How Technology Can Foster a Seamless Patient Care Continuum
Innovations such as the Apple iPhone HealthKit could help create a smooth transition throughout the patient journey all the way to the specialty pharmacy.
When I was doing clinical rotations during my latter years of pharmacy school, and even sometimes still, the question of why I became a pharmacist was often asked. Answering that question is easy. I wanted to be a pharmacist to empower others, to help patients become and stay healthier, and to influence positive change in the lives of many.
Sick patients don’t take days off and there is no off switch for many of their conditions. Sure, they have some good days, but they also have many bad days. I always felt that patients having to deal with their respective disease states was hard enough for them, so managing their specialty prescriptions shouldn’t have to be. I got into this profession because I feel it’s a pinnacle platform to provide hope to our patients.
Abraham Lincoln once said, “The best way to predict the future is to invent it.” My intent in this article is to spark creative thinking by exposing you to a new perspective. I want to inspire you to help me create change. It’s an absolutely remarkable time in health care. We are in the midst of a gold rush to transform the US health care system and we are going to do it together through technology.
During the course of this article we’re going to go on quite a ride throughout the many technological advances that I feel can get us to our health care utopia.
Ever since I was a kid, I have been infatuated with technology. I often hold my iPhone or iPad and just ponder in amazement how a device so thin can hold a 1000-page book, be a camera, a TV, a digital assistant, a scanner, a gaming console, store thousands of pictures and video, be a bank, and so many other limitless possibilities. It’s remarkable that a device so small can be so powerful.
Although it‘s astonishing how capable these devices have become, I can’t help but to be even more excited about the future of technology. The new Apple Watch has the capability to read your heart rate, notify you if your heart rate is too high or too low, take an electrocardiogram of your heart and collect your results for the test in a PDF document that you can share with your health care provider.
However, it puzzles me how technology is not further along within the various health care settings, whether it be a provider’s office, hospital, or pharmacy. When I was practicing as a specialty pharmacist, it was a daily occurrence that I would call a provider’s office to gather information about a prescription and be greeted with complaints of a computer taking forever to access the requested information.
I was always grateful for this person’s time, so I would put the onus of the delay back on the technology, often even playing into their statement by saying “It’s okay, even the computer knows its Monday.” We have figured out how to create robotic dogs that can open a door, climb steps, and jump, therefore it’s time that we double down on developing and deploying our best technologies to improve patient care.
It’s critical to explore the exhausting, endless patient journey from beginning to end to understand the perspective of health care consumers to improve the patient experience and get them more engaged in their own well-being. Apple’s technology will serve as the premise of this utopian view of the patient journey, with the understanding that not everyone has an iPhone. But Apple’s robust health care innovations, particularly HealthKit, are worthy of consideration for the potential to transform many aspects of patient care.
The talk of improving health care and patient care via technological implementation is never-ending, but improvements are unlikely to be achieved unless we actually get patients excited and motivated about their own well-being. Technology will never work unless the consumer has an interest in using it.
Consider that seemingly every year thousands of people wait in line to buy a shiny new iPhone. Go to New York City and you’ll see a line wrapped around the block. But when is the last time you saw a line at a provider’s office or pharmacy because people were so eager and excited to be there? When is the last time you witnessed people setting their alarm at 3 am to rush to a health care setting for a preventive service because they are just so excited about taking care of their health?
This sort of behavior does not exist when it comes to taking care of what matters most: our health. We have become excellent consumers of buying things we want, not what we need. This is by no means a dig at Apple, technology, or the people waiting in line.
It’s not that people don’t want to be excited about their health or that they don’t care, but they are frustrated and tired. Compared with how user-friendly our personal electronics have become, the majority of technology in health care is cumbersome, slow, clunky, and not user friendly.
It’s quintessential for the future of patient outcomes that we begin to create a more enhanced, frictionless, and unfragmented experience for patients. The best technology just gets out of the way and the consumer is only aware of what they are doing, not of the device or technology that is accomplishing the task.
You may only think of Apple for its iPhones, iPads, and Mac computers. However, they continue to buildout the infrastructure to enable patients, providers, and all-provisioned health care professionals to have quick, accurate, and frictionless access to their health data, while doing it in a secure and user-friendly manner. Furthermore, Apple is creating platforms such as ResearchKit and CareKit, which enable researchers to better understand, diagnose, and treat disease states.
The new continuum of care
HealthKit is the behind-the-scenes technology that powers the Health app in the iOS ecosystem. This app comes standard on every iPhone and is a free, Apple-developed application. It allows people to track many health metrics, including blood pressure, blood glucose measurements, lab results, immunizations, and other vitals. It allows you to create an emergency identification card that populates your information, such as current medications, allergies, medical notes, and health conditions.
One day you are at a family function and all of a sudden, a beloved family member begins to express they are in immense pain. You pack the car and rush to the emergency department, where scans show the patient has a gastrointestinal narrowing that will require surgery.
Once the patient is admitted, they are provided with an iPad that has a list of all the medications they’re taking, their current medical conditions, allergies, etc. This information has been synced to the iPad via their HealthKit-enabled iPhone. The iPad now becomes a health companion for the patient by uniquely populating patient-specific information that is pertinent to their medical history.
For example, a patient with hypertension and diabetes could access information relevant to their disease states on their iPad, providing interactive material about their health, as well as lifestyle tips to help them improve their quality of life. Additionally, the iPad can be specifically tailored to the patient’s medication profile, providing information regarding their specific medicines. Further, the patient has a list of medical notes from prior appointments, which allows the health care team to have a full picture of the patient’s condition.
Upon discharge, the medical notes from this visit are synced to their iPhone, continuing to act as a personal central hub for all things health-related. The patient has been diagnosed with Crohn disease and requires a follow-up visit with a gastroenterologist.
A few weeks post-discharge, the new provider is able to access all of the patient’s medical notes, again, providing an unfragmented care continuum for the patient. The patient is prescribed a specialty medication to combat progression of their newly-diagnosed Crohn disease. A complete synopsis with medical notes and any new medications prescribed from the patient’s visit is synced to their iPhone.
Continuing along the patient journey, the patient’s information has now arrived at the specialty pharmacy. As a natural progression of the onboarding process, the patient is asked for a list of all the medications they are currently taking, along with allergies and other comorbidities they may have.
This is often a pain-point for many patients, particularly if they are on multiple medications, have a list of allergies, or have several ailments. This can also be a strenuous task for the patient service representative at the specialty pharmacy trying to intake all of this information, frequently having to ask the patient to slow down or repeat themselves.
This practice can become a hamster wheel of frustration. But what if our systems were so advanced that the specialty pharmacy could send a permission request to the patient to obtain their health information from the HealthKit enabled-device? This would allow the specialty pharmacy to more easily collect the required information for patient onboarding.
Acting as a central hub of up-to-date, accurate health information, the pharmacy would be able to have a more complete, accurate picture of the patient data, which enables enhanced safety for the patient. I remember during my time in specialty pharmacy, the prescription would frequently bounce off another medication for a potential drug interaction or another comorbidity of the patient, but neither were listed in the profile.
This led to significant confusion for the pharmacy team trying to determine whether further action of consulting the prescriber was warranted. Perhaps the patient is no longer on the medication, therefore the drug interaction is no longer relevant.
There are many occasions in which a potential drug interaction can cause delay in therapy because incomplete or inaccurate information occurred. This technological integration and evolution would help irradiate that problem, leading to quicker prescription turnaround time that allows the patient to begin therapy sooner and safer.
Furthermore, with access to patient health information, a mobile application can be deployed by the pharmacy to allow the patient to see all relevant clinical information, as well as disease-management information, such as lifestyle tips, medication-related information, and patient considerations that will help them stay adherent to their therapy.
Additionally, the information provided from HealthKit can help predict adverse effects that a patient starting therapy may experience, along with tips to help manage them. Within this mobile application, the patient would have the ability to report this adverse effect and connect with their specialty pharmacy instantly via secure-messaging or via phone, if they desire. The occurrence or nonoccurrence of the adverse effects is recorded within HealthKit, keeping an up-to-date log of the all things related to the patient’s health.
Now, take a moment to consider how the diagnosed patient feels trying to navigate and juggle all of this information, be it for the first time or their thousandth time. Patients are connected to mobile technologies now more than ever. We need to push technology forward to create an enhanced experience so that it just works.
My vision for the future of health care heavily involves the use of technology, but in a way in which the technology gets out of the way to create a frictionless and harmonious experience between the patient and their own health.
Perhaps this example of technology integration that allows health data to pass across devices seems underwhelming to you, but it’s actually designed to. This is the kind of experience we all desire and expect as a consumer of health care. We shouldn’t have to adapt to learn the technology, the technology needs to learn to adapt to us.
Providing an iPad to a patient allows them to become more engaged and more involved in their own care. This technological evolution allows their medical team to have all of the patient’s pertinent health information in one place with instant access. The ability to provide an uninterrupted handoff in a patient’s care continuum is essential for optimal health outcomes.
About the Author
Mark Thomas earned his Doctor of Pharmacy degree from Lake Erie College of Osteopathic Medicine and received his Master of Science in Pharmacy Business Administration program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines. Mark spent the past 4 years as a clinical pharmacist in a specialty pharmacy working on high profile initiatives to expand his organization’s national footprint, as well as directly coordinating with patients, prescribers and other healthcare providers to educate and promote the utilization and uptick of generic specialty medication. In his current role as a clinical advisor in the managed care setting, he works directly with clients to help manage and develop strategies that promote optimal health outcomes in the most cost-effective manner.