicians’ caseload.

Supporting patients

Patient engagement with their medical devices is also critical for more subjective measures, especially pain. Abbott’s Neuromodulation division developed the NeuroSphere platform to support virtual care and interactive data collection between patients who have received an implant as part of treatment for movement disorders such as Parkinson’s disease and/or chronic pain. 

What’s compelling about this platform from a medical device company is that physicians are able to adjust the patient’s implant settings remotely, based on patient-reported data. Abbott gets right to the sweet spot of the dynamics that can drive increased patient engagement and lead to better outcomes. If patients share data and express discomfort, that engagement will lead to a physician response, adjusting the settings of their implant, and help them feel and move better. This should empower patients and make them feel they can take an active role in managing their condition and potentially reduce their stress. So even patients in rural areas or where neurologists are in short supply can have the same level of access to physicians who receive their data and respond accordingly. 

Dr. Erika Ross, director of clinical and applied research of the Neuromodulation division at Abbott, noted that it’s incumbent upon the medical device manufacturer to balance the patient’s ownership of their own data with building interfaces so a clinician can use timely insights based on the patient’s data to make a decision in a short amount of time and communicate with patients as clearly as possible . 

“These small movements forward in truly understanding objectively what’s happening in a very subjective disorder, this is going to completely revolutionize an area like the chronic pain practice area,” said Dr. Erika Ross, director of clinical and applied research of the Neuromodulation division at Abbott.

The Covid-19 pandemic has played a role in making individuals more aware of their health and on the alert for symptoms related to the virus. That’s helped make people more engaged in their health generally. 

Alex Gilbert, who works in digital medicine at Huma, said Type 2 diabetes patients he’s working with are sharing data from their devices at a rate of 80%, which is an unusually high level of engagement for patients with this chronic condition. The implications are that when patients can see the benefits of sharing data to track and manage their condition they will be more likely to adopt medtech and companion digital health apps at a higher rate. That, in turn, will lead to more patients opting into sharing their information with both medical device manufacturers and hospitals. 

“It just pays to be very honest and clear about how data is being transferred and transmitted,” Gilbert shared. “We explain that to patients, we help them to understand the process that’s going on. We’ve actually spent a lot of time in terms of engaging them in the right way and getting them involved.”

De-escalating patient concerns

As the case of Abbott demonstrates, medical device manufacturers are taking on a larger role in patient engagement. It’s part of a slow but widening trend. That interaction is not only illustrated by changing a patient’s device settings in response to them sharing data. It is also reflected by medtech companies using patient data and feedback to de-escalate patient concerns.

Patients using Smith and Nephew’s devices receive an explanation from the company when they’re concerned about the pace of their recovery from surgery or concerns over developments like swelling and stiffness and how long those symptoms will last and give them a sense of the parameters of their recovery. 

“We’re not directly intervening,” Trueman explained. “But where we have signs and symptoms of an escalation of an infection, for example, we’re trying to give the patient enough insight and knowledge and education to actually know when to pick up the phone to [call] their provider.” 

To optimize patient engagement, it’s crucial for there to be synchronicity between medical device companies, patients, clinicians and payers. When medical device companies build an interface for their devices that supports data sharing between patients and clinicians, this can make it easier for patients to share meaningful data with clinicians and, passively, medtech companies. It can also help patients better understand their condition and motivate them to be more candid about the data they share with their clinicians and even medtech companies. By sharing more personal information in a timely manner, it could improve communication between clinicians and patients and avoid needless trips to the emergency room and reduce complications that lead to hospitalization.

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Healthcare is an industry designed to provide essential services and care for patients to improve their health and well-being. Over generations, the expertise of medical professionals has allowed the industry to continuously innovate and meet the ever-changing demands and needs of patients — ranging from spikes in mental health to safety concerns regarding an in-person doctor’s visit during a global pandemic. Most recently, the Covid-19 pandemic has shown the agility of the healthcare industry to innovate, as we have experienced a surge of medical startups emerging to accommodate new demands and gaps in the industry with digital innovations. There are a number of digital-first methods that improve the healthcare experience for patients, from remote patient monitoring to tech-enabled patient care, virtual reality in the operating room, and more.

As digital health companies solidify their services and technologies as a preference for many, and innovations continue to be developed, it’s critical for healthcare startups to understand the needs of patients and physicians. Companies can hear those important perspectives during innovation development for a successful product or treatment that ultimately propels the healthcare industry.

Improving R&D with the voice of patients and physicians

Many new medical tools and technologies being developed ultimately end up in a doctor’s office, prompting the need for startups to collaborate with physicians during the research and development phase. By engaging physicians in this critical stage, startups can ensure physicians feel confident in adopting and implementing the new innovations within their own practice.

Beyond verifying medical accuracy, physicians can provide exclusive insights to help navigate any number of strategic issues or healthcare challenges that may be unseen to a startup, as well as inform any gaps in a new tool or technology — such as a potential feature or add-on recommendation — based on what they are seeing in the field.

Complementing their medical expertise, physicians also serve as the voice of the patient; with a growing emphasis on tools and technologies being developed specifically for patient use and improved health outcomes, physicians are a valuable asset in informing startups with unique patient perspectives during the R&D phase. Physicians are in constant communication with patients, which provides them with a front row seat to their evolving healthcare needs and desires, as well as feedback or concerns regarding industry innovations at large. With an inside look into what patients need, and the ability to identify consistent trends among patient groups, physicians can share invaluable insights to startups that reflect today’s patient and help optimize new tools or technologies.

Maximizing go-to-market strategies

While the healthcare landscape is known for constant change, these transformations have created a new type of patient. Increasingly, patients are much savvier and more engaged with their personal healthcare journeys; and they are investing the time to become better informed about any health product, tool or treatment. As such, startups should approach their innovations and market strategy with the understanding that patients will do their own research and read the fine print before buying into a new product or technology.

While physicians can ensure medical accuracy during the R&D phase, moving forward these experts can help maximize startups’ go-to-market strategy. Particularly in healthcare, it can be challenging to simplify a new product or technology into layman’s terms without removing any critical medical information pertaining to use. Physicians can help startups identify key messages to include in communication and product materials, as well as common questions or concerns that may arise from patients to include in an FAQ. A physician’s — and startup’s — goal is to help patients, and by enlisting the support of physician expertise, startups can ensure easy-to-understand, transparent, and factual language within their go-to-market strategy to best reach patients.

Fuel startups with leading experts

Often, companies are challenged in sourcing the right expertise for a new project. And as the healthcare digital innovation market continues to grow at a rapid pace, time is of essence — however, startups cannot compromise real science. Thankfully, a national network of expert physicians can be found in one location.

By applying a gig economy model to healthcare innovation, flipMD from GoodRx is lowering the barrier for physicians and businesses to connect and collaborate through an easy-to-use online platform. Whether the latest innovation is in the research and development phase or ready to go to market, the on-demand marketplace for physicians allows startups to remain at the forefront of medicine and conserve their time in identifying the right expertise by posting a job with unique parameters to recruit experts from a broad range of specialties.

In today’s evolving healthcare industry and amid rising consumer demand, it’s important for startups to collaborate with physicians to successfully innovate while staying on track. Discover how to fuel your startups’ momentum by collaborating with expert physicians.

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Currently, according to Tufts researchers, clinical trials in a variety of therapeutic areas experience patient dropout rates close to 20%, with the consent process being the number one factor contributing to this figure.

Additionally, according to Advarra, “35% of patients who dropped out of a study early reported that it was difficult to understand the Informed Consent Form”.

It is critical that the consent process be tailored to ensure that participants understand what’s being asked of them and how their data will help further future disease treatment.

The Solution: eConsent

1. eConsent simplifies overly long and complex forms as it can be tailored to different audiences & have interactive, engaging elements.
2. Medable eConsent enables the enrollment of underrepresented and geographically diverse populations through remote consenting, something that has been shown to reduce screening timeline periods by 50%.

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