Jerry Fahrni

Tag: mHealth

  • Sensor-enabled medication inhalers

    I recall being really excited about sensor-enabled asthma inhalers several years ago. I even remember giving a presentation in 2013 on “the future of pharmacy” that included two such products: Asthmapolis and GeckoCap. Each was an add-on device for existing inhalers. They were marketed as tools for improving medication adherence, and by default helpful in controlling patient’s asthma symptoms. Each had a very different approach but were both pretty cool in their own way.

    Asthmapolis is still around, as far as I can tell, but at some point, the product was rebranded as the Propeller Sensor by Propeller Health. The only reason I know this is because earlier this year the Propeller Sensor received FDA 540(k) clearance. I always thought the approach used by Asthmapolis was interesting because the product utilized crowed-sourced data to generate “Asthma risk maps” to help keep patients with asthma informed about potential hot zones in and around their area. It appears as though not much has changed. While the Propeller Health website doesn’t offer many details, a quick search of the web generated several articles that lead me to believe the mission remains the same. I’m still impressed with the Propeller Sensor and would love to see it in action sometime. It seems like it would be well suited for use by ambulatory care pharmacists.

    Propeller

    The other product, a little doohickey known as GeckoCap was a glowing “smart cap” that used a blinking light and gamification to remind patients when to use their inhalers. Data collected by the device was transmitted to a database via Bluetooth connection where family members and physicians could access it. I thought the use of gamification was rather clever, especially for kids. Parents could set goals with accompanying rewards to encourage kids to remain compliant. In this day and age, that made sense to me.

    Similar to Asthmapolis, it appears that at some point GeckoCap became CareTRx [pronounced care-tracks]. However, it doesn’t appear that the product is actively being developed at this time. The last few reviews on the Google Play Store included complaints about server issues, and those were from December 2015. Based on information at the CareTRx website, the company was acquired by Teva in September of 2015. I’m not sure what that means. I don’t know if the product is dead or alive.

     

    CareTRx

    I wonder why these products never took off? Seems like these little devices would fit right into the up and coming Internet-Of-Things era.

  • Mobile health apps not meeting expectations

    I read with great interest a recent piece at FierceHealthcare. According to a study in the Journal of General Internal Medicine, health apps aren’t living up to the hype. To me, the entire field has been overblown from the beginning.

    “A new UC San Francisco study … revealed nearly every participant who used health apps could not get to a productive point. The respondents also were able to complete just 51 percent of data entry tasks and just 43 percent of them could access data from the tools.”

    Most of the problem stemmed from usability, or rather a lack thereof. This should come as a surprise to no one. Most of the health apps that I’ve tried haven’t been very good. In fact, I have yet to find a single health app that I consider anything more than a waste of time.

    All this on the heels of other studies showing similar results. “A study released in mid-June noted very few apps providing high-quality heart failure symptom monitoring. Research earlier this month evaluated 40 fertility and pregnancy apps and found just six recorded a perfect score for accuracy.”

    While I understand the desire for mHealth to be a success, at this point I believe it’s nothing more than over-hyped mediocrity. The worst part is the number of app developers and “researchers” taking advantage of the situation to further their own career, or in some cases their agenda. The mHealth movement is full of snake oil salesmen taking advantage of a population desperate for help.   As a healthcare provider myself, I find it hard to believe that other healthcare providers are putting so much stock in so little actionable information. Does that mean that all mHealth applications are useless? Probably not, but I think it’s time to step back and take a long, hard look at the entire ecosystem. The first thing we should be asking is whether or not the information being collecting provides any value to the patient or their provider. If not, I think it’s fair to question whether or not the application should even be available.

    As a healthcare provider myself, I find it hard to believe that other healthcare providers are putting so much stock in so little actionable information. Does that mean that all mHealth applications are useless? Probably not, but I think it’s time to step back and take a long, hard look at the entire ecosystem. The first thing we should be asking is whether or not the information being collecting provides any value to the patient or the provider. If not, I think it’s fair to question whether or not the application should even be available.

    Now I’ll sit back and wait for the onslaught of people telling me how wrong I am. Obviously I “just don’t get it”. Well, remember this, even homeopathy has supporters. Just sayin’.

  • Saturday morning coffee [August 1 2015]

    “True humility is not thinking less of yourself; it is thinking of yourself less.” ― C.S. Lewis,

    So much happens each and every week, and it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts…

    MUG_SMC
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  • Saturday morning coffee [June 6 2015]

    “Three things you cannot recover in life: the word after it’s said, the moment after it’s missed, and the time after it’s gone.” – unknown

    So much happens each and every week, and it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The mug below is the sister of the one from my May 16 2015 SMC post. I picked them up from the Starbucks Roastery & Tasting Room in Seattle, Washington at the same time. I liked them both. Couldn’t leave one behind.

    MUG_RoasteryWhite
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  • Saturday morning coffee [February 21 2015]

    “An error doesn’t become a mistake until you refuse to correct it.” – Orlando A. Battista

    So much happens each and every week, and it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The mug below was sitting next to my laptop filled with chocolate covered espresso beans last Saturday morning, Valentine’s Day. A gift from my lovely wife. Apparently she’s aware of my addiction. It made me smile.

    MUG_Valentines
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  • Lexicomp’s new Drug ID mobile module [video]

    Lexicomp has a new Drug ID module for their suite of mobile applications.

    Based on the Tweet I thought the new application would identify “loose drugs” with the camera on a mobile device like Medsnap, but that’s not the case.
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  • The yin and yang of mobile healthcare

    My “swag bag” from the unSUMMIT contained an issue of Specialty Pharmacy Continuum, a throw-away pharmacy journal focused on specialty pharmacy practice. Like most throw-away pharmacy journals I read these days, I found the content timely and interesting.

    One of the articles – Get Appy! New Tech a Bridge to Patient Care – discusses how Avella Specialty Pharmacy is using mobile technology to connect with their patients. Apparently Avella is pretty forward thinking.
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  • Saturday morning coffee [September 13 2014]

    “The illiterate of the 21st Century will not be those who cannot read or write, but those who cannot learn, unlearn, and relearn.” –Toffler

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    MUG_SMC
    (more…)

  • Medication Therapy Management as a tool for reduced cost of care and fewer readmissions

    A colleague asked me if I had any information on the use of Medication Therapy Management (MTM) as a way to reduce healthcare cost and prevent, or decrease, readmissions.

    I’m kind of a digital packrat and I knew that I had some stuff sitting in Evernote, so I spent the better part of a day rummaging through the information I had. The deeper I dug the more I realized that MTM is a no-brainer. There’s enough information out there to convince even the staunchest opposition.

    Some thoughts I had as I read through my Evernote notes:

    1. I find it interesting that we’ve coined the phrase Medication Therapy Management (MTM) for something that pharmacists have been doing for decades. I remember interning for a community pharmacy back in the late 90’s. Speaking to the patient about their medication, adherence, compliance, adverse effects, etc was simply part of the job. Have we forgotten about that?
    2. MTM comes in many forms. Positive intervention can be achieved over the phone, via Telepharmacy, face-to-face with a pharmacist or technician, and so on. It is not a one size fits all approach.
    3. Even the simplest interaction between provider and patient can create a positive impact.
    4. MTM should start when a patient is admitted for any condition, continue throughout their hospital stay, and follow the patient out the door to their homes. In other words it should be continuous.
    5. Not everyone will need pharmacist intervention once they leave the hospital. Healthcare systems should first target patients with chronic conditions, problems with cognition, poor history of compliance, or a heavy medication burdens. Like everything else in the world around us, some people will do better with more help while others will prefer less.
    6. mHealth and sensors should be part of MTM. Continuous glucose monitoring, heart monitors, blood pressure sensors, smart bottles, devices to monitor and record inhaler use – classic area for pharmacist intervention, wireless digital scales for weight – think heart failure, and so on . This information should be fed directly into the patients MTM record for review by the pharmacist, physician and nurse.

    Below is a summary of the MTM information I sent my colleague.
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  • Using facial recognition for medication adherence?

    While doing a routine search of Twitter I came across AiCure (@AiCureTech), which touts itself as “Computer vision and facial recognition technology to confirm medication adherence on mobile devices”. Ok, you got my attention. Unfortunately the Twitter account appears to be dead as the last Tweet listed on the account was from September 25, 2013. The AiCure website is a bit more recent, however. The last item posted to their News & Events section was from March of this year.

    There’s a video on the website that gives a basic overview of the process. I would have embedded the video here, but couldn’t figure out how to grab it, which is a real shame because it’s in their best interest to make information easy to share.

    After watching the video I’m not entirely sure that the process makes sense to me. The video shows a jogger running on a pier. The jogger receives a notification on her smartphone reminding her to take her medicine. She stops, pops the tablet in her mouth, records the transaction via facial recognition on her smartphone, and then merrily continues on her way. In my experience people that are as “with it” as the person portrayed in the video don’t have any trouble remembering to take their meds; calendar reminders, pill bottle next to the coffee pot, etc. And why is the jogger carrying her medication with her while out jogging? I assume her jogging session wouldn’t last more than an hour or two. Take the med before or after. There’s no sense of the importance of the medication to the patient’s condition, nor is their any sense of the person being so busy that they couldn’t remember to take their medication. It would have made more sense to show some teenager with a serious medication-dependent disease state going through a busy school day. Right? Having so much fun with their friends that they forget to take their medication?

    Thoughts on marketing aside, the concept of using facial recognition is intriguing.

    From the AiCure website:

    The combination of automated computer vision technology with dynamic patient feedback, offers a new gold standard in medication adherence monitoring. The computer vision platform is being extended to develop a robust identification and authentication system for medication.

    Much like a voice recognition system, which understands what the user says, AiCure’s sophisticated, patented computer vision system visually understands what the user is doing.

    The software-based technology is uploaded onto a smartphone or tablet computer. The user follows a series of pre-determined steps that are instantly recognized and confirmed through the webcam.

    Automated DOT® [Directly Observed Therapy] confirms facial identity, medication dosage, correct ingestion, and time of ingestion. In addition, built-in data tools allow for ongoing patient-provider feedback; reminders in case of nonadherence; positive feedback; self-reported data by the patient; and therapy information – all designed to ensure real-time adherence monitoring and improved patient adherence over time.