Barbara Rapchak, Founder of eMedonline

Leverage mobile technology to make the delivery of health care easy, low in cost, and comfortable for the patient.

In April 2011, the social networking website PatientsLikeMe revealed the results of their patient-initiated observational study regarding the use of lithium carbonate in the treatment of amyotrophic lateral sclerosis. It was the first time a social network had been used to evaluate a treatment in a patient population in real time. Significantly, it refuted an earlier published study claiming that lithium carbonate slowed the progression of the disease.

While not a replacement for a double blind clinical trial, the PatientsLikeMe study was able to use a novel algorithm to reduce bias in an open label, real-world situation to improve the statistical power of the study, making the patient data obtained from social media meaningful.

In another ongoing study at Rex Cancer Center in Raleigh, North Carolina, patients with chronic phase chronic myeloid leukemia are using smartphones to track and manage adherence while monitoring outcomes associated with oral cancer drugs to enable early intervention.

 Outcome data is being collected using The M.D. Anderson Symptom Inventory, a multi-symptom, patient-reported measure for clinical and research use.

These are 2 examples of how cellphones and social media are being used to collect and aggregate data to supplement and transform more traditional sources of medical information. The rising cost of health care and complexity of prescribed therapies require new approaches to obtaining information in order to engage patients and manage disease in real time. Patient-centric, technology-enabled approaches have significant time and cost advantages, and can add value to the medical knowledge base.

The sociology of patient care and how patients value the experience are important considerations in health care delivery today. Value differentiation occurs on the experiential side, not the technical side. Air travel is a good example of this. Travelers in first class, business class, and coach all arrive at the same time. All of the differential value to the traveler is in the experience.

The more personalized the experience, the greater the perceived value. There is a great opportunity to drive the personalization of the health care experience using technology and social media. Greater personalization and perceived value lead to positive behavior change and ultimately better health based on the health belief model. If the behavior has an effect that is perceived to be personal, relevant, and valuable, then it is more likely to be adopted.

Pharmacists have the opportunity to play an important role in personalizing the health care experience, adding value along the way. One good example of this is in initiatives to reduce hospital readmissions. Faced with large penalties for high readmission rates, hospitals are focusing on medication reconciliation and adherence to help patients transition from the hospital to the next source of care.

Pharmacists—armed with mobile health technologies that can be used to facilitate adherence with medication regimens, monitor vital signs, and send reminders and alerts about critical follow-up within the first 30 days post-hospitalization&mdash;have been successful in reducing readmissions.

At Nyack Hospital in Nyack, New York, for example, pharmacists gave congestive heart failure and pneumonia patients smartphones to help manage dosing regimens and monitor medication adherence upon discharge. They saw readmissions drop from 26.7% to zero.

 This was in a population with significant comorbidity and poly-pharmacy—up to 27 dosing events per day.

Barnes-Jewish Hospital in St. Louis, Missouri, found that readmissions largely stem from almost half of discharged patients failing to fill their prescriptions.

 New technology and new full-time pharmacists at the hospital gave patients the ability to fill prescriptions at their bedside, resulting in 40% of patients now leaving with their medication.

Other opportunities for technology-enabled pharmacy programs exist in improving the experience in health plans. In 2012, the Centers for Medicare & Medicaid Services added medication adherence to their Five Star Quality Rating System for Medicare Advantage Plans, providing health plans an added incentive to measure and capture adherence among covered members.

A technology-enabled pharmacy program can be a key factor in better care coordination. Aetna built in a financial incentive of $2 to $3 per patient per month to primary care doctors across its network if practices meet certain standards for care coordination. Other insurers including Blue Cross Blue Shield (BCBS) of Florida, Anthem BCBS, and Empire BCBS are offering similar programs.

Social media has the potential to impact the provider-patient relationship akin to what Facebook, Twitter, and LinkedIn have done for relationships among friends, family, and business colleagues. In addition to fostering one-on-one relationships, social media and mobile technologies leverage the power of crowds, facilitating patient-driven, participatory, organic change.

The potential and wonder for technologies like smartphones and social media in the field of health care are clear. But so is the “disconnect” between what can be and what is. Max Lugavere, founding host for Al Gore’ s 

, put the question bluntly—“If there really is so much potential, why is the current state of health care, at the patient level, such an uninspired mess?”

Hospitals are complex decision-making settings. When dealing with the kinds of records that involve countless variables where even the slightest overlooked nuance can have huge consequences, the need to move beyond what Lugavere calls “the MS-DOS-like abyss” is clear. Around 25% of medication errors included in the 2006 Pharmacopeia MEDMARX involved computer technology as a contributing cause. Issues cited included alert fatigue, screen fragmentation, and terminology confusion.

Much can be done in terms of user interaction and interface design to improve usability and link disparate systems to connect what have previously been silos of data, adding significantly to knowledge value. Innovative mHealth platforms are now being combined with medical interface terminologies to allow mobile technologies to become fully integrated with clinical systems, work flow, and knowledge. Leveraging the best that mobile technology has to offer can make it easier to deliver treatment in a low-cost setting outside of the acute environment in the emergency department or hospital, making it more comfortable for the patient.

The medical field by definition is social, involving interaction between people. It is also dependent on information. Social media and mobile technologies bring people and information together in a way that fosters a rich environment for the practice of medicine and health care. The ready access to virtually unlimited information from various media is revolutionizing the exchange of medical information and the interaction among stakeholders in the health care experience. Armed with more data than ever before, patients are in a better position to challenge treatment plans and weigh options. Physicians and pharmacists are in a better position to have the medical information that they need instantly at their fingertips with a few keystrokes.

The challenge becomes how to use technology in a meaningful way. Are we up to the challenge?

Barbara Rapchak is an experienced health care technology and business executive with specific expertise in behavior informatics—studying how people use technology to enhance the health care experience. She is the founder of eMedonline, a patented software-as-service platform for mobile medication therapy management that improves adherence and facilitates care transition and disease management, resulting in reduced health care costs for providers and payers, and enhanced drug use for pharmaceutical manufacturers and specialty pharmacies. The technology is uniquely built on Ms. Rapchak’s extensive research in medication adherence and behavioral informatics. It has been shown to deliver 98% compliance and clinically significant improvements in self-efficacy in numerous clinical trials funded by the National Institutes of Health (NIH) and industry. It has also reduced hospital readmissions in a pilot study, engaging the patient, facilitating care transition, and supporting meaningful use. Ms. Rapchak has managed complex technology development projects and is experienced in providing clinical research services and expertise to companies and institutions conducting health informatics research and clinical trials. She has led sponsored research and technology development for the NIH, collaborating with hospitals, universities, major corporations, and government agencies on a wide range of health care projects. Her expertise includes technology development, research design, protocol development, and clinical monitoring. She is a member of the Scientific Review Panel for NIH, and supports entrepreneurism in the private sector by participating as a mentor to student interns and a guest lecturer to academia. She received her bachelor of science degree from Notre Dame.

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Barbara Rapchak, Founder of eMedonline

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