DTx Spotlight: An Interview with Angel Enrique

In this month's episode of DTx Spotlight I sat down with Angel Enrique Roig , Senior Digital Health Scientist at Amwell .

I had the pleasure of meeting Angel at DTx Conference Series Berlin in December and had the opportunity to learn about leading digital mental health platform SilverCloud?, which was acquired by Amwell in 2021 after completing its Series B funding round.

Angel has more than 10 years’ experience in conducting research and implementation on digital mental health solutions and in his current role, he contributes to the strategy and vision of the Amwell Science team and leads research studies focused on the generation of evidence for the SilverCloud? by Amwell platform.

At DTx Berlin, Angel and his colleagues, Derek Richards and Dan Duffy, PhD, delivered an insightful session on The Digital Transformation Journey and the experiences from pioneering countries in the adoption of digital mental health solutions. You missed it? Not to worry, because in this interview Angel and I delved into this and what is needed for the road ahead.

At DTx Berlin you discussed about how pioneering countries have experienced the digital transformation required to adopt and scale DTx solutions – can you tell me how they have done this and the country’s leading the charge?

"If we look at the literature, we can find examples on nationwide Digital Therapeutics offerings that were established more than a decade ago and that have been sustained and scaled over time. Countries like UK and Sweden (2007) have been pioneers in these and closely followed by other countries like Canada, Norway, Australia and Denmark.

"The adoption of Digital Mental Health solutions by healthcare systems and organizations in these countries required a digital transformation that created the space for such interventions to exist and grow within service pathways. This digital transformation is a complex process that entails changes at all levels of the organization, so it requires careful consideration of the aspects that are affected by this process. The positive news is there are many learnings that can be extracted from all the countries who have been navigating this journey.

"The digital transformation did not happen overnight."

"When reflecting on what the experience of implementing DTx offerings for these countries has been like, some aspects are common to all of them:

1. The digital transformation did not happen overnight. Digital Transformation is not a one-off effort. It’s not a place you arrive at. Instead, the digital transformation needs to be seen as a journey. This (bumpy!) journey has several major milestones that need to be achieved before getting to scalability.
2. The Return on Investment (ROI), similarly, did not happen overnight. It is not until the system gets to a level of sustained adoption and use that the integration of DTx is going to pay itself off.
3. Digital transformation requires a willingness to engage in transformation activities, and to foster a culture of hope and belief in DTx as the way forward in creating a sustainable healthcare system.
4. In line with the third point, it requires a continuous commitment stream of funding and resources from a variety of stakeholders (e.g. internal health system, external referrers, government) to push the DTx journey forward."

You also mentioned an interesting point that adoption does not guarantee sustainability and scale - why is this?

"A lot of companies who get accreditation to be used within a given market quickly realise that market entry, or market readiness, was only step 1 of the journey. The crux of it is, just the fact your product is ready for the market does not imply the market is ready for your product. This is because access and adoption are two clearly defined steps in the digital transformation journey.

"In our experience of working with services, adoption of DTx solutions does not always result in successful stories of scalability and ROI. Instead, there are many stories of services that tried to adopt these technologies and failed at getting to that point. This happens for example when customers are not set with realistic expectations about what is going to take to integrate a DTx product into a given pathway and get to realize later on that they are not ready to adopt it. Equally, this also happens when DTx companies do not facilitate the necessary “hand holding” efforts (e.g. training, coaching on pathway development, presenting successful use cases from within the wider healthcare ecosystem) that are required to guide their clients through the digital transformation journey.

"Through our breadth of experience within the field of research, implementing and developing DTx, we have identified 4 major milestones in the digital transformation journey: 1) Market Access, 2) initial adoption, 3) sustainability, and 4) scalability. Each milestone is composed of enablers and components that would allow to move a given solution from one point to the other within a given system."

"After all these years you realise there is no silver bullet that will make your product successful, but there are things that will increase your chances of success."

What are some of the key components in going from initial adoption to the sustainability of DTx products into healthcare systems?

"After all these years you realise there is no silver bullet that will make your product successful, but there are things that will increase your chances of success.

"In our experience we have identified some ingredients that have been key not only to us, but also to the organizations we have worked with. I’ll name a few of the ones we described in our presentation at DTx Berlin:

• Product-Market fit. When developing your product you must consider who are the key stakeholders that are going to be involved in the of your technology along with the pathway you are trying to integrate into. This means forgetting about what you want your product to be and instead, understanding what the need is and how to tailor your product to address that specific need. Basic questions like what they were doing before you arrived are key so that it is very clear what you are substituting, and then define a clear use case you can build your solution around.
• Continued scientific validation and generation of Real-World Evidence. Demonstrating your product is safe and effective and generates market claims aligned to this evidence must be a priority most companies will strive to get. But a less obvious aspect is having a robust infrastructure that allows for the generation of continued real-world evidence. Data not only serves your product through demonstrating impact to the wider market, but it also facilitates buy-in from customers when they see the positive effects it has on their service or provision of care.
• Establishment of key partnerships. Finding and nurturing partnerships where there is a high level of trust and mutual benefit from this collaboration is essential, specially in companies at early stages. Then capitalize on it. Build your product around their services and start creating roots within the service. Once you reach this point find a way to generalize this model to other services that operate similarly or even try to leverage the network of your key partner to reach out to others."

What advice would you give on how you can successfully implement DTx solutions?

"As I said, there is no silver bullet, but one piece of advice would be to be as flexible as possible around the value proposition of your product, the product itself, as well as what it does. A common problem is to initially develop very curated solutions that are not really fit for purpose when trying to implement it in a given pathway. This happens because companies spend most of their resources and time building a first version of the product, even involving end users, but they forget about the service and the pathway where they are going to be integrated. Your product should be malleable; initial versions can be used to collect pilot data, which can then be used to form the basis of business cases for further iterations or deployments of the product."

What do you think 2024 holds for the DTx industry?

"I think 2024 is still going to be a year of transition and stabilization for companies in the DTx space. The healthcare industry is more mature, and it is becoming better at adopting these technologies, so I anticipate the demand for DTx solutions will continue to increase 2024. The negative side is this growth may not be at the pace some companies need it to happen to attract more investment or become sustainable before they run out of cash."

If you'd be interested in contributing your thoughts to the DTx Spotlight series please get in touch.