Digital Health: Future of Health CareImplication to the Profession of Pharmacy

Brian LeePharmD Candidate, 2016University of Pittsburgh

US Healthcare is having a serious issue

• Free Misfit wristband pedometer• Earn $1 every day or $20 Amazon gift card/month

Digital health being adopted by a payer

Healthier membersSaving healthcare cost

You have already experience digital health

• Use of activity tracker, also known as Fitbit is widely adopted• Fitbit shows your lifestyle in numbers• Promoting healthy lifestyle• Competing with your peers

So what is digital health?• Digital Health is the

collaborative integration of technologies into healthcare to prevent, diagnose, treat, and manage diseases and to encourage, measure, track, and support wellness. 1

1) Phil Baumann, The definition of Digital Health, http://healthissocial.com/digital-health/the-definition-of-digital-health/, Feb 2015

Learning objectivesUnderstand the definition of digital health and its trends

Differentiate types of digital health devices

Understand the barriers to adopt digital health and what it means for pharmacist

Aware of career opportunity within Digital Health

Discuss the advantages and effectiveness of digital health devices

What are the different types of digital health?

Overview of digital healthUser Model

Outcome Model

Patient-centered

Disease-centered

Drug-centeredClinical trialsFDA clearanceHealth economics studiesReimbursementDTP / DTC salesMarketing and promotion

Phenomenal user interaction (UI)Usually available on the app stores

Digital health by examplePatient-Centered Disease- Centered Drug-centered

Description

Mobile App Therapy provides patient-level

decision support, tools for self-management, and educational coaching

Device that measures, interprets physiologic data, allowing remote

chronic care management of

physician

Device that adds additional value to the specific drug

Example WellDoc’s BlueStar Philips Respironics, ResMed CPAP

Advair:.Diskus Propeller, Proteus

Patient-centered example: WelldDoc’s BlueStar• Give patients personalized guidance,

educational tips, and a shot of motivation in real time, at the moment you need it.

• Keep track of blood glucose levels, medications, diet, and exercise all in one place

• Send a report of your progress to your doctor before each office visit.

BlueStar is the first mobile prescription therapy

Potential reimbursement rate: $185/patient/month

1.Doctor writes a prescription and faxes it to the pharmacy

2.BlueStar Customer Care contacts you about one-time training session

3. A pharmacist calls to review the prescription, then give an access code

BlueStar clinical trial results

• A1c declines 1.9% among patients with mobile-based self-management coaching system

• vs 0.7% in the usual care group over 12 months

1.9% vs. 0.7%A1c

Digital health by examplePatient-Centered Disease- Centered Drug-centered

Description

Mobile App Therapy provides patient-level

decision support, tools for self-management, and educational coaching

Device that measures, interprets physiologic data, allowing remote

chronic care management of

physician

Device that adds additional value to the specific drug

Example WellDoc’s BlueStar Philips Respironics, ResMed CPAP

Advair:.Diskus Propeller, Proteus

Disease-centered example: ResMed CPAP

• Care providers can collaborate by storing patient's diagnostic, prescription and therapy information

• Patient's care team can troubleshoot remotely –avoid unnecessary patient visits and minimize therapy downtime

• Collaborate more efficiently across patient’s healthcare network

http://www.healthcareitnews.com/news/remote-patient-monitoring-market-booming-amid-readmission-fines-doctor-shortages-report-says

New CPT code released for virtual patient care services

• Beginning January 1, 2015• 20 minutes of clinical staff time

per calendar month• Physicians• Nurse Midwives• Clinical Nurse Specialists• Nurse Practitioners• Physician Assistants

• Patients require multiple chronic conditions expected to last at least 12 months

• Comprehensive care plan established, implemented, revised or monitored

• ~$250 reimbursement / 20min

•

Chronic Care Management Services, Department of Health and Human Services, Center for Medicare & Medicaid Services, 2015

Digital health by examplePatient-Centered Disease- Centered Drug-centered

Description

Mobile App Therapy provides patient-level

decision support, tools for self-management, and educational coaching

Device that measures, interprets physiologic data, allowing remote

chronic care management of

physician

Device that adds additional value to the specific drug

Example WellDoc’s BlueStar Philips Respironics, ResMed CPAP

Advair:.Diskus Propeller, Proteus

Drug-centered example: Proeller Sensor

• The sensor keeps track of the medication use with a record of the time and place patient have used your inhaler.

• Physicians can remotely monitor the symptoms and determine when a change in therapy may be needed.

How does SmartInhaler workTracking Medication Use

• Information is available in the cloud Medication Reminder

• If the user forgets to take the prescribed medication, the inhaler provides a discreet audio-visual reminder

Bluetooth Communications• Automatic wireless transmission of data from the inhaler to

the cloudTouch-Enabled

• Users can view the medication usage charts, and change preferences

SmartInhaler benefits asthma patientsRandomized control trial to investigate whether electronic adherence monitoring with reminder alarms and feedback can improve clinical outcomes in childhood asthma

Robert Morton, Mark Everard, Heather ElphickDOI: 10.1183/13993003.congress-2015.OA4772 Published 1 September 2015European Respiratory Journal

Methods: Children with asthma in the UK were recruited and followed up in standard clinics for 12 months. The intervention group had their adherence electronically monitored and regularly fed- back. The devices in this group also played medication reminder alarms. The control group had their adherence monitored, but received no feedback or alarms. Clinical outcomes were recorded 3 monthly.

144% in adherence

14.9% FEV1lung function

37% inoral steroidCourses required

http://erj.ersjournals.com/content/46/suppl_59/OA4772

Drug-centered example: Proteus Pill Ingestible sensor in a single tablet to digitally record ingestion

• Up to 50% of patients with chronic diseases are noncompliant with medications

• Medical noncompliance adds between $100 - $300 billion annually in healthcare costs (estimated in 2014)

http://www.forbes.com/sites/robertglatter/2015/09/14/proteus-digital-health-and-otsuka-seek-fda-approval-for-worlds-first-digital-medicine/#2715e4857a0bc33d6964b5ca

• a

Proteus Discover to a drug regimen results in statistically significant reductions in blood pressure and low-density lipoprotein-cholesterol (LDL),85% vs 33%

http://www.fiercemedicaldevices.com/story/proteus-unveils-outcomes-data-demonstrate-medication-adherence-benefits-pay/2016-04-05

How is Digital Health affecting Healthcare?

Digital Health improves healthcare quality

• Reduce inefficiencies in healthcare delivery• Make medicine more personalized and precise• Improve access• Increase quality of care

Improved Access to Care

Improved Continuity of Care

62% 64% 66% 68% 70% 72% 74% 76% 78%

78%

68%

The American Academy of Family Physicians Telehealth Survey, n=1557

http://mobihealthnews.com/content/survey-15-percent-family-physicians-used-telemedicine-2014

• a

Digital Health solutions could save primary care $10 billion annually.

http://hitconsultant.net/2015/10/20/digital-health-solutions-save-primary-care-10b-annually/

Digital Health benefits all healthcare stakeholders

Patients

Healthcare Providers

Payers

Pharma

• Creates new avenues of direct communication with consumer to promote brand presence and loyalty

• Payers can quickly measure the quality of disease care and performance on key indicators

• Minimal investment as technology already exists

• Better monitor patient behavior such as usage patterns, quality of medication intake, and adherence

• Increase access to patient data and tools at the point-of care to support decision-making

• Improved self-awareness of the disease status and its treatment

• Vehicle for communication with HCP• Facilitates disease education

AMCP

SIO

APhA, ASHP

A Chawla et al. Companion devices: transformative mobile health technology towards improved patient care delivery, Conference poster, ISPOR, Philadelphia, May 2015.

Barriers and Opportunities

Who can influence consumers to adopt digital health offerings ?

USA

UK

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

PharmacistHealth InsurerPhysicians

So are the doctors knowledgeable about Digital Health?

USA

UK

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

What’s driving this change?

It is all about patient• Patients are actively involved in their

health than ever• Use of mHealth apps grew 87% faster than

the overall app industry• Over 100,000 mHealth apps are on the

market

http://flurrymobile.tumblr.com/post/115192181465/health-and-fitness-apps-finally-take-off-fueled?utm_medium=referral&utm_source=pulsenews

Digital Health is vital part of healthcare

• 53% of clinicians use a tablet to access electronic health records• 47% of clinicians use smartphones to search for information• 84% of young adults age 18 to 34 would prefer telemedicine

Government and organizations are pushing for health innovations

• University of Pittsburgh School of Pharmacy has Pharmacy Innovation Lab(PIL) program

• America Association of Retired People (AARP) hosts annual health innovation competition

• US Department of Health and Human Service (HHS) 18 months residence program

http://health50.org http://www.hhs.gov/idealab/ www.pillab.com

Increasing funding for digital health startups

• Venture investment in digital health in 2014 reached $4.1 billion• 123% increase year-over-year

So how do you get involve?

Opportunity for pharmacy student• Stay up-to-date. Subscribe http://mobihealthnews.com/• Research opportunity available using various digital

health devices(propeller health, proteus health)• Apply for summer internship at a digital health startups• Bring your ideas to health innovation competitions (ex.

Big Idea Competition)• Attending digital health conferences (Digital Health

Summit, HIMSS Conference, Health 2.0 and many others)

Thank you