Emerging technologies driving the evolution of healthcare
One of the “silver linings” from the continuing challenges of the coronavirus pandemic has been the realization that we need to change the way we think about our processes, and consider new and innovative strategies to improve them. One area that has received a lot of attention, which will continue in 2023, is the development and use of technology to improve processes and delivery of care.
The World Health Organization (WHO) defines health technology, as the “application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of lives.”
For 2023, pharmacy will be a part of this medication-use technological expansion. We are excited to share some examples of emerging companies and new technologies to watch out for.
AI with Invistics: Drug Diversion
Invistics is applying machine learning (ML) and artificial intelligence (AI) to the challenges of drug diversion. A study published in AJHP details the benefits of using this technological approach as opposed to more traditional detection methods. In the study, 10 acute care inpatient hospitals across four independent health systems extracted two datasets from various health information technology systems for comparison. The machine learning model had 96.3% accuracy, 95.9% specificity, and 96.6% sensitivity in detecting transactions involving a high risk of diversion using the initial sample dataset. In subsequent testing, using the much larger historical dataset, the analytics detected known diversion cases in blinded data faster than existing detection methods (a mean of 160 days and a median of 74 days faster).
Tula Health Smart Watch: Type 2 Diabetes
Tula Health is transforming the care of Type 2 diabetes. The company currently provides a smart watch that captures a variety of outputs such as exercise, blood pressure, heart rate and sleep patterns. They also offer a smart phone/glucometer combination where patients can enter their glucose levels and communicate with their health coach at the touch of a button. All this information is provided real-time to a health coach who is available 24 hours a day to work with the patients to optimize their diabetes control. Tula Health has shown improved use of primary care providers and decreased use of emergency and hospital services, which has reduced costs in their target patient populations by up to $3,000 per patient per year.
The company is also adding some amazing technology to this system. Working with the physics department at Brigham Young University, they have miniaturized a full-size spectrometer to the size of a dime. They have also successfully created an impedance algorithm that only reads moving items, effectively filtering out skin and tissue and reading only blood. Inserting the miniature unit into the smart watch provides the ability to capture real-time, continuous blood glucose levels without finger sticks, which could be a “game changer” for diabetes management when the technology becomes commercially available.
Pharmacy Stars Smart Glasses: Medication Inspections
Pharmacy Stars is working with Iristick, along with the pharmacy team at Houston Methodist, on the use of “smart glasses” to improve the efficiency of medication inspections. In addition to its IV Quality Management System, called Compounding 360, Pharmacy Stars also offers a Joint Commission inspection tool. They can load the inspection tool into the smart glasses so the pharmacy technicians who are conducting inspections receive a “heads-up display” of all their required inspection items. The technicians can quickly and easily check off needed items and use the glasses to take a picture of any out-of-compliance elements. All this information is downloaded directly from the glasses into the Pharmacy Stars tool to produce a report of the inspection, thus saving significant time. Additional use of the glasses for observation of technician sterile compounding technique to allow for remote monitoring and remote facility inspections is also planned.
Vitae Industries 3D-printing: Compounding
Vitae Industries Auto Compounder gives pharmacies the ability to 3D-print drug dosage forms. The unit utilizes ready-to-dispense NDC-coded cartridges filled under cGMP (503b facility) containing standardized non-sterile compound formulations as source material. The unit can be programmed for drug strength and quantity to make a variety of customized dosage forms like gummies, troches, or suppositories quickly and accurately.
Emancro Robtics Corp. Robots: Dispensing Automation
Emancro Robotics Corp. is working on a fully autonomous robot that can be utilized for functions such as picking drugs in the central pharmacy to fill automated dispensing cabinets (ADC) and/or the actual filling of the ADCs themselves. The robot’s secure locker is filled with medication in the hospital’s central pharmacy. It can then visit desired locations in the hospital, restocking medication and updating inventory autonomously. The robot can scan bar codes and operate elevators and electric doors. It is also designed to handle all dosage forms.
Audaire Platform: Clinical Outcomes Data
Audaire Health Inc (“Audaire”) is a healthcare technology company with a mission to increase patient access to high-cost lifesaving medications, deliver impactful clinical programs and facilitate innovative outcomes-based contracting models. Audaire’s platform captures high quality clinical outcomes data outside of the claims infrastructure, which provides full visibility into the efficacy of gene and cellular therapies. By leveraging clinical outcomes data, the Audaire platform facilitates greater flexibility in contracting for high quality clinical outcomes and deploying impactful clinical programs.
These are just some examples of what we can look forward to in the near future. 2023 looks to be an exciting time for emerging technologies to further develop and reach the marketplace. At Visante, our pharmacy informatics and technology practice group is helping clients invest in and optimize technology to improve financial performance and clinical outcomes. Contact us to learn more about how we can support your organization’s goals in 2023. Email firstname.lastname@example.org.
IV medications: Push should not become a permanent solution
As one of more than four million nurses in the U.S. today, I think I speak for many of us in saying that it is a great time to be a nurse! The advances in nursing and patient care that we have experienced over the last 40 years are incredible, and we are caring for sicker patients with more and more successful outcomes. No single profession can claim accountability for the improvement in patient care outcomes, instead, this success should be shared by the entire multidisciplinary team. While I want to celebrate all things good in nursing, it’s important to also recognize the challenges ahead, especially in medication management.
This past year healthcare faced an unprecedented shortage of commercially available medications and IV solutions, which presented an opportunity for innovation and creativity in order for patients to receive safe care. For example, when small volume IV bags weren’t available, hospitals delivered drugs via IV push syringes. Suddenly, the nursing staff was routinely preparing sterile compounds at the bedside for immediate use and administration. As a result, nurses’ responsibilities were stretched beyond capacity, specialized training had to be done quickly for nurses unfamiliar with the process and safety requirements for preparing IV medications, and existing equipment had to be shared between care settings. Regrettably, IV push medications were often given too quickly or incompletely by the busy nurse.
However, now that the shortage is over many hospitals have not resumed their previous process of pharmacy preparing IV piggyback products. Nurses continue to use their limited time to prepare IV medications, despite the availability of commercially available products. The reasons for this are unclear. One possibility is that the nursing team has not yet provided feedback to the pharmacy about the impact on nursing workload. Another possibility may be the inconvenience of changing electronic medical records back to giving the drugs IVPB instead of IV push. Neither of these reasons seems to outweigh the importance of adhering to best practices.
In fact, the preparation of continuous and intermittent IV medications by the pharmacy is one of the improvements in care that has evolved over the last few decades. The pharmacy is the most appropriate place for compounding, and preparing intermittent drugs via IV piggyback helps to ensure the appropriate dilution and rate of infusion for the medication. The IV room pharmacist is less apt to be interrupted or distracted which leads to fewer medication errors. The IV room pharmacist is highly-trained in the ever-changing, complex safety standards for compounding which protects the patient, the care team and the community. While many of us in nursing remember the days when we made our patients’ IVs (mixed the KCl into the glass IV bottles, reconstituted and gave IV piggyback medications through a Buretrol or Soluset), I for one would not want to go backwards. There are very good reasons why medication management evolved from these practices.
In order to get back to best practices for patient care, nurses need to speak up. While this was a creative solution meant to manage a temporary shortage, it, unfortunately, came with an increase in risks for patients. Nurses need to recognize the value of using the best methods for IV medication preparation and administration. We aren’t pharmacists, we don’t practice in a clean room, and it makes sense for us to collaborate with the pharmacy experts to design the best solutions before, during, and after a shortage. Clear and timely communication with the pharmacy team will help to improve safe delivery of medications and optimize patient care.
Nursing workload is dynamic and is affected by many variables. Drug and supply shortages are a variable that must be accommodated in order to maintain safe and effective care. Active, ongoing engagement between nursing and pharmacy can prevent short term solutions from becoming permanent practices. If nursing resources are short, workload increases may inadvertently contribute to the cycle of nursing shortages. We have worked hard to make significant improvements for our patients, let’s not let workload and nursing shortages take us back in time. We are 4 million voices strong, let’s remember to speak up.