Real-world evidence for mental health research and practice

Physical health conditions such as diabetes or high blood pressure can objectively be assessed with quantitative biomarkers (e.g. blood glucose levels or blood pressure). In mental health, however, the collection of objective data on how the disease progresses is much more complicated. “We want to close this real-world evidence gap,” says Jordan Abdi, Strategy and Business Development Lead at Holmusk. The Singapore-based startup, which is part of 5-HT’s digital ecosystem, develops analytics solutions and digital therapeutics and has created the largest research grade dataset in mental health. In this interview, Jordan Abdi and Stefan Suter, Head of Holmusk Europe, talk about their solutions for the pharma, payer and provider industries – and about Holmusk’s plans to enter the German market.

Who is Holmusk?

Jordan Abdi: Holmusk is a five-year-old company focusing on real-world evidence in mental health with data science and digital therapeutic solutions. Our fundamental mission is to close the mental health evidence gap. We build models to help all major stakeholders in the healthcare ecosystem gain a deeper understanding both at a disease level and at a treatment level. The models we have developed also have applicability in chronic diseases like diabetes, cardiovascular disease, and chronic kidney disease.

Why do you focus on real-world evidence for mental health?

Jordan Abdi: The problem in mental health is that there is remarkably little evidence to understand how disease progresses and what treatments work for different patient cohorts. In psychiatry, there are very few objective metrics to measure peoples’ state of mind, whereas in other fields, e.g. diabetes or cardiovascular disease, you have a lot of quantifiable measures like blood glucose level or blood pressure to monitor and track disease progression. This lack of data hinders innovation, development and commercialization of new treatments in mental health.

Stefan Suter: If you compare mental health to other disease areas like cancer, research is probably 20 years behind, leading to a large unmet need for patients. This huge untapped potential is what drives the direction of our company. We believe that with new technology, e.g. natural language processing and digital biomarkers, we can make a difference and advance data-driven decision-making in mental health practice and research.

Since it is difficult to collect objective data in mental health, how do you manage to provide real-world evidence to your customers?

Jordan Abdi: In 2016, we acquired MindLinc, the deepest and most longitudinal real-world dataset on psychiatry that exists anywhere in the known world. It includes 50+ million rows of data from 550,000 patients over 20 years. MindLinc was not a typical electronic health system: it was developed at Duke University School of Medicine who wanted to gain a better understanding of patient journeys. Every time a clinician made a clinical record, he or she had to fill in mandatory quantitative assessment fields, such as Clinical Global Impression-Severity (CGI-S) scale. This means that the dataset has labelled quantifiable metrics for every single patient interaction. At Holmusk, we de-identified, aggregated and normalized all the data and enhanced it with natural language processing to transform clinician notes into 300+ validated labels. This is the basis of our platform NeuroBlu which is now available for assessment and research purposes. For example, pharma companies can use this platform to identify unmet needs and to enhance clinical trial design by understanding real-world patients. NeuroBlu can also be of value for payers, regulators, and providers.

Besides NeuroBlu, what other solutions do Holmusk offer?

Stefan Suter: Our second line of products comprises analytics capabilities across disease areas, combining biological models with AI and neural network technology. Furthermore, we develop digital therapeutics, based on a single platform which enables us to rapidly expand and build new digital healthcare solutions. These different lines of products show that Holmusk is offering a full stack of technologies, from generating data to putting it into clinical practice. Although we are grounded in psychiatry, we aim to look at patients more holistically. Since a patient often has more than one disease, we want to be able to treat them with all the conditions they might have, e.g. depression, diabetes, and cardiovascular disease.

What kind of digital therapeutics has Holmusk developed up to now?

Jordan Abdi: Our digital therapeutics are designed to support patients with chronic diseases and mental health disorders in their daily lives. The most advanced of these solutions is GlycoLeap, a mobile application that helps diabetes patients to achieve a healthier weight and better glucose control. In the area of mental health, our mConnect solution interfaces between patients suffering from major depressive disorder and their clinicians, enabling the clinician to assess his patient’s condition between consultations. Our second mental health app, which is currently in an early development stage, supports mental wellbeing in everyday life.

What is the story behind the foundation of Holmusk?

Jordan Abdi: Our founders identified the core challenge that there is a lot of data being generated in healthcare but there are no mechanisms for this data to feed back into the process and improve healthcare overall. This is why Holmusk was founded.

Stefan Suter: Singapore was a fantastic environment to start Holmusk because there is a lot of support for young companies. I have known the founding team since the beginning, and it’s impressive to see what happened within just five years. Now, Holmusk is a 100+ people company spanning the globe and growing fast in Europe and the US. Last year, in the midst of the pandemic, we were able to raise $21.5 million in a series A round. We also won a number of AI and healthcare awards. In 2019 we were named World Economic Forum Technology Pioneer for our ability to work with real-world data at scale, which sets us apart from many other companies. Furthermore, we have already published a number of peer-reviewed scientific publications, either alone or together with renowned partners from across the globe like the University of Zurich or the University College London.

What are the next milestones for Holmusk?

Jordan Abdi: We are looking forward to three key milestones. The first and foremost is to grow our dataset by entering into more and more data partnerships. By the end of this year, we hope to reach 2 million more patients. Second, we aim to raise the number of structured dimensions we can extract from our data via natural language processing from 300 to 500. This way, we will continue to enrich our database and improve our understanding of patient cohorts. Finally, we want to bring our dataset to regulatory grade so that it can participate in regulatory approval process.

What are your plans for the German market?

Stefan Suter: We are just beginning to enter the German market, so we first need to get more familiar with it. In order to bring new insights to the clinics, we need to be grounded in the healthcare system. This is why we aim to engage with hospitals and enable them to make better decisions in patient treatment with our digital therapeutics. Furthermore, we are looking for partnerships in the German pharma industry, both in mental health and in cardiovascular disease where we can improve the development of new products with our data and analytics solutions. We are also very interested in working together with German research institutes.

How can 5-HT help you to gain a foothold in Germany?

Stefan Suter: We are hoping to build connections with an ecosystem of partners, in the pharma, the provider, or the payer world. To any of these networks, Holmusk technology can be value-adding and support transformation toward more personalized therapies and interventions. We are also excited to get in contact with other startups to learn and partner. Despite the strong growth, Holmusk is still a small company, and organizations like 5-HT play a vital role in providing platforms to demonstrate our capabilities to a wider audience. We look forward to seizing opportunities together with our partners.