Digital Health

Loren Bonner

From left to right: Eugene Borukhovich, from YourCoach Health; Parisa Vatanka, PharmD, of APhA, Jim Joyce, MBA, from HealthBeacon; Yoona Kim, PharmD, PhD, from Arine Inc.; David E. Albert, MD, from AliveCor, Inc.

We’ll see soon that digital health is simply health care, said Daniel Zlott, PharmD, APhA’s senior vice president of education and business development, during APhA’s second annual DigitalHealth.Rx summit, chaired by Parisa Vatanka, PharmD, which was held in-person on March 17, 2022, in conjunction with APhA2022 in San Antonio, TX.

If we are right now in the age of wearables like FitBit and Apple Watch, what is coming next?

According to Timothy Dy Aungst, PharmD, we will see how all these various technologies come together.

“Maybe there will be one device that can do everything,” said Aungst, associate professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences, who spoke at the summit about the pharmacist’s role in digital medicine and digital therapeutics.

Daniel Kraft, MD, another featured speaker, said we’ll see more integration of all the various technologies in the next couple of years.

“Don’t think of one technology, but how they converge,” said Kraft, founder and chair of Exponential Medicine and founder of Digital.Health.

Virtual reality in medicine is another facet of digital health that has taken off. FDA authorized marketing of a virtual reality system to reduce chronic pain in addition to the first prescription-only game-based digital therapeutic to improve attention function in children with ADHD.

As Brennan M. Spiegel, MD, MSHS, explained during a presentation, medical extended reality (MXR) is a new branch of medicine and his hospital, Cedars-Sinai in Los Angeles, has begun using it, particularly to try to alleviate pain in certain patients.

“Medicine will meet the metaverse, and we have to be prepared and see what that will look like,” said Spiegel.

He said it’s often pharmacists in the hospital who call him and his team to see if they can try virtual reality with a patient who may or may not be taking opioids.

“FDA has been moving pretty fast with MXR stuff, and they are interested in it,” said Spiegel. He said the barrier is not on the regulatory side, but whether insurance will cover these digital therapeutics.

As these technologies and the continuous collection of data move in the direction of precision medicine, challenges remain with knowing who owns one’s personal data. On top of everyone’s mind is also “techquity”—that is, making sure all groups of people have equal access to digital health.

Virtual reality therapies can be mailed to patients, which means recruiting patients for clinical trials can happen in weeks. “The research and evidence base are speeding up, which is the first barrier to approval,” Spiegel said. However, Spiegel has noticed that the individuals signing up for the trials have not been representative of all communities.

“We are trying to evaluate disparities in care,” he said.

For pharmacists, the question is how they can apply digital health in practice.

Aungst said pharmacists need to be asking questions—for example, how medications might interact with these prescription digital therapeutics—and they need to understand how it all works together.

Aungst has been urging pharmacists to take ownership of this space for years, and one immediate area where he sees this happening is with hypertension management. Pharmacists have repeatedly demonstrated that they can manage patients’ hypertension well.

Several digital blood pressure monitors validated to meet AMA criteria, many with Bluetooth-enabled technology, already exist.

Blood glucose and blood pressure monitoring devices will likely be here in the next 5 years as well.

In 2019, FDA granted clearance to Biobeat for their wearable patch and smartwatch, which can measure blood pressure—the first time FDA has cleared a blood pressure monitor without a cuff.

According to Megan Coder, PharmD, chief policy officer of Digital Therapeutics Alliance, the mentality is no longer in favor of waiting and letting early adopters figure out this technology.

“We are seeing a groundswell,” said Coder, who spoke alongside Jennifer Goldsack, CEO of Digital Medicine Society (DiMe), and Bakul Patel, chief digital health officer for global strategy and innovation at FDA’s Center for Devices and Radiological Health.

If the existence of FDA’s Digital Health Center of Excellence is any indication, digital health is now mainstream. ■