Parisa Vatanka, PharmD, CTTS

Treatment modalities are expanding beyond medications to include digital therapeutics, which are software-based therapies that help manage, prevent, and treat disease.

The first prescription digital therapeutic (DTx) was cleared by the FDA in 2017 to treat substance use disorder (SUD),

and the first virtual reality (VR) therapeutic received FDA breakthrough device designation in 2020 to help treat chronic pain.

 Sensor-enabled medications that record and transmit data on medication use have entered the market, supporting patients in taking care of their health and providing pharmacists with actionable insights to guide medication optimization.

The coronavirus disease 2019 (COVID-19) pandemic has accelerated digital health advances. Direct-to-consumer prescription delivery services, patient monitoring, and telehealth have been instrumental in maintaining essential services during a time when virtual care has been critical to continuity of care.

Even beyond the pandemic, these technologies will continue to expand and integrate, creating a hybrid of in-person and virtual care. These hybrid models will augment, not replace, the human touch, enhancing the patient-provider experience and improving access, quality, and outcomes of care.

Pharmacists and student pharmacists should prepare for evolving roles that leverage advanced technologies to support patients' health, well-being, and treatment optimization.

Technological advancements in health care have yielded a range of products and solutions under the umbrella term 

. Examples include health apps, medication reminders sent via email or text, remote patient monitoring (eg, continuous glucose monitoring), wearables such as fitness trackers, and telehealth/telemedicine services.

 A framework categorizing these products and solutions has been developed by leading digital health organizations.

As described by the FDA, "these technologies can empower consumers to make better-informed decisions about their own health and provide new options for facilitating prevention, early diagnosis of life-threatening diseases, and management of chronic conditions outside of traditional health care settings. Providers and other stakeholders are using digital health technologies in their efforts to reduce inefficiencies, improve access, reduce costs, increase quality, and make medicine more personalized for patients."

Telehealth (clinical and nonclinical remote services) experienced an exponential rise in use during the pandemic, offering continued, safe access to care. Before the pandemic, the use of telemedicine (clinical remote services) was less than 0.01% of all medical appointments.

 Between mid-March and early May 2020, the use of telemedicine increased 300-fold.

 It is anticipated that there will not be a return to prepandemic rates, as health care providers and patients both value the virtual experience. There were unexpected benefits, as described by a pharmacist who, noticing her patient was always in his vehicle during telehealth appointments, learned that he had been living in his van. It helped explain some of his challenges, and she was able to initiate social worker services, something she would not have observed during a traditional in-person clinic visit.

It is estimated that telehealth may calibrate to 15% to 20% of care post pandemic.

 A key element for sustainability will be overcoming integration challenges, such as the gap between those who have ready access to computers and internet and those who do not, known as the digital divide.

Digital health companies have focused on ways to increase medication adherence. Technologcial advancements in the past decade have seen a push to go beyond notifications by a smartphone app in favor of sensor-enabled medications or the Internet of Things (IoT) integrated drug delivery systems. Studies have investigated the effectiveness of these devices and software on large-scale patient adherence with mixed results.

Trends include objective or subjective tracking of patients' self-administration of medications. For instance, an app may remind a patient to take their medication, and the patient then indicates if they followed through. Others include smart-pill bottles or packaging that lights up, alerting patients to take their medications. Once engaged (eg, the pill bottle is opened), the software indicates that the patient removed the medication. Fully integrated medications with built-in sensors, such as bioingestible drugs, smart inhalers, and smart injectable devices, also are available.

The advantage of these technologies is that pharmacists can remotely monitor how patients take their medication, allowing a targeted approach to support medication use, patient engagement, and treatment optimization. For instance, if a patient is using a rescue inhaler more frequently, it could be a sign that they are not using the maintenance inhaler as directed or there may be a need to escalate treatment.

REMOTE PATIENT MONITORING AND AT-HOME DIAGNOSTICS

IoT has enabled connecting commonly used products to a larger data set to observe use and provide insights into consumer habits. Integrating IoT with health devices was a natural evolution that led to blood glucose monitoring devices and smart blood pressure cuffs, enabling remote monitoring between patient visits. These devices will expand telehealth/telemedicine services by lessening the need for in-clinic objective measurements, as the data will be captured remotely, strengthening the trend away from episodic care toward continuous, proactive care and supporting hospital-to-home management strategies.

Another area that has seen growth is at-home diagnostics. Patients increasingly have access to a range of tests that provide results within minutes or that can be shared in an app for assessment via a combination of artificial intelligence and provider assessment. The accessibility of these products creates the opportunity for early detection of illness and connecting individuals to the health care system via telehealth and/or in-person patient care services.

DTx is "evidence-based therapeutic interventions that are driven by high-quality software programs to prevent, manage, or treat a medical disorder or disease."

 This category is focused on a central software platform that may integrate with external hardware, such as a sensor-enabled measurement tool or VR headset, or be paired with a medication for disease management.

Market examples include DTx focused on pain management with home physiotherapy delivered by an app, pulmonary condition management using smart inhalers to guide treatment, SUD with cognitive behavior therapy interventions, and sleep management. Ultimately, medications may come paired with DTx, and pharmacists will need to include them in the medication reconciliation process to ensure treatment continues.

PHARMACISTS' ROLE IN INTEGRATING DIGITAL HEALTH

Digital health products and solutions will increasingly be integrated into the care that pharmacists provide. Eventually, the term 

 may fade away as these treatment modalities become the norm. Pharmacists may find themselves serving as coaches, curators, and digital translators for patients, accessing data on remote patient monitoring platforms, assisting with setting up software or devices, engaging with patients via hybrid care models, and matching individuals with medication and a digital companion, all to contribute to health and wellness and support treatment optimization.

Articles

Digital health products and solutions expand ways to guide prevention and treatment.

New Technologies Boost Pharmacist's Role

The California Pharmacists Association’s (CPhA) second annual digital health conference, 

 has broken new ground once again. Last year’s 

 was the first-of-its kind to explore digital health application in pharmacy practice.

This year’s conference built upon this theme, and, importantly, expanded its reach to include interprofessional presenters and participants representing perspectives from across the health care ecosystem with the aim of designing pharmacy’s future together.

In the digital age, exponential technologies are converging and transforming how we connect with family and friends, access products and services, and even how we engage in health care—all accessible with a click of a button. The global pandemic has accelerated the integration of a range of digital health products and solutions such as telehealth, remote patient monitoring, and at-home diagnostics and demonstrated their value in maintaining essential care services.

Today, evidence-based treatments have expanded beyond drugs and biologics to include modalities such as prescription digital therapeutics—software that delivers a therapeutic intervention to prevent, manage, or treat disease. Pharmacists may soon find that patients are routinely receiving medications plus their digital companion to support self-management of their health, transitioning from reactive care to proactive, personalized care.

As founder and chair of DHX, my vision was to contribute to increasing pharmacists’ awareness about this rapidly advancing area of health care, to create a forum for learning and exchange of ideas among leading experts and those on the frontlines, and to inspire pharmacists to take the lead in defining our role in leveraging these technologies to optimize our approach to care. It has been exciting to observe how DHX has resonated with participants.

Many at the individual and organizational level have shared how they are now actively taking steps to ensure pharmacists and student pharmacists are prepared and engaged to shape how digital health technology can be applied to augment the care provided today and shape the future of pharmacy practice.

During the 3-day interactive conference, individuals from across the United States and around the globe (27 states and 4 countries) 

connected virtually to hear from renowned pharmacy luminaries

 and digital health innovators and thought leaders. Beyond providing continuing education and exposure to new technologies, the conference served as a summit or large-scale stakeholder meeting in which presenters and participants shared perspectives, identified opportunities and challenges, and suggested approaches to address gaps while collectively exploring health, well-being, and medication optimization through digital health integration.

The first day at DHX was devoted to networking and discovery, where participants had the opportunity to customize their own adventure. Participants explored the exhibit booths in the virtual expo, attended breakout discussions, and engaged in 1:1 video chat.

The expo provided an opportunity to learn about a range of digital health products and engage in dialogue with company representatives and fellow conference participants to consider use cases for the products and approaches to effectively applying them in practice. The Pharmacists Paving New Paths breakout discussions provided exposure to new and emerging roles for pharmacists.

A few examples of topics covered included pharmacists working as domain experts designing digital health products, pharmacists using data science to drive clinical outcomes and business value, and pharmacists applying pharmacogenomics in personalizing medication therapy—the importance of 

On the second day of DHX, the foundational elements of the digital health ecosystem were discussed: categories, evidence base for digital medicine and digital therapeutics, and evolving policy, regulatory, and payment considerations. Keynote presenters provided a look at the acceleration of health innovation and the digital future of pharmacy.

Panelists from leading digital health companies, academia, and professional organizations discussed several areas that have seen significant growth and uptake in 2020 including telehealth, remote patient monitoring, and devices that assist with early detection and self-management of chronic conditions. A common theme was that these technologies will not replace the human touch, but instead are tools that will augment the care we provide.

The final day of DHX focused on pharmacy practice transformation through technology integration. Presenters shared how they are re-imagining traditional pharmacy, creating net new models of pharmacy (virtual and hybrid models), scaling clinical pharmacy services, and leveraging machine learning and data analytics. The closing session explored opportunities on the horizon integrating 3D printing medication and multi-omics to deliver personalized medicine, as well as novel approaches on how to prepare student pharmacists and practicing pharmacists for emerging roles now and into the future.

Want to learn more about digital health? CPhA welcomes you to join us for DHX 2021. You can also access CPhA’s 

 to read monthly articles on the fundamentals of digital health and gain insights from health and technology thought leaders.

Parisa Vatanka, PharmD, CTTS, founder and chair, DHX

VatankaP, LoftonJC. Re-envisioning the Pharmacist’s Role in the Era of Digital Health — CPhA’s Inaugural Digital Health Conference. Journal of Contemporary Pharmacy Practice

In the digital age, exponential technologies are converging and transforming how we engage in health care.