From smart pills to augmented intelligence, technology has presented the health care industry with a host of options to improve medication adherence and safety.
Novel computer technologies for improving medication adherence and safety have ushered in a new era of medication reminder and tracking apps, smart
pill canisters, and medications with nanosized biosensors contained within. Although these technologies represent new treatment paradigms for a variety of diseases, they could have unintended implications.
Antipsychotics—available as oral disintegrating tablets, oral solutions, short-acting intramuscular injections, and long-acting injectable formulations—are now being combined with wireless technology. Tahir Rahman, MD, an associ- ate professor of psychiatry at Washington University School of Medicine in St Louis, Missouri, explained how one approach includes a patch worn on the abdomen to track and record medication adherence. A related smartphone app tracks medication ingestion and activity level data, as well as self-reported mood and other factors.
“I see trackable pills playing an important role in the future. People who are adherent with care don’t really need them, but there are always medications that are difficult to adhere to,” Rahman told Drug Topics®. These medications include those that require dosing 3 or 4 times a day. “That is where some apps can be helpful to increase adherence.”
Advances in Medication Tech
With wireless technologies, patients can share their collected data with others, including their health care pro- vider. Aripiprazole tablets with sensors and other similar products are being touted as electronic drugs, nanodrugs, or digital drugs, Rahman explained.
A recently published review on emerg- ing smart technology innovations in the health care sector suggests vari- ous advanced technologies and methods may now significantly improve medication adherence.1 Two significant advances have been the ability to measure medication adherence and safety issues with medication event monitoring systems (MEMS) and smart blister packs containing radio frequency identification technology.
MEMS is a “customizable medication package” capable of recording and storing 4000 dosing events, according to a review published in the Global Health Journal.1 Microcircuits record each date and time when the packaging is opened on either the SmartCap or TrackCap product.
The ID-Cap System—another smart medication adherence tool, manufactured by etectRx—includes an ingestible sensor that provides real- time dose-level ingestion event verifcation. According to Eric Buffkin, etectRx president and CEO, the ID-Cap System is currently the only FDA-cleared method to document a dosing event, going beyond reminders and self-reporting. “In addition to the ease of patient use, the ID-Cap System’s real strengths are in the verification of ingestion and thorough reporting and tracking of adherence,” Buffkin said.
In this new era of applied technology, partnerships between pharmacists and software developers are becoming more commonplace in order to maximize medication outcomes and improve overall safety. Pharmacists, Buffkin said, are uniquely positioned to leverage this technology to improve medication safety.“As medications increase in expense and complexity, pharmacists can provide even more value [by] ensuring medications are taken as prescribed, and etectRx would welcome the opportunity to partner with pharmacy further on this initiative,” he added.
Augmented Intelligence and Personalized Medicine
The current technological revolution is paving the way for health care providers to make the move from reac- tive disease management to a predictive and personalized approach. “I think we are in an era of digital health, where we can use wearables, telehealth, digital therapeutics, and health information technology [HIT] to improve medication safety,” said Sandra L. Kane-Gill, PharmD, MSc, a critical care medication safety officer in the Department of Pharmacy at the University of Pittsburgh Medical Center in Pennsylvania.
Kane-Gill refers to this technology as augmented—not artificial—intelligence. The volume of data health care professionals can access for a single patient continues to increase, and augmented intelligence can quickly digest that information in an organized manner.
“Augmented intelligence [is the preferred term] because we are designing [HIT] to support health care professionals’ decisions,” Kane-Gill said.“The [biggest] advantage to aug- mented intelligence is the support it provides by managing large amounts of data with a streamlined process, typically [faster] than humans.”
It may be possible to lower morbidity and mortality across a variety of conditions by using validated aug- mented intelligence algorithms. Rahman believes machine learning will allow providers to spot medication safety issues much earlier than is currently possible.“Machine learning is the future. We can use big databases, and we will know which patients do better on certain drugs,” Rahman said.
The Game Is Just Beginning
Kane-Gill and her team are working to develop machine learning algorithms that can be used to improve drug-related acute kidney injury detection and prevention. Currently, HIT can provide clinical decision support to aid with medication safety. However, HIT has the potential to do much more than pick up on potential drug safety issues.“I think we have moved beyond the first inning,” Kane-Gill said.
The COVID-19 pandemic has expe- dited patient monitoring through telemedicine. Now new transmitting devices may help to maintain effective and sustainable communication. The use of wearables for medication monitoring is increasing and these wearables can handle a huge volume of data and provide real-time responses.“We are not sure when medication monitoring will reach the ninth inning, as we are just beginning to understand multirace, multi-ethnic, and genetic-specific research and technology [needed] to guide advanced therapies,” Kane-Gill said.
Daniel C. Malone, PhD, BSPharm, professor in the Department of Pharmacotherapy at the University of Utah College of Pharmacy in Salt Lake City, said that although medi- cation adherence continues to be an issue, there is not a one-size-fits-all approach. In fact, Malone questions whether patients will be willing to consent to having someone look over their shoulder to observe their medi- cation-taking behavior.
Machine learning, which can detect unique patterns of use associated with a greater risk of negative health outcomes, is useful for generating hypotheses and perhaps identifying some previously undiscovered characteristics.“On the other hand, I don’t see it fitting into the daily practice of pharmacy in a significant manner,” Malone said. “Perhaps some nuggets of gold will come from the approach, but I think those will be relatively rare and less impactful than many anticipate.”
Lisa Schwartz, PharmD, senior director of professional affairs at the National Community Pharmacists Association, said it is exciting to see how advances in technology are providing patients and their care teams with more objective data to assess drug safety and effectiveness. However, she worries soft skills, such as motivational interviewing, may be pushed to the side and patients will lose some continuity of care. “Pharmacists will still make observations and elicit information that helps treat the patient and not just their data,” Schwartz said.