Delivering Digital Drugs (D3)

Lead Research Organisation: London School of Economics & Pol Sci
Department Name: Management Department

Abstract

This research pioneers a new area of study, that of digital drugs. It brings together people with different backgrounds to share knowledge and understanding about current and future developments in how medicines are used and the digital systems they are embedded in. Using theories and models from studies of the digital economy - concepts such as digital materiality, platforms, digital business models, open innovation - we set new agendas for researchers, business and NHS managers, clinical professionals and policy makers. We will enable better strategy-making among key stakeholders as well as spurring further research.

Until recently most medicines were developed, tested and licensed for specific uses, and manufactured and distributed in standard doses. But things change with new developments in the ways that medicines are developed, supplied and used and new policy for patient-centric care. Much of this change is dependent on using information technology, networks, databases and other kinds of software to help safely and efficiently deliver the right medicines for patients and the right information for all stakeholders. Thus as people work with and use medicines, they work with not just a specific chemical or molecule in a standard dose, but with a lot of digital resources and information services that let them refine these uses. Medicines are now a hybrid, in part physical product (a chemical), part an informational product (data and information), and part a service (algorithms) that a user interacts with.

Still, medicines are often not used to their full potential or safely; research estimates that 1 in 5 of hospital admissions are related to inappropriate use of medicines. Error rates in medicines use are high, sometimes leading to serious harm. The toll from misuse of medicines may be reducible by applying digital technologies - a more intensive digitization. The UK NHS has, for example, undertaken major projects in the last decade to computerise prescribing and the transmission of prescription data for both GPs in community settings (primary care) and in hospitals (secondary care), as well as to improve patient understanding of their medicines and thus their ability to participate actively in taking them.

This project will map out the full range of digitisation initiatives underway today. We will study in more depth a carefully selected set of about five examples. To collect this data and analyse it, and to provide a detailed overall model of the digitization processes at work (the why, and the how), we will need to develop some new tools to describe medicines in their digital character. Here we can borrow a number of contemporary ideas from other studies of the digital economy, innovation and business models. These tools and models, which we will document and distribute, will be useful for other people who want to understand digital drugs and other complex products and services that are changing as they embody more data and connectivity.

This research is useful and important. It may help to address the needs of our aging population with multiple, treatable chronic (long term) diseases such as diabetes or high blood pressure. New medicines will become available that depend on data rich and multidisciplinary practices, flexible and reliable supply chains, and active patient participation. They will draw upon medicines' digital resources and be delivered through new business models, perhaps very different from today. Three examples illustrate these ideas; 1) the kinds of smart pills that transmit data from inside your body to a mobile phone as they are taken and help to ensure that you take the right dose at the right time; 2) innovative patient centred information systems as a basis for new approaches to managing diabetes in the community, 3) the potential of replacing high street pharmacies with a small number of an 'Amazon' type online supplier.

Planned Impact

The impact of this project is seen through its ability to connect and respond to various constituencies of academic, business and clinical users/managers who share an interest in the future of medicines and their informational infrastructures. The rate of change in the sector and the degree of new innovative digitisation initiatives create an as yet unmet need for support and sharing of relevant and applicable conceptual structures. We will offer this diverse set of actors applicable theories and models of digital change, their own networking opportunities and shared agenda setting, and a means to establish negotiated common goals.

This project aims to meet these diverse needs as well as to work to foster and extend the UK's significant role as a producer of novel and innovative pharmaceuticals and its reputation as an innovative, responsive and safe user of them. We see policy makers and senior manages within the NHS. in associated suppliers and professional regulatory bodies and organisations with a desire to refine their understanding of the potential for beneficial change and of the new business models emerging. We still see constituencies that are confused or even dissuaded by the difficulty of framing and sustaining digital initiatives. Our research agenda will deliver tangible and applicable benefit to these primary stakeholder groups who include software and service suppliers, policy makers, professional bodies, patients and their representatives and regulators in health care.

This work is exploratory and opens up a new field of study, to support this we will have a well chosen and appropriate Advisory Board with industry and practitioner members and engage with the wider public debate through Public Lectures. We undertake many engagement activities and purse an active on-line strategy using video, blogging and targeting the trade press. Our Open Conferences will be designed to attract and inform practitioners, managers and policy makers in this area. Their interests will also be served by he production of the Policy Briefs and patient oriented resources.

One of the impacts we should have is to catalyse more research, and more focused research that can respond to identified stakeholder needs. This research should also establish a set of models and approaches for others industries or sectors to consider as they too evaluate and perhaps embrace new digital business models and as digital materiality becomes embedded in their new work practices.
 
Title 'I am not a diabetic' (short film) 
Description The film (approx. 7 mins) was made as part of the project. The film centred round a man who has been recently diagnosed with adult onset type 1 diabetes and it is his story of how he copes on a daily basis. In particular, he has developed an API to upload and collate all of his glucose and insulin readings online but, while he does this everyday, he ultimately wonders whether all this data will be of much use to anyone. The video was informed by a series of interviews with the participant and was filmed with his agreement, at his work, his home and socialising. 
Type Of Art Film/Video/Animation 
Year Produced 2015 
Impact The film is available online and as an LSE product. It was first shown at a workshop. 
URL http://blogs.lse.ac.uk/ddd3/i-am-not-a-diabetic/
 
Title A Warfarin Dosing App 
Description A short video interview with a consultant pharmacist talking about the warfarin dosing app she commissioned. This app is intended for junior doctors and other prescribers as an aid to dose calculation and as a way of sourcing Trust protocols easily and effectively, producing better patient outcomes in a speedy, mobile way. 
Type Of Art Film/Video/Animation 
Year Produced 2017 
Impact Collaboration with the pharmacist and Healthcare Trust. This video will reside on a special warfarin website, intended to deliver impact after the project has finished. 
 
Title Interview with Nick Barber part 2: The New Medicines Service 
Description This is part two of an extended interview with Professor Emeritus at UCL, Nick Barber on the medication warfarin. Part two concerns the New Medicines Service and how this impacts on the medication warfarin. 
Type Of Art Film/Video/Animation 
Year Produced 2017 
Impact This short film is intended to be included on a website currently in production, dedicated to the material culture of warfarin, one of the drugs we followed and the way it has become a digital drug in recent years. It is intended to inform and educate. 
URL http://blogs.lse.ac.uk/ddd3/warfarin-and-the-new-medicines-service/
 
Title Interview with Nick Barber part 3: Warfarin as a Digital Drug 
Description This is part 3 of an extended interview with Professor Nick Barber, Emeritus of UCL School of Pharmacy on warfarin. It includes how pharmacists view the medicine digitally and materially. 
Type Of Art Film/Video/Animation 
Year Produced 2017 
Impact This short film is intended to be included on a website currently in production, dedicated to the material culture of warfarin, one of the drugs we followed and the way it has become a digital drug in recent years. It is intended to inform and educate. 
 
Title Interview with Nick Barber, part 1: The Pharmaceutical Gaze 
Description This is part one of an extended interview with Professor Emeritus at UCL, Nick Barber on the medication warfarin. Part one concerns a paper he wrote a few years ago and is an interesting introduction to what and how pharmacists 'know' medicines. 
Type Of Art Film/Video/Animation 
Year Produced 2017 
Impact This short film is intended to be included on a website currently in production, dedicated to the material culture of warfarin, one of the drugs we followed and the way it has become a digital drug in recent years. It is intended to inform and educate. 
URL http://blogs.lse.ac.uk/ddd3/warfarin-and-the-pharmaceutical-gaze/
 
Title Life signs 
Description As part of our process of following the drug, we interviewed people who research, prescribe, develop apps for and take warfarin. This is the first of a series of short films revealing how people construct knowledge about the medication. This first film features a genetics researcher, Dr Harsh Sheth, who works at Newcastle University and whose ground breaking research could change the way warfarin is prescribed and taken. 
Type Of Art Film/Video/Animation 
Year Produced 2016 
Impact This film has acted as a point of research for the project and it has establised links with a research group at another university. The film iself is informative and will aaact as a source of information sited on the website. This should continue after the project has finished. It is also the first film in a series for which we intend to publish a seperate website for information and further links to academic work on medications. 
URL http://blogs.lse.ac.uk/ddd3/life-signs/
 
Title Participant Interview Videos (from workshop 2) 
Description During the second workshop (5/11/15) we invited 5 participants to be videoed talking about digital drugs. This resulted in 5 short videos. 
Type Of Art Film/Video/Animation 
Year Produced 2015 
Impact Participants suggested that these videos gave them an opportunity to reflect on the connections between their work and ours. 
URL http://blogs.lse.ac.uk/ddd3/workshop-participant-videos/
 
Title Participant interview videos (from workshop 1) 
Description During the first workshop (19/05/15) we invited participants to be videoed answering a number of questions regarding digital drugs. Three videos were made and are available to view on the website. 
Type Of Art Film/Video/Animation 
Year Produced 2015 
Impact The videos are part of our research portfolio, and also contribute to participant and wider engagement. 
URL http://blogs.lse.ac.uk/ddd3/workshop-videos/
 
Title Photograph Database 
Description Database of 400+ images for use on the website, leaflets and posters. 
Type Of Art Image 
Year Produced 2015 
Impact Images from the database were used in promotional materials including the Twitter and website accounts, leaflets and workshop advertising. One image in particular forms the central identity of the project. 
 
Title Project leaflet 
Description The project leaflet serves to both advertise and inform interviewees, members of the general public and interested people regarding the project. 
Type Of Art Artefact (including digital) 
Year Produced 2015 
Impact Because it is well designed and written, it serves as one public 'face' of the project especially to reinforce the identity of the project and disseminate information about it. 
URL http://blogs.lse.ac.uk/ddd3/files/2015/03/15_0212-D3-Leaflet-Visuals4.pdf
 
Title The History of Warfarin 
Description This is a short film documenting the history of one of the most prescribed medicines in the world: warfarin. It is not meant to be extensive, but it has a great origin story, set in the prairies of Canada and the US in the 1920s and the film goes on to talk about some interesting entanglements with world leaders. 
Type Of Art Film/Video/Animation 
Year Produced 2017 
Impact This short film is meant to be educational, instructive and entertaining (but not exhaustive). It is intended to live on the LSE hosted blog for as long as possible and on a specially dedicated website thereafter. 
 
Description The central idea of this project, that medicines are changing and becoming more digital in their essence, has attracted interest from practitioners and policy makers. Digital medicines are supplied in different ways, used in different ways and experienced by patients in different ways. The computerization of the past two decades has been very 'task' focused (e.g. prescribing, administration, adherence). Policy and practice in the decades ahead needs to be far more integrated and developed around the digital drug itself.
Exploitation Route We have seen some early evidence of influence on policy making (NHS England), and on how NHS hospital trusts plan for managing medicines - their 2nd largest operational budget. We have also had some discussion with the software side of the industry e.g. app developers, and we expect to develop this further in the final phase of the project and in follow-up work.
Sectors Healthcare,Manufacturing, including Industrial Biotechology,Pharmaceuticals and Medical Biotechnology
URL http://blogs.lse.ac.uk/ddd3/
 
Description Findings from this work have informed some aspects on ongoing NHS England policy. In particular one Co-I (Dr Valentina Lichtnre) has been seconded for 6 months to NHS Digital to work on the analysis of Incident report data from NRLS. In particular incidents of harm or near misses) as it relates to medicines and the use of technology. This work may inform the development of this aspect of the National Reporting and Learning System (NRLS -https://report.nrls.nhs.uk/nrlsreporting/ )
First Year Of Impact 2016
Sector Healthcare
Impact Types Policy & public services
 
Description Reviewer for NHS Digital
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
Impact Tony Cornford (D3 PI) was an invited member of the panel that reviewed and recommended funding for applicant for the Global Digital Excellence funding for NHS secondary care trusts in England.
URL https://www.england.nhs.uk/2016/08/centres-digital-excellence/
 
Description EPSRC Impact Acceleration Account - Knowledge Transfer Secondment (KTS)
Amount £38,879 (GBP)
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Academic/University
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 05/2016 
End 10/2016
 
Description H2020-MSCA-IF-2016
Amount € 276,107 (EUR)
Funding ID 740131 
Organisation European Commission (EC) 
Department Horizon 2020
Sector Public
Country European Union (EU)
Start 12/2017 
End 12/2020
 
Title Photographic Database 
Description Database of 450+ images for use on the website, leaflets and posters. 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact Images from the database were used in promotional materials including the Twitter and website accounts, leaflets and workshop advertising. One image in particular forms the central identity of the project. 
 
Description Collaboration in NHS training videos 
Organisation Imperial College Healthcare NHS Trust
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Hospitals 
PI Contribution As a result of working with a pharmacist on the British National Formulary (BNF) research, Jane Dickson was invited to film NHS training videos.
Collaborator Contribution The videos aid training of clinicians in the handling of bed bound patients.
Impact More appropriate training of medical staff in hospitals with visual examples.
Start Year 2015
 
Description Collaboration with the Norwegian University of Technology (NTNU) 
Organisation Norwegian University of Science and Technology
Department Department of Computer Science
Country Norway, Kingdom of 
Sector Academic/University 
PI Contribution Collaboration between W. Venters and R. Hibberd of the London School of Economics and Political Science with E. Parmiggiani of the Department of Computer Science at NTNU
Collaborator Contribution Collaboration in development of theory around emerging infrastructures underlying the European Union's Falsified Medicines Directive. This work forms part of the D3 project's interest in the counterfeit of medicines.
Impact Submission of paper to the European Conference on Information Systems 2017 entitled, Politics of Repair in Medicines Supply Networks: Harnessing Fear of Falsification.
Start Year 2015
 
Description D3 Project Outreach at Wellcome Collection - Mapping My Drugs 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact An afternoon workshop with members of the general public in which participants were invited to map the questions and activities they undertake in managing medicines. The aim of the workshop was to both promote the project and also to support further data collection.
Year(s) Of Engagement Activity 2016
 
Description D3 Workshop on Collaboration with the Karolinska Institute on Research into Digitalisation of Drugs 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact A workshop was held between members of the D3 project team, members of the Swedish Karolinska Institute and previous workshop attendees with an interest, to explore potential opportunities for future collaborative research. The event involved presentations of current work from both the D3 project and also from other workshop attendees, and looked at the development of a future research agenda. A number of potential avenues for future research were suggested which could draw in work from both Europe and Africa.
Year(s) Of Engagement Activity 2016
 
Description D3 Workshop on DIY Health Technologies (9th May 2016) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Workshop Themes: histories of Technology and Empowerment in Health Care; roles for citizen science in digital health care; open devices and patient empowerment; apps, adds and platforms. From 'lay perspectives' to patients who know and do to providing care in the borderlands of hacked health.

Keynote: Jeremy Greene (Johns Hopkins University) speaking on "The Analog Patient: DIY Medicine Before the Digital Era"
Year(s) Of Engagement Activity 2016
URL http://blogs.lse.ac.uk/ddd3/2016/04/21/d3-workshop-on-diy-health-technologies/
 
Description D3 Workshop on Usability, Safety and the Marketplace 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Workshop Themes: Usability and errors - how much do we really know. The history of usability in NHS and beyond. Dimensions of usability and usability processes. Usability issues for digital drugs. The enduring but evolving link between usability and safety in digital health. Can usability be left to the marketplace or who owns usability?
The Keynote speaker was Ross Koppel from University of Pennsylvania.
Year(s) Of Engagement Activity 2016
URL http://blogs.lse.ac.uk/ddd3/2016/04/13/d3-workshop-on-usability-safety-and-the-marketplace/
 
Description D3: research findings to date (feedback to NHS Trust and research participants) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Valentina Lichtner presented preliminary findings from the Delivering Digital Drugs research project at the MEDICINES MANAGEMENT & PHARMACY SERVICES COMMUNICATIONS AND STRATEGY MEETING (4 August 2016, 2 - 4pm) in the NHS hospital Trust where data collection took place in the period Feb-July 2016. The meeting was attended by 20+ pharmacy managers and executives, with nursing and medical managers.
Valentina distributed handouts of the presentation and four briefs summarising four of the emerging themes.
Year(s) Of Engagement Activity 2016
 
Description Roundtable Discussion on Digitalisation of Healthcare, Personalised Medicine, and the Law 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact The Roundtable was hosted by Prof Graham Dutfield (School of Law) and Dr Valentina Lichtner (Faculty of Medicine and Health) at the University of Leeds as part of the Emerging Technologies Research Group seminar series. The purpose of the event was three-fold:
(1) To explore the interactions between the digitalisation of healthcare and the law.
(2) To enhance interdisciplinary engagement at the university concerning issues having enormous societal implications.
(3) To identify areas of mutual interest that could form a basis for cross-disciplinary research grant applications
The event was attended by academics and PhD students from Law, Medicine & Health, Computing, and Ethics, as well as representatives of HSCIC and NIHR DEC.
Year(s) Of Engagement Activity 2016
 
Description The Warfarin Project 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact This website is focused on research round 'following the drug' methodology. It is dedicated to warfarin and the research we did on the medication in different settings. In particular, it showcases the videos we made. These are a good way of presenting research in a different way and to different audiences. It is particularly important to have an ongoing website because LSE will only host our project website for about a year (although it will be cached). It it also an alternative way to keep focus on the team of researchers involved.
Year(s) Of Engagement Activity 2017
URL http://ejdickson6.wixsite.com/thewarfarinproject
 
Description Twitter Account 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Twitter account (@D3project) with, as of 13th February 607 tweets, and 180 followers. Other accounts link to and re-tweet the things we post and the account is valuable to drive traffic to the more substantial blog and website.
Year(s) Of Engagement Activity 2015,2016
URL https://twitter.com/
 
Description Visit (University of the Third Age, Ivybridge, Devon) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact A presentation to the senior citizens attending the University of The Third Age. The talk was entitled
'Delivering Digital Drugs: How computers may make medicine more effective'
Year(s) Of Engagement Activity 2015
 
Description Website and Blog 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The website has 43 pages (including the blog) and has achieved a total of 7,667 views to date. This has provided information for workshops engagement and has a worldwide engagement. We have posted 217 blog posts as of 13th February 2016.
Year(s) Of Engagement Activity 2014,2015,2016
URL http://blogs.lse.ac.uk/ddd3/
 
Description Workshop Researching Digitalization (19/05/2015) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A one day research workshop on the theme of Researching Digitalization was hosted by the D3 Project at the London School of Economics.
Participants were invited to address two interconnected issues: the processes of digitalization and the doing of digitalization research.
Two panels with 3 speakers in conversation with 2 rapporteurs each formed the structure of the day. Additional team members from the project also spoke.
Year(s) Of Engagement Activity 2014
URL http://blogs.lse.ac.uk/ddd3/files/2015/05/D3-Workshop-Programme-19May2015.pdf
 
Description Workshop presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Panel Presentation
A Tale of Two Apps: Collective Individualism and Bridging
Presented at the Patient Activism & Digital Technology Workshop at Sussex University
21st June 2016
Year(s) Of Engagement Activity 2016
 
Description Workshop: Making Medicines Digital (5th November 2015) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The focus of the workshop was on the multiple ways that medicines are rendered in digital systems, and the proximal and cumulative emergent effects. We are also examined the implications of considering medicines as 'new technology', and in particular the consequence of drugs becoming (by degrees) a digital technology.

Contributions related to aspects of the processes of digitalization of drugs. Work from the D3 project was presented. We also had a keynote from Professor Johanna Westbrook from Macquarie University, Sydney. As ever, our aim was to generate and test ideas and to learn from people working in related areas and using diverse approaches.
Year(s) Of Engagement Activity 2015
URL http://blogs.lse.ac.uk/ddd3/files/2015/09/D3-Workshop-invitation-November-2015-v2.pdf