“The smartphone will see you now.”
That, declared noted cardiologist and technology guru Eric Topol, MD, might well be the motto for the next generation of health care.
In a wide-ranging keynote address at the Armada Specialty Pharmacy Summit, Dr. Topol, the chief of innovative medicine at Scripps Research Institute, La Jolla, Calif., described an array of new remote monitoring and diagnostic options that are either already available or coming soon to a smartphone, tablet or computer near you, including apps that measure and track lung function, blood sugar, heart rate and blood pressure, and can even perform an electrocardiogram.
Such personalized digital intervention (PDI) tools enable health care providers to tailor care more specifically for individual patients, noted Al Babbington, CEO of PrescribeWellness, a company that provides cloud-based provider- to-patient communications. Such PDI “technologies must be more effectively leveraged to provide patients the support necessary to improve outcomes,” Mr. Babbington said during the Centers for Disease Control and Prevention’s recent Conference on Health Communication, Marketing and Media.
Remote monitoring via smartphone and other technology tools is likely to transform the practice of pharmacy within the next few years, and holds particular promise for solving—or at least mitigating—a challenge that has long confounded pharmacists: patient nonadherence.
One example: eMedonline, a “medication adherence telehealth platform” that already has secured multiple rounds of National Institutes of Health funding. It works on multiple devices—smartphones, BlackBerry, and for patients with no such devices, a basic Internet appliance from the company.
This tool gives “the patient a reminder on their phone or their device when it’s time to take a specific dose of medication,” said Kevin Clauson, PharmD, an associate professor of pharmacy practice at Nova Southeastern University, in Fort Lauderdale, Fla. “Then, they have to use the camera on their phone or a scanning app to scan the specific bottle or pill that they’re taking. The program then confirms that they’re getting the right drug, at the right dose, at the right time.”
In some cases, the patient is then prompted to answer a few questions about the medication via text, such as “how do you feel this drug is working for you?” and “what side effects have you noticed?”
The data can be used to do predictive modeling, Dr. Clauson told Pharmacy Practice News. “For example, if the data shows that your patient is usually taking all of their doses correctly, but on Tuesday afternoons they often miss a dose, you can pinpoint what might be happening then. The patient might realize, ‘Oh, that’s when I take Ella to soccer, and there’s so much going on that I forget.’ So, you can develop nonpharmacologic interventions to help the pharmacologic piece.”
AdhereTech’s patented “smart bottles” approach compliance from another direction. Somewhat akin to scales at the grocery store self-checkout lane that notice if you’ve pulled that two-ounce magazine back out of your bag, these vials measure the exact amount of pills or liquid in a bottle in real time and wirelessly send the information to a system that reminds patients to take their medication via automated phone calls or text messages. “If you don’t take the medication after that, the prompts become more insistent. They’ll text, then they’ll call, then maybe they’ll call your mom,” joked Dr. Clauson. “You can control how much you want that to escalate.”
AdhereTech recently got funding through Pilot Health NYC, a project of the New York City Economic Development Corporation and Health 2.0, for a trial at Weill Cornell Medical Center, where it will be used to assess patient adherence to an HIV drug regimen over a 12-week period and compare it with the usual standard of care.
Maybe the most promising and the most controversial drug adherence technology is Helius, the long-awaited ingestible biosensor from Proteus Digital Health, which got the green light from the FDA last year after four years of wrangling over exactly how the agency would oversee it. (It was ultimately approved as a de novo medical device because there is no comparable technology on the market.) An “ingestible event monitor” is embedded within a pill a patient takes; that monitor then communicates with a patch worn on the patient’s stomach.
“The other devices are proxies—strong proxies, but still proxies,” said Dr. Clauson. “But with a biosensor, you know where and when the patient takes the drug; it also transmits basic physiologic data as well as drug disposition information. That’s not a proxy, that’s [evidence of] actual adherence.”
Dr. Clauson noted that when the sensor was rolled out in the United Kingdom, it wasn’t piloted through clinics or hospitals. “They partnered with Lloyds, a pharmacy chain, to introduce Helius.”
Some pharmacies are working to develop their own remote monitoring tools. Diplomat Specialty Pharmacy, the largest privately owned specialty pharmacy in the United States, is developing an interactive texting tool that uses decision-tree technology to allow automated two-way conversations based on the patient’s responses.
Describing how the texting tool works, Gary Rice, RPh, Diplomat’s vice president of clinical services, said, “If
you want to validate that a patient took their medication today, you can send them a text asking if they took it. If they did [take it], then you’re done, and the system records that the patient has acknowledged taking their medication. If they say no, they’ll get another text message asking which of five reasons describes why they haven’t taken it.”
If, for example, the patient selects “side effects,” the system will ask, “Which of the following side effects are you experiencing?” At some point, the patient can ask to be transferred to a live pharmacist for education on managing that particular side effect; or if the side effects described are severe enough, they may be transferred directly to their physician’s office.
Mr. Rice told Pharmacy Practice News that Diplomat plans to implement this program over the next year “to enhance [their] patient care management program.”
The transition of the health care system from a fee-for-service to a “fee-for-outcomes” model, the participatory medicine movement and quantum-leap style advances in technology are converging to jump-start remote monitoring, said Dr. Clauson. “It’s not a wave of the future. It’s quickly becoming a wave of the present.”
None of the sources reported any relevant financial conflicts of interest.