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In a few short weeks, the Covid-19 pandemic radically changed the way health and care services are delivered. The rapid acceleration of digital transformation has been one of the most dramatic changes. As 2023 draws to a close, it is perhaps a good time to reflect on some of the changes to our healthcare services over the last few years and to explore emerging medication administration trends, priorities and action steps to focus on in the year ahead.
Telemedicine and Remote Medication Administration
Telemedicine is the use of telecommunication and information technology (IT) for the purpose of providing remote health assessments and therapeutic interventions. This includes video or voice messaging services on mobile phones, computers and tablets. Telemedicine encompasses a range of remote healthcare services, including phone consultations, video conferences and remote monitoring. Patients can connect with healthcare providers from the comfort of their homes, eliminating the need for lengthy travel and long waiting times.
Introduced in certain NHS areas before the Covid-19 pandemic, telemedicine and remote medication administration were comparatively underdeveloped before the Covid-19 pandemic necessitated the shift towards an increased focus on telehealth.
During the peak of the Covid-19 crisis, the UK Secretary of State for Health Matt Hancock declared that NHS general practitioners (GPs) should see patients remotely by default. This precipitated a significant leap in the number of virtual GP appointments from 25% to 71%, and telemedicine services still remain a key part of healthcare provision in the UK.
Regulatory changes, such as reimbursement policies and licensing requirement relaxations, were swiftly implemented during the pandemic to facilitate widespread telemedicine adoption. In the UK, regulations and guidelines governing the prescribing and monitoring of healthcare are regulated by regulatory bodies including the Medicines and Healthcare products Regulatory Agency (MHRA) and the National Institute for Health and Care Excellence (NICE).
Technological advancements have played a pivotal role in enhancing the capabilities of telemedicine in the UK, and key emerging digital health technologies include, for example:
- Digitised health systems – in particular, the extensive digitisation of patient data and prescription delivery in the UK National Health Service (NHS).
- mHealth – apps on mobile and connected wearable devices to monitor and improve health and wellbeing.
- Telemedicine – delivery of health data from mHealth apps to the patient’s clinician, the provision of distance support to patients either through healthcare practitioners or AI, and the integration of telemedicine services with digitised health systems.
- Health data analytics – the digital collation, analysis and distribution, including on a commercial basis.
- Personalised medicine – using genomics to get a faster diagnosis of a condition and being given personalised treatments based on that diagnosis.
Telemedicine has offered numerous benefits for both patients and healthcare providers, which include:
- Telemedicine breaks down geographical barriers, allowing patients in remote or underserved areas to access healthcare services. It eliminates the need for long travel distances and provides convenient access to specialists and healthcare professionals.
- By allowing patients to schedule appointments at their preferred time and location, telemedicine offers flexibility and convenience. Patients can consult with healthcare providers from the comfort of their homes, reducing the need for travel and waiting times.
- By eliminating travel expenses and reducing the need for in-person visits, patients can save on transportation costs, parking charges and potential accommodation expenses, leading to significant cost savings for the patient.
- It also provides better allocation of resources for healthcare providers, leading to significant cost savings.
- Virtual consultations enable quick access to healthcare providers, enabling earlier diagnosis and treatment.
- Telemedicine enables remote monitoring of chronic conditions, medication management, and follow-up appointments, ensuring that patients receive ongoing support and continuity of care.
- Patients are empowered to actively participate in their healthcare. It enables patients to access their medical records, view test results, and engage in shared decision-making with their healthcare providers, promoting a patient-centred approach.
There are, however, some challenges to overcome such as:
- The lack of personal touch and face-to-face interaction. Patients may feel more comfortable sharing sensitive information or developing rapport with their healthcare providers during in-person visits.
- Lack of access to technology and lower digital literacy can limit the reach and impact of telemedicine.
- The transmission of sensitive patient information over digital platforms raises concerns about data security and privacy breaches. The digital collation and handling of patient data is required to comply with the UK General Data Protection Regulation (UK GDPR), the UK Data Protection Act 2018 (DPA) and the relevant UK healthcare regulatory regime.
- Some medical conditions may require complex diagnostic procedures, specialised equipment, or imaging studies that cannot be performed remotely. In such cases, patients may still need to visit healthcare facilities for further testing or evaluation, reducing the overall convenience and benefits of telemedicine.
As technology continues to advance, telemedicine is expected to play an even more significant role in the future of healthcare.
Personalised Medication Dosage
The NHS defines personalised medicine as “a move away from a ‘one size fits all’ approach to the treatment and care of patients with a particular condition, to one which uses new approaches to better manage patients’ health and target therapies to achieve the best outcomes in the management of a patient’s disease or predisposition to disease”.
A report from the Royal College of Physicians and British Pharmacological Society joint working party states that around 6.5% of hospital admissions are the result of adverse drug reactions, and these admissions are estimated to cost the NHS £530 million every year. Personalised medicine offers the opportunity to move away from trial-and-error prescribing to optimal therapy first time round.
Personalised medicine recognises that complex diseases should no longer be considered as a single entity. One disease may have many different forms, or subtypes, resulting from the complex interaction of our biological make-up and the diverse pathological and physiological processes in our bodies. These will not only vary between patients who have the same disease but also within an individual patient as they get older and their body changes.
When all patients with the same condition receive the same first-line treatment it may be only 30% to 60% effective. Personalised medicine provides opportunities to improve how disease is treated, comprehensive genomic and diagnostic characterisation, and different subtypes of patients within a given condition can be identified, and treatment can be tailored to the underlying cause. Pharmacogenomics is the study of how our individual genomes affect how we respond to medications. Genomes can determine whether a particular drug is effective, what dosage is required and, in some cases, what side effects might be experienced.
This approach is already more commonplace in cancer treatment, where genomic or molecular diagnosis information helps select the most effective treatment, greatly improving the chances of survival.
The potential benefits of personalised medicine are significant. Technological developments across a range of areas in healthcare are coming together to provide the necessary factors to spread a personalised medicine approach across healthcare in the UK. The national NHS Genomic Medicine Service is to be rolled out over the next year (2024).
Smart Medication Dispensing Systems
The Internet of Things (IoT) is still in its infancy; it works in a similar way to the internet but instead of connecting Personal Computers (PCs), it connects things. These things are manufactured with components that can communicate with other devices and send data through signals, as well as operating as their primary function. These are smart devices such as smartphones, smart TVs, smartwatches and home devices such as Amazon Echo or Google Dot. IoT technology works by connecting all these devices to a centralised central processing unit (CPU), which processes, organises and analyses all the data sent to it from each connected device.
Remote patient monitoring (RPM) is the most common application for IoT in healthcare. IoT enables healthcare professionals to be more watchful and connect with patients proactively. Data collected from wearable IoT devices such as smartwatches etc. can help healthcare professionals identify the best treatment process for patients and achieve better outcomes. Devices can be connected via the internet or Bluetooth and send data in real time for a healthcare provider to review. Measurements are synched and shared with relevant parties automatically, and some devices have a memory function that stores information from the last measurement and previous readings.
Digital diagnostics made possible by IoT in healthcare have been, and will continue to be, a game changer in medicine, for example Moorfields Eye Hospital use IoT for 3D retinal scans which are analysed and used to detect severe diseases such as glaucoma and age-related macular degeneration in their early stages.
Manufacturing, supply chain management and warehousing, including those in the pharmaceutical sector, all use IoT along the production and storage chain. Automated pharmacy dispensing systems, or dispensing robots, are machines that allow medicine to be stored and dispensed near the point of care. Enabling machines to regulate and monitor the distribution of drugs eliminates the possibility of human error, resulting in more controlled and effective patient care. Automated dispensing systems can help drive compliance by minimising manual processes through the automation of clinical checks, making it easier to adhere to safety guidelines and legal requirements.
Various advanced IoT technologies are available for measuring medication adherence, including medication event monitoring systems (MEMS), smart blister packs, radio frequency identification (RFID) embedded smart wristbands/packaging and wireless connection based smart pill bottles. Some examples of this technology include:
- Smart pill containers are capable of prompting the use of medication, warning patients when they are taking the wrong medication, recording side effect complaints, and promptly alerting treatment staff of failures to take medication as prescribed.
- Smart packaging technology devices have been reported to positively enhance medication adherence. They encompass electronic devices integrated into the containers in which pills, inhalers or other products are dispensed. Various forms of smart packaging technology exist with integrated features such as condition monitoring, event recording, feedback mechanisms, reminder systems and status display technology. Smart packaging technology, however, possesses limitations such as reduced ease of use, dosage flexibility and higher cost.
- A Medication Event Monitoring System (MEMS) is a customisable medication bottle cap with a microprocessor that records the occurrence and time of each bottle opening of the medication bottle. MEMS caps fit on standard medicine bottles and are integrated with microcircuits to record the date plus time at which the bottle is opened and closed. It is capable of recording and storing up to 4,000 dosing events. The device also has a liquid crystal display screen that shows the time elapsed since the last dose and the total number of doses taken by the patient. These devices are available in a wide range of shapes and sizes. A few other smart pill bottle technologies offer automated visual and audible alerts to the users during a window of scheduled medication dosage. The systems also have an integrated mobile app to view and track the user’s medication adherence in near-real time.
- Smart blister packaging uses electronic circuitry that can track the action of taking out a pill. Besides this, it can collect information regarding the rupturing time, medication category and location. Smart blister packaging can also act as pill reminders when integrated through a mobile application. More importantly, both healthcare professional and patient can monitor the medication uptake at the requisite time by accessing the records.
Artificial Intelligence and Medication Management
Artificial Intelligence (AI) is the use of digital technology to create systems capable of performing tasks commonly thought to require human intelligence. Artificial intelligence (AI) tools are increasingly being used within UK NHS healthcare for various purposes, including:
- Analysing X-ray images, for example mammograms, to support radiologists in making assessments. This frees up radiologists to spend more time with patients, or to screen greater numbers of people more quickly.
- Helping clinicians read brain scans more quickly. This shortens the time it takes for patients to be treated, giving them a better quality of care.
- Supporting people in virtual wards, who would otherwise be in hospital, to receive the care and treatment they need in their own home or usual place of residence. Remote monitoring technology such as apps and medical devices can assess patients’ health and care while they are being cared for at home. Patients with diabetes and high blood pressure are benefiting from pioneering artificial intelligence (AI) that turns a smartphone camera into a clinical-grade tool to detect early kidney disease.
Blockchain and Medication Traceability
AI-powered algorithms can analyse vast amounts of biological and chemical data to identify potential drug targets and design innovative compounds. By considering genetic and molecular variations among patients, AI can help create more targeted drugs that are tailored to specific patient populations.
AI is assisting in drug trials and drug development. It can scan existing databases of drugs and their known effects to identify potential candidates for repurposing. This approach can save considerable time and resources in drug development, as existing drugs can be adapted to treat different conditions. Patients benefit from this by having access to new treatments more quickly and at a lower cost. AI can also analyse patient electronic health records and identify suitable candidates for clinical trials based on their medical history, demographics and genetic profiles. This ensures that trials are more representative of the target patient population, leading to better results and more patient-centric research.
Non-adherence to medication regimes is a common issue in healthcare. AI can help improve patient adherence by sending reminders, monitoring side effects, and providing personalised information and support. Patients are more likely to adhere to their treatment plans when they receive tailored guidance and encouragement, leading to better health outcomes.
AI can also optimise drug dosing based on individual patient factors, such as age, weight, genetics and response to treatment. This ensures that patients receive the right amount of medication to achieve therapeutic effects while minimising side effects. Personalised dosing reduces the risk of adverse events and enhances patient outcomes.
AI is instrumental in the growth of telemedicine and remote patient monitoring. Patients can receive medical consultations and monitoring from the comfort of their homes, reducing the need for frequent hospital visits. AI algorithms can analyse data from smart wearable devices and sensors, alerting healthcare providers to potential issues and allowing for timely interventions.
In the pharmaceutical industry, transparency and traceability are of critical importance as they form the backbone of safety, quality and ethical practices. The increased role of blockchain technology is revolutionising transparency and traceability within the pharmaceutical industry.
Blockchain technology is an advanced database mechanism that allows transparent information sharing within a business network. A blockchain database stores data in blocks that are linked together in a chain. In traditional systems, data is typically stored on central servers which may be vulnerable to breaches. Blockchain, however, distributes data across its network of participants, making it incredibly difficult for any single entity to manipulate information.
Once data is recorded on a blockchain, it becomes almost impossible to alter or delete. Each block contains a reference to the previous one, and changing any block would require altering subsequent blocks across the network, a virtually impossible task. Every contributor in a blockchain network has access to the same information. Transactions are visible to all, promoting a high level of transparency and reducing the probability of fraudulent activities.
Blockchain uses Smart Contracts, which are self-executing contracts with predefined rules. When certain conditions are met, the contract automatically executes the specified actions. In pharmaceuticals, this can ensure adherence to quality standards and contractual agreements throughout the supply chain.
Blockchain uses cryptographic techniques to secure data, enhancing protection against unauthorised access. Cryptographic techniques protect information and communications through codes so only those for whom the information is intended can read and process it. This is particularly crucial in the pharmaceutical industry to safeguard sensitive patient information and intellectual property.
Due to the chronological and unchangeable nature of blockchain records, it is possible to trace the entire journey of a product or information. In pharmaceuticals, this means tracking the origin of raw materials, manufacturing processes, distribution, and even patient usage.
Transparency and traceability in the pharmaceutical industry are crucial for patient safety. Transparent supply chains and traceable processes ensure that medications are manufactured, stored and distributed under stringent quality standards, minimising the risk of compromised products reaching patients. They also assist companies in demonstrating compliance with the pharmaceutical sector’s maze of regulations and standards, avoiding legal complications and reputational damage.
Pharmaceuticals undergo a complex passage from raw materials to final products. Transparent processes and traceable data points enable real-time monitoring, enabling early detection of any quality deviations and ensuring timely interventions, so ensuring quality assurance. Counterfeit drugs pose a significant threat to patient health and the pharmaceutical industry’s credibility. Transparent supply chains make it far more challenging for counterfeiters to infiltrate the system, as the route of each product can be reliably verified.
Maintaining the integrity of data is paramount in the pharmaceutical industry. Using blockchain enables transparent and tamper-proof records that minimise the risk of data manipulation, promoting trust in clinical trials, research and regulatory submissions. Blockchain can bring unprecedented transparency to clinical trial data, ensuring the authenticity and accuracy of results.
Blockchain’s impact and transformative potential in ensuring trust and accountability in the pharmaceutical sector is set to reshape pharmaceutical operations. Its capability to securely store and share patient data could enable the development of personalised treatment plans. Patients can control access to their medical history, empowering them to contribute to research while safeguarding their privacy. It can also enable predictive analytics, assisting with demand forecasting, inventory management, and minimising supply chain disruptions.
The extended use of technology in healthcare relies on vast amounts of patient data. Ensuring the privacy and security of this data is paramount. Striking the right balance between data access and patient confidentiality is a complex challenge that requires robust regulations and safeguards.
The cyber threat facing healthcare providers has increased drastically. Research indicates that healthcare is now one of the three industries most impacted by cyber-attacks, with the volume of attacks globally increasing by 38% in 2022 compared to the year before. In response, the UK government recently announced a new cyber-security strategy to improve resilience in the sector.
So, as well as the continual development of technological advances, including AI and wearable technology to improve patient outcomes, security will be a strategic priority for healthcare providers in 2024.