Opinion: Pharmacy Profession Needs to Invest in Digital Health This Year

JANUARY 31, 2019
The year 2018 was a wild ride in the pharmacy space. PillPack was acquired for $1Billion by Amazon. CVS and Aetna are merging together. And companies are coming out with on-demand delivery and ride-sharing services. We've seen also seen the rising costs of medications, usurps in staffing across the board, and expansion of pharmacy services in some states.

Pharmacy bears the brunt of these changes, in part due to such a focus on a 'product-based model' at this time. But it's not just pharmacy. Health care at large is going through rapid strife, due in no part to the rampant expansion of technology and a changing consumer mentality. There is talk on how AI can replace certain professions, how chatbots are being used in England to triage patients, and how companies are leveraging behavioral science to predict human actions better and guide them to better health outcomes.
 
This technological renaissance will continue to impact the health care space without precedent. We saw approval of the first digital medicine in 2017, with the partnership between Otsuka and Proteus Digital Health bringing a smart sensor enabled pill to market. This is only the beginning, and pharmacists should expect further additions to the oral oncology, infectious diseases, and mental health markets.

At the start of this year, the first sensor enabled inhaler, Digihaler by Teva, was introduced to track use in real-time, and we can expect the arrival of smart insulin pens in the next few months.  And yet, digital health goes beyond just integrating our pharmaceutical products with sensors to get tract adherence and assess objectives. We are seeing the nascent realm called 'digital therapeutics' gather mass attention. These are software focused services that can lead to a therapeutic outcome and have evidence to support them. It won't be long before payors start backing them and patients using an app to manage their health.

In addition, Pear Therapeutics with Sandoz got the first FDA approvals, with reSET-O, focused on opioid addiction and substance abuse. Otsuka has teamed up with Click Therapeutics to bring together similar therapeutic collaborations. 

But where does this put the pharmacy profession? By and large, we are unprepared and have not been engaged in the digital health space. While the possibilities are endless, the movement has garnered little attention in pharmacy. We pursue provider status, and yet ignore the issue of where this technology comes into place to leverage the clinical abilities that we already are engaged upon.

The following are areas that the profession needs to get a better grasp on, lest we are left behind:

Professional Advancements
Our societies and associations across the board will need to determine what digital health means for their members. Digital health is arguably a topic that can branch all groups and will impact pharmacists at all levels.

Education
Formal education for students will become tantamount for a future that will drastically change in the coming decade. Topics ranging from data analytics, behavioral science, digital biomarkers, IOT, etc. will need to expand. This isn't informatics; it's beyond that at this point. In addition, a certificate model or such will likely need to be done to get current practitioners up to par, or at the bare minimum, continuing education modules. 

Workflow Integration
One of my most substantial concerns is the impact that digital health products will have on pharmacy. Our pharmacy management systems are built around getting medications to the patient, and while in some areas they are changing, we are not enabled to integrate the data from digital medicines to track adherence in real-time and support patients. Or, the question could be, 'should we even be responsible for monitoring and acting on that data?' 

Payments
If we are enabled and responsible for using data collected, such as adherence, we should be paid for it. In a hypothetical scenario, if a pharmacist were to prescribe an app approved to help with smoking cessation, they should be remunerated for the assessment and action to get the patient on that service. Pharma, start-ups/tech companies, and our societies should focus on this, as it could be a means to move beyond a product-focus model to a service-based model. There really is not a set language for who should or should not be prescribing and starting these tools for patients. The more we lobby for this right, the better chance we have of owning it, versus letting it pass by and trying to claw back.

These are the areas that need to be disrupted, and that needs to start happening this year. Failure will allow other organizations and professions a head start, and we need to have a voice on this technology. If pharma is thinking 'beyond the pill' with tech, pharmacy must 'think beyond the fill.'

Let's get going.

Timothy Aungst, PharmD
Timothy Aungst, PharmD
Timothy Dy Aungst, PharmD, is an associate professor of pharmacy practice at MCPHS University. He graduated from Wilkes University Nesbitt School of Pharmacy and completed a PGY-1 Pharmacy Practice Residency at St. Luke's University Hospital, and then a Clinical Geriatric Fellowship at MCPHS University. He is passionate about the rise of technology in health care and its application to pharmacy. He has published primarily on the role of mobile technology and mHealth, and made multiple national and international presentations on those topics. He blogs at TheDigitalApothecary.com, is a Co-Host of FurtureDose.tech a podcast part of the Pharmacy Podcast Network, and you can find him on Twitter @TDAungst.
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