Blockchain, mobile health, and predictive analytics are just a few areas that could improve patient care and enhance the pharmacy industry.
“When you grow up you tend to get told that the world is the way it is, and your life is just to live inside the world—try not to bash into the walls too much but have fun, save a little money. But that’s a really limited life. Life can be much more than that once you realize that everything around you that you call life was made by people no smarter than you and you can change it, you can influence it, you can build your own things that other people can use. The minute you understand this, that you can poke life and once you push something in, something will pop out the other side, that you can change it, you can mold it…that may be the most in important thing, to shake off the erroneous notion that life is just there and you are going to live in it rather than embrace it, change it improve it, make your mark upon it.”
This quote by Steve Jobs was his response when asked about his philosophy on life. This is perhaps one of his most profound quotes and it has influenced my own perspective.
Today, I share it with you in hopes that it helps influence your perspective as well. I hope this helps motivate you to challenge the status quo in the pursuit of something better.
This is a time in health care in which change is needed. It’s no secret that our current health care model is flawed, outdated, and beginning to buckle under the pressure of an obese financial problem that has a poor prognosis in terms of sustainability.
There have been many articles written about this topic, many interviews, YouTube videos, etc, that are shedding light on this macro-issue as well as the many micro-issues that are encompassed by our current care model. So, I would like to do my civic duties by adding another article to this list, but I am going to take you on a wild ride through the future of my technologically-advanced health care utopia.
It’s going to seem far-fetched, naïve, and unlikely; however, it’s going to seem like everything but realistic. Below are a few technologies that I see as playing a critical role in our future health care system.
Although there is no official definition of for the mobile health (mHealth), it can generally be classified as the delivery of health care services via mobile communication devices. Telehealth, a subclass of mHealth, has been around for some time now but has been a slow evolution to making its impact mainstream.
As more health care companies (such as hospitals and pharmacies) create their own versions of telehealth platforms, American Well in particular has emerged as the industry leader for telehealth. American Well’s platform allows doctors to connect with patients for live, on-demand visits via video chat in a secure manner. A key benefit is the ability to provide health care access to a patient is would otherwise be unable to get to the doctor’s office. This model of care has created the ability for providers to come directly to the patient, not the patient having to go to the doctor.
Let’s apply this to the patient journey in regard to specialty pharmacy. A patient with a history of rheumatoid arthritis (RA) has tried all of appropriate non-specialty therapies becoming a candidate for a biologic medication.
They take their prescription to their local pharmacy where they get the rest of their medications filled; however, unlike all of their medications, this is requiring a prior authorization. The pharmacy team hands the prescription back to the patient, apologizing for the inconvenience that they can’t fill it.
Subsequently, the patient is turned away and their frustration is already growing. The patient is already trying to manage the stress from their disease state progression and now their pharmacy experience exacerbates their difficulties. The patient discovers a type of pharmacy they have never heard of, called a specialty pharmacy, which has a dedicated team for RA with patient service representatives, pharmacy technicians, pharmacists, and even nurses.
The prescription gets authorization to be dispensed but the patient’s anxiety is growing. Never before have they given themselves an injection and after hearing about how expensive the medication is, they surely don’t want to waste any by practicing on themselves.
This is where telehealth technology comes into play. Assuming the patient has a device capable of video chatting, the specialty pharmacist is able to have a live video chat with the patient to walk them through the injection process from start to finish. This includes appropriate storage and disposal of the medication, proper injection techniques, additional tips for reducing injection site reaction or pain upon administration, and other lifestyle tips that will help the patient have a more successful experience with their new therapy.
Instead of following traditional patient care support via telephonic outreach where we would once hear anguish, anxiety, and uncertainty in a patient’s voice, we have now provided them with an educational experience that will likely instill in them a higher level of confidence to have a more successful course of treatment. Effectively, we have taken the guess work out of the self-injectable administration process for the patient.
What if we could accurately predict a patient’s treatment journey? Using predictive analytics, we could have a better chance of predicting when a patient might encounter a complication or potential disruption in therapy.
By leveraging historical data from other patients who have a similar condition, the same ethnicity, live in the same or similar neighborhood, and other demographic information, we would be able to accurately predict a patient trajectory. This could allow health care professionals to intervene in the patient’s trajectory wherever they may be likely to experience a disruption to therapy. There is no need to provide stats regarding hospitalizations due to medication non-adherence, however, we can see how predictive analytics can play a critical role in helping patients live a healthier life.
Again, let’s take a look at specialty pharmacy’s role in the patient journey. For example, a patient is newly diagnosed with cancer, naturally scared, and uncertain about their future. As a specialty pharmacist, you get the call from this patient.
You can hear it in their voice, the “c word” is already making them uneasy. They are anxious to get started on their oncology medication, but the less than desirable adverse effects that many of these agents have is adding to the patient’s distress.
So, the patient gets their prescription and begins therapy. Now what? Because we have been able to gather historical data from thousands of patients, predictive analytics enables us to intervene soon after the start of treatment because history has shown the 2-week mark begins the patient’s trajectory towards encountering nausea and other adverse effects. We are able to get in touch with the prescriber to request an anti-nausea agent and the patient is able to better manage their adverse effects.
Health care is a ripe opportunity for disruption and blockchain technology is leading that charge to be its disrupter. In its most fundamental state, blockchain is a decentralized ledger of timestamped transactions recorded every time a transaction is made. The blockchain is incredibly secure and transparent with very little room for the data to be tampered with or altered.
What better technology to disrupt health care during a time in which transparency is a part of nearly every topic of discussion? There are multiple ways in which blockchain could flip the health care industry on its back.
From supply chain pharmaceuticals, to the opioid crisis, to specialty pharmacy, blockchain is the future.
Supply Chain Pharmacy
In an effort to streamline accountability, safety, and lower drug pricing, blockchain will seek to accomplish these tasks by creating enhanced transparency. In the new model, the drug development process will integrate blockchain technology starting in the pre-clinical trial phase until development is complete.
Each step along the way will be recorded as a transaction on the ledger creating more accountability and transparency that will hold drug manufacturers accountable for pricing. This will encourage manufacturers to construct more enhanced processes for the development stages, which will reduce costs.
Ultimately, by creating a transparent model for drug development, manufacturers will be obligated to fine-tune drug costs that are more in-line with actual developmental costs.
Reducing prescription opioid use by tracking the medications from manufacturers to patients is the primary endpoint for this hypothesis. Using blockchain technology to trace opioid prescriptions from development until it ultimately gets to the patient will be the future of combatting the opioid epidemic.
With all of the information being recorded from start to finish—including manufacturers, prescribers, pharmacies, and patients—the days of doctor and pharmacy shopping will be no longer. Using a ledger that is accessible to every health care stakeholder and incapable of being altered would be a secure way to keep prescribing and dispensing practices in check.
Specialty pharmacy has become a data gold mine with more third parties requiring more information about patients. One example for blockchain implementation in specialty pharmacy is a drug manufacturer that creates a limited distribution model for their specialty drug.
They expect the designated specialty pharmacy to collect specific patient-related information in exchange for product exclusivity. Using blockchain, the drug manufacturer will be able to see a timestamped transaction to verify when and if a particular intervention occurred, holding specialty pharmacies to an accountability standard.
The entire premise of blockchain is to develop a more responsible, transparent model that creates a more efficient process and yields a more cost-effective end-product.
Much of the future is being created daily, however, unless we challenge the current status quo of our standard practices in health care, we will continue to remain complacent. We will be forced to think health care is what it is and we should only stay within the structure of this current model without causing disruption.
I encourage those who seek greater health care reform on a grand scale to dare to fail. Seek to be the change in our system that will be the disrupter we are all waiting for.
About the Author
Mark Thomas earned his Doctor of Pharmacy degree from Lake Erie College of Osteopathic Medicine (LECOM) and received his Master of Science in Pharmacy Business Administration (MSPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving