What does a 21st century

technologically savvy pharmacist

look like?

Cody J. Midlam, PharmD,CGP

Introduction

This program will identify emerging technologies affecting

the practice of pharmacy in a transitional healthcare

delivery system, with a focus on those technologies that

improve pharmacist-patient communication, and tools that

aide in drug therapy monitoring

Objectives

1. Identify what a technological savvy pharmacist looks

like in 2014

2. Identify mobile health devices and applications (apps)

to monitor blood pressure, blood glucose, and other

patient-based labs

3. Differentiate between historical, current, and future

programs to aide in medication adherence and

compliance

4. Distinguish which technologies enable pharmacists to

become more involved with their local healthcare

communities

Terms Used

• Cloud-based: programs and storage reside in remote

location

• Wi-Fi : local area network (LAN) range of 100-300

feet

• Bluetooth : personal area network (PAN) range of 3-

300 feet

• mHealth: health and medicine via mobile devices

• HIE: health information exchange

Examples of Transition

• There is a shortage of primary care doctors in the US

• 30% of all physicians practice in primary care (compared to 70%

fifty years ago)

• An additional 52,000 PCPs needed by 2025

• World Health Organization (WHO)

• In 2006 there is global shortage of almost 4.3 million

healthcare professionals

1. AAFP News. 52,000 More Primary Care Physicians Needed by 2025. American Academy of Family Physicians. Retrieved June 13, 2014 from http://www.aafp.org/news/practice-professional-

issues/20121114workforceneeds.html

2. Aluttis, Christoph, Bishwaw, Tewabech, Frank, Martina. The workforce for health in a globalized context – global shortages and international migration. Glob Health Action. 2014; 7:

10.3402/gha.v7.23611. Accessed Online July 31, 2014 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926986/

Healthcare Goes Digital

• The World Health Organization (WHO) released in 2006 a

document titled “Electronic Health Records: Manual for

Developing Countries”.

• At that time it was proposed that eventually healthcare will move to

a paperless environment, stating EHRs should

• Improve the accuracy and quality of data recorded in a health record

• Enhance healthcare practitioners’ access to a patient’s healthcare

information

• Improve the quality of care as a result of having health information

immediately available at all times for patient care

• Improve the efficiency of the health record service

• Contain healthcare costs

• Have you heard Electronic Records will help?

1. The World Health Organization Western Pacific Region. Electronic Health Records: Manual for Developing Countries. Published 2006. Accessed online August 24, 2014 at

http://www.wpro.who.int/publications/docs/EHRmanual.pdf

Different Types of Records

1. EHR: electronic health record

2. EMR: electronic medical record

3. PHR: personal health record

4. PP-EHR: pharmacist-pharmacy

provider EHR

1. Spiro, Rachelle. The impact of electronic health records on pharmacy practice. Drug Topics. April 10, 2012. Retrieved June 13, 2014 from http://drugtopics.modernmedicine.com/drug-

topics/news/clinical/community-pharmacy/impact-electronic-health-records-pharmacy-practice?id=&sk=&date=&pageID=4

Personal Health Record

1. HealhtIT.gov. Provider and Professionals. Are there different types of personal health records (PHRs)? Retrieved June 13, 2014 from http://www.healthit.gov/providers-professionals/faqs/are-

there-different-types-personal-health-records-phrs

• Electronic application used by patients to maintain and

manage their health information in a private, secure, and

confidential environment

• Standalone PHR

• Patients fill in information from their own records

• Data stored on patient computer or in the cloud

• Accepts data from other sources such as providers, labs, or devices

• Tethered/Connected PHR

• Linked to a health care organization’s EHR

• Patients access their data via online portal

Microsoft HealthVault

1. Microsoft HealthVault. Explore HealthVault. [Author’s Screenshot]. Retrieved June 13, 2014 from https://www.healthvault.com/us/en

STA

ND

AL

ON

E P

HR

Blue Button Initiative in the US

• Available to VA and

Medicare beneficiaries

• Access to health records via

online portal

• Pharmacies join

• Walgreens

• Kroger

• CVS Caremark

• Rite Aid

• Safeway

• Pharmacy organizations join

• NACDS

• Pharmacy Health IT

Collaborative

• National Alliance of State

Pharmacy Associations

1. HHS.Gov Digital Strategy. Leading Pharmacies and Retailers Join the Blue Button Initiative. Retrieved June 13, 2014 from http://www.hhs.gov/digitalstrategy/open-data/leading-pharmacies-

retailers-join-blue-button.html

Application to Community Pharmacy

• How do these electronic

health records apply to

a (busy) Community

Pharmacist?

A Time of Change…

"The ongoing success of community pharmacy requires evolution from

a business model based on product distribution to a new approach that

emphasizes the provision of patient care services for which pharmacy

is fairly compensated.”

— Carmen Churcott, CEO, Pharmasave Drugs

“…as all players across the continuum of care are increasingly

pressured to focus on patient outcomes, new and innovative models for

care delivery are emerging...”

— Jon Giacomin, president, U.S. pharmaceutical distribution,

Cardinal Health

1. Chain Drug Review. 2014 Outlook: Industry adapts as pharmacy evolves. January 14, 2014. Chain Drug Review Online. Retrieved June 13, 2014 from http://www.chaindrugreview.com/front-page/newsbreaks/2014-outlook-

industry-adapts-as-pharmacy-evolves

Changing Gears

• Overarching goal of

health reform =

Increase quality/ save

cost

• Do so with

• Technology

• Reimbursement

• Patient engagement

Participatory Medicine

• Model of cooperative

health care that seeks to

• Achieve active involvement

by patients, professionals,

caregivers, and others

across the continuum of

care on all issues related to

an individual's health

• Improve outcomes, reduce

medical errors, increase

patient satisfaction and

improve the cost of care

1. E-patient Dave. New in JoPM: “I No Longer Have to Go to See the Doctor:” How the Patient Portal is Changing Medical Practice. May 18, 2014. E-patients.net. Retrieved June 13, 2014 from

http://e-patients.net/archives/2014/05/new-in-jopm-i-no-longer-have-to-go-to-see-the-doctor-how-the-patient-portal-is-changing-medical-practice.html

PATIENTS

Patient caregivers

Health care professionals

Self-management Tools

• Participatory medicine movement is new and it is evolving

• Data generation will be a driving force for adoption

• Benefits population health

1. Reuter, Katja. Notes from the 2011 Medicine 2.0 Summit at Stanford. [Photograph]. Retrieved from http://biomed20.ucsf.edu/2011/09/22/notes-from-the-medicine-2-0-summit-2011-at-stanford/

mHealth

• mHealth: Health care delivery via mobile health

technology such as text messaging, mobile phone

apps, remote monitoring, or portable sensors

mobile Health

• By nature is ‘mobile’

• Mobile means, health where the patient IS

• Home, work, jogging, sleeping, out in the field, remote clinics

• This generates a ton of data which raises questions

• Where do we put the data?

• How do we analyze it?

• Whom should we send it to?

• How do we address it clinically?

Devices + Apps = Mobile Health

Plug into your phone

Connect to your phone via bluetoothor wi-fi

Connect to a home hub

Devices

Disease-specific apps

Apps that accept monitoring data

Total health care apps

Apps

Have you seen a health or fitness- based cellphone app?

Blood Pressure into PHR

• Omron 10 Series+ Upper

Arm Blood Pressure

Monitor

• Connect to your PC via USB

cable to track readings over

time

• PHRs

• Microsoft HealthVault

• Omron Health-Management

Software

1. Omron Health Care. 10 Series+™ Upper Arm Blood Pressure Monitor (BP791IT). [Photograph]. Retrieved from

http://store.omronhealthcare.com/store/omron/en_US/pd/productID.275300500/parentCategoryID.62441100

Wi-Fi Blood Pressure

• Blipcare Blip BP

• Wi-Fi Blood Pressure Monitor

• FDA approved

• Patient portal and tracking tools

• Withings Wireless Blood Pressure

Monitor

• Health Mate app launches automatically

when cuff turns on

• App stores BP history in the cloud

1. Blipcare. “World's 1st Wi-Fi Blood Pressure Monitor”. [Photograph]. Retrieved June 12, 2014 from http://www.blipcare.com/blip-bp.html

2. Withings. “Wireless Blood Pressure Monitor”. [Photograph]. Retrieved June 12, 2014 from http://vitrine.withings.com/us/blood-pressure-monitor.html#

Bluetooth Glucometers

• Johnson and Johnson

OneTouch VerioSync

• Uses OneTouch VerioSync

test strips and sends data to

the OneTouch Reveal mobile

app

• Automatically sends BG

results to iPhone, iPod, or

iPad

• Feature to share results via

email or text

1. Johnson & Johnson. “VerioSync”. [Photograph]. Retrieved June 12, 2014 from http://www.onetouch.com/veriosync

BP, Glucose, and More

• iHealth cloud-based platform that connects

various devices to phone app via bluetooth

technology

• Blood pressure monitor

• Body analysis scale

• Glucometer

• Activity and sleep tracker

1. iHealth. “Wireless Blood Pressure Monitort” [Photograph]. Retrieved June 12, 2014 from http://www.ihealthlabs.com/

Respiratory Disease• PropellerHealth

• Wireless sensor added to top of

inhaler

• Monitors adherence

• Monitors locations where rescue

inhaler is used

• Helps map out environmental

triggers

• FDA approved sensor

• Syncs with phone via Bluetooth

• App for iOS and Android

1. Propeller Health. “Propeller Sensor”. [Photograph]. Retrieved June 12, 2014 from http://propellerhealth.com/

Enterprise Solutions

• WellDoc BlueStar program uses

phone or computer to monitor BG

and med adherence

• Applies data to patient-focused

educational efforts

• Qualcomm 2net Platform cloud-

based platform to integrate

medical devices, applications,

and EHRs

• Connect to platform via 2net Hub or

2net mobile

1. Qualcommlife. “2net”. [Photograph]. Retrieved from http://www.qualcommlife.com/images/2netMobile.png

2. WellDoc. “BlueStar”. [Photograph]. Retrieved from http://www.welldoc.com

Apple HealthKit

1. New York Post Market Watch. Apple HealthKit stuns startup: ‘That’s our name’. [Photograph]. Retrieved from http://nypost.com/2014/06/04/apple-healthkit-stuns-startup-thats-our-name/

Large, well-

known

companies

like Apple may

significantly

change the

uptake of

mHealth

Samsung S Health

1. Samsung S-Health. [Photograph]. Retrieved from http://nogalskisam.files.wordpress.com/2013/03/shealth.jpg

Released in

the same week

as Apple

HealthKit

indicates a

competitive

market for

growth

Pharmacy Apps

• Most focus on

medication refills and/ or

adherence

• Alert patients they need to

refill meds

• Allow patients to refill meds

• Remind patients it is time to

take their meds

• Ask the patient if they took

their med

Yes… there is

an app for that!

Medication Reminder Apps

200+ “medication reminder” apps Google Play store

1. GooglePlay Store. “200+ “medication reminder” apps Google Play store” [Author’s Screenshot]. Retrieved from https://play.google.com/store

Historical Adherence Aides

Pharmacy Health Connect

1. Cardinal Health. “Pharmacy HealthConnect Smartphone App”. [Photograph]. Retrieved from

http://www.cardinal.com/mps/public/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3gjA3cDAwtfZ18fV2NTA09HL_dAYz8TQ4NQM_2CbEdFADfU32U!/?WCM_PORTLET=PC_7_20G008MCMLCQD

0I6KL912K3005_WCM&WCM_GLOBAL_CONTEXT=/mps/wcm/connect/us/en/communityindependentpharmacies/solutions/orderexpresssmartphoneapp

• Refill prescriptions

• Set reminders to take

and refill medications

• Access pharmacy-

specific news and

event information

• Receive messages

from your pharmacy

Adherence Devices

• CleverCap

• Fits standard pill bottle

• Multiple alarms

• Visible flashing

• Audible beeping

• SMS, emails and phone call follow-ups

• Cloud-based reporting analytics

• Mobile if in cellular range

• 2Net HUB Version

1. CleverCap. “Homescreen” [Photograph]. Retrieved from https://ssl.clevercap.org/arc/about.html

Adherence Devices

• GlowCap

• Cap glows and plays melody

at dosing time

• Order refills by pushing button

on bottom of cap

• Connects to pharmacy via

AT&T broadband network

1. GlowCap. “bottle and cap”. [Photograph]. Retrieved from http://www.glowcaps.com/product/

(almost) Science Fiction

• Proteus Digital Health Feedback System

• Ingestible sensor is activated by gastric acid

• Sends data to patch worn on the body alerting the

sensor a medication has been taken

1. CNN Money. “'Digital pill' with chip inside gets FDA green light”. [Photograph]. Retrieved from http://money.cnn.com/2012/08/03/technology/startups/ingestible-sensor-proteus/

Is a Pharmacy the Right Place?

• Most wireless devices focus on major therapeutic areas

• Hypertension, Diabetes, Weight loss, Asthma/ COPD

• Unconnected devices already sold at pharmacy

• Glucometers, test strips, BP cuffs, weight scales

• Connected devices further involve pharmacists

• Trusted resource to recommend products and help interpret results

• Do you sell these products?

1. Image from timesunion.com “New 24/7 Glucose Monitor. Accessed Online August 24, 2014 at

http://www.timesunion.com/local/article/A-test-market-of-a-costly-kind-2794207.php

Technology Aides Transition

• Access to health data is key for advancing role of the

pharmacy team

• Armed with data, pharmacists can lower cost for new healthcare

systems (ACOs and Medical Homes in the US)

• Innovative pharmacists can get around slow EHR/

Pharmacy software interoperability

• Access Personal Health Records

• Collect device biometrics and readings directly or via a portal

• Share cloud-stored data with select patients

Key Takeaways

• Numerous changes affecting pharmacy over the next

decade(s)

• Community pharmacy is a good fit to accommodate many

emerging health care models

• Technology aides transition with increased efficiency

• Pharmacy technology is not perfect

• Work with technologies currently available

• Innovation will be key to differentiate services

• Develop unique payment models

• Participate in the emerging health care model(s)

• Help your patients become engaged in their health care!

Thank You

• Cody Midlam, PharmD, CGP

• codymidlam@gmail.com

• Questions?

References1. AAFP News. 52,000 More Primary Care Physicians Needed by 2025. American Academy of Family Physicians. Retrieved June 13, 2014 from http://www.aafp.org/news/practice-professional-issues/20121114workforceneeds.html

2. Aluttis, Christoph, Bishwaw, Tewabech, Frank, Martina. The workforce for health in a globalized context – global shortages and international migration. Glob Health Action. 2014; 7: 10.3402/gha.v7.23611. Accessed Online July 31, 2014 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926986

3. The World Health Organization Western Pacific Region. Electronic Health Records: Manual for Developing Countries. Published 2006. Accessed online August 24, 2014 at http://www.wpro.who.int/publications/docs/EHRmanual.pdf

4. Spiro, Rachelle. The impact of electronic health records on pharmacy practice. Drug Topics. April 10, 2012. Retrieved June 13, 2014 from http://drugtopics.modernmedicine.com/drug-topics/news/clinical/community-pharmacy/impact-electronic-health-records-pharmacy-practice?id=&sk=&date=&pageID=4

5. HealhtIT.gov. Provider and Professionals. Are there different types of personal health records (PHRs)? Retrieved June 13, 2014 from http://www.healthit.gov/providers-professionals/faqs/are-there-different-types-personal-health-records-phrs

6. Microsoft HealthVault. Explore HealthVault. [Author’s Screenshot]. Retrieved June 13, 2014 from https://www.healthvault.com/us/en

7. HHS.Gov Digital Strategy. Leading Pharmacies and Retailers Join the Blue Button Initiative. Retrieved June 13, 2014 from http://www.hhs.gov/digitalstrategy/open-data/leading-pharmacies-retailers-join-blue-button.html

8. Chain Drug Review. 2014 Outlook: Industry adapts as pharmacy evolves. January 14, 2014. Chain Drug Review Online. Retrieved June 13, 2014 from http://www.chaindrugreview.com/front-page/newsbreaks/2014-outlook-industry-adapts-as-pharmacy-evolves

9. E-patient Dave. New in JoPM: “I No Longer Have to Go to See the Doctor:” How the Patient Portal is Changing Medical Practice. May 18, 2014. E-patients.net. Retrieved June 13, 2014 from http://e-patients.net/archives/2014/05/new-in-jopm-i-no-longer-have-to-go-to-see-the-doctor-how-the-patient-portal-is-changing-medical-practice.html

10. Reuter, Katja. Notes from the 2011 Medicine 2.0 Summit at Stanford. [Photograph]. Retrieved from http://biomed20.ucsf.edu/2011/09/22/notes-from-the-medicine-2-0-summit-2011-at-stanford

11. Omron Health Care. 10 Series+™ Upper Arm Blood Pressure Monitor (BP791IT). [Photograph]. Retrieved from http://store.omronhealthcare.com/store/omron/en_US/pd/productID.275300500/parentCategoryID.62441100

12. Blipcare. “World's 1st Wi-Fi Blood Pressure Monitor”. [Photograph]. Retrieved June 12, 2014 from http://www.blipcare.com/blip-bp.html

13. Withings. “Wireless Blood Pressure Monitor”. [Photograph]. Retrieved June 12, 2014 from http://vitrine.withings.com/us/blood-pressure-monitor.html#

14. Johnson & Johnson. “VerioSync”. [Photograph]. Retrieved June 12, 2014 from http://www.onetouch.com/veriosync

References15. iHealth. “Wireless Blood Pressure Monitor” [Photograph]. Retrieved June 12, 2014 from http://www.ihealthlabs.com/

16. Propeller Health. “Propeller Sensor”. [Photograph]. Retrieved June 12, 2014 from http://propellerhealth.com/

17. New York Post Market Watch. Apple HealthKit stuns startup: ‘That’s our name’. [Photograph]. Retrieved from

http://nypost.com/2014/06/04/apple-healthkit-stuns-startup-thats-our-name/

18. Samsung S-Health. [Photograph]. Retrieved from http://nogalskisam.files.wordpress.com/2013/03/shealth.jpg

19. Qualcommlife. “2net”. [Photograph]. Retrieved from http://www.qualcommlife.com/images/2netMobile.png

20. WellDoc. “BlueStar”. [Photograph]. Retrieved from http://www.welldoc.com

21. . GooglePlay Store. “200+ “medication reminder” apps Google Play store” [Author’s Screenshot]. Retrieved from

https://play.google.com/store

22. Cardinal Health. “Pharmacy HealthConnect Smartphone App”. [Photograph]. Retrieved from

http://www.cardinal.com/mps/public/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3gjA3cDAwtfZ18fV2NTA09HL_dAYz8TQ4NQ

M_2CbEdFADfU32U!/?WCM_PORTLET=PC_7_20G008MCMLCQD0I6KL912K3005_WCM&WCM_GLOBAL_CONTEXT=/mps/w

cm/connect/us/en/communityindependentpharmacies/solutions/orderexpresssmartphoneapp

23. . CleverCap. “Homescreen” [Photograph]. Retrieved from https://ssl.clevercap.org/arc/about.html

24. GlowCap. “bottle and cap”. [Photograph]. Retrieved from http://www.glowcaps.com/product

25. CNN Money. “'Digital pill' with chip inside gets FDA green light”. [Photograph]. Retrieved from

http://money.cnn.com/2012/08/03/technology/startups/ingestible-sensor-proteus

26. Lockwood, Will. Harnessing the Power of Pharmacy Data. Computertalk for the Pharmacist. Retrieved June 12, 2014 from

http://www.computertalk.com/feature-stories/cover-story-harnessing-the-power-of-pharmacy-data

27. Image from timesunion.com “New 24/7 Glucose Monitor. Accessed Online August 24, 2014 at

http://www.timesunion.com/local/article/A-test-market-of-a-costly-kind-2794207.php