Narrator - Dr. Abel  00:00
Welcome to HelixTalk, an educational podcast for healthcare students and providers, covering real life clinical pearls, professional pharmacy topics and drug therapy discussions. This podcast is

Narrator - ?  00:12
provided by pharmacists and faculty members at Rosalind Franklin University, College of Pharmacy.

Narrator - Dr. Abel  00:17
This podcast contains general information for educational purposes only. This is not professional advice, and should not be used in lieu of obtaining advice from a qualified health care provider.

Narrator - ?  00:27
And now on to the show.

Unknown Speaker  00:31
Welcome to HelixTalk episode, 156 I'm your co host, Dr. Kane,

Dr. Khyati Patel  00:36
and I'm Dr. Patel, and the title of today's episode is, there is an app for that, digital health advancements and more. In this episode, we're going to define digital health. I don't think we've talked about that before. Provide some categories and examples within each category, and particularly talk about how it relates to pharmacy and pharmacist and practice in future, as well as share some examples of current practices where pharmacists are involved in digital health, and then kind of discuss, as we are educators, how we are shaping the curriculum or education in pharmacy to train future pharmacists.

Speaker 1  01:15
Dr. Patel, I'm so excited about today's episode because I've heard a ton about digital health, specifically with pharmacy education, but just as the role of the pharmacist is evolving, I've heard a lot about digital health, and to be honest with you, I'm not that familiar with the topic, so I'm very excited that we're going to delve deeper into it and give the audience a good overview of what it actually means when we talk about digital health and what the role of that pharmacist is in the future.

Dr. Khyati Patel  01:41
I love it, and we do have some great articles and references in the show notes. Dr. Timothy Aungst. And I read one of his publication and he said that, right now we're calling this digital health, but in future, this will be the health and there won't be a terminology digital health, because this is, this will be a norm of what we do as part of healthcare. And to that, you know, it brought goosebumps, because it is so exciting. But at the same time, there are a lot of unknowns, and there are limitless possibilities as to what we know healthcare now. And so we're in for a good ride, and we're going to see where this train takes us. But yes, the possibilities are endless.

Speaker 1  02:28
I love that. Well, probably the best place to start so that we're all on the same page is Dr. Patel, what exactly is digital health? When we talk about digital health, what does that encompass, or mean? Obviously, it sounds something related to like technology. But can you give us maybe a better definition or a better scope of what that involves?

Dr. Khyati Patel  02:47
Yes, and I wish you know as familiar as of a phrase digital health is to everyone. I wish we had a solid definition. Turns out we don't, because even FDA kind of raised their hand and say, You know what? It's too global, it's too broad, it's super evolving. We're not going to define it, and by defining it, limit its horizons. And so really, if I were to describe it as a subset of medicine that's focused on development and use of wireless technology via smart devices to facilitate patient care, but I do want to emphasize this word that it's going to help facilitate scalable patient care. And scalable really is because it's trying to reach patient care that wasn't possible before to the scale it was impossible before. And so this talks about, you know, utilizing technology, personalized medicine, utilizing AI. And we're going to go over some of these examples. But currently it's a broad umbrella term. If you go on the FDA website on digital health, it defines as the use of computing platforms. So yes, informatics and the AI connectivity and software and sensors for healthcare use. And so you would hear other subsets, like M health, which is mobile health, it informatics, wearable devices, telehealth, which pharmacists are heavily involved in. Lot of different telehealth provisions, care provisions, and then personalized medicine kind of falls into it.

Speaker 1  04:24
Dr. Patel, I would assume that some of the excitement about digital health was probably prompted in part by the covid 19 pandemic in terms of the need for, you know, telehealth as an example. But just in general, using technology as opposed to some of the more traditional ways that healthcare occurs because of that pandemic would is that your impression as well? Oh, 1,000%

Dr. Khyati Patel  04:49
I was just speaking with one of the COP faculty, and I said, you know, I was involved in a, you know, clinical project looking at ANC improvement using telehealth modality when I was a resident. And and I'm gonna reveal my age, because it was 10 years ago, so yes, but pandemic seems to have definitely fast forwarded that process, and I can personally give my example in the clinic, is literally two weeks before things shut down, I reached out to my IT department and say, Hey, give me access to direct patient messaging through our secure app, where I can get patients home blood glucose data, and I don't always have to do in person care. I can review things and do phone calls for follow up, and then, lo and behold, once that access was given, the pandemic came and shut things down, and it was really a blessing, because I could still provide care to my patients, because they were able to message me their blood glucose readings. And so this is just one example. We know that when the PREP Act came out, it relaxed the use of some of these CGM devices, even in the hospital settings where clinicians, for example, didn't have to go into the ICU individual beds to check patients glucose to risk contact. They could monitor patients glucose if the patients were wearing their CGM devices. So these are some examples of how technology just took, you know, nitro speed since the pandemic hit, and the utilization of telehealth, you know, as an example, was also very vast after pandemic, because that was the way we could provide access to care.

Speaker 1  06:28
So in terms of the the role of a pharmacist as it relates to digital health, I mean digital health itself can encompass even non healthcare providers, from the perspective of the computer programmer that makes the app, or the electrical engineer that makes the device. In your view, at least, what are some of the common roles or common areas that a pharmacist in particular would be involved in digital

Dr. Khyati Patel  06:51
health, right? And these are, you know, predicted areas currently based on where pharmacists have been involved or where medication management would be affected, where pharmacists would be consulted, or their oversight will be needed, or insights will be needed in a collaborative manner. This one article that we have put in the show note kind of summarizes these different areas. And the first and the foremost, it's variable devices and sensors and so, Dr. Kane, I can think of, you know, I'm wearing my I watch right now, and if I wanted to, it would probably do an EKG

Speaker 1  07:27
right away. That's pretty crazy to think about right, right?

Dr. Khyati Patel  07:31
And so these are some of the examples of variables and sensors. When we talk about sensors, obviously those will be CGM, as I was learning more about it, I found another example of a band that creates nerve stimulation for Irritable Bowel Disease pain. It's called IB stim. And so more and more such tools are being put out where patients can not only get diagnostic benefit, but also treatment benefit. But of

Speaker 1  07:59
course, the pharmacist needs to be aware of these technologies, because we are a frontline healthcare provider. You know, when a patient has on their Apple Watch that it's detected something like atrial fibrillation, the pharmacist does need to know, you know, what is the accuracy of that kind of a claim? What does that actually mean? Obviously, that patient needs to go see their physician. But at the same time, the pharmacist might be the first line in terms of helping them understand what that warning means and directing them to the right person.

Dr. Khyati Patel  08:29
And haven't we all heard the story of iWatch based EKG diagnosing patients with afib? And sure, behold, they will say to their physician, say, hey, my, my, my EKG told me I have afib, and they do an in office EKG, and that confirms the diagnosis. Some of these devices are helpful. I'll give you my example in pharmacy world, when I had a patient on a GLP-1 receptor agonist, we do know some of them can increase heart rate. And so I had a patient bring up the resting heart rate increase, you know, it was a resting heart rate increase example. And I told him to continue varying his watch and continue to monitor it. And we realized that it was exactly by the book where the GLP, one precaution, you know, in the label, says it increases by about four to five beats more than the normal upper limit. And that was exactly the case for the patient, but we were able to kind of keep an eye on the patient's heart rate while they were taking a GLP.

Speaker 1  09:27
One interesting and, you know, Dr. Patel, another area that we kind of already mentioned is telehealth, right? So being able to have those remote patient interactions could be through telephone or a web based call, whatever modality it is. This telehealth is certainly a thing that the pandemic has accelerated as you mentioned, any thoughts in terms of the telehealth component of digital health?

Dr. Khyati Patel  09:49
Yes, and so this, you know, when you look at pharmacist intervention using digital health, you would find that telehealth spans across the evidence we're. Old, where there are a lot of evidence and education and research out there, where pharmacists have involved themselves into providing care. Back when I was a student at UIC, I remember serving patients in the Illinois prisons for hep C therapy, and that was done via telehealth. And so there is the modality component, where you sit and learn how to communicate with the patient using this HIPAA secure technology. But then there is also remote diagnostics. And so one example I could give is, you know, a nurse at that given facility would be able to put their stethoscope on the patient's heart in the physician, sitting on the other side will be able to actually do a physical exam, you know, or listen to the patient's heart sounds and stuff. And so there are a lot of this technology exists to what degree it's been utilized. It depends on the practice and the care

Speaker 1  10:59
love that. I mean, it seems intuitive or obvious that in this day and age, any anyone who has lived through the pandemic should be familiar with things like zoom or web based conferencing, but there are nuances in terms of how you communicate with the patient and the loss of some of the nonverbal communication that would normally happen during an in person visit. And there are things that, and we'll get to this later, that healthcare providers need to be aware of that are a little bit different when you are conducting a telehealth visit as opposed to an in person visit.

Dr. Khyati Patel  11:32
Right different skills required. And therefore certain training, whether it be part of the pharmacy school curriculum or additional training, is necessary to be able to do these, you know, and handle the technology well. Another area of focus is people hear about this is digital biomarkers and digital therapeutics. An example of digital biomarker would be any kind of measurable data that comes from a device that you're wearing. So again, you know, a series of heart rate monitoring by I watch as one or if the patient is doing blood pressure logs, there is a, you know, Omron, for example, has an app, and you could produce e log, and there is an ability for patient to send that data to, you know, share that with their provider. So that's just another example of digital biomarker.

Speaker 1  12:18
And, you know, Dr. Patel, I know another area is digital therapeutics, where you're kind of using software, whether it be an app or something like that, as a therapeutic, so a treatment for a condition. Can you kind of tell the audience a little bit more about that area?

Dr. Khyati Patel  12:33
Yeah, and it doesn't always have to be medication related therapeutics. So let's just give an example of cognitive behavioral therapy, for example, and when I was looking into it more detail, I found multiple different apps that patients can purchase and therapists would provide CBT care to patient when they're interacting on these platform looks like they're playing games, you know, and just talking to the person, but really, mood kit is an example. Happy phi is another example where they're providing cognitive behavioral therapy for conditions like depression and anxiety.

Speaker 1  13:10
Interesting, and those typically would be things that would happen, you know, with a psychiatrist or psychologist in a, you know, in an appointment format. This is a little bit different in terms of using an app as an example, as opposed to that healthcare provider. Obviously, it doesn't replace the healthcare provider, the psychiatrist or psychologist, but it does offer a different modality that patients may be more comfortable with, right?

Dr. Khyati Patel  13:33
And just you know, not not just this particular example, but any healthcare as a as an example. I've realized, you know, not just because of the pandemic and we wanted to save patients from being exposed, but think about, you know, traveling to a healthcare facility waiting for the provider to see you. All of that time could be saved by doing some of these things remotely. And I think that's that's a big blessing

Speaker 1  14:00
in other areas would be something like personalized healthcare, where we're using digital means to kind of individualize anything, whether it is a patient specific pathway based on things that are fed into an algorithm. You know, this thought of personalization has certainly been something that has been on the radar from a pharmacogenomic standpoint, but just using data in general and big data and modeling, those are potential options or opportunities for a more personalized approach to any given patient as well. Right?

Dr. Khyati Patel  14:34
We're going to share one of the examples how it was utilized in an academic setting. But personalized healthcare, you know, we think usually about genetic based care, and so there is, like you said, Dr. Kane data, data is money, and data analytics is something that is greatly evolving to provide better care, to enhance care delivery models, as well as. Just care quality in general, mobile health is another one, as I mentioned earlier, M health is the word that's out there really is a broader category where includes variable devices, like smartphone apps to provide general care that you know, help patients and daily health activities and care these are sometimes not always supported by clinical evidence to be considered medical device or software, and that's a whole nother ballgame. We can talk about regulatory issues. When it comes to approval by FDA, it needs to it goes through a certain approval pathway. There are a lot of apps out there that are not FDA approved, and there are apps out there. There are FDA approved, and so there are just some nuances to consider behind the scene. When you're looking at an app and maybe recommending it that your patient uses the app.

Speaker 1  15:52
And you know, the next area is a little bit different, and it's cyber security. And that, at first glance, that might not make sense for a pharmacist, but if you think about it, you know, pharmacists could be involved in the decision making process of how, you know, telehealth is set up, or how information is transmitted from device to patient to provider. And there are HIPAA oriented considerations when it comes to that. You know, privacy is a really big deal, and a pharmacist may be involved in that decision making process when it comes to utilization of software or devices to make sure that it's HIPAA compliant, and that the way that that data gets back to the provider is done so in a HIPAA compliant way, right?

Dr. Khyati Patel  16:33
And while companies that are working to develop these modalities of care want data from you, because they want to analyze the data, and like I said, they want to come up with a better modality of healthcare. Not everybody is out there to best intention or use of the data. And so yes, data privacy will be a huge market that would matter to pharmacists, not just big companies who are mining the data. And then artificial intelligence is another area of digital health where pharmacists will be involved. This basically is using algorithms and data analytics processes to make medical interpretation. And one good example I can give you is, you know, creating an AI model that will look at patients medication dose based on their renal function, and it will just change it in the, you know, dosing order system in the hospital automatically. Another example is Alexa's medication management skill. And Dr. Kane, I actually looked into that yesterday, and it's pretty cool. It's, it's a third party Giant Eagle pharmacy that has developed the tool for Amazon. And really, you just have to tell Alexa, hey, help me manage my medication. And just kind of walk you through, take a list of what medications you're taking, how frequently you're taking, and create alarms for you, and it's going to beep at you. You know, whenever it's time to take your medication dose.

Speaker 1  17:58
That's fascinating. And you know, just going back very briefly, Dr. Patel, when you're mentioning the concept of kind of dose adjustments using AI or just machine learning. You know, to some degree, we are starting to see this with vancomycin dosing on the inpatient side. You know, the current vancomycin guidelines by IDSA talk a lot about Bayesian dosing, which is a form of a model and using a you know model to help inform future doses for a patient. So we're already seeing this a little bit, and I do think that this is definitely an area where pharmacists will play a huge role, because we're often looked to as the dosing experts, the medication and dosing experts. So the pharmacist being able to utilize these models, or AI models or machine learning models, I think is really important.

Dr. Khyati Patel  18:44
Thank you for sharing that example. I did not know we are already there yet. When I when I read that example for renal dosing, I thought it was really abstract, but it makes sense that medicine world is already there, and then there is home diagnostics. So this would be kind of like, imagine collecting a sample at home, but the assessment is done using technology. So like, for example, doing urine test assessment using a smartphone app, and then, you know, the results are sent to the doctor's office, and then they can, you know, approach the treatment accordingly. And so lot of different areas that are getting traction. Over in digital health, where pharmacists will be involved.

Speaker 1  19:24
You know, Dr. Patel, I would classify most of what we just talked about as more future looking where, for the most part, I don't, aside from maybe telehealth, I don't know how many pharmacists are really involved in many of these aspects of digital health at this point, it seems more future oriented. Can you give us some examples of where pharmacists currently have involvement in digital health?

Dr. Khyati Patel  19:48
Yeah, absolutely. As I mentioned earlier, telehealth is probably the oldest sector of digital health where pharmacists have pretty good footing institutions that are. Veterans such as the Veterans Health Department, VA, do have plenty of data and kind of workflow integration of how to use telehealth to reach veterans who live in remote areas or who can't always come to Veterans Hospital. Va, hospitals for receiving care, a lot of other institutions have picked up this modality to provide ruler health engagement as well, and these services include disease state management or medication monitoring. These could be either referral based services or even collaborative services, like the Hep C example I had provided earlier. So yes, plenty of data for telehealth. And that's, I would say, more of more of a dinosaur when it comes to pharmacists and digital health. And so while telehealth is something that's been there, done that, you know, we have data for it, some of the emerging ones where pharmacists are getting involved are use of sensor technology for diabetes management, so use of continuous glucose monitor, personally, speaking, from my experience, this is what I've been busy in the in the last one year, of integrating this workflow in my clinic, in the primary care so pharmacists could be involved in understanding just overall, like, You know, trial and error, and perfecting the workflow, doing a lot of patient and provider training and education. What are the different components you know how to interpret the data? Really, pharmacists could be involved in getting access to CGM, as I said. You know, coverage and billing of digital health in those technologies are going to be expensive. And so while a patient can come to you and ask for glucometer coverage at a pharmacy, they may come and ask for you for any kind of these digital health devices and their coverage as well. So access is another thing, and then interpretation of the data and how to utilize that data in making medication changes and medication management. So lot of evidence emerging evidence how pharmacists start being involved in implementing CGM use. And then couple other studies that I looked at, looked at medication adherence to, especially in the transplant world, as well as asthma world. So we know Dr. Kane, there are smart inhalers out there where you can assess patients adherence to inhaler therapy, and also if they're taking their inhalers properly or not. So like the Swift breath versus a slow breath monitoring as well, a lot of oral medication adherence tools like I gave you Alexa's example, and then medication safety monitoring as well for drugs with neurotherapeutic window, like warfarin and not of this. So it's going to be done via telehealth modality. So plenty of examples exist. And like you said, you know, a lot of things are forward and future looking. Pharmacists are going to get more involved, and we'll have more examples available.

Speaker 1  22:55
And you know, Dr. Patel, as you mentioned, at least with telehealth, this has been around for a while, but really any aspect of digital health. Do we have any actual data out there in terms of how much is this occurring from a pharmacist driven approach? Is it common yet? What are the typical things that we're seeing in the digital health world? What kind of data do we actually have to help inform our knowledge of the topic?

Dr. Khyati Patel  23:19
Great question. Dr. Kane, and you know, we could, we could pick one study here and there, and there are a lot of emerging protocols and Qi initiatives going around, at least from the colleagues that I speak with in the primary care world. But when it comes to an effective publication, there is one meta analysis that we can break down that was published earlier in January, that looked at 19 different trials. Most of these trials had low methodological bias risk, and they looked at variety of digital interventions, or digital health interventions that a clinical pharmacist was involved, and most as we kind of established that. We've been there. We've done telehealth. Most of the studies use telephonic technology, whether it be Kelly video versus just telephone use. We're about 15 studies of those. And then two of the studies looked at web based tools for medication management. And then two other studies looked at mobile application based interventions. And if you asked me, like, what did the studies look for, or what were they evaluating? What was the trend? A lot of the study looked at the improvement in the lab value. So did pharmacist intervention improved patient's agency, or did pharmacist intervention improve patients blood pressure. So there are a lot of these lab or vital changes that we're looking at. Most of the studies looked at that. Some studies looked at the pharmacist intervention using digital health reduce, reduce the utilization of health services, other health services. So kind of looking at decrease. Cost healthcare cost enhancing adherence was another one, which is, I'm personally also very interested in learning more about looking at drug related outcomes. So again, medication safety related issues, very few number of studies looked at kind of like a healthcare related health risks such as a CVD risk reduction, or mortality data, such as increase in survival, but yes, very few studies looked at that as well.

Speaker 1  25:30
And I would say in terms of like actual hard clinical outcomes, like reducing ascvd risk, that's a pretty hard one for a pharmacist to actually impact and be able to observe that in a clinical trial. I do think it's more reasonable to look at where those surrogates, like blood pressure, a 1c adherence, preventing an ADR, something like that. That probably is a more realistic endpoint for this kind of a trial, looking at the pharmacist role with digital health and improving patient outcomes.

Dr. Khyati Patel  25:59
And that makes sense as well. And so talking about outcomes, they kind of related these interventions and then took it back to global category of interventions, so the telephonic use versus the web based tool or the mobile app. And what they found for that telehealth world, the results were kind of mixed file of the child that show that pharmacist led interventions were beneficial. Five didn't show any benefit, and five showed inconsistent results based on telephone telephonic interventions, when we looked at the web based tool, these were focused on looking at patients blood pressure improvement, so that hypertension focused outcomes, the outcomes were positive. So they looked at things like, you know, improvement in systolic blood pressure, diastolic blood pressure, how many patients achieved gold blood pressure, and then, kind of, what was the intensity of anti hypertensive regimen? Where were the patients properly treated based on the comorbidity when they have hypertension.

Speaker 1  27:02
And then, I believe there was an app that looked at kidney transplant patients, right?

Dr. Khyati Patel  27:06
Yeah, a couple other studies were looking at mobile app used to improve kidney transplant patient outcomes, and these were medication errors. You know, how many patients came back for hospitalization, or particularly looking at the transplant drug tacrolimus and intra patient variability, and they found decreased medication errors, decreased hospitalization and reduced intra patient variability. When it came to tycholimus drug

Speaker 1  27:36
monitoring, I think that's a really big deal, even though that's a very niche area of kidney transplant patients. That's kind of the perfect patient population. We have a very niche population, very targeted types of interventions or monitoring that need to be done. So maybe that's one area that we can look forward to, which is as opposed to one app that fits at all needs. You have some of these very specific apps for very specific areas, almost like a niche area where it can really thrive in that very specific area, right?

Dr. Khyati Patel  28:07
And so we have examples of very, very niche areas to some primary care conditions like hypertension, to just global category of telehealth. And there could be plenty of different interventions happening in telehealth. And more data to come. As you know, pharmacists get more and more involved in a lot of these different telehealth intervention but you know, it would be a miss if we didn't talk about what lays ahead of us in terms of the limitations or opportunities. And as I mentioned, Dr. Aungst before I'm going to mention him again. He's the guru of digital health for clinical pharmacy. He says, you know, this is going to force pharmacists and companies to think beyond the pill and think beyond the fill and so, you know, that kind of stuck to me when I read that Dr. Kane, is that we will have to change. Change is inevitable, is what I read in that

Speaker 1  29:05
and I think we've already seen that when we had our PBM episode with HelixTalk, for example, where we're recognizing more and more that the future role of the pharmacist does go beyond the pill and the fill. As you mentioned, Dr. Patel, that just being reimbursed for the dispense itself is not a sustainable model, and it's not really where the pharmacist can have the biggest impact on patient care. So I would agree that digital health is one of those areas that will likely be leading the way in terms of innovating how the practice of pharmacy happens with respect to that. Then Dr. Patel, what are some things that need to be addressed for that transition to happen, for digital health to have a larger role in what the role of the pharmacist is, right?

Dr. Khyati Patel  29:51
And while we say data is ample, data is expensive, and so really in order for pharmacist or pharmacy. Based companies to develop a digital health or integrate pharmacists more into the digital health care. We need access to data, and that will be at the forefront of effective integration of pharmacy services. And as you know, pharmacy services kind of are going integrated, not as a direct service or direct payment model. They're like value based models. We want to make sure that we have access to data so we can develop the technology around it.

Speaker 1  30:33
And I would assume, you know, as this technology continues to improve and more technology comes out, there's going to be a huge role or need for the training and education. You know, not just in pharmacy school, but particularly after pharmacy school, as new stuff comes out, you know, the workforce needs to be trained on how to access the data and interpret the data and act on the data. That lifelong learning philosophy is really important here, so that if the technology exists but no one knows how to use it, then it's not very helpful, right? So the training and education is a huge need and opportunity here as well, absolutely.

Dr. Khyati Patel  31:08
And you know, we have a link to AACP's digital health workshop, where there is plenty of resources for our audience to access further. That's just one example of what teaching institutions and organizations are doing in order to make sure competent education is provided for what would be needed for care in future. And another thing is to take digital health outside of that niche where we are doing effective workflow integration. We are standardizing this care. And so a good example would be, up until now, CGMS were very much housed as something that's accessible to endocrine only. If you have advanced, you know, or complex diabetes, you go to endocrine, they give you insulin pump, they give you CGM and I think the companies and everybody is realizing that people who are not under endocrine care still need this technology, and we need to make it more accessible to people who are getting care in primary care, and that's where they're kind of moving the marketing and use of CGMS in the primary care as well. And that's where more standardization and widespread use of technology is going to come in play. And to what Dr. Aungst said, that's where we're going to lose the term digital health, because then it would be the norm of health care.

Speaker 1  32:39
And, you know, Dr. Patel, we mentioned training and education already as a kind of barrier to entry here, and we said that, sure, pharmacy school is important for training, but because it moves so quickly, there has to be post graduate training as well. Is there any movement currently with respect to pharmacy school education to at least build the foundational understanding and groundwork for these graduates when they graduate that they have some understanding of digital health concepts so that it can be built on, as opposed to starting from scratch.

Dr. Khyati Patel  33:10
Yeah, absolutely. And so you know, enough surveys have been done worldwide, actually, as well as, you know, United States wide. And what we found is there is not a consistent integration of digital health in the curriculum. If the programs do have part of their curriculum, it's more in the exploratory phase, where concepts are taught, as we discussed earlier, as a niche, you know, in an elective course or as an adjunct degree, we don't still see a curriculum that lives and breathes digital health. However, we know Copa is about to change, that there's enough mentions of digital health and future integration of that in pharmacy curriculum. So lo and behold, we're going to move from the exploratory stage to more of a standardization phase, but it will take some time for us to work around it. Some of the examples that I was looking at that to survive what's you know done across pharmacy schools is integration of digital health in their IPI and API learning. So this is experiential learning, where students are involved in telehealth based medication management services for hypertension patients, diabetes patients, etc, even pharmacogenomic based services, and then some of the didactic courses that use risk management tool based on patients genetic profile to provide medication management care. And so there's some examples here. Obviously, the goal is to bring in more activities and more kind of standardize the curriculum, rather than just making it niche, elective or action degree based curriculum.

Speaker 1  34:51
I would assume, then, as you mentioned, that digital health is going to just become health in the same way this just becomes part of the curriculum, right? It's not necessarily you. A course on digital health, but it is integrated in many of your courses, both on the didactic side and the experiential side, where it's just part of the normal thing that you do when you learn about healthcare and how you do healthcare in the classroom, in the clinics as well.

Dr. Khyati Patel  35:16
Yep, and lots of discussions happening, you know, not only on our campus, but campuses across United States as to how that's going to look like. But if we can talk about what's happening at RFU just for a couple of moments, we do have students getting involved in certain co curricular activities, such as the underserved interprofessional clinic we have on campus, you know, Dr. Kane, pre pandemic, we used to have that clinic run. We kind of took it for granted, as, you know, traditional in person clinic, and then we realized that these patients do need care in the pandemic months too. And so we opened up care based on telehealth. And now our doors are open for in person care, but we realized some of our patients were experiencing difficulties with transportation. They didn't have means for transportation to come to the clinic. We were offered, we're continuing to offer telehealth to these patients, and we meaningfully kept this IP clinic IP, and created workflow to involve pharmacy faculty and pharmacy students in kind of like the telehealth model of care at ICC.

Speaker 1  36:25
I think that's wonderful and a good example of how post pandemic, the changes because of the pandemic have persisted, and something good has come out of it. I think it's easy to forget that being remote or being at home was very difficult for many people, but there have been some wins or some opportunities that have come out of that, that have now been adopted in a somewhat post pandemic world where we're utilizing the remote nature of telehealth because it is more convenient for certain patients. And if that's the case, we should do that.

Dr. Khyati Patel  36:56
I couldn't agree more, and I think that's that's the decision we took at the clinic, and we're going to continue to do that. And some other examples, you know, I would give you my appy ambulatory care rotation example, where students are required to know the CGMS. You know, they're getting pulled into patient education, kind of coverage assessment, accessing data and interpreting data, and then utilizing that data for medication adjustment, and so my students are doing that at the clinic, and I'm sure there are plenty of API examples out there where other type of digital health is being used. And as far as the didactic course are concerned, at our institution here, we do offer some education on, you know, basic understanding of CGMS in the core courses, and then elective courses and the skills courses are offering more hands on learning, or at least that's the plan to do in future. Is to get educational grants to have these devices for students to use so they can share their experiences with the patient and be more comfortable with using this technology.

Speaker 1  38:01
And I would, I would say too, that, you know, at national meetings that I've been at, I have seen a push towards more genomics, informatics, certainly telehealth, within the pharmacy curriculum in general, also just data analytics or understanding, you know, statistical analyzes and things like that, to be able to build models. This is something that is not just at RFU or just at these national meetings. This is something that is certainly coming forward and will be part of many pharmacy school curricula in the future, because, as you mentioned, Dr. Patel, this is something that is coming, whether you like it or not, and we have to prepare our students to be able to embrace those changes as the practice of pharmacy changes too

Unknown Speaker  38:41
100% very well. Said,

Speaker 1  38:43
Well, Dr. Patel, I feel like I've learned so much about digital health today in terms of the basics of what it encompasses. What is the role of the pharmacist? How are we preparing our future pharmacists to be able to embrace these changes? So I think that this is a wonderful episode. Do you have any recommendations in terms of where listeners can go if they'd like to know a little bit more.

Dr. Khyati Patel  39:04
Yeah, as we said earlier, we do have a footnote with the resources to American Association College of Pharmacy, and this is you know, their digital health workshop resources focus more on education interventions of digital health people can also go on digital health institution website, which we will also put in the reference show note. And there is thoughts to learn. Digital Health just doesn't encompass pharmacy only, but other professions too. And so everybody's eager to jump on to this digital health bandwagon, and perhaps in future, that's a good thing, because we're going to be able to figure out how to do collaborative care using technology.

Speaker 1  39:45
So those show notes are at our website, HelixTalk.com, again, this is episode 156 where you'll be able to have access to all of those references for today's episode for the listener, we love the five star review and the apple podcast, or it's. So keep those coming. We'd love to hear that. We're also on Twitter at HelixTalk, if you'd like to have some clinical pearls from previous episodes, and we also have a mailing list. So if you'd like to have an email every time a new episode comes out, you can sign up at our website, at HelixTalk.com, so with that, I'm Dr. Kane

Dr. Khyati Patel  40:17
and I'm Dr. Patel, and as always, thanks for listening and study hard.

Narrator - Dr. Abel  40:22
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Narrator - ?  40:33
to suggest an episode or contact us. We're online at HelixTalk.com thank you for listening to this episode of HelixTalk. This is an educational production copyright Rosalind Franklin University of Medicine and Science.