A lung cancer patient wakes up one morning coughing slightly more than usual. A source of anxiety, but using the Noona smart phone app, it is possible to make an instant report and get direct clinical feedback on whether this is an exacerbation for which medical attention is needed, or get assistance with self-care if not.
The result is not only to relieve the patient’s anxiety, but also avoid an emergency admission.
In addition to instant advice, the data can be used track progress as patients recover from cancer therapy. This shows doctors which patients are in greatest need, allowing resources to be allocated accordingly.
From its formation three years ago, Noona has grown to have 3,000 patients in 12 hospitals using its app. Last November the company attracted €1.5 million from a syndicate including Inventure, a Nordic venture capital fund, Noaber Ventures, from the Netherlands, and Capricorn ICT Arkiv, a Belgian fund.
Patient engagement is the key to success of Noona, said Jani Ahonala, co-founder, speaking at a recent Healthy Measures event in Helsinki. Noona’s team spent many hours working on a layout that would encourage patients to use the app.
“If you can create something that is really engaging people, then you are the king, then you have a lot of friends,” he said. It is an approach similar that of Facebook, Google and other social media companies, of creating an app people want to use, leading them to hand over their data.
Ahonala said that between 91 to 97 per cent of Noona’s users are prepared to answer a survey sent through the app, while one out of four people would answer a message from a hospital. “It looks and feels like a service that is designed for humans – it is easy to understand why patients would embrace it.”
Like Facebook, Google, et al, Noona now has plans to monetise its system. In the near future it will offer pharma companies and healthcare payers access to tools to collect and analyse health outcomes of individual cancer treatments.
There are currently hundreds of new cancer molecules in late stage trials. Noona claims its unique user experience and strong patient engagement offers an opportunity to collect real world data quickly and cost-efficiently in all cancer types.
The company also wants to give clinical scientists access to the data, to better understand the effects of cancer treatments and put together side effect management programmes.
At the same time, hospital managers and insurance companies could use the date to evaluate the outcomes of different treatments as part of a move to value-based healthcare.
Predict sickness to save lives
The ability to report symptoms online, as and when they occur, can change the treatment trajectory. Around 60 per cent of cancer patients develop side-effects to treatment and most of these are predictable. “You can see the early signs hours or days before, based on the patient-reported outcomes data,” said Ahonala.
Noona has developed specific modules for each major type of cancer, each with its own analytics for assessing the severity of symptoms and other indicators, such as heart rate, sleeping patterns, presence of skin rashes and coughing frequency.
Widespread adoption of Noona could change cancer care pathways, Ahonala said. The typical cancer treatment follow up, based on visiting the doctor every three or four weeks, “Is not a modern way to treat patients,” he said. “When they call the clinic, it is usually too late.”
“We see that early interventions are helping [….] the core team can act, be pre-emptive and see the signs before the bad things happen - and then we can improve overall survival. We can decrease the number of emergency room visits and hospitalisations,” said Ahonala.
According to the Noona, cancer patients being treated at hospitals where the app is in use called the emergency service 60 per cent less often, made 20 per cent fewer visits to A&E, halved the number of hospital admissions, while adherence to treatment rose by 30 per cent.
Noona’s founder started development of the app three years ago in collaboration with Helsinki University Hospital. Visa Honkanen, director for strategic development at the hospital, said there is a clear need to integrate services like Noona into healthcare. “Advanced analytics and machine learning are the most important things for the coming five years if you want to be a top-notch hospital or [leading] country [for healthcare],” he said.
To encourage further such innovations, Helsinki University Hospital is setting up small teams where members can test new ideas, close to the patients. Outdated, hierarchical, organisations do not have the power to promote innovation, Honkanen believes.
Health Capital Helsinki is another project aiming to help institutions and companies collaborate to promote the formation of other digital healthcare start-ups. The project, involving Helsinki city council, Helsinki University Hospital and Helsinki and Aalto universities, started a year ago.
The objective is to make the Helsinki metropolitan region the leading research, innovation and business development hub for life science and health technology in Northern Europe, said project leader Tuula Palmén.
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