DESTINY®

DESTINY® – DatabasE-assiSted Therapy decIsioN support sYstem

NTD and NTC GmbH work together on linking medical, content and patient-oriented aspects, offering physicians and patients an integrated system that promotes networking and communication between physician and patient on the same level, involving the patient actively in the treatment process (DESTINY®).

DESTINY® helps to achieve a significant improvement and acceleration of treatment outcomes and optimises adherence and compliance. In turn, this can lead to significant cost reductions (fewer hospital admissions, physician visits and days of incapacity for work, lower medicine costs). Scientific knowledge is also acquired, enabling a better understanding of the disease and its effects. DESTINY® is also transferable to other indications.

DESTINY® has already received multiple national and international awards as an innovative platform for personalised healthcare:

  • CQ5 Global Awards 2019- Germany, healthtech company of the year
  • GHP- healthcare&pharmaceutical awards 2019
  • German Medical Award 2019
  • German Prize for Excellency 2018, 1st place, “Health” category
  • Bavarian Innovation Prize Health Telematics (BIG) 2018, 1st place
  • Stevie Award – International Business Award 2018, 1st place, “Health & Medical Information Solution”

NTD database

The core of DESTINY® is the web-based NTD registry database, which has received pseudonymised patient data in relation to diagnosis, treatment and quality of life, side effects and reasons for changes in treatment since 2008. This database was developed in conjunction with Ludwig Maximilians University in Munich and was inspected and approved by the Ethics Committee of the Bavarian State Chamber of Physicians in 2012. This approval was re-confirmed by the Ethics Committee of the North-Rhine State Chamber of Physicians in 2017.

Web-based since 2013, the registry database is a modular system containing basic documentation and a multitude of specialist modules (healthcare module, register module, study module, patient module, administration module etc.). All data collected is taken systematically at each participating practice and saved to the database. Statutory data protection requirements, in particular the German Federal Data Protection Act (BDSG) and the EU General Data Protection Regulation (GDPR), are ensured through an appropriate consent and encryption process. The healthcare and register modules have standard disease-specific basic documentation, whereas additional assessments for partial database collections are mapped in the study module. For the purposes of standardisation, medications are recorded according to current ATC (Anatomical Therapeutic Chemical) classification and diagnoses according to the current version of ICD (International Classification of Diseases). For the purposes of treatment monitoring and support, disease progression and treatment procedures are shown as a graphic display for each individual patient. The administration module manages system users, practice master data, studies and metadata. The patient module allows for active inclusion of patients in the treatment process via electronic surveys.

The appropriate technical and organisational measures are taken to ensure confidentiality, integrity, availability, authenticity, reviewability and transparency with regard to the registry database. For the purposes of data quality control, practice-oriented protocols and queries are displayed on the online registry database and processed by the practices.

The registry database is updated continuously, being adapted and expanded to meet clinical practice requirements. Due to its modular construction, the system can easily be extended to cover other indications and areas of application.

The following indications are currently available on the NTD database:

  • Dementia
  • Depression
  • Epilepsy
  • Migraine
  • Multiple Sclerosis
  • Parkinson’s and motor disorders
  • Schizophrenia and Bipolar disorders

The modular nature of the registry database means that further indications from the fields of neurology and psychiatry may be added at any time.

PHREND

The predictive module PHREND makes it possible to locate the most suitable MS medication for an individual patient and predict disease progression under a specific treatment. Working with an experienced team of mathematicians and statisticians from PricewaterhouseCoopers (PwC) AG, Switzerland, a special algorithm was developed that can use past data from the NTD database to calculate how, in all likelihood, the disease will develop in a specific patient under the influence of various treatments.

To obtain this type of prognosis, the physician first enters the patient data, such as gender, month and year of birth, date of MS diagnosis, current treatment, any previous treatments, current EDSS value, date of the last relapse and the number of relapses in the previous twelve months. The software uses the data to create a graphic, showing the degree of probability of the patient remaining relapse- and progression-free under a certain medication for a set period of two to four years. Physician and patient therefore receive an independent qualified second opinion that they can discuss together.

In addition to the clinical data, important factors and preferences for the individual patient are taken into consideration in the treatment decision-making process:

  • Pregnancy/childbearing preferences
  • Application type
  • Risk of side effects (to be expected)
  • Frequency of control tests (e.g. laboratory tests)

Ideally, there will be up to two or three treatment options left, from which doctor and patient can choose a medication together. The physician also has the option of printing out the result or emailing it to the patient so that they can think about again quietly at home.

This makes the patient more strongly and actively involved in the treatment of their illness. This not only improves the relationship between physician and patient, but will also have an impact on the success of the chosen treatment. Adherence to treatment is increased on the one hand. On the other hand, it is a sure and certain thing that a medication works even better the more convinced the patient taking it is of that medication.

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The pioneering PHREND concept has already received multiple national and international awards:

  • Best of Swiss Web Award 2019: Business Silver
  • Best of Swiss Web Award 2019: Innovation Silver
  • PwC Global Innovation Challenge 2019, 1st place
  • PwC Europe Innovation Challenge 2019, 1st place
  • Business Week's Best of Consulting Award 2019 Special Category „Artificial Intelligence“: „Blue Chip Award“

My Ntc Health Guide Patient Portal (powered by Vitabook)

The My NTC Health Guide patient portal (powered by vitabook) is another important DESTINY® module that substantially helps to increase adherence to treatment. Insufficient adherence to treatment is one of the biggest dangers to effective treatment. Studies on MS treatment show that only 50 to 60 % of patients use the prescribed medications in accordance with the physician’s instructions.

There are many reasons for this lack of adherence. They are often related to the patient‘s personal circumstances. But communication with the treating physician has a major part to play. Physician and patient usually only see each other for planned treatment appointments. The physician is unaware of how the patient is living with the disease in between times. This is where the My NTC Health Guide (powered by vitabook) portal comes in:

Patients can use their data to follow the course of their disease in the form of a graphic. They can also enter data for themselves via this portal (e.g. results from their family physician). For the first time, the individual patient has an overview of the overall treatment process. They have the same information as the physician and, like them, they can add new diagnosis-related information. Treatment results are shown clearly as graphics.

The application also keeps the patient in contact with their treating physician outside consultation hours. An editorial team from the physician network also regularly posts new developments, treatment options and research results on the patient portal in the form of brief articles in laymen’s terms, keeping the patient constantly up to date with new information. This gives the patient a much stronger role – moving from a simple “information recipient” to a “contributor”.

The electronic headache diary has been a major component since the migraine indication was introduced, showing data entered graphically in the different dimensions for both patient and physician.

The “treatment configurator“ is another central component: by coupling it with the NTD database, it is possible to send patients customised information about their illness, an individual treatment plan and a medication regime. Times for taking medication, necessary follow-up exams and physician appointments are also transferred to the patient’s profile automatically. This ensures treatment in line with the guidelines in a verifiable and traceable way and encourages the patient to adhere to treatment. Feedback to the physician on patient activity gives them a permanent understanding of how the treatment regime is being adhered to and how the patients is developing.

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Elispot biomarker test

The ELISPOT laboratory test differentiates whether an MS patient will respond better to treatment with interferon than treatment with the active substance glatiramer acetate (GA). The test was applied over 2 years at NTD practices as part of a validation study. The results are now being analysed.

If the evaluation shows positive results, the plan is to extend the test procedure to other B-cell mediated treatments. This would identify a suitable biomarker that can be assessed before a medication is administered to establish which treatment the patient responds to best.

Interaction Check – Powered by Pgxperts®

The “PGXperts® InteraktionsCheck" module from HMG Systems Engineering GmbH tells the physician whether a scheduled medication interacts with other medicines that the patient is taking. Within seconds, information is identified relating to interactions between medicines, active substances, food, lifestyle and genetic variations. The clear representation of genetically determined interaction risks quickly identifies patients who could benefit from a pharmacogenetic examination. This type of examination can be carried out under the collaboration between HMG Systems Engineering GmbH and the Institute for Human Genetics of the University Clinic Bonn. PGXperts® InteraktionsCheck helps physicians to optimise patient medication accurately, safely and efficiently.

Pharmacovigilance Module

When medications are adjusted and discontinued, reasons for discontinuation and adverse events are recorded in the database as standard. Until recently, the pharmacovigilance module has only been used in studies, but it has now been used in routine practice since March 2018. Where adverse events occur, they are recorded in a standardised, electronic report following the requirements of the Federal Institute for Drugs and Medical Devices (BfArM). Entries are stored centrally, followed up and emailed to the competent authorities. The standardised recording of adverse events in everyday practice is a major factor for making treatment even safer, identifying side effects earlier and making outpatient healthcare data more valid and meaningful.