Neil Creasey, Director Of Pharmacy Operations, Holzer Health System
We live in a vast and ever-expanding world of technology composed of electronic wizardry that can only be described as such to those not hardwired to the flow of circuits and electrons. We are in an era where space travel is on the cusp of reality, foreign language is translated at the touch of a button and we can detect possible arrythmias with our watches. Healthcare has been at the front of technological innovations from the first surgical needles to the da Vinci Surgical System.While still short of the sci-fi dream of nanobots sewing up blaster fire; we still have current tech performing amazing feats. As time lopes about on its undulating frequency of innovations; we are about to enter a world where a toilet can monitor waste for blood and biomarkers and your annual checkup will be via smartphone. Technology has been far ahead of the health care legacy to maintain care. As a silver lining to the pandemic it forced the healthcare world to pause long enough to close some of those ideal and technological gaps. The first mass produced mRNA vaccine was brought to market to the effective impact of slowing a raging pandemic; Face-to-Face meetings and interviews now involve a computer monitor and telemedicine was finally given its first true opportunity out of the necessity to maintain patient care, a path I feel we can never reverse, all for the better patient care.
In the sub-sect of Pharmaceutical healthcare, this change in American perspective has a remarkable impact.Pharmacists are becoming more utilized as care givers and providers beyond the perception as simple re-packagers the chain pharmacies have created for the profession. As we look at our growing digital world, it is critical we also evaluate how we are discussing our levels of patient care. Often when we speak of “health care” it is focused as the physical health and condition of how the body is composed; it also includes mental and behavioral health. Technology has allowed us a new way to interface between those three major components via our smart devices and communication systems driving the idea of Digital Health. This is a common place discussion when discussing a vehicle as it contains a variety of electrical wires, component relays and computers. The human body is perceived differently, even though the same is true; a system of nerves, neurons and brain tissue that function on those same electrons.Technology is driving the way humans access information about our worlds and more so specifically, health information. Digital health is our bridge between the physical and technical world.
At this time, we have the opportunity to produce products that are available in the space where patients need the greatest guidance, at their homes! In our world economy, where patients are consumers of everything from peanuts to Porsche cars from the seat of their couch, it is critical healthcare meets patients where they want to receive care. This technological shift has helped to create a whole new business segment of the new healthcare landscape;digiceuticals. While not clearly defined, a digiceutical is essentially any medically prescribed smart device application designed to improve personal health. The goal of these platforms is to provide real-time suggestions to alter behavior in the goal to improve medical outcomes.This is simply another tool in the toolkit we can use to assist patients beyond physical medications and therapy.As medicine continues to move to a more patient specific biological impact; additional touch points are needed for the patient to achieve optimal care. This gap has been filled traditionally by the physical presence of the pharmacist, but due to changes in the pharmacy landscape and Pharmacy Benefit Manager practices, a new space forSpecialty Pharmacy services has risen. It is not feasible to have a pharmacist in 24-hour contact with every patient, nor is it a reasonable request. However, by utilizing the digiceutical network of smart applications, you can obtain some benefits of a side-by-side health advocate without the burden being physically present.As this is combined with the telemedicine model gaining traction post-pandemic, a new patient centric form of healthcare is being beta tested.You will see the descriptions of telemedicine, digiceuticals and biological medicine all continue to merge to the general “medicine” term as we familiarize as a culture to this new healthcare technology toolkit.
There is not a day that goes by that a patient does not need to know more about their medication. We have become complacent on the beauty of Google and the infinite knowledge it holds. That said, there is a large gap between the ability to find information and the ability to help successfully translate and utilize that same information. Often the life of a pharmacist is that of a parent, full of effort with limited gratitude. In conjunction, the internet has created a dangerous amount of free unreliable information about our health, medications, and treatment options. It has always been the duty as pharmacist to manage information, provide insight and identify the snake oil proclaiming to be holy water. I would like to take this space to briefly celebrate those staff in charge of carrying the] torch of knowledge and providing care to our patients and communities.
A fist bump: Ambulatory Care
The mighty dollar reigns supreme in this multi-verse of Payor Contracts, Long-term Care Pharmacy Operations, Infusions and Specialty Services; not to ignore the industry mainstay of Community Pharmacy. Forgotten in this world of diminishing returns lies a keystone of health care, the human interaction. Cheers to the cashiers, technicians and pharmacist of this world who have dedicated their lives to the pursuit of pharmacology, so your Nana has someone to talk to on Sunday afternoon about stool softness. It has been a long-standing joke that the PharmD. should come with a minor in psychology. It's a joke based in reality; pharmacists talk to the patient more than any other provider. As you walk to your local Walgreens, CVS or Family Pharmacy waiting to ask us about that article on Facebook, TikTok or Instagram, please know influencers are not professionals and their ability to regurgitate information does not make them educated. Thank you to our community pharmacists, techs and cashiers for being there every day; to answer the same questions, accept the criticism, argue the Science and fight for payment. Thank you for doing what is best for every patient regardless of race, creed, or color. Knuckles out: I appreciate you!
Slap those over-sanitized hands: Acute Care
Down a flight of stairs into the spell of Peridox, alcohol and constant hum of fluorescent lighting. Welcome to the home of the acute pharmacist and the team of under-celebrated technicians who keep the meds coming. Tucked away into basements of health facilities across the United States.Hidden in the depths to complete the perfunctory magic of dose conversions, IV compatibility and an endless process of IV and TPN production. Day-by-day the orders come down, every other is "STAT" and due to supply chain challenges, you have about 60 percent of what you need. We work in antiquated EMRs that meet the needs of payors well but not clinicians. A world of computer software, tracking documents and patient charts. Well, raise that open palm high and mighty;you collection of glorious problem solvers! It might be an alternate therapy today, a newly formulated IV tomorrow or a DI questions from Dr. Smith about the newest COVID therapy. Silent are the support staff inside the hospital stay. It all occurs from vancomycin dosing adjustments, warfarin monitoring and anti-microbial stewardship, with not a whisper in provider rounding. In this place where a PharmD.is still “just a pharmacist”; I appreciate you and your teams for keeping our family and friends alive in their most critical state. The technicians running laps to deliver meds to the oncology team producing chemo to keep our communities alive longer. It is a hard job and one often overlooked. So peel back that nitrile glove and give another spray of alcohol and pass out a round of High Fives please!
As the healthcare landscape continues to evolve and patient preference for access continues to steer technology; a steward for safety will be required. An epic battle; fought in the court rooms and conference tables across the world.The opportunity of profits versus the safety of our patients and a goal of finding that Shangri-La where technology and humanity work in tandem to improve the lives of all beings, big and small.It is important to acknowledge that there is an impact of human touch that cannot be replaced by technology, though it might be we just need better holograms; a discussion for another day.