Interview: Lucile Blaise – VP Western Europe, ResMed, France

Lucile Blaise - President- ResMed France BeneLux MaghrebResMed MD, Lucile Blaise, explains the medical device company’s focus on delivering data informatics and analytics to patients with sleep-related diseases and disorders in the comfort of their own homes.

Very few doctors realize the dangers of sleep apnea, often referred to as a “silent killer.” ResMed is unique in raising awareness of sleep apnea and respiratory related disorders around the world. How would you characterize the awareness level in France and what initiatives are you taking to further your cause?

More than 650,000 patients are treated in France today, whereas prevalence indicates that two million people suffer from severe Obstructive Sleep Apnea (OSA)

Awareness is increasing year after year in France, but there is still lot to do. More than 650,000 patients are treated in France today, whereas prevalence indicates that two million people suffer from severe Obstructive Sleep Apnea (OSA). Building awareness for sleep apnea and sleep disorder breathings are a main focus at ResMed. Evidence-based medical awareness is essential to understanding sleep apnea and its causes, and we are driving this awareness through clinical protocols, educational programs, intensive trainings and external communication. The online ResMed academy is a good example.

Sleep medicine is very young science and has yet to be fully uncovered. Paradoxical sleep better known as REM sleep (Rapid Eye Movement – deep sleep that occurs in intervals during the night, where dreaming and rapid eye movement occurs) was only discovered a bit more than 50 years ago by Michel Jouvet, Colin Sullivan invented the Continuous Positive Airway Pressure (CPAP) with a first publication in the Lancet in 1981. He later began working with our founder, Peter Farrell, to create ResMed.  ResMed is only 27 years old!

Like most of the major innovations, CPAP is a simple concept. The CPAP is a pump which generates a positive pressure. The air blows through a tube and a mask into the patient upper airways. The positive pressure maintains the upper airways opened during the sleep to prevent sleep apnea.

It is now proven that Obstructive Sleep Apnea is closely linked and interacts with a lot of comorbidities like diabetes, cardio vascular diseases, COPD, and more recently very interesting data have been published about cancer, so YES we have done a lot but the awareness and the market development in front of us is still huge. ResMed globally aims at treating 20 million people by 2020, and definitely ResMed France will contribute

For instance, the prevalence of OSA in patients with resistant hypertension is above 80%. Cardiologists were not aware of these factors 10 years ago. Guidelines evolutions are a pre requisite, but this is not enough. It has been a hard work to inform, educate and train to modify routine practices. Now addressing and diagnosing sleep apnea among these patients has become routine care. Once we have the evidence, it is our duty to promote best practices and networks.

A major step is to educate about symptoms and consequences. Where snoring, overweight, sleepiness are clear indicators for men, it is less obvious for women. For those, depression might be even more relevant. It is not well known but the prevalence of OSA in women becomes equivalent to men after menopause. To drive women awareness, our task is even bigger.

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At ResMed we are focused on providing the diagnostic abilities to help treat these types of issues. Most people still do not realize that snoring is a sign of sleep apnea and most patients will never even consider getting tested for such minor things. We have a dedicated team of “Therapy Specialists” who are responsible for raising awareness among medical specialties by building screening capabilities and diagnosis networks. Our external communication team focuses on developing different media outlets cautiously abiding by all advertising laws and regulations. But again, I will like to highlight how all our awareness building efforts are based on evidence, facts and figures.

ResMed is a leader in designing, manufacturing and marketing equipment for the treatment of sleep disorders and other respiratory conditions. How are you working to build partnerships and collaborations in your specific areas of expertise?

We produce and manufacture CPAP (Continuous Positive Airway Pressure), customized Mandibular Repositioning Devices, ventilators, masks for sleep disordered breathing and respiratory diseases. Our PAP (Positive Airway Pressure) devices have evolved immensely over the years. 27 years ago, our product was the size of a microwave and was so noisy it had to be setup in an adjacent room!  Today, the device can fit in the palm of your hand. We also develop smaller, lighter and more comfortable masks that limit pressure points on the face. Our goal is to limit the side effects and to make the treatment easy and comfortable for the patient. In each area ResMed innovation has contributed to patient comfort and compliance: Silent, small and smart devices, heated tubing, customized humidification, smaller lighter softer masks etc.

To answer precisely your question we have built strong partnerships and collaborations with sleep physicians, homecare provider organizations, and key stake-holders through constant innovation and highest standards in quality. Innovation and quality are deeply embedded into our DNA.

ResMed globally aims at treating 20 million people by 2020

ResMed have first evolved from being a hardware company to a software company, now moving to a connected care company. Thanks to software innovation like APAP (Automatic Positive Airway Pressure), treatment has become personalized to each patient condition, following different patient needs throughout the night. Automatic software innovation has allowed setting and adapting the treatment at patient home.  Thanks to this innovation the largest majority of the French patients are fully managed at home, from their diagnosis to their treatment titration and follow-up. As opposed to lots of countries where patients still systematically have 2 to 3 nights of hospitalization, the French sleep labs are now exclusively focused on the difficult cases. The common pathway is efficiently managed at home, and many publications like the one from Frédéric Gagnadoux with the  Angers cohort shows that French patients have among the highest compliance in the world with an average usage of 6,4 hours per night*. Apap is an example among others to demonstrate that thanks to smart software, we can bring positive clinical output together with significant efficiencies in the patient pathway.  I could have also mentioned central apnea detection, Adaptive Servo Ventilation in sleep and in respiratory failure etc..

After hardware and software, we have more recently evolved to Healthcare Informatics. We have entered into the data age. Our latest generation devices have embedded telemonitoring capabilities. Our customers can now easily monitor the state of each patient daily through a telemonitoring portal. They can manage patient difficulties from the homecare provider or the physician’s offices while the patient stays at home. Telemonitoring does not only generate a customized and personalized follow-up, it drives efficiencies. Thanks to telemonitoring in France we are gradually moving from a systematic follow-up to a specific and customized patient follow-up. We concentrate the resources for the ones who need them the most. Telemonitoring allows doing more with less, in other words we generate productivity.

Next step of Healthcare Informatics will be to develop and leverage predictive medicine. The future is to develop smart data and algorithms to not only treat and prevent but eventually predict patient exacerbations.

The group has had 20 consecutive years of growth (1996-2015). How is this trickling down to the French operations? How important is France to the Group?

France is among the largest revenue generators outside the US. Our company produced USD 1.7 billion in revenues last fiscal year, my region contributing for approximately 9%.

We have been able to perform and succeed inside France thanks to the team efforts for years. We have always had a high focus on recruiting and developing talents. Hard work, cooperation, creativity and seek for excellence have always been strong enablers for us.

France is among the few countries where sleep medicine has been highly developed, sleep treatment is very clinically driven. Our success has been the result of a long and strong collaboration between several pioneers: eminent physicians discovering and continuously exploring sleep medicine, Homecare providers’ early development and ability to implement qualitative and efficient homecare patient management, and finally innovative technology to screen, diagnose, treat and drive patient compliance.

ResMed France results can be attributed to strong customer focus and support, robust market development activities, relevant clinical trial investments and high focus on training and education both internal and external.

In 2009 ResMed acquired Laboratoires Narval  in France, which has developed a  Mandibular Repositioning Device (MRD) an alternative treatment to CPAP. What is your strategic intent and what is the extent of your manufacturing capabilities in France?

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Narval acquisition has been instrumental in our evolution, particularly in France. We are not a CPAP and masks manufacturer anymore, we are a solution provider. Nowadays, customized Mandibular Repositioning Device (MRD) is the second line validated treatment of severe Obstructive Sleep Apnea

The MRD works by moving the jaw forward, which increases the size of upper airway and reduces the air resistance that leads to sleep apnea and snoring. Thanks to this complementary offer, we can cover all patient needs from mild to severe sleep apnea.

The manufacturing site of Narval MRD is based in Lyon and we have started exporting in many countries in the world. In this area as well, innovation is the key driver. We are now validating the 100% digital MRD in 3 steps: Intra Oral Scanner imaging, Computer Aided Design (CAD), Computer Aided Manufacturing (CAM) through 3D printing.

In this particular area, market development and market access strategies are even more crucial as by adding the dental expertise step,  the patient pathway becomes even more complex. . Thanks to strong medical evidence and robust health  economics data,  we expect soon a 1st line treatment for MRD in the moderated sleep apnea indication.

That is very impressive indeed. Ms Blaise, where would you like to see your operations as a whole when we return in five years’ time?

Thanks to a widely and largely developed Healthcare Informatics infrastructure we will have developed interoperability with all our homecare providers’ information system.

Our customers will have gained significant efficiencies and will have developed lower touch and smart follow-up algorithms that maintain the quality of care at lower cost.

Patients will become more and more engaged and will have an easy access to their data. They will also largely use coaching apps for better compliance purpose.

Narval Mandibular Repositioning Device complements even more efficiently the CPAP offer by capturing systematically the patients who stopped using the CPAP and by treating efficiently moderate OSA.

France will remain a clinically focus market and telemonitoring capabilities will also largely be used for clinical purposes. For instance we’ll have a strong and compelling offer to support telemedicine programs for respiratory care patients, COPD, Obesity hypoventilation and neuromuscular patients.

ResMed will contribute to develop 5P medicine: personalized, preventive, predictive, participative and proven medicine

ResMed France will significantly contribute to reach 20 million lives changed by 2020!

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