He sees this deficit in digital health knowledge as something that must be addressed now that the pandemic has accelerated the “hospital at home” model with devices coming on the market (and companies such as Amazon getting involved) that allow patients to share data with providers. “There is really no pharmacy school that has made digital health a huge part of their program. Some have done odds and ends or an overview,” he explained. “[The FIP survey] illustrated that a lot of schools thought they were offering digital health but had limited expertise. The survey asked, if we were to engage in it, how would you teach it? What kind of technologies should you look at? Should we teach students how to program or how to do remote patient monitoring? I don’t know what the best answer is. There’s an opportunity for pharmacy schools and organizations to come together and say as stakeholders, what do we want to engage with versus what we don’t need to talk about. There are a lot of technology companies out there that don’t know that pharmacists fit into this so we’re being ignored. If there was more emphasis from the profession as a whole, we could see new jobs and opportunities for our students to leverage.”
Some pharmacy schools have made strides integrating digital health into the curriculum and recognize that it needs to be a priority. They discuss what is working, what is still missing and what student pharmacists need going forward to thrive in the digital health world.
Tracking Emerging Tools
Dr. Ana Hincapie, assistant professor, University of Cincinnati James L. Winkle College of Pharmacy, suggests that schools start by identifying areas where digital health can be incorporated into an existing curriculum. For example, student pharmacists are already learning about diabetes in terms of therapeutics, so information can be added to courses to include discussions about apps for diabetes care management and how to advise patients. “One of the biggest barriers is that some of these new tools were developed without patient input,” she noted. “We need to be teaching our students usability in terms of the devices so they can better consult with patients. New tools will be developing such as biosensors. We need to improve the usability of those tools and recommend things that are appropriate and personalized for those patients.”
She favors a team-based learning approach and said that it lends itself to a hybrid model of teaching, which many schools were forced to use during the pandemic. “The philosophy of it is that some of the basic content is expected to be acquired before class. We have prerecorded videos and when students come to class, they have to demonstrate that they’ve mastered that content by taking a quiz individually,” she explained. “With team-based learning, they benefit by testing themselves in a group and getting interactions with the team and answering the same quiz. All of those conversations that happen in the team enrich the learning experience. They can discuss why they chose one answer over another. As a faculty member you can introduce more advanced experiential education and spend less time on something that students can master on their own.”
Hincapie said pharmacists need to become familiar with the personalized aspect of digital health, which is rapidly expanding. “We need to work on more in exposing our students to the potential benefits of these tools and also talking about their limitations.” Digital health applications offer benefits beyond improved patient outcomes. “It expands pharmacists’ opportunities in terms of career paths,” she continued. “For example, you say to a patient, you have to take your statin and change your diet. How can a pharmacist help incorporate using those digital health tools with pharmacotherapy? If the patient is already in the pharmacy, he or she doesn’t need to go to a different provider—you might as well do both.”
As Aungst sees it, one place to start is by addressing the lack of continuing education for faculty. “We need to empower faculty to have a better knowledge base about this stuff,” he said. “Some ability to help train pharmacists who are going to teach students is needed. Schools could come together and talk about how to integrate standards. For the time being it will be every school for themselves. That’s the most realistic scenario right now.”
He added that schools have to consider what patient care is going to look like in the future and acknowledge the landscape students will be entering. “I see further pushes toward remote care, teleservices, monitoring remotely and doing treatment. Smart medications are coming to market that track adherence,” he pointed out. “Even with MTM services, a few companies are trying to use AI to make that go faster. With all of this technology, pharmacy schools need to step back and say, what is changing in healthcare? Where is our best value statement that we can put ourselves out there? The recent empowerment of technicians to do things like administer vaccines…I don’t see that being rolled back. I can see them being empowered to do more. What clinical services offer value and what can pharmacists do? The digitalization of healthcare and integration of digital health tools will change how healthcare is conducted.”
The pandemic ushered in changes in healthcare delivery that had to be implemented quickly, some of which are likely here to stay. “We saw the drastic change with telehealth in 12 months. The technology was already there but we had no incentive to use it. Now the incentive is there,” Aungst said. “With the fee-for-service model, with the volume of patients getting seen in person go way down we saw health providers and health systems lose a lot of money. Those that had value-based models did fine in the pandemic because they swapped their models out to focus on keeping members healthy. They were using services like telehealth and they were still doing fine. This has opened up a conversation about pushing value-based services even further to reach patients in the home. You’re going to see more people going toward these business models.”
A New Virtual World
Lipscomb University College of Pharmacy & Health Sciences has several health informatics offerings, which include a strong digital health component. A required health informatics course in the P2 year covers areas such as electronic health records, data analytics, blockchain technologies and virtual health. IPPEs and internships offer additional opportunities to learn about digital health tools. “The leadership for Lipscomb really identified informatics as key for pharmacy right from the beginning,” noted Dr. Kevin Clauson, associate professor, Department of Pharmacy Practice. “Informatics was going to be a core component for the entire profession. That enabled us to explore a lot of opportunities for our student pharmacists.” He emphasized that students do hands-on work and recommended that colleges of pharmacy look beyond teaching and research and try to partner with companies to engage in digital health within the broader community.
“We provide virtual reality headsets to all of our students. With blockchain, they are directly interacting with networks. We try to get introductions to things like coding,” he continued. “We’re not trying to teach them to be programmers, but we want them to be exposed to baseline, fundamental knowledge that they would be working with out in practice. We’re mindful to say, ok, if you have an interest in digital health and you’ve explored how to use this technology to improve patient outcomes, what sort of career opportunities are there for you? We show them specific resources and career opportunities and other broader areas they can look to in order to extend the role of the pharmacist going forward as well.”