By Ken Perez, vice president of healthcare policy, Omnicell, Inc.
Discussions about the application of artificial intelligence (AI) in healthcare often span multiple areas, most commonly about making more accurate diagnoses, identifying at-risk populations, and better understanding how individual patients will respond to medicines and treatment protocols.
To date, there has been relatively little discussion about practical applications of AI to improve medication management across the care continuum, an area this article will address.
The Significance of Medications
What’s the first thing that comes to mind when someone mentions prescription drugs in the United States? In poll after poll, the high and rising costs of medications are American voters’ top healthcare-related issue.
This concern is well founded. The U.S. spends almost $400 billion a year on medications–$325 billion on a retail basis and about $75 billion for inpatient and outpatient use.
To put the $400 billion in perspective, it is equal to about 11% of total U.S. healthcare expenditures, and it’s one of the top reasons why the U.S. spends much more on healthcare than other industrialized countries.
Medication Management Shortcomings
Unfortunately, there are a lot of issues with the medication management system, broadly defined.
It’s estimated that 20-30% of prescriptions are not even filled, not even picked up at the retail pharmacy. According to the Centers for Disease Control and Prevention (CDC), each year, adverse drug events result in 1.3 million visits to the emergency department, and of those ED visits, over a fourth, 350,000, result in hospitalizations, which result in significant costs.
Over the past 50 years, much legislation has been passed to regulate and reform the U.S. healthcare system, and this has significantly increased the administrative burden on healthcare provider organizations. As a result, according to data from the Bureau of Labor Statistics, the National Center for Health Statistics, and the United States Census Bureau’s Current Population Survey, the number of administrators has grown by 3,200% since 1970, while over the same period, the number of physicians has been relatively flat, in line with population growth. Correspondingly, per research funded by the Physicians Foundation, it is estimated that the average physician and/or his or her staff spends 785 hours per year on quality reporting.
The administrative burden also falls heavily on pharmacists. According to a national survey by the American Society of Health-System Pharmacists (ASHP), pharmacists spend over three-fourths of their time on non-clinical activities—mostly manual, administrative processes.
In spite of the massive amount of spending on medications, the medication management system is fraught with errors at multiple steps in the medication-use process, prescriptions are often not filled, and over one-fourth of all hospital readmissions are potentially preventable and medication related.
The COVID-19 crisis is accelerating the future of healthcare. In fact, I’d like to argue that the future is here today as demonstrated in digital health. Within weeks, this pandemic spread across our healthcare system, shutting down the traditional care delivery model and forcing us to adopt technology.
Supporting patients in a social distancing time did not provide many options but to turn to the advancements that already exist. We simply had to turn to the existing technology available and flip the switch to deploy our future healthcare model.
This is most evident with the rise of telehealth usage in lieu of point-of-care facilities such as doctor’s offices. Since the coronavirus outbreak telehealth has experienced a surge of 1,700%, particularly supporting mental health patients.
But what do patients need during this crisis and will they adopt technology as future healthcare models? We recently surveyed Medisafe users to better understand their concerns and needs during this outbreak. What we discovered is that patients are extremely appreciative of the ability to touch base, acknowledge this crisis and ask “how can we help?”
Noting that this is a primary concern, and with more than 7,000 patients responding, a majority of whom are very concerned about the coronavirus and its effects, we need to think about how to best reach a community in need an empathetic solution is needed more than ever.
Additionally, with the recent surge in telehealth to compensate for social distancing it is evident that are gaps in the daily connections and check-ins required from patients managing medications.
A majority of patients are in some form of social distancing and 55% of patients indicated that they are concerned that the coronavirus will interfere with their medication regimens. Enter the role of the digital companions. From a telemedicine solution, digital companions can offer additional insights as well as aiding in isolation by deploying guidance in a rapid response while offering a human touch in times of isolation.
Digital health technologies also offer support beyond a virtual “check-in” that can digitally handhold patients with their everyday needs, especially those managing chronic conditions or multiple medications. Digital companions keep patients continuously connected with condition management and care givers. For example, patients on multiple medications or managing complex doses or even taking injections require additional support at while at home to remain adherent to their treatment.
Digital health platforms are adept to support patients during this time, bridging isolation and bringing healthcare support into their home. In fact, more than 42% of our patients indicated that they have changed their traditional treatment routines by adopting telehealth. In addition to telehealth, digital companions offer features to keep patients connected.
Following the survey, we opened unlimited Medfriend capabilities which digitally connects family or friends with the patient’s medication schedules. Immediately, we saw Medfriend engagement activity triple. In fact, one user replied, “My mental health isn’t great right now, so knowing that you’ll tell my Medfriend if I haven’t taken [my medication] is great.”
Connection to care givers is also critical to digitize the care support teams. Fewer field support home visits are also creating concerns with patients, “I appreciate the help you’re giving. My doctor put me in home isolation 2.5 weeks ago for my sake, the only people I see are my caregivers but now they are not allowed to visit.”
Digital health that connects the daily interactions of patients with care support teams fill a critical gap. Clinicians can monitor their patient panels by following tracked activities and in fact scale their monitoring capabilities of one to many. Digital companions keep patients on therapy but also notify care support teams when patients behavior is at-risk. The combination of high-tech and high-touch is quite powerful to support patients managing chronic conditions.
Ultimately, humanizing your digital capabilities goes a long way. Digital health at its core operates on sophisticated data-driven AI to deliver personalized interventions at time of need. It’s within each of these interactions that the digital support becomes more and more relevant for patients establishing a digital relationship, trust and loyalty. However, during a crisis we also need to make sure to “check-in.”
We are all human on each end of this digital connection and when dealing with medical conditions alone during a crisis a human touch goes a long way, best stated by a patient: “I’m good. Just knowing that you are out there is a good feeling.”
Nearly 100 percent of chief medical information officers (CMIOs) in U.S. hospitals believe medication management improvement initiatives are having a positive impact and that patient safety issues are less likely to occur today as compared to five years ago, according to a new survey from the Association of Medical Directors of Information Systems (AMDIS). The survey of physician leaders, sponsored by DrFirst, also revealed that CMIOs believe there is more work to be done to address gaps that could potentially impact patient safety.
Among the top patient safety gaps identified by CMIOs is the “inability to prevent financial constraints” from impacting patients’ adherence to prescribed medications. In fact, 71 percent of the survey respondents cited concerns with the lack of price transparency—the ability to inform patients how much a prescribed medication will cost, including their insurance co-pay amount. Medication costs are a key concern for patients as well, as evidenced by a Truven Health Analytics-NPR Health Poll which found that 67 percent of patients who failed to fill their prescriptions in the last 90 days reported high costs as their reason.
Addressing high drug prices is also a priority for the Trump administration, which earlier this year introduced the American Patients First blueprint, a comprehensive plan to bring down prescription drug prices and out-of-pocket costs.
The surveyed CMIOS also identified a major gap related to the opioid epidemic. Sixty-five percent of respondents cited the need for an integrated clinician workflow that makes it easy for clinicians to coordinate the entire medication management process, including electronic prescribing of controlled substances like opioids, access to state Prescription Drug Monitoring Programs (PDMPs) to identify patients’ opioid histories, and electronic access to prescriptions from other providers and locations to avoid potentially harmful drug combinations. Similarly, 41 percent shared concerns about providers’ abilities to prevent opioid abuse since they often cannot easily distinguish “drug shoppers” from genuine patients.
Overall, 82 percent of surveyed CMIOs concur that medication management improvement initiatives have had a positive impact on adverse drug events. However, only half of the CMIOs expressed satisfaction with the medication management process, while 12 percent indicated dissatisfaction. According to the survey, the biggest gaps in the entire medication management process are incomplete patient medication histories (80 percent) and misaligned medication reconciliation and care transition cycles that lead to misinformed decisions by care teams (75 percent).
“While the industry has clearly made significant strides to improve medication management processes, CMIOs remain troubled by a number of gaps that compromise patient safety and quality outcomes,” said G. Cameron Deemer, president of DrFirst. “That’s why DrFirst has remained firmly committed to addressing these pain points with innovative new technologies that make a meaningful difference in patient care and the physician experience.”