Thoughts on "The Future of Medicine Is in Your Smartphone" and Pharmacy


The Wall Street Journal is all about mHealth Lately (Must be that CES high)


Between Eric Topol's Saturday essay entitled "The Future of Medicine Is in Your Smartphone: New tools are tilting health-care control from doctors to patients" and Vivek Wadhwa's article on "How Technology Will Eat Medicine," the WSJ has been putting the spotlight on mHealth and the changing role of technology in medicine.

A lot of this stuff isn't necessarily new for those that have been keeping track of mHealth related news, but it's nice to see it consolidated and put into the broader sphere. That being said, there were several snippets in each article that stood out to me, especially when I consider how my own profession is approaching the role of mobile technology (which is rather slim).

Thoughts on "The Future of Medicine Is in Your Smartphone: New tools are tilting health-care control from doctors to patients" and how it relates to Pharmacy Practice

Topol really hit a lot of key points I felt in his article, and I think several of his comments really should be considered by pharmacists and the practice of pharmacy as a whole.

Let’s say you have a rash that you need examined. Today, you can snap a picture of it with your smartphone and download an app to process the image. Within minutes, a dedicated computer algorithm can text you your diagnosis. That message could include next steps, such as recommending a topical ointment or a visit to a dermatologist for further assessment.
— Eric Topol

A great way to start the conversation on mHealth and pharmacy. Overall, most pharmacists are educated to be the guide for patients regarding self-treatment and the use of OTCs. But, what about in the future when patients will be advised by their smartphone as to what to buy in the pharmacy. They'll never ask us again. Taking this further, let's suppose a patient has a cold, and you want to find a product to help with their symptoms. There are already online services that help with this (Iodine for example), and they will minimize pharmacists' input. 

In the next year or two (depending on approval by the FDA), many Americans will probably start sporting wristwatches that continuously and passively capture their blood pressure and vital signs with every heartbeat, without even having to press a start button....Such wristwatch sensors could do enormous good. By having the equivalent of intensive care unit monitoring on your wrist, hospital rooms—those $4,500-a-night risk zones for serious infections and other complications—can be replaced by our bedrooms. As a result, except for ICUs, operating rooms and emergency rooms, hospitals of the future are likely to be roomless data surveillance centers for remote patient monitoring.
— Eric Topol

I completely agree the use of wearables is going to make a huge impact in my perspective on medicine. What I am unsure of is will it be a huge game changer for pharmacy? I think it's going to come down to several factors, and that really comes down to current pharmacy operations. If hospitals start closing beds and need less rooms, I can imagine a lot of pharmacy departments cutting staff. You simply will not need as much preparation for daily med dispensation and will concentrate primarily on IV preparation and meeting the needs of the ER, ICU, and related departments.

Someday, socks and shoes might analyze the human gait to, for instance, tell a Parkinson’s patient whether his or her medications are working or tell a caregiver whether an elderly family member is unsteady and at risk of falling... And your medications could soon be digitized to provide you with reminders to ensure that you’ve taken them as prescribed.
— Eric Topol

On the flipside, wearables may also be a large beneficial step in terms of medication safety and monitoring. We are looking at suddenly having access to an immense amount of information we never were able to get in past. Well, maybe, that's if this data is shared with pharmacists. Pharmacists spend a lot of time educating patients on potential side effects and drug interactions, and unless the patient reaches out (which they do) we never know whether they are experiencing any of those effects.

Did that new blood pressure med help the patient? Was their blood pressure reduced to safe and efficacious levels? Is the patient adherent? Wearables may offer the chance to let pharmacists know whether a patient is on target or facing significant incidences of hypotension that need immediate attention or would benefit from coaching on adherence. This covers almost all chronic medication use and could give pharmacists another way of helping with the continuum of patient care. But, then again, the technology coming into practice could even negate pharmacists oversight or input in Topol's next example...

Take asthma attacks. A teenager who’s prone to wheezing in gym class could get comprehensive data on environmental exposures such as air quality and pollen count, along with data on physical activity, oxygen concentration in the blood, vital signs and chest motion; their lung function can be assessed through their smartphone microphone, and their nitric-oxide levels can be sampled via their breath. Then that information could be combined with the data from every other tracked asthma patient—and trigger a warning, delivered by text or voice message on the teenager’s phone, that an attack is imminent and tell the teenager which inhaler would prevent it.
— Eric Topol

Damn. Talk about amazing and, in another sense, scary. I think pharmacists used to pride themselves as being the one person patients knew they had easy access to for health concerns. I mean, all you need to do is call the pharmacy with your question and ask for the pharmacist. No appointment, no billing. But, now we have apps and the internet and WebMD to take care of all that. Couple this with the growth of mobile technology and very smart technology, and we could see a lot of the things pharmacists take pride in being a source for suddenly swept away. 

Pharmacy has taken a lot of pride in coming far from its roots as a profession that simply prepared and dispensed medications to a member in the healthcare environment that could be involved in patient care. The push for provider status is just the culmination in this idealization.

However, I think pharmacists need to take stock in the role of this upcoming technology. We have the opportunity to use this technology to be more entrenched with patient care and open up a wider form of communication with patients and providers than ever before. But, if we do not capitalize on this technology, we face the risk of being swept back into our roles of the past as simple pill pushers (take that comment for what you will).

However, the question becomes, why would the pharmacist even need this data, and what would they do with it? I think thats an important question in the current practice of pharmacy. Pharmacists do not really make money outside of their dispensing role. There are some clinical capabilities, but overall, the mainstay pharmacy workforce do not have such responsibilities. Provider status will most likely be the only way to justify the use of this technology, because that means then pharmacists can bill for services. I do not think most community pharmacies (e.g. Walgreens, CVS) will push for their pharmacists to oversee patient data if they cannot receive some monetary worth for such a service.

Additionally, on the topic of patient generated data, it is asinine that in this current environment that pharmacists have no access to EHR data in their daily practice. This is where Topol and Wadhwa's article I feel hit home closest to me. For example, lets suppose we get a drug to dispense, and we know it would need to be dosed adjusted based on renal function, and the patient has a history of Diabetes (which you can figure out from their medication list) and are elderly. Odds are that they may have reduced renal function, but we do not truly know. Now, lets suppose that technology really progresses to the point that patients can do home laboratory tests and blood work. What is going to happen when a patient has an app that combines their laboratory data, and their medications, and the thing tells them they are on to high of a dose? What do you think patients are going to make of that? For me, I think they will lost trust in the pharmacist for not knowing, due in part to the pharmacists ignorance. But ignorance is something we may not be able to hide behind in the coming future. 

For some reading this piece, I may come across as a doomsayer for the practice of pharmacy. Let me be honest, I am a realist, and I do have hope. But that will be meaningless unless we are preemptive and look to the future of practice, and not stagnate in our current practice. Healthcare will keep advancing, using any advantage it can get to improve patient care. Patients will always need medications (in one form or another), but the role of pharmacists in this system will change, whether we do it ourselves with societies blessing, or it will change without us and our wishes and desires. So in the end we can bury our heads in the sand, or choose to recognize the growing role of such technology and the likely uptake by patients and industry, and be a part of this environment, and try to stay relevant in the future of the healthcare field.