The digital therapeutics field has attracted the interest of major players in the healthcare industry lately, from big pharma to the NHS. But there is debate among stakeholders around issues including reimbursement, regulation and business models that work.

The space, however, continues to grow, and Cambridge-headquartered Ieso Digital Health unveiled earlier this year plans to build an autonomous digital therapeutic through its new Eight Billion Minds research project. Last week, MobiHealthNews caught up with Valentin Tablan, SVP of AI at the British mental health startup, to find out his thoughts on the current state of the digital therapeutics space and the new initiative. 

This interview has been edited for length and clarity.

MobiHealthNews: Valentin, you have nearly two decades of experience in Natural Language Processing, Knowledge Representation, and AI. Before Ieso Digital Health, however, you were the lead scientist for the service powering Amazon Alexa. Why did you decide to make the switch to digital health?

Tablan: Right. So, working on Alexa was really exciting to me as an AI scientist because I was doing something really at the cutting-edge of technology, of AI, so that was definitely pushing the right buttons for me as a scientist, but the transition to Ieso was mainly motivated by the fact that I wanted to use my skills for something that has a direct positive impact on society. And that’s not to say that Alexa doesn’t, because I believe it does, but I believe that working in healthcare was something that I found more motivating. And, again, as a scientist, I was particularly attracted to Ieso by the dataset that we have here, which is unique in the world and it opens up some possibilities that were really exciting to me and that I probably couldn’t have access to anywhere else.

MobiHealthNews: And I guess that’s very important in your work as SVP of AI, which is quite a big title. What are you focusing on in this role?

Tablan: We use AI in multiple ways here at Ieso, but kind of, from a high-level point of view, we have been treating patients for many years now, we have treated more than 40,000 patients, we have more than 200,000 hours of therapy recorded, so we believe there’s a lot of insight available in this dataset that can improve the way mental health is being treated in the world. There is an issue in the fact that clinical recovery or clinical outcomes have not been improving for mental health, and the standard way of discovering new techniques and new ways of improving healthcare, especially mental health, they kind of stopped bearing fruit, or if they do, it’s very slow, it’s a very slow process, whereas now we believe that, with this dataset, we will be able to accelerate that discovery process and find ways to start improving the clinical outcomes again.

MobiHealthNews: And this is an area where your Eight Billion Minds project comes in, right?

Tablan: Absolutely. So, Eight Billion Minds is about addressing the global need that’s currently very poorly served.  So, at Ieso, we have a long history of treating patients with mental health complaints and we do that by facilitating therapists and patients talking to each other via an online channel. And that, essentially, is a change in the traditional model, where you have face-to-face therapy. For us, it’s still one-to-one therapy, which is therapist to patient, but rather than being face-to-face is done via technological platforms, is done online, which is kind of moving in line with the times. By doing this, we are able to understand what works in therapy and we are able to improve the quality of care.

However, there’s a fundamental barrier towards improving access to where it needs to be. For example, here in England we work under a programme called IAPT, which stands for Improving Access to Psychological Therapies, and that’s probably one of the best programmes for mental health in the world, and, despite that, we are currently only able to address 19% of the need in England. So, that clearly indicates that there is an issue with the supply of clinicians, there are just not enough therapists to address the need properly, and that’s why we’re launching this Eight Billion Minds programme to start looking at how we can use technologies, digital technologies, to start addressing this access issue and try to find ways to help people who otherwise would have no access to care.

MobiHealthNews: I understand that the plan is to build an autonomous digital therapeutic. But, at the moment, there seems to be quite a lot of debate around digital therapeutics in general, from the state of investment to the need for robust data and even the definition. So I thought we would start with this. What is a digital therapeutic or what would you say counts as one?

Tablan: Yeah, well, it’s quite a new area, so the definition I think is still not fully accepted or not everybody has the same definition. For us, if you talk about therapeutics, it should be something that has clinical evidence behind it, so we know that it is efficacious and effective, so it should be something that has a proven clinical impact, and that means there should’ve been a study that measures its impact and shows it’s actually helping patients. And because of that, because that’s what makes it a therapeutic, then you have to think in terms of, how would patients access it, and, we don’t know for sure, but we feel that the most appropriate way for that is to have it be prescribed by some form of clinician, some form of expert, either a general practitioner or maybe a therapist, somebody with a clinical background, just because it is something that is proven to have a clinical impact, a clinical effect, and it’s indicated for certain conditions, so it should be prescribed and it should be delivered under those kind of conditions.

That’s kind of what are the core elements of it, the fact that it’s an active therapeutic, it does actually help the patients, and [there is] scientific evidence to back that claim.

MobiHealthNews: Right. It also looks like the market is growing, yet there are not a lot of clinicians that are prescribing digital therapeutics or patients that are using them – why is that, how can it be addressed and by whom?

Tablan: I would say that the reason behind that is that it’s still quite a new market. If you look at what’s available, there aren’t that many actually therapeutics in the sense that I was mentioning earlier, that have clinical science behind them, and a proper effectiveness study. So there are lots of self-help tools in the area of mobile apps and digital interventions, there are lots of wellbeing and self-help tools, but there aren’t that many things that have clinical validation behind them, so probably that’s why there’s isn’t as much penetration. Another reason is that, again, it’s a new market and we have not quite discovered what’s the successful business model for this, so there are a number of companies that are developing digital therapeutics and are trying different avenues, they’re trying D2C or B2B, or B2B2C, there’s no one product that can currently be counted as successful, we’re still kind of finding our way, all of us, the entire community, entire, all other businesses, finding our way towards what is the right model, so that’s another reason we don’t yet know how to be successful in this area.

MobiHealthNews: And what would you say are the incentives for different stakeholders to adopt digital therapeutics?

Tablan: I think, generally speaking, in healthcare, there’s a (…) pressure at the same time to increase access to care and to reduce costs, and there’s also a cultural shift towards digital interactions, so people do more and more things via digital channels. So I think the idea of digital healthcare is only going one way, and that’s out, so it’s going to be a growing thing. And, for payers, it’s clearly a way to reduce costs, it’s clearly a way to improve access, and it’s clearly a way to meet the demand of their patients or their members, who would expect to be able to do certain healthcare interactions via digital channels.

In terms of, on the other side, people who develop digital therapeutics, they need to provide proof of value. And that’s why it’s important that we not only have a clinical study that proves the efficacy of the model that’s been delivered, but also a certain amount of real-world evidence or some kind of proof of effectiveness in the actual population, not in a controlled study condition that the therapeutic is working and it’s helping patients.

MobiHealthNews: But what is the regulatory landscape looking like?

Tablan: The regulatory landscape is itself in flux, so this growth of digital interventions is something that is being recognised, and I think all regulators are not there yet, they are not quite ready to work with this, but they are aware of that and they are making changes and they are trying to align themselves so that they can handle digital therapeutics. [The] FDA has recently made the first approvals for products, so clearly we’re at the first steps, but there are all kinds of programmes that are being developed or piloted in order to facilitate the rapid delivery of digital therapeutics while maintaining safety.

One of the great advantages of digital in general is the high speed to market, so you can quickly develop something, that, there’s an entire culture in digital that’s all to do with delivering quickly, and we have to find the right balance before we marry that with the healthcare environment or it’s paramount to have the right balance between safety and speed to market. And I think that’s what the regulators are trying to facilitate at the moment, to make their processes a bit more streamlined whilst not sacrificing safety, and these are problems that are probably happening with all regulators.

MobiHealthNews: Looking more generally, what would you say are some of the key areas where digital therapeutics could have an impact, as pressures on healthcare only seem to be intensifying?

Tablan: I think digital has a big role to play in general, so, obviously, for us, in the area of mental health there is an excellent opportunity because a lot of mental health therapies are what’s called talking therapy, they don’t involve any chemicals, and those kinds of interventions can be delivered via digital channels quite easily. There’s a lot of opportunity, we believe, in the area of physical medicine to help with compliance to treatment plans. There’s a great opportunity probably in the area of comorbidities between long-term physical conditions and mental health, where a digital element can have a great contribution to make. You have general practice, there’s already quite a few businesses that are looking at replacing some of the work that the GPs do in terms of diagnostics, replacing that with digital tools, which, again, will probably have quite a large impact.

MobiHealthNews: It is definitely an exciting field to keep an eye on. Lastly, can you tell us where you are with the Eight Billion Minds project and what else can we expect from Ieso in the near future?

Tablan: Eight Billion Minds is aprogramme that we’ve only just announced, we’ve only just been working on it for quite a while, just to investigate what can be achievable, and we are now confident enough that we can be successful in this area, which is why we’ve made a public announcement. So, we’re kind of moving out of the lab and into the production environment, trying to build, starting work on building the digital therapeutic. I think there will be announcements coming out of Ieso in the coming months and years. In terms of actually building the therapeutic, we’re really at the beginning of the road now, and we’re starting to work towards it.