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Medication adherence is a worldwide issue impacting more than half the population. The cost associated with nonadherence is tremendous and has spurred the growth of novel technologies to address this growing problem.This perspective covers the different digital health medication adherence tools that have come to market in the past decade and their clinical impact. These digital interventions and their applicability to medication adherence across different stakeholders are then evaluated.Digital health will play a significant role in creating new pathways to care in the 2020s. However, the current design of medication adherence tools has not demonstrated a clinical impact that will be relevant for the digital health space without a change in redesign factoring in relevant stakeholders' incentives to address adherence issues. A focus on only adherence has not yielded the economic or clinical benefit as expected, which is likely due to a lack of focus on broader drug-related problems (DRPs) that are causative factors beyond adherence alone. As such, adherence tools will see disparate uptake, likely due to condition-specific interventions rather than adherence issues as a whole, and future endeavors will need to address the larger DRP considerations to actualize clinical outcomes.

Objective To determine whether crowdfunding of pharmacy-related products through popular online platforms is a viable means to attain funding and what factors influence success. Methods Kickstarter and Indiegogo were searched for projects related to pharmacy using select key words. Projects were included for analysis if they were a device or system relevant to pharmacy care and excluded if found to be nonrelevant to medication management purposes or were of an artistic nature. Projects were assessed for their success in reaching their primary funding goals and also whether they were still in business following completion of their crowdfunding phase. Results Subsequent to the application of the inclusion and exclusion criteria to the dataset, 40 projects were identified, of which 13 reached their desired crowdfunding funding amounts. The most commonly created crowdfunded projects were those involving medication adherence or storage tools. Anecdotal evidence points to media attention leading to continued success beyond the initial crowdfunding phase of the business. The presence of a medical professional on the project team or the inclusion of a product demonstration did not lead to a different rate of success. Conclusion The crowdfunding of pharmacy care–related products appear to have a low success rate, although Indiegogo might offer a higher success rate compared with Kickstarter in this niche product area. The products’ ability to garner media attention seems to be a primary driver in the business surviving past the crowdfunding stage and becoming a lasting success.

Autoinjectable devices continue to provide real-life benefits for patients with chronic conditions since their widespread adoption 30 years ago with the rise of macromolecules. Nonetheless, issues surrounding adherence, patient administration techniques, disease self-management, and data outcomes at scale persist despite product design innovation. The interface of drug device combination products and digital health technologies formulates a value proposition for next-generation autoinjectable devices to power the delivery of precision care at home and achieve the full potential of biologics. Success will largely be dependent on biopharma’s digital health maturity to implement this framework. This viewpoint measures the digital health maturity of the top 15 biopharmaceutical companies in the US biologics autoinjector market and establishes the framework for next-generation autoinjectable devices powering home-based precision care and the need for formal digital health training.

UNSTRUCTURED Autoinjectable devices continue to provide real-life benefits for patients with chronic conditions since their widespread adoption 30 years ago with the rise of macromolecules. Nonetheless, issues surrounding adherence, patient administration techniques, disease self-management, and data outcomes at scale persist despite product design innovation. The interface of drug device combination products and digital health technologies formulates a value proposition for next-generation autoinjectable devices to power the delivery of precision care at home and achieve the full potential of biologics. Success will largely be dependent on biopharma’s digital health maturity to implement this framework. This viewpoint measures the digital health maturity of the top 15 biopharmaceutical companies in the US biologics autoinjector market and establishes the framework for next-generation autoinjectable devices powering home-based precision care and the need for formal digital health training.

The evolution of technologies to manage diabetes has led to improvements in patient adherence, technique, and monitoring. Insulin pens, for example, have distinct advantages over vials and syringes; they allow for more accurate dosing, improved adherence, less injection site pain, and greater patient satisfaction (1,2). As the population with diabetes grows internationally, second-generation insulin pens have been engineered with USB or Bluetooth features to enable closer monitoring of pharmacotherapy. Similarly, many devices for self-monitoring of blood glucose have also become integrated with Bluetooth to enable wireless transmission of data to a smartphone. As of 2016, the smart insulin pen market was valued at $59 million and is expected to increase to $123 million by 2023 in Latin America, the Middle East, and Africa (3). One report predicts that Europe will have the greatest smart insulin pen market growth, bringing in more than $2 million by 2027, based in part on high current utilization of such pen devices. The trend toward increased use of smart insulin pens can also be seen in North America; in fact, the same report estimates that, by 2027, the North American smart insulin pen market will have a continuous annual growth rate of 26.7% (4). The emergence of new technologies such as smart insulin pens, caps, attachments, and virtual platforms can help both patients and health care providers (HCPs) overcome problems such as poor insulin adherence, incorrect insulin initiation and titration, and medication errors. Adoption of such new devices may increase even further if clinical trials can show long-term cost-effectiveness (5). This review highlights the technologies now available on the market in the United States and internationally that are designed to improve insulin administration. A comprehensive literature review was conducted using manufacturer websites, press releases, commercial data resources, educational and training tools, …

The rise of technology in healthcare has led to dramatic changes in approaches to patient care by healthcare professionals. The realm of digital health has created new opportunities for pharmacists to engage patients in clinical practice. Pharmacies and industry are increasingly integrating these innovations into their businesses and practice. This article highlights areas of digital health for pharmacists to be aware of, in particular regarding areas of medication adherence and disease management. Technology plays a massive role in our individual lives; it has morphed the human experience in ways that were simply unimaginable 50 years ago. We use technology in nearly every facet of our lives. From detecting an appropriate intensity with which to brush our teeth to counting calories lost through the course of a day, technology has made a major impact on individual health. The integration of technology into our everyday lives has changed the way we communicate, how we capture and share our lives with others, how we seek answers, and how we experience life overall. Given this change in the way people operate, it is important that pharmacists adapt to these trends and incorporate technology into daily practice. The incorporation of mobile devices and technology into healthcare has been coined as mobile health (mHealth), which falls under the broader spectrum of digital health.1 –4 Digital health focuses on the integration of mobile tools (e.g., smartphones), wearable devices, and telehealth to help personalize the treatment of patients through the widespread adoption of wireless technology. The idea of involving pharmacists in mHealth has been a topic of recent interest, due in large part to the potential ramifications for the profession.4 Today, patients are using the Internet to research their health questions and help guide their personal health choices, and some of the information they find can be misleading and unreliable. It is of the utmost importance that healthcare professionals ensure there are credible sources for patients to research their questions. As pharmacists, we can research and recommend tools to patients to help solve problems related to drug information, medication adherence, and access, which includes the recent rise of novel technological devices. All of our patients will have different comfort levels with technology; despite this spectrum, there is a place for everyone to feel comfortable using digital health tools. However, there are recent technological advances coming to the field, which are already providing a benefit to patients, ranging from mobile applications to wearable technologies to ingestible medications that notify providers of patient medication adherence. We seek to help pharmacists understand the different areas of digital health, which may have substantial influence on the realm of pharmacy practice in the years to come by addressing current and upcoming digital health developments.

Preventing utilization of hospital and emergency department after diagnosis of venous thromboembolism is a complex problem. The objective of this study is to assess the impact of a care transition intervention on hospitalizations and emergency department visits after venous thromboembolism. We randomized adults diagnosed with a new episode of venous thromboembolism to usual care or a multicomponent intervention that included a home pharmacist visit in the week after randomization (typically occurring at time of discharge), illustrated medication instructions distributed during home visit, and a follow-up phone call with an anticoagulation expert scheduled for 8 to 30 days from time of randomization. Through physician chart review of the 90 days following randomization, we measured the incidence rate of hospital and emergency department visits for each group and their ratio. We also determined which visits were related to recurrent venous thromboembolism, bleeding, or anticoagulation and which where preventable. We enrolled 77 intervention and 85 control patients. The incidence rate was 4.50 versus 6.01 visits per 1000 patient days in the intervention versus control group (incidence rate ratio = 0.71; 95% confidence interval = 0.40-1.27). Most visits in the control group were not related to venous thromboembolism or bleeding (21%) and of those that were, most were not preventable (25%). The adjusted incidence rate ratio for the intervention was 1.05 (95% confidence interval = 0.57-1.91). Our patients had a significant number of hospital and emergency department visits after diagnosis. Most visits were not related to recurrent venous thromboembolism or bleeding and of those that were, most were not preventable. Our multicomponent intervention did not decrease hospitalizations and emergency department visits.

Objectives To describe novel methods regarding innovation for pharmacists and student pharmacists to leverage local and national events, such as hackathons and innovation labs, that provide guidance and resources for developing novel products and solutions in health care. Data sources Not applicable. Summary The profession of pharmacy exists in a diverse and complex system where collaboration is essential for innovation and can leverage existing resources to accelerate this. Hackathons occur over one or more days and offer a venue and resources to support innovation as interprofessional teams develop and pitch new product ideas for potential investment. Innovation labs serve as more permanent locations that offer resources and expertise to help realize ideas and guide development into potentially viable solutions and products for health care. Conclusion Although currently hosted hackathons and design spaces may prove to be beneficial to pharmacists looking to innovate, they are frequently located in urban areas or large academic institutions that are not readily accessible to the larger pharmacy community. Fostering opportunities, whether as local hackathons or innovation labs, can potentially help to accelerate the innovation cycle for the pharmacy profession. These resources can be developed in local communities or through national pharmacy societies and organizations to increase access.

The objectives of this workshop were to characterise the use of mobile health (mHealth) devices among second year pharmacy students, discover perception of their potential use in practice and obtain workshop feedback. The workshop consisted of two sessions. The first session introduced the concept of mHealth and allowed for hands-on experience with wireless mHealth devices such as blood pressure cuffs, scales and smart body analysers, personal health devices and glucometers. The second session consisted of a facilitated discussion and lecture that addressed these concepts. Students completed a preworkshop and postworkshop survey. 106 students completed the preworkshop survey and 96 students completed the postworkshop survey. 22% of the class owned an mHealth device and a majority of students reported increased knowledge of mobile health devices due to this simulation. The workshop was successful in introducing mHealth technology. The change in students’ perception that such devices could be useful in practice or easily incorporated could be due to technical difficulties and cost of the devices.

There is a significant and as yet underexplored area of literature related to the use of mobile devices and their impact on radiology education. This editorial will highlight some of the novel tools and techniques, which are accessible to radiology trainees that may enhance their medical education. The recent growth in popularity of mobile devices among clinicians and other healthcare professionals since the introduction of the ‘smartphone’ and ‘tablet’ has been exponential. Mobile devices offer multiple functions that allow them to function as an adjunct clinical tool. Many have identified that mobile devices can serve as mobile clinical references, with easy access to the literature which has seen a surge in expansion from printed format to ‘apps’.1–3 Recent data has demonstrated a large utilisation of mobile devices among the medical professionals and students.4–6 Overall, usage by medical professionals has ranged from point-of-care references to clinical and drug references, medical calculators and access to the electronic health record.4–6 Medical students have found mobile devices as a tool to supplement their education, with access to e-textbooks, simulation tools and similar medical references.6 The visual nature of digital radiology makes it highly suitable to modern mobile devices. There is significant potential to use these devices to support day-to-day clinical radiology activities including mobile viewing and assessment of Digital Imaging and Communications in Medicine (DICOM) format images. Mobile devices have greatly improved in the past decade to now support high definition displays that improves image visibility. Accordingly, formal investigation into the utility of these devices has predominantly focused on their suitability for this clinical task including mobile image reporting, mobile diagnosis and comparison of interobserver reliability.7–10 Many of these early studies have been encouraging and there certainly appears to be value to continue this research further as mobile hardware …

Objectives To (a) determine potential cost savings of a pharmacy outreach teleservice program conducting Medicare Part D plan reviews for a large population of beneficiaries allowing for comparison of multiple preferences; and (b) explore client demographic comparisons, plan features, and stratification by cost and number of medications. Methods Retrospective cohort evaluation of a Medicare D review service during open enrollment period (October 15 to December 7, 2012). Reviews were conducted at a university-based pharmacy outreach program in Massachusetts and completed by pharmacists (17%), case managers (52%), and students (31%). Recommendations were created by entering medication regimens into the Medicare.gov plan finder, and factors including deductible, premium, and copayment or coinsurance, formulary restrictions, secondary assistance, and annual cost were considered. A comparison of the overall cost of the client's 2012 plan in 2013 with that of a lower-cost plan in the 2013 benefit year determined potential cost savings. Results Demographic data were available for 1062 individuals, with the majority being women (66%), an overall mean age of 73 years, and most living in a single household. Clients (75%) were taking 5 or more medications. Lower-cost plans were recommended for 61% of clients with a median cost savings valued at $538 per member, per year. Cost was the leading consideration for plan change (87.4%), followed by deductible (32.7%) and premium (30.1%). Cost savings were analyzed by evaluating current plan versus alternate plan by sex, age, client type (repeat vs. referred vs. new), and according to number of medications. Lower-cost plans were identified for 75% of new members. Individuals taking 0-14 medications had a cost savings of approximately $833 per client per year. Conclusion Teleservice pharmacy outreach programs create value by identifying therapeutically comparable alternative plans and reducing plan spending while efficiently consulting for a large number of Medicare Part D beneficiaries statewide.

Background There are thousands of medical applications for mobile devices targeting use by healthcare professionals. However, several factors related to the structure of the existing market for medical applications create significant barriers preventing practitioners from effectively identifying mobile medical applications for individual professional use. Aims To define existing market factors relevant to selection of medical applications and describe a framework to empower clinicians to identify, assess and utilise mobile medical applications in their own practice. Materials and Methods Resources available on the Internet regarding mobile medical applications, guidelines and published research on mobile medical applications. Results Mobile application stores (e.g. iTunes, Google Play) are not effective means of identifying mobile medical applications. Users of mobile devices that desire to implement mobile medical applications into practice need to carefully assess individual applications prior to utilisation. Discussion Searching and identifying mobile medical applications requires clinicians to utilise multiple references to determine what application is best for their individual practice methods. This can be done with a cursory exploration of mobile application stores and then moving onto other available resources published in the literature or through Internet resources (e.g. blogs, medical websites, social media). Clinicians must also take steps to ensure that an identified mobile application can be integrated into practice after carefully reviewing it themselves. Conclusion Clinicians seeking to identify mobile medical application for use in their individual practice should use a combination of app stores, published literature, web-based resources, and personal review to ensure safe and appropriate use.

Informatics is an increasingly important component of pharmacy practice. This domain, along with several technological modalities and services that underpin it, can facilitate the connection of the pharmacist to larger networks of information systems, healthcare providers, and health information technology (HIT). This, in turn, can help optimize all steps of the medication use process. In addition, digital health offers new roles and opportunities for pharmacy related to the leveraging of patient health-related data (e.g., medication adherence, behavioral, and wellness) over time. Informatics and digital health may also enhance patient-centered care within pharmacy and other allied health disciplines. Its inherently multidisciplinary nature also is suggestion of one route to enhance interprofessional education. Therefore, pharmacy educators and students should be familiar with the educational requirements and modalities associated with the integration of informatics and digital health in the goal of becoming practice-ready.

Advancements in technology have led to the development of medical applications (apps). Contents of 44 apps related to travel medicine were assessed demonstrating that many were updated infrequently and several developers had no medical background. There is an opportunity for healthcare professionals to develop apps in travel medicine.

Background: The use of mobile apps in health care is growing. Current and future practitioners must be equipped with the skills to navigate and utilize apps in patient care, yet few strategies exist for training health care professional students on the usage of apps. Objective: To characterize first-year pharmacy student use of medical apps, evaluate first-year pharmacy student's perception of skills in finding, evaluating, and using medical apps before and after a focused learning experience, and assess student satisfaction and areas for improvement regarding the learning experience. Methods: Students listened to a recorded, Web-based lecture on finding, evaluating, and using mobile apps in patient care. A 2-hour, interactive workshop was conducted during which students were led by an instructor through a discussion on strategies for finding and using apps in health care. The students practiced evaluating 6 different health care–related apps. Surveys were conducted before and after the focused learning experience to assess students' perceptions of medical apps and current use and perspectives on satisfaction with the learning experience and role of technology in health care. Results: This educational intervention is the first described formal, interactive method to educate student pharmacists on medical apps. With a 99% response rate, surveys conducted before and after the learning experience displayed perceived improvement in student skills related to finding (52/119, 44% before vs 114/120, 95% after), evaluating (18/119, 15% before vs 112/120, 93% after), and using medical apps in patient care (31/119, 26% before vs 108/120, 90% after) and the health sciences classroom (38/119, 32% before vs 104/120, 87% after). Students described satisfaction with the educational experience and agreed that it should be repeated in subsequent years (89/120, 74% agreed or strongly agreed). Most students surveyed possessed portable electronic devices (107/119, 90% mobile phone) and agreed with the concept of medical apps being an important part of the health care profession in the future (112/119, 94% before and 115/120, 96% after). Conclusions: Student pharmacists recognize the key role technology plays in the future of health care. A medical apps workshop was successful in improving student pharmacists' perceptions of ability to find, evaluate, and use medical apps. [JMIR Mhealth Uhealth 2016;4(2):e55]

BACKGROUND: Postoperative atrial fibrillation (POAF) is a frequent complication following cardiothoracic surgery and is associated with an increase in morbidity, mortality, and cost. One small prospective study of patients undergoing isolated coronary artery bypass graft surgery has demonstrated a decrease in the risk of POAF with the use of sodium nitroprusside. OBJECTIVE: To determine whether there is an association between intraoperative sodium nitroprusside use and the incidence of POAF. METHODS: A retrospective cohort of 1025 patients aged 18 years and older who underwent any cardiac surgery between April 2007 and July 2010 was evaluated at Regional Hospital of Scranton. Patients with a history of atrial fibrillation, those who had undergone cardiothoracic surgery, or those undergoing surgical treatment for atrial fibrillation were excluded. The primary outcome was the odds of developing POAF given the utilization of sodium nitroprusside during cardiothoracic surgery. POAF was defined according to the Society of Thoracic Surgeons Adult Cardiac Surgery Database version 2.61 as a new onset of atrial fibrillation/flutter requiring treatment that was not present preoperatively. Data on use of intraoperative sodium nitroprusside were obtained from the pharmacy department's billing database. RESULTS: The final analysis included 699 patients; 473 received sodium nitroprusside. The incidence of POAF was 25.4% in the sodium nitroprusside group and 27.9% in the control group. Univariate analysis demonstrated no association of sodium nitroprusside with POAF (OR 0.880; 95% CI 0.615 to 1.257). Multivariate analysis also showed no significant difference in the odds of POAF with sodium nitroprusside (OR 0.827; 95% CI 0.565 to 1.210). Repeating the analysis in 276 propensity score–matched patients also failed to demonstrate any association (OR 0.774; 95% CI 0.454 to 1.319). CONCLUSIONS: There was no significant association between the use of sodium nitroprusside during cardiothoracic surgery and POAF.

The growing expanse and interest in using mobile and wearable devices has made significant inroads into the practice of medicine and healthcare. Utilizing digital health tools in the management of diabetes is quickly becoming a large interest area by both medical researchers and companies at large. Within the last few years, there have been significant developments in tools and technology developed that could have long-lasting impact on the future of diabetes management, patient engagement and interaction, and clinical practice.

The first mobile devices to enter the market were the personal digital assistants (PDAs) of the late 1990s and early 2000s, and they ushered in the era of handheld computers. PDAs combined popular features of electronic tools (e.g., calculator) and computer apps applications (e.g., e-mail, calendar

OBJECTIVE To share successful techniques pharmacists can use to educate community-based older adults about health and medications. SETTING Events coordinated through MCPHS University Pharmacy Outreach Program and offered at Massachusetts senior centers. PRACTICE DESCRIPTION The MCPHS University Pharmacy Outreach Program, staffed with pharmacists, caseworkers, and pharmacy students, under the supervision of licensed pharmacists, provides free medication-related information to Massachusetts residents. Clients also receive assistance with cost-minimizing programs and insurance benefits. Seventy percent of contacts are older adults. Services are provided through a toll-free number and outreach programs. PRACTICE INNOVATION Focus on expanding educational health services and includes selecting Medicare D plans, working with support groups, providing medication management for diverse cultures, educating older adults on how to search for health information on the Internet, and discussing medication safety and adherence. MAIN OUTCOME MEASUREMENTS Participant and pharmacy student knowledge assessed utilizing survey tools. Additional measurements include savings for Medicare beneficiaries and improvements in medication management. RESULTS Observed results of the Pharmacy Outreach Program include decreased out-of-pocket costs for Medicare beneficiaries, improved medication adherence resulting in reduction of glycated hemoglobin and blood pressure, identifying and recommending medication treatment changes to reduce patient fall risk, and increased confidence in locating Web-based health information. Pharmacy students demonstrated increased knowledge of and ability to communicate Medicare benefits. CONCLUSION Outreach programs can improve older adults' understanding about their health and medications. Pharmacists can increase visibility in the community by engaging in effective outreach programs.

The number of research studies published which focus on medical “applications” or “apps” continues to grow exponentially. Many academics use these terms interchangeably, however we believe that the discrepancy of terminology used may present a problem for future researchers to systematically identify and conduct appropriate literature searches. We believe it is now time for the mHealth research community to come to a universal consensus and reach a common standard on whether studies should refer to medical “apps” or “applications”. In this article we highlight a number of advantages that standardization of nomenclature will deliver. We also highlight a number of reasons why we believe that mHealth researchers should use the terminology: app [plural-apps]. We conclude by recommending that leading eHealth medical informatics publications such as Journal of Medical Internet Research (JMIR) to implement a policy to utilize common nomenclature moving forward to facilitate improved reporting of studies investigating mobile medical app interventions. [J Med Internet Res 2014;16(7):e174]

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BACKGROUND Mobile devices (eg, smartphones, tablet computers) have become ubiquitous and subsequently there has been a growth in mobile applications (apps). Concurrently, mobile devices have been integrated into health care practice due to the availability and quality of medical apps. These mobile medical apps offer increased access to clinical references and point-of-care tools. However, there has been little identification of mobile medical apps suitable for the practice of pharmacy. OBJECTIVE To address the shortage of recommendations of mobile medical apps for pharmacists in daily practice. DATA SOURCES Mobile medical apps were identified via the iTunes and Google Play Stores via the “Medical” app categories and key word searches (eg, drug information, medical calculators). In addition, reviews provided by professional mobile medical app review websites were used to identify apps. STUDY SELECTION AND DATA EXTRACTION Mobile medical apps were included if they had been updated in the previous 3 months, were available in the US, used evidence-based information or literature support, had dedicated app support, and demonstrated stability. Exclusion criteria included apps that were not available in English, had advertisement bias, used nonreferenced sources, were available only via an institution-only subscription, and were web-based portals. DATA SYNTHESIS Twenty-seven mobile apps were identified and reviewed that involved general pharmacy practice, including apps that involved drug references, clinical references, medical calculators, laboratory references, news and continuing medical education, and productivity. CONCLUSIONS Mobile medical apps have a variety of features that are beneficial to pharmacy practice. Individual clinicians should consider several characteristics of these apps to determine which are suitable to incorporate into their daily practice.

Since the launch of the modern smartphone, medical applications have become ubiquitous in both clinical practice and education. Despite the lack of a formal evidence base, many see mobile technology as being an integral part of future health care. A recent study by Wolf et al1 assessing the efficacy of commercially available smartphone applications designed to assess melanoma risk of suspicious skin lesions highlights this dilemma. Their findings of sensitivities and specificities ranging from 6.8% to 98.1% and 30.4% to 93.7%, respectively, illustrate the existing variability in applications currently available to patients and clinicians. We applaud the authors for their investigation into the accuracy of these applications as the prevalence and usage of mobile devices in clinical practice is extremely high despite the lack of formal US Food and Drug Administration regulation.2 However, their findings are not isolated. For example, Abroms et al3 have shown similar findings in the content of applications designed for smoking cessation. In addition, in an unprecedented action, the Federal Trade Commission brought civil charges against the developers of 2 applications that claimed to treat severe acne using light generated via the screen of a smartphone.4