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Similaire à digital health lecture slide v6
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digital health lecture slide v6
- 1. Digital Health: Future of Health Care Implication to the Profession of Pharmacy Brian Lee PharmD Candidate, 2016 University of Pittsburgh
- 2. US Healthcare is having a serious issue
- 4. • Free Misfit wristband pedometer • Earn $1 every day or $20 Amazon gift card/month Digital health being adopted by a payer Healthier members Saving healthcare cost
- 5. 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
- 6. 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
- 7. Learning objectives Understand 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
- 8. What are the different types of digital health?
- 9. Overview of digital health User Model Outcome Model Patient-centered Disease-centered Drug-centered Clinical trials FDA clearance Health economics studies Reimbursement DTP / DTC sales Marketing and promotion Phenomenal user interaction (UI) Usually available on the app stores
- 10. Digital health by example Patient-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
- 11. 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.
- 12. 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
- 14. 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
- 15. Digital health by example Patient-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
- 16. 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
- 18. 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
- 19. Digital health by example Patient-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
- 20. 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.
- 21. How does SmartInhaler work Tracking 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 cloud Touch-Enabled • Users can view the medication usage charts, and change preferences
- 22. SmartInhaler benefits asthma patients Randomized 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 Elphick DOI: 10.1183/13993003.congress-2015.OA4772 Published 1 September 2015 European 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. http://erj.ersjournals.com/content/46/suppl_59/OA4772
- 23. 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
- 24. 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
- 25. How is Digital Health affecting Healthcare?
- 26. Digital Health improves healthcare quality • Reduce inefficiencies in healthcare delivery • Make medicine more personalized and precise • Improve access • Increase quality of care 60% 65% 70% 75% 80% Improved Access to Care Improved Continuity of Care 78% 68% The American Academy of Family Physicians Telehealth Survey, n=1557 http://mobihealthnews.com/content/survey-15-percent-family-physicians-used-telemedicine-2014
- 28. Digital Health solutions could save primary care $10 billion annually. http://hitconsultant.net/2015/10/20/digi tal-health-solutions-save-primary- care-10b-annually/
- 29. 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.
- 31. Who can influence consumers to adopt digital health offerings ? 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% USA UK Pharmacist Health Insurer Physicians
- 32. So are the doctors knowledgeable about Digital Health? 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% USA UK USA UK Patients 42% 30% Physician 24% 12%
- 33. What’s driving this change?
- 34. 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
- 35. 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
- 36. 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
- 37. Increasing funding for digital health startups • Venture investment in digital health in 2014 reached $4.1 billion • 123% increase year-over-year
- 38. So how do you get involve?
- 41. 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)
- 42. Thank you
Notes de l'éditeur
- The healthcare industry represents nearly a fifth of U.S. GDP and it is going through a period of dramatic change. What are the underlying currents of this change? What previously unimagined models are emerging and proving successful? Which models will find themselves closing their doors? US spends far more money in healthcare than any other OECD countries in the world. However, that doesn't mean that citizens are healthy. the average life expectancy is just about the average. Annual U.S. Healthcare Spending Hits $3.8 Trillion and it is expected to rise for the next 10 years. A change in the healthcare system is desperate and government and companies are working hard to reduce the healthcare cost.
- So Why is it matter? Because Digital Health can make America great again..
- Different approaches are being taken to make the change. Most recent adoption of misfit by Oscar health, startup medical insurance company based in NewYork, is a great example of how digital health can be used to improve population health. Adoption of misfit to their member expect to reduce healthcare cost and encourage people to stay healthy
- Fitbit is the most widely adopted digital health device As you may have experienced, use of Fitbit or other types of activity trackers are being widely adopted by variety of people. It promotes healthy lifestyle of the users by allowing them to see their lifestyle in a number as it measures different biometrics. Users can compete their numbers/scores with the co-workers and friends
- Technologies can capture various information from our body. That include heart rate, temperature, weight and medication compliance. Those information are actively being communicated with healthcare providers in order to keep patients healthier.
- There are thousands of digital health apps and devices in the market. It is important to categorize them properly! User Model is the most prevalent type. Most health apps that you find in apple app store and google app stores are in this category. Anyone with basic health knowledge can create an app. However, there are apps that are FDA approved and going through clinical studies to see if the app really helps and improve patient’s health. Those are called outcome model. Outcome models are designed by professionals and it can be an app or a devices. They require clinical trials, FDA clearnace, health economic studies, sales and marketing team. Outcome models can be reimbursed from the insurance company just like any other medical services. Outcome models can be divided by patient-centered, disease-centered, or drug-centered.
- Patient-centered model is also call mobile app therapy and it provide patient-level decision support, tool for self management, and education. Such app really makes patients well-educated and make better decisions WellDoc’s blue star is the great example of the patient-centered model
- Explain about welldoc’s blustar app The app gives an alert when patient is low on sugar and tell the patient to give extra 15g of fast acting carbs. The app monitors the patients glucose level and send out personalized guidance and educational tips
- So how’s such app being downloaded? BlueStar is prescribed like how doctor prescribe a medication.
- BlueStar clinical trial published in Diabetes Care, 2011
- While patient-centered model guides patients to healthier behaviors and lifestyle Disease-Centered is focused on a remote chronic care management for physician. Resmed cpap is an example
- Remote patient monitoring benefits hospitals from readmissions penalties, and shortages of medical staffs.
- Remote patient monitoring is no longer a future. Clinical staffs are now being reimbursed for the services. Pharmacist getting the provider status will allow us to be reimbursed for the service as well
- The last drug-centered category. Drug-centered models are specific to each medication. They enhance the efficacy of the medication by monitoring and improving medication adherence
- How propeller sensor (smartinhaler) works
- Interim data from the study being undertaken at the University of Sheffield has demonstrated that use of the Smartinhaler™ platform substantially increases adherence and significantly reduces the number of oral steroid courses required over the period. The interim data shows that at 12 months: a 144% increase in adherence in the Smartinhaler™ group vs control arm; a 37% reduction in the number of oral steroid courses required in the 12 months from 2.7 to 1.7, a clear marker of reduced severe exacerbations; and a 14.9% increase lung function as measured by FEV1 (mean forced expiratory volume in 1 second % predicted) which increased from 87% to 100%.
- "The promising results from the pilot study demonstrate that this innovative digital approach to therapy optimization is not only patient-centered, but can lead to improved clinical outcomes," said Proteus CMO George Savage in a statement. "The findings suggest that deploying a panel of medicines that reflect the needs of patients and physicians can move the needle in treatment optimization." After four weeks, 85% of subjects in the digital medicine arm of 72 patients achieved their blood pressure target--that's opposed to the usual care 24-patient arm in which only 33% did. The digital medicine arm also had a larger reduction in diastolic blood pressure and LDL than usual care. The 96-patient, 12-week study enrolled patients with uncontrolled hypertension and Type 2 diabetes who had failed at least two antihypertensive medications plus metformin and/or sulfonylurea. The randomized, control trial adds Proteus Discover to an existing medication regimen for four or 12 weeks, with a control group receiving usual medical care. Dr. George Savage, Proteus chief medical officerThe primary outcome in the trial is change in systolic blood pressure. Secondary outcomes include change in diastolic blood pressure and the proportion of subjects to achieve a target blood pressure of less than 140/90 mm Hg. The study also includes a patient subset specifically on sensor-enabled version of the cholesterol-lowering atorvastatin. Final study data are slated to be published later this year. Proteus is also partnering with its customers to produce further real-world clinical and economic data; it hopes to demonstrate its usefulness in optimizing treatments and improving patient outcomes.
- As we discussed their effectiveness with prior slides, Digital health improves quality of care. According to a just-published 2014 survey of 1,557 US physicians, 8 percent of respondents reporting a belief that telehealth improves access to care, 68 percent believed it improved continuity of care.
- There are significant economic saving by adopting digital health. The example here is reducing the emergency room visits by adopting the mobile text message system. It not only saves times and money by reducing healthcare utilization and allows the medical team to be available for the real emergency
- Digital health solutions could save primary care $10 billion annually,
- Digital health benefits various healthcare stakeholders. No matter which pharmacy career that you are planning to pursue, digital health is going to have impact on your career. It impacts on the pharmaceutical industry, managed care organizations, and clinical and retail pharmacists.
- Although patients expect their doctors to know about digital health, previous survey showed there is a huge knowledge gap. While physicians struggle to learn about digital health, it is an opportunity for pharmacists to excel its role as a healthcare professional. As the survey shows, pharmacists are capable to influence consumers to adopt a digital health offering. Pharmacists should challenge themselves and become an expert in this new health paradigm and help patients to find the best digital health tool that suit their need. Ipsos also surveyed consumers on whether they thought providers, health insurers, or pharmacists could influence them to adopt a digital health offering. 45 percent of US respondents said they could be influenced by a doctor, followed by 31 percent who said they could be influenced by a health insurer, and 26 percent who said they could be influenced by a pharmacist. In the UK the percentages were slightly lower across all groups, but the general population also showed more trust in the pharmacist than in the health insurer. Some 47 percent in the UK said they could be influenced by a provider, 22 percent said they could be influenced by a health insurer, and 25 percent said they could be influenced by a pharmacist.
- THE SURVEY SHOWS A KNOWLEDGE GAP is a big barrier IN DIGITAL HEALTH In the US, 42 percent of patients think doctors are knowledgeable about connected health devices, while 24 percent of doctors said they were knowledge about these devices In the UK, 30 percent of patients perceive doctors to be knowledgeable about connected health devices, 12 percent of doctors perceived themselves as knowledgeable "Perceptions are a lot stronger for those perceiving DOCTORS to be knowledgeable compared to doctors themselves" Sangar said. "There’s definitely a knowledge gap. When we look at diabetes patients, these individuals are visiting doctors more frequently... They have co-morbidities, therefore they are much more revolving door individuals. They actually have a lot more confidence. They have more contact with their doctor and they are a lot more amenable to being advised." Previous graphs shows pharmacists opportunity to really help patients to understand digital health and their uses as we are the last place patients stop by
- Everything starts from the patients. As we mentioned earlier, people are more actively involved in their health management than ever before. As a result, patients are driving the higher usage of the digital health
- Physicians are adopting digital health by using their tablets or smartphone to provide patient care as well. Providers have access to the patients profile anytime anywhere
- As a result, various organizations are seeking for health innovations by creating a educational program, idea competitions, and residence program.
- This is a booming industry. And luckily UPMC is up there too.
- The number of deals for medication management is significant
- Being affiliated with UPMC, and studying pharmacy, you are at a great place. There are few things you can pursue if you are interested. The most important thing as a student is staying informed. This market is constantly developing and changing so keeping your ears open is very important.