Digital Health Corner Editor: Parisa Vatanka, PharmD, CTTS
While conducting interviews as part of a study on the high cost of cancer drugs, I asked what the biggest challenge was for patients undergoing care, fully expecting to hear it was the cost of the drugs to treat their cancer. I was surprised to discover it was transportation to get to their physician appointment. On reflection it made sense, a patient-centric approach would be to meet patients where they are in their communities and homes instead of a provider-centric approach expecting patients to come to us to receive care. Advances in technology have increased our ability to solve problems like transportation and increase access to healthcare for consumers, particularly the underserved, through the virtualization of care. We can think of virtualization as changing a physical process or experience to one conducted virtually through technology.
We are already familiar with virtualization through the move from paper prescriptions to e-scripts, or a paper medical record to an electronic health record. Telehealth is another example of taking an in-person patient-provider interaction and making it virtual. We have already overcome the technological barriers including reliability and privacy and would expect wider adoption particularly since the majority of patients prefer telehealth visits over in-person visits as demonstrated in a recent study at Massachusetts General Hospital.1 But barriers to the adoption of virtualization remain including the slow pace of change in healthcare practices, regulations that have not kept pace with emerging technologies, and reimbursement for virtual healthcare. COVID-19 has made us re-evaluate these practices resulting in a tremendous increase in telehealth visits as a public health measure. This was made easier through recent decisions by federal and state agencies to increase reimbursement for telehealth visits at rates equivalent to in-person visits for the duration of the pandemic. Where once we viewed telehealth as a patient convenience, it is now seen as a necessity which will likely continue in the post-pandemic environment.
The move towards virtualization will also accelerate changes in pharmacy practice in several ways. One example is pharmacist-led telehealth visits and counseling to assist patients in managing their medications. Less obvious examples are where pharmacists utilize virtual information to perform tasks that used to require a physical presence. This can include virtual authorization of prescription dispensing that has been physically prepared and filled either by a pharmacy technician or through automation and artificial intelligence with greater efficiency and accuracy.
This creates a tremendous opportunity for pharmacists to oversee the redesign of dispensing systems to focus on proper medication use for individual patients and patient populations through targeted interventions and patient consultations, and to conduct direct patient care activities in the community setting such as prescribing in specific situations, vaccinations, patient medication monitoring, and point of care testing. The community pharmacy remains a critical element of care delivery but changes in both regulation and pharmacist reimbursement are still required to keep pace with new applications of technology to improve care delivery.
Donelan K, et al. Patient and clinician experiences with telehealth for patient follow-up care. Am J Manag Care. 2019;25(1):40-44.
About the Author
Dr. Kevin Rodondi is a Professor of Clinical Pharmacy at the School of Pharmacy at the University of California, San Francisco. In his current role he is focused on the development and evaluation of innovative care delivery models in health systems and teaching entrepreneurship & leadership. Dr. Rodondi is a national instructor for the National Science Foundation and the National Institutes of Health Innovation Corp (I-Corp) programs. Dr. Rodondi has over 20 years of experience in health care start-up companies primarily providing services in the community-based oncology market. Positions he has held include: Vice-President and General Manager of the Specialty Solutions Group at McKesson Specialty; Co-founder, President/COO of the National Oncology Alliance, providing GPO and clinical services to community oncologists; Vice-President of Corporate Operations at OnCare, a physician practice management company; and Director of Pharmacy Programs at the Oncology Therapeutics Network, a specialty pharmaceutical distribution company. Dr. Rodondi received is PharmD from the UCSF School of Pharmacy and completed residencies in both clinical practice and administration.