Pharmacies are making the most of tech from automation to big data.
Technology use in healthcare is growing with the increased use of electronic health records and health informatics, and pharmacy is no exception. Pharmacists should embrace the innovations technology can offer in order to enhance patient engagement, improve workflows, increase patient safety, and simplify communication.
Automation and Patient Engagement
One of the biggest challenges consumers face is incorporating complex and multiple medication regimens into their daily lives. “It’s important to design behavioral and therapeutic interventions that engage patients throughout their journey from their first prescription fill through refill,” says Omri Shor, co-founder and chief executive officer, Medisafe, a medication management platform. Today, various platforms assist with dosing, how to take specific medications such as injections, and how to mitigate adverse effects.
For example, Shor recommends designing interventions for selective serotonin reuptake inhibitor patients in the beginning of treatment that reinforce adherence, since patients may not initially feel a medication’s effects because it takes time to titrate. Interventions might include digital messages, reminders, or even surveys through the company’s app to understand a patient’s needs. Equally important is educational content about medication applications, such as how to properly inject medications, connections to care support, and condition-related measurement trackers.
Another technology gaining popularity is the central fill automation machine, which can fill medicines in high volumes in lieu of a technician or pharmacist, says Elizabeth Unni, PhD, MBA, BPharm, chair and associate professor, Social, Behavioral, and Administrative Sciences, Touro College of Pharmacy, New York.
Central fill automation machines are especially beneficial for medication refills: Based on the first fill of a medication, subsequent fills are automatically filled for verification and dispensing. In addition to lowering operating costs and reducing dispensation errors, this can save significant time for pharmacists, allowing them to work on more clinical aspects of medication dispensing, such as patient counseling or medication therapy review.
Automation isn’t only for pharmacists, however. Machines can now dispense medicines for patients, similar to vending machines. Instead of waiting at the pharmacy window for a technician or pharmacist to hand over a bag of medicine, a patient can access a machine inside the pharmacy, Unni says. Pharmacy personnel scan and load filled medicine bags into the machine.
If a patient is interested in using the machine, they are registered within the pharmacy and given a unique pin number to access their medication bag and pay electronically for their medicine. Before receiving their medication, a patient must accept or decline counseling by the pharmacist. If counseling is requested, the patient can pick up a phone located on the machine and be connected to a pharmacist. “These machines can make prescription dispensing windows less crowded and allow patients to pick up their medications at their own convenience, as long as the store is open, even when a pharmacy is closed,” Unni says.
In a hospital setting, automated dispensing cabinets are used to increase workflow efficiencies and patient safety, Unni says. Unit dose medicines are prepared and stored in these cabinets, which a nurse can access after a pharmacist verifies the prescription order entered by a physician.
Pharmacies are using the large amount of data they generate in a variety of ways. The current pharmacy management systems used through pharmacy benefit managers have information about each patient’s prescriptions and prescription pick-up habits, Unni says. Several health insurance companies use this data to flag patients who haven’t picked up their medicine in recent months-an indication of medication non-adherence. This provides an opportunity for the pharmacist to either call or speak with the patient about the necessity of taking their medicine as prescribed.
Additionally, some pharmacies and health insurance companies are using big data to predict the risk of medication non-adherence, Unni says. This medication adherence prediction model is based on several variables, such as patient demographics, the number of medications a patient takes, out-of-pocket costs for medications, and past refill habits. When a patient is identified as high-risk for medication non-adherence, a pharmacist provides them with additional counseling to reduce the possibility of non-adherence. They focus on educating the patient about the importance of adherence, the need for the medicine, what to expect for treatment outcomes and side effects, cost concerns, and so forth.
In clinical pharmacies, in collaboration with physicians, big data is now used to develop algorithms to predict treatment outcomes or medication errors. Based on past outcomes and medication errors with various patient and condition characteristics such as age, gender, duration of disease, and severity of disease, risk models are developed to determine treatment outcomes and medication errors, Unni says.
Medisafe’s AI technologies are based off of machine learning analyzing more than 2 billion managed doses. The company leverages this data to identify persona types based off of behaviors such as reasons for non-adherent behavior, demographics, digital profiles, and therapeutic needs. “Once patients match persona types, then the power of AI guides patients through their personalized journey in their medication management needs,” Shor says. For example, periodic surveys or interventions check in with patients to assess their progress. If needed, persona-based management designs will change to meet patient’s needs.
Pharmacists are also using AI to monitor and prevent opioid abuse. “Incorporating AI can remove some of the burden from healthcare providers and improve patient safety,” says Rachael Fisher, PharmD, senior clinical implementation analyst, Wolters Kluwer, Health, which provides evidence-based health information and technology. Nationwide databases and prescription history can be used alongside AI to identify patients at risk for opioid misuse or patients who are doctor shopping, which could be an indicator that they are obtaining multiple controlled substance prescriptions illegally. Also, AI can identify physicians who overprescribe opioids, so education can be recommended.
Many state-specific laws have been created in response to the epidemic. “Pharmacists can use AI to assess compliance of local laws in addition to national recommendations from organizations such as CMS and CDC,” Fisher says. “The environment is ever changing; AI can help providers be more vigilant, effective, and improve overall opioid monitoring and safety.”
Looking ahead, technologies will continue to transform the pharmacy industry in positive ways.
Fisher expects pharmacy dispensing to become more automated in the next decade. With electronic prescribing becoming the norm, pharmacists will no longer need to manually interpret prescription data or enter it. “As dispensing machines and systems become smarter, the whole process will be mostly automated with minimal clinical oversite,” she says.
This will force pharmacists to evolve. They will need to embrace their place in clinical roles, such as medication therapy management programs, patient education, or health information technology. “Pharmacists can make a huge impact on drug costs and patient education, which impacts overall compliance and healthcare outcomes,” Fisher says. As technology evolves, programs will accurately target the most needy and costly patients.
On another front, Benjamin M. Bluml, RPh, senior vice president, Research and Innovation, American Pharmacists Association Foundation, which is focused on patient-centered, team-based care, has predicted that through new technology innovations medications will be customized to an individual patient’s genome, health status, and point-of-care needs via 3D printing. This may even include all-in-one pills for some patients.
The supporting technologies for this revolution are already in place. Hard work from clinicians on data aggregation and standards that support individualized care is ongoing through the Clinical Pharmacogenetics Implementation Consortium (CPIC), Bluml says. Technology companies are also working on innovations that will increase the variety of medications available for 3D printing. “The challenges for moving this innovation to scale are significant, but the combination of human and artificial intelligence at the point-of-care will undoubtedly contribute to its eventual reality,” he says.
Finally, with many grocery stores containing pharmacies and with a focus toward lifestyle management for chronic disease conditions, a new technology that could emerge in the next decade is linking an individual’s shopping habits to their prescriptions. “By using store loyalty cards, consumer shopping habits can be captured, which can be connected to their prescriptions for point-of-buying suggestions,” says Unni. For example, if a patient has a prescription for cholesterol-lowering medicines and is buying red meat, the technology (in the form of a mobile app) could inform the individual about red meat’s fat and calorie content and could make recommendations about the appropriate use of that food, even including healthy recipes.