Technological advancements empower patients to manage their own health.
Cancer care continues to evolve in innovative ways, from novel treatments to new technologies designed to help patients manage their therapy and associated adverse effects. All aspects of the care team will play a role in deploying and activating these technologies with their patients. Certainly, physicians, nurses, and social workers will be at the front lines of these developments. In addition, due to the increase in oral cancer therapies reaching the market over the past 5 years, the role of the pharmacist will be crucial in integrating these technologies into patient care.
Technological advancements empower patients to manage their own health. Tools such as smart pills and pill bottles, wearable technology, and cloud-based communications are essential to engage patients and also ensure safety and adherence to medications. It is important for specialty pharmacists to be aware of and know how to best leverage these advancements.
Smart Pills and Pill Bottles
In November 2017, the US Food and Drug Administration approved the technology to insert a microchip into a pill to track when patients have taken their medications. However, the availability of this technology has been slow as companies test its use in individual drugs. Despite this ongoing testing, the use of smart pill bottles has increased.
The smart bottle differs from the traditional bottle in numerous ways, such as monitoring when the cap is opened, weighing the bottle’s contents, and alerting patients when it is time to take their medication. A common theme with all these options is the ability to track and report adherence data back to patients, providers, and caregivers. Specialty pharmacies are considering multiple factors as they decide whether to adopt and offer this technology to their patients.
Cost and training are among the biggest considerations. Pharmacies must decide whether they want to invest in training pharmacists on how the bottles work, how to troubleshoot if a patient is having an issue, and how to incorporate this tool into their existing arsenal of resources to help patients stay on therapy. These factors add to the hard costs of smart bottles, which cost considerably more than traditional ones. However, most pharmaceutical companies are footing the bill to avoid passing on the increased cost to the patient or the dispensing pharmacy. Finally, as pharmacists consider the required time and costs, many may also be evaluating patient adoption. Some patients may be reluctant to share their personal information or be monitored, and some may be unwilling to undergo the education required to get comfortable with using the new technology.
Pharmacies that offer these options to their patients could see significant adherence benefits and will gain access to data to prove that these technologies can increase overall adherence. This is important as specialty pharmacies become increasingly accountable for patient outcomes, which are inherently tied to adherence.
Insulin pumps, pedometers, and wearable fitness trackers have been in use for years in health care. Most of these wearable technologies measure only a specific aspect of health care, such as number of steps taken. However, in recent years, the offerings have expanded to include such things as heart rate and electrocardiogram monitors.
Wearables not only track steps but also encourage standing or exercising and monitor consumption of food or water. This is important for cancer care, as studies have demonstrated the positive impact that exercise and diet can have on cancer treatment. For example, the National Institutes of Health states that dietary changes can help reduce the symptoms of cancer and cancer treatment.1
As pharmacists play a larger role in cancer care, it is important to understand how patients are using these technologies to make decisions regarding their lifestyle, diet, exercise, and even treatment. Wearables give pharmacists an additional tool to help treat their patients. Some pharmacies complement these devices with their own services to assist in holistic cancer care. An entire section of the Walgreens website is dedicated to helping patients with cancer manage common adverse effects related to treatment by making changes to their diet (walgreens.com/topic/pharmacy/specialty-pharma- cy/side-effect-help.jsp).
As these devices are more broadly adopted, questions arise about what will be done with all the data being collected and who will have access to them. Some app designers and insurers would like to use this information to promote overall heath, including adherence to medications. A February 2019 Washington Post article reports that an employer in Texas has begun a program with United Health that allows supervisors access to certain employee information in order to promote better and healthier choices.2 Given the consolidation in the pharmacy space, it could be easy to imagine a future in which those same data are shared openly with pharmacy teams to help improve outcomes in patients.
Cloud-Based Health Care Records
Until recently, patients with cancer could be seen carrying large binders containing all their research and health information related to their care. This was not very portable or convenient to share with various care team members. Information regarding treatments and other aspects of the patient's condition was hard to find among the pages and pages of information enclosed in these heavy binders. This began to change with the introduction of cloud technology. As the use of the internet and cloud technology grew among health care organizations, patients became more empowered with quicker and more convenient access to their own health care information. However, privacy concerns and usability have been major hurdles to increased adoption of these technologies. In addition, patients may not know what to do with this information or how exactly to use it to improve their health.
Newer technologies are working to leverage the increased portability of the cloud to make health information more sharable while protecting patients’ privacy. New cloud-based platforms allow patients to download their health information to an app on their phone. When patients want to share that information with a heath care provider, they can show a QR code that can be scanned to grant access to their health records.
Other companies are partnering to use the cloud to develop new health care delivery models and transform the cus- tomer retail experience. Walgreens and Microsoft recently partnered to migrate data centers to the cloud and adopt a cloud-native and artificial intelligence—first mind-set. Combining the expertise of both companies with cloud-based technology will enable new and seamless health networks that integrate the digital–physical experience; deliver new care management solutions; and better connect patients, providers, pharmaceutical manufacturers, and payers to deliver a more cost-effective, personalized, and integrated health care experience.
Cloud-based services offer many potential benefits. Pharmacists, in particular, can take advantage of this technology to help advise their patients on medication management and drug interactions. One challenge that pharmacists could face involves the possibility that patients may fill prescriptions at multiple pharmacies and must be relied on to accurately report their medications and dosages. A technological solution that would allow pharmacists to leverage the data, thus eliminating the human error factor of reporting, could lead to better advice for patients and better overall outcomes. The interoperability of this technology likely still needs additional work before widespread usage, but advances in this space seeming to happen every few months.
An Evolving Approach to Specialty Care
Cancer care remains a highly complex endeavor in which patients are best served when they are actively engaged with their entire care team, from physicians and nurses to navigators and pharmacists. Advances in technology will assist all members of the team to better help patients stay on their therapies and manage adverse effects. However, some of the technology is still in its infancy, and it will take some time and buy-in from pharmacies to see a sustained and measurable impact on patient care. All pharmacies are experimenting to determine how best to incorporate these advances. As outcomes studies reveal new insights, pharmacies will begin to understand which technologies have the largest impact on patients.
1. Nutrition in cancer care (PDQ)—patient version. National Cancer Institute website. cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-pdq. Updated March 16, 2018. Accessed March 3, 2019.
2. Rowland C. With fitness trackers in the workplace, bosses can monitor your every step — and possibly more. The Washington Post. February 16, 2019. washingtonpost.com/business/economy/with-fitness-trackers-in-the-workplace-bosses-can-monitor-your-every-step--and-possibly-more/2019/02/15/75ee0848-2a45-11e9-b011-d8500644dc98_story.html?noredirect=on&utm_term=.d31c0bb1a335. Accessed March 3, 2019.