mHealth, wearables, and invisibles on Hilton Head Island

While not quite Fantasy Island, I recently enjoyed a trip to Hilton Head Island, South Carolina where I stayed…at a Marriott. Turns out the island is named after Captain William Hilton. No relation to the Marriott International, Inc (formerly Hot Shoppes!) folks. I was there for the 2015 Annual Meeting of the South Carolina Society of Health-System Pharmacists to speak about the emerging area of wearable technology in pharmacy. It was a nice, tightly run conference with good speakers and active attendees.

mHealth Multidisciplinary Verticals

The summary and book chapter below represent our contributions to this text. The topic remains an area I have great enthusiasm about and high hopes for, when executed well.

Irrational use of medications is a global challenge, with the World Health Organization (WHO) estimating that “more than half of all medicines are prescribed, dispensed, or sold inappropriately”. This situation is exacerbated by half of all patients not taking their medications as intended, with non-adherence rates in disorders like schizophrenia reaching over 70%. Medication non-adherence and polypharmacy (i.e., use of multiple medications) are massive barriers to optimal medication management and are the source of substantial health and financial costs. Mobile health (mHealth) offers myriad methods to address these challenges, ranging from simple text message reminder systems to ecological momentary interventions (EMIs) to leveraging interface versatility for eHealth literacy solutions. In this chapter, current scientific evidence will be used to explore the role of mHealth in enhancing pharmacy-related outcomes in varying healthcare settings and diverse populations. Current and future developments in mHealth will be explored through the lens of select disease states and patient populations.

@kevinclauson

The potential of mHealth in pharmacy

mHealth_AJHP2013The next frontier in healthcare? The next step in patient-centered delivery of health services? Technology’s next overhyped bubble? There are grains of truth in all of these labels that have been given to mHealth. However, what is beyond debate is that there are opportunities with mHealth. In particular, I am optimistic about the opportunities with mHealth for pharmacists. To that end, I asked several colleagues to help outline the potential of this informatics arena. Those efforts were recently published as an article in the American Journal of Health-System Pharmacists (AJHP). My hopes are that this article serves to increase awareness of these opportunities and perhaps spurs some pharmacists to capitalize.

@kevinclauson

Source: Clauson KA, Elrod S, Fox BI, Hajar Z, Dzenowagis JH. Opportunities for pharmacists in mobile health. Am J Health Syst Pharm. 2013;70(15):1348-1352.

Kevin A. Clauson, Pharm.D., is Associate Professor; and Shara Elrod, Pharm.D., is Assistant Professor, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL. Brent I. Fox, Pharm.D., Ph.D., is Associate Professor, Harrison School of Pharmacy, Auburn University, Auburn, AL. Zaher Hajar, Pharm.D., is Fellow in Consumer Health Informatics, College of Pharmacy, Nova Southeastern University. Joan H. Dzenowagis, Ph.D., is Senior Scientist e-Health World Health Organization, Geneva, Switzerland.

Stanford Medicine X: To inform and inspire

Skinny jeans are a surrogate marker, Nick Gross was not who I expected, and the e-patients are even braver than I thought. Listening to the Club Med X play list (selections at bottom), I found myself reflecting on the things I learned, who I spoke with, and what inspired me at Stanford Medicine X.

The Things I Learned
Bringing the science/citizen science
Scientist and wine aficionado Ian Eslick (@ieslick) was the first winner of my daily ‘Bringing the Science’ (BtS) award at Med X. He explained how his own condition of psoriasis informed and affected his approach in creating the first MIT-run authoring experiment. The purpose of the experiment is to study “how patients think about self-experimentation and figuring out how making changes impacts them” at PersonalExperiments.org. He also opened the door to the n-of-1 vs epi debate and the idea of future sampling.

The next day CEO of Asthmapolis David Van Sickle (@dvansickle) claimed the coveted (albeit fictitious) BtS award with his fantastic marriage of humanizing the process of research with almost zealous inquisitiveness. He shared the origin of his obsession of “stalking asthma” from Navajo villages to Alaska and then to the CDC where the limitations of public health data and the role of technology were crystallized for him. Van Sickle went on to describe his excitement about the role of mHealth in preventing diseases in populations. Acknowledging that I may have sipped the Kool-Aid when it moved into mHealth for prevention, you must watch his 15 minute talk. “The hardest cause to identify is the one that is universally distributed.” Indeed.

Rhiju Das was the very next speaker discussing EteRNA, which necessitated creation of the ‘Bringing the Citizen Science’ faux-ward. His Das Group at Stanford in conjunction with Carnegie Mellon challenges citizen scientists and gamers to create RNA sequences that fold into target shapes via the interface they’ve developed. Interestingly, in part due to Das’ involvement as part of the team that created Foldit, EteRNA is seen as its successor by some.

Role of design and UX
So, it turns out design isn’t just for architects and frogs anymore. I had some feel for the roles of human-computer interaction and behavioral health design from working with researchers and others like Tonic. However, I was blown away by the roles of design and UX ranging from the seemingly mundane (e.g., hospital equipment) to the ambitiousness of the IDEO Design Challenge Workshop to its potential in transforming children’s fears about nebulizer treatments into nurturing moments.

Self-trackers and Quantified Self
Before the Med X Self-Tracking Day, I was peripherally aware that people like @FredTrotter were hacking away at things and tweeting their weight and that Ernesto Ramirez (@e_ramirez) was causing waves in something called Quantified Self. But I definitely did not realize how widespread self-tracking is until @SusannahFox debuted her new Pew data (re-defining it for much of the crowd), nor did I appreciate how creative (@nancyhd; Winner: Best smile-powered LED headdress) or dedicated (@bettslacroix) some of those involved are. This is an area worth exploring for future research and I’ll be curious to see what comes of some of the specific efforts such as MyMee.

Who I Spoke With
Surprises and plans
Just because it seems cliché to say that the best part about conferences are often the hallway conversations doesn’t make it any less true. In this case, the Medicine X First Look video archive of the entire conference goes a long way for those who couldn’t make it…but being surrounded by the attendees of this conference conferred an entirely separate set of benefits and opportunities. I had a series of eye-opening impromptu meetings and promising conversations. One was with Nate Gross (he of the minimalist Twitter handle @NG; co-founder of Rock Health and Doximity) at a group dinner. As I have zero feet in the business world and most of my business savvy comes from having watched the movie Wall Street in 1987, I was sort of resigned to sitting next to a brusque, bottom-line type. Instead, I found him to outwardly be a more contemplative sort who spent more time observing than speaking…or maybe he was just happy to be seated next to someone who didn’t have something to pitch.

Most of my other notable conversations portended more specific possibilities. I found myself in one sitdown listening to opportunities described on the fly between AMIA Fellow and researcher Qing Zeng-Treitler, Medify’s Derek Streat, and Alliance Health’s David Goldsmith (@dsgold). Later I enjoyed an intial exploration with Sarah Kucharski (@AfternoonNapper) about extending the role of the patient in research design. That was a conversation I suspect will continue.

What Inspired Me
Two people and an object
Unsurprisingly, it was the people and their stories at Medicine X that I found most inspiring. Many of the Ignite talks by the e-patient scholars were personal and touching, but I found two people particularly so. Sean Ahrens has taken his own story about Crohn’s and literally built a community for others suffering with the same struggles in Crohnology. It’s amazing to me that someone with a potentially debilitating condition refuses to cave to its daily demands and instead sources it to create a virtual bridge to connect and benefit others.

The other person is @DanaMLewis. Personal bias aside (see panel slide deck), to have a person at her age & stage create another type of virtual community in #hcsm that has such far reaching effects that it even inspires Alicia (@stales) Staley (herself quite the wow-inducer) to create #bcsm is immensely encouraging to me.

Youth. Creation. Connection. Wow.

A different kind of enchanted object
Watching David Rose of Vitality present at the mHealth Summit introduced me to the concept of the ‘enchanted object’. At Med X, I saw a more literal version of this implemented in the form of the Magic Mask. The Magic Mask used augmented reality tech and lessons from IDEO to transform what can be a frightening experience of nebulizer treatments to a parent-involved storybook time for these children with asthma. Trust me, you’ll want to read the full description of this work by @RoujaPakiman and @LucieRichter here.

Our Panel and Fin
An e-patient, an entrepreneur, and an academician collaborate to conduct research. In our panel, @DanaMLewis, @BorisGlants, and I tried to share our lessons in adopting the participatory design model for research. Hopefully we were able to inform a bit about misteps and successes and provide a dash of inspiration so that more patients and researchers will partner to capitalize on the strengths of each other.

I have been to a lot of conferences, and no one puts the level of thought and care into each detail of a conference like @LarryChu. This was a stellar experience that I look forward to next year!

@kevinclauson

Club MedX Playlist (selected songs)

Harvest Moon – Poolside
Night Falls – Booka Shade
Pharaohs – SBTRKT
4 years – Kid Savant
Rocket No. 3 – A Rocket in Dub
Skylight – Gramatik
Save the World – Swedish House Mafia
Shuffle a Dream – Little Dragon
Somebody That I Used to Know (feat. Kimbra) – Gotye [h/t @iam_spartacus who told me who the artist was, as I am old and thought the chorus was Sting]

TC (Theft Citation i.e., where I stole this post title from): I read @SusannahFox’s post on Stanford Medicine X. As with many of her posts (and I think she would agree), some of the best value is in the comments. In this case, it was the contribution by David Goldsmith who pointed out that Med X is the rarest of birds in that it managed to both inform AND inspire.

Helping Your Patients Make Sense of the mHealth Marketplace

One of my favorite developments within the Florida Society of Health-System Pharmacists (FSHP) has been membership’s growing interest in informatics. Of course, there are FSHP members who have been active in informatics for 20+ years, but the increased focus on it in the last 5 or so has been particularly encouraging.

To that end, I was asked to present this year at FSHP Annual on one of my favorite topics – patients’ use of mobile health (mHealth) apps to enhance their self-management. The expanded slide deck from my FSHP presentation is below. 

@kevinclauson

Evaluation of paediatric medicines information content on smartphones & mobile devices

One of the benefits of working at a large university is all of the different faculty you get a chance to work with. In this case, I collaborated with a group led by someone I have immense respect for – Dr. Sandra Benavides. She relayed that, “Medication safety and dosing information is often poorly delineated for paediatric patients as 75% of medications demonstrate insufficient labelling for these two purposes.” [1] So off-label or ‘unlicensed’ use of meds in peds is very common, with accompanying safety problems exacerbated by the more narrow therapeutic window in this population. Since use of clinical decision support tools is one strategy that has demonstrated the ability to help prevent med errors in peds [2] and the use of mobile devices in clinical practice has expanded substantially – we decided to systematically examine the quality of medicines information in a sample of commercially available tools. The article that came out of the study was recently published in Informatics in Primary Care.[3]

Paediatric-specific tools evaluated included: British National Formulary for Children, Harriet Lane Handbook, and Paediatric Lexi-Drugs. Generalist tools included: A to Z Drug Facts, American Hospital Formulary Service Drug Information, Clinical Pharmacology OnHand, Epocrates Rx Pro, Lexi-Drugs, and Thomson Clinical Xpert. 108 questions (e.g., Can the sudden appearance of extrapyramidal symptoms in an 11-month-old infant be attributed to administration of metoclopramide for injection?) were distributed evenly across infant, children and adolescent subgroups. Answers for the evaluative questions were sourced from established sources and (due to the high rate of off-label prescribing for which no conventional source exists) clinical guidelines.

The verdict? “The best performer [Pediatric Lexi-Drug] provided 75.9% of the answers…Databases generally performed less effectively in providing answers sourced from clinical guidelines compared with more conservative sources such as package inserts”. Obviously the article itself goes into much more detail regarding scope and completeness of the tools and their performance based on several criteria. Hopefully the article adds some useful guidance and identifies both strengths and shortcomings with which these increasingly important tools and their nextgens can be improved upon.

@kevinclauson

1. Benjamin DK, Smith PB, Murphy MD et al. Peerreviewed publication of clinical trials completed for pediatric exclusivity. Journal of the American Medical Association 2006;296:1266–73.
2. Fortescue EB, Kaushal R, Landrigan CP et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics 2003;111:722–9.
3. Benavides S, Polen HH, Goncz CE, Clauson KA. A systematic evaluation of paediatric medicines information content in clinical decision support tools on smartphones and mobile devices. Informatics in Primary Care 2011;19(1):39-46.

Launching a Center for Consumer Health Informatics Research

We are very excited that the Nova Southeastern University College of Pharmacy has officially launched our Center for Consumer Health Informatics Research (CCHIR)! Like all undertakings of this magnitude, it has been in the works for some time and has benefited from tremendous support from many corners – in particular the Chair of the Department of Pharmacy Practice and the Dean of the College of Pharmacy. Below is a presentation outlining some basics about the Center. I look forward to working with its faculty and collaborators and steering the CCHIR toward many great developments in the future.

@kevinclauson

 

UPDATE: The dedicated site is up at www.CCHIR.com

Texting for Diabetes @ Medicine 2.0’11 Stanford

For Medicine 2.0 (#med2) at Stanford this month, I am excited to be delivering a Research in Progress presentation of our study,  “Impact of Texting and Predictive Potential of Health Literacy on Medication Adherence in Type 2 Diabetes Mellitus”. The study, supported by the McKesson Foundation Mobilizing for Health grant program, aims to help a diverse and largely uninsured and underinsured population in South Florida improve adherence to the medications they take for type 2 diabetes mellitus. Our study intervention is designed as a simple series of text messages through treatment targeting one of the primary hurdles to optimal medication adherence – reminders. I will also be sharing our plan for integrating health literacy assessments and disease state knowledge into the clinic EHR as a means to provide more patient-centric counseling and support. Our hope is that we produce an effective intervention to improve health which is also low-cost and thus ultimately scalable. There are a lot of scary numbers being bandied about for diabetes such as its $174 billion annual cost and forecasts that as many as 1 in 3 Americans could develop diabetes by 2050; it would be massive if this contribution could assist in stemming the tide.

Beyond being surrounded by a great study team, I have also been fortunate that providers at our primary care clinic partners have become very enthused about the study. We actually amended our original protocol to account for the fact that physicians at other clinics within the Memorial Healthcare System approached us and volunteered to help recruit participants.

Over the years, Mednet and its offspring, the Medicine 2.0 Congress have been among the most ambitious, surprising, and practically beneficial conferences I’ve attended.  Every year I see new attendees from seemingly disparate areas and sectors that come and then find commonalities that produce stimulating discussions, research collaborations, business ventures, and even friendships. This year will continue that tradition with the pre-conference lineup at the Stanford Summit on September 16, 2011 and the two-day Medicine 2.0 conference proper that follows on September 17th and 18th.  I will be there to share our research to date and eager to participate in the other sessions. I hope to see you there too!

@kevinclauson

Pharmacy: Is there an app for you

The 45th Annual Meeting of the Florida Society of Health-System Pharmacists (FSHP) was held in Orlando during the weekend. Since it is a state organization conference, it is much smaller than gatherings like the ASHP Midyear Clinical Meeting. This allowed for a streamlined set of programming tracks and a more relaxed atmosphere. There were also some interesting individual sessions (and necessities) on medication errors, pain management, etc.  I particularly liked the presentation on “Cyberhealth”, which focused on issues with Internet Pharmacy. Additionally, I had the opportunity to present “Pharmacy: Is there an app for you” at the meeting.

@kevinclauson