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Video Transcript: Provider-facing Technologies' Impact on Pharma's Success

Webisode transcriptions completed by third-party vendor. AmerisourceBergen Specialty Group assumes no liability for the accuracy of the content.

Gina: Electronic medical records. Inventory management systems. Clinical data portals. How are new, provider-facing technologies delivering strategic insight and value for physicians and pharmaceutical manufacturers? What untapped opportunities lie ahead? Join us to find out. “In the Know” starts now.

Hello and welcome to “In the Know,” your source for insight and analysis on the issues that matter to specialty pharma. I’m your host, Gina Clark.

Today, we take a look at the role of technology in the care environment—not only how it is poised to increase efficiencies and improve patient care, but also how it can help manufacturers make more informed decisions about their products.

Joining us are two guests: Dale Danilewitz, chief information officer for AmerisourceBergen Specialty Group, and Neil Herson, president of ASD Healthcare. Thanks to both of you for being here today.

Neil: Thank you, Gina.  

With our discussion today centering on provider-facing technologies, it begs the question: why should manufacturers care? In what ways will new technologies in the care environment affect the pharmaceutical industry? Neil, let’s start with you.

Neil: Sure Gina. Well, we are living in a new world where technology is the driver and in order to get information, manufacturers want to know the disease states of the patients so they can do all of their planning to know what the future looks like, so, in order to do that they are going to collect more data. As they collect more data, they will then be able to create new therapies that will be able to take care of the patients. And, as we move forward, we are going to start seeing technologies where chips could be utilized that could be inserted into the patient, gene testing at birth; these are the type of things manufactures will want to know more about because then they can plan and prepare for the future.

Dale, what are your thoughts?

Dale: Well Gina, it’s also about the regulations and the FDA requiring physician and providers to supply more information on the drugs that are being utilized. And, not only asking the physicians to qualify the patients prior to drug intake, but then also following up on longitudinal analysis of the drug intake and the drug outcome.

Traditionally, healthcare has been viewed as lagging behind other industries when it comes to technology innovation and adoption. Do you see this changing in more recent times, and if so, what is driving this change? Dale?

Dale: Yeah, and there is no question that it is changing, and I think it’s changing because of the pervasiveness of technology throughout society. So now, people who were afraid of technology are becoming more comfortable in its use; they’re buying products over the Internet, they’re auctioning their own products over the Internet, they are collecting their taxes, they’re collecting news broadcasts, sports scores, as well as on their smart phones. So there is no question that they are becoming more familiar with technology, and thereby requiring and suspecting of their business partners to do the same.

Neil, what are your thoughts?

Neil: Well, Dale brought up the smart phone, and I believe that the smart phone is the future, to some degree, of where we’re going. Everybody is so comfortable with their cell phones today that a lot of information is going to come through that, and I, in healthcare, I see procurement working through the smart phone. But again, there are a lot of the pieces that we will be able to draw, specifically real-time information. But really looking back, I think healthcare in general really lags behind other technologies, and part of the reason is because healthcare is so broad and there are so many components that provide for therapies to be delivered to patients. And it really starts with the manufacturers, and there has got to be uptake there and the government has some input, and we’ve seen some dollars coming in from the government to try stir this up and move it forward. But, at the end of the day, it’s really about all the different pieces of healthcare getting together and really finding one platform that works for everybody.

Dale, you look like you have something else to add.

Dale: Yeah, I think, just following up from what Neil said on the smart phone, one of the things that we’re doing, just as an example, is notification back to the patient using or leveraging the use of their smart phone to inform them when to take the drug and then asking them to provide feedback on how they feel after taking the drug; data that can of course be used by the manufacturer to manage the drug utilization in the future. This is something we’re doing, actually, within our pharmacy.

In your discussions with healthcare providers, what types of technology are they looking for? And, is there a common trait among these solutions? Neil, lets go back to you.

Neil: I think the big one and probably the most difficult one is electronic medical records (EMR), because that is the basis of patient care. What you see is patients, because they have access to so much information, really go from doctor to doctor and will probably have more than one prescription running for a therapy, and obviously, that would be contra-indicative. So, if we had a centralized medical record, I think we would have a much safer system where doctors will be able to see what prior docs have prescribed. And, as we move forward, I think manufacturers to a degree will be able to collect data back, which will able to help them make better therapies.

Dale?

Dale: Absolutely, I completely agree. Of course, with Neil on the electronic medical record (EMR), I also believe that the practice and the provider in the clinics are expecting and are being asked to manage their practice a lot more efficiently. There’s a lot more financial pressures that are being placed on them because of their reduction in drug reimbursement, as well as their margin reduction, and so they’re also looking for practice management systems, lab systems, other solutions. And, I think, following up from what Neil said, once you collect the data in the medical records system, then you need to actually report on that data, do analysis. And they’re looking for tools to help them, if you will, do business intelligence on their own information as well as information across the industry.

Neil: I think data has become so much more important and physicians are really getting squeezed and so, as they get squeezed, because reimbursement has been cut back in so many areas, whether being the private case sector or even on the government and state side, they are looking for solutions that will help them not only be efficient, but profitable so that they can even stay in business.   

Recently, the U.S. government has taken an especially active role in promoting healthcare technology. What effect do you believe this has had on both technology development and implementation? Dale.

Dale: There is no question that it has had a significant impact, and a positive impact. It’s exposed the opportunity to deliver more technology to a much wider audience and it’s led to the proliferation of a lot of tools and technologies. The money that has been infused into this area has also led to more creative solutions and I think it is going to benefit all of us: patients, healthcare providers, insurers, and manufacturers.     

Neil, your thoughts?
 
Neil: My thoughts are, that while dollars have been infused, it’s going to take a while to see the uptake; I think that healthcare is very slow at changing. People like how their systems run, and to get them all at the same level is going to take more than just dollars. We are really going to have to see people becoming more focused and really more compliant in general to make this work.

Compliance is an important word. What other internal or external elements are hindering adoption, such as compliance? What effect does this have on the technology’s ability to provide value to manufacturers? Neil?

Neil: Wow, that’s a tough question Gina. Overall I think it’s going to take a long time to, as I said earlier, to get people in line on where this needs to go. I think some of the technologies that we have today, where we see uptake on items like Facebook and Twitter, these are going to be tools that make people more aware. YouTube, for example, where we can get information in front of the patients so they can learn more about their therapies, may aid in driving that compliance, so it doesn’t just come from the doctor, it’s coming from the manufacturer, who is driving that.  And getting the manufacturers to overcome their legal departments, to really control a large part of this compliance is going to be a critical factor as we move forward.

Dale, your thoughts?

Dale: Yeah, I think also, one of the things we have to be concerned about with is any burgeoning industry and also, I say with technology solutions, is again the proliferation of these tools, tools that are being developed to do the same thing, and I think it’s confusing the consumer, or in this case, the provider, with what tools to select. They are being faced with so many options and it’s really difficult for them, as they don’t have the savvy or the guidance to select the tools that would best meet their needs in the short and the long term. And this confusion is creating a lot of mismanagement and fragmentation in the market, and I think that’s definitely going to hinder the adoption of these particular products.

Neil: So again, that can be a positive from a government perspective if they help drive this compliance system, and then maybe we have unified systems that everybody adopts.

Dale: I think that’s a great point, because I think the other thing, and I think Neil alluded to this a little earlier, is about the standards, and there have been a few standards that have been implemented or adopted primarily in the hospital systems, but those are few and far between, and so we need standards to interface the respective solutions. But then also, how do we standardize the data itself on the patient records, so that we can collect aggregate data and then leverage that to gain more richness from that data, the manufacturers are looking for that potential, but it’s difficult for them to combine the data because it’s coming at them from so many different formats.   

Great points, Dale. Let’s talk a little bit about in what ways can manufacturers and providers find some mutual value through third-party solutions like inventory management systems or clinical data warehouses?

Dale: Well ultimately, of course I think that manufacturers and providers are looking for the same thing, and that is improved healthcare for the patient. And these systems, I think, are helping them to accomplish that, by delivering them to, as Neil was referring to, as more valuable data, more valuable clinical information so that they can make better decisions as they administer the drug or as they manufacture the drugs for the next generation. I think also, going back to the practice efficiency, and let’s not underestimate that. I think that’s important for the practice because it will help them to treat more patients and to provide a higher quality care to the patient, at, I would say, a more accelerated rate.      

Excellent. Neil, your thoughts?

Neil: Again, I would say new technologies as they evolve, maybe a good example would be something we developed called Cubix, which is an RFID able technology that allows for inventory management to be consigned, that allows physicians, at this point, to be able not to purchase the drug until they actually need it, but have it at point of care, again, very critical. But as this evolves, the possibility of putting this into the patient home is so much more critical, where payers are able to see when patients are driving that compliant therapy. And, as time evolves, we will probably have chips that actually go on to the vials or the bottle of tablets that will actually determine how much therapy the patient is taking, the time and date it’s taken, and we can then see that we have better compliancy and better outcomes and better results. And so, as we evolve, these are the kinds of places we want to go, but it’s going to take standardization, cooperation, and communication between all the different parties to get us there.     

Exciting and challenging! Let’s talk a little bit about the consumer side and about to what extent are general consumer electronic trends and expectations affecting providers’ attitudes toward technology in the care environment? So Neil, we’ll start with you.

Neil: I think to a degree patients sometimes have too much information, and it may be the wrong information, I think the internet has changed how we look at healthcare and consumer usage of therapies, so if a patient has determined they have a certain “c” state, they will go do the research and do the research prior to going and seeing the physician and, in a way of kind of dictating to the physician which therapy direction they should go. And again, obviously puts a lot of pressure on the physicians to stay educated in their field of interest and focused to make sure they’re doing the right thing. Again, even if the physician is telling the patient the therapy they recommend, if the trust factor is not there, the patient is now looking at second, third, and fourth opinions and actually putting a burden on the healthcare system.

Dale: Yeah, absolutely, but I think we can also look at it very positively, not only, again, as you say, is the patient holding the provider a lot more accountable to the type of treatment that they’re getting, as well as the insurer, but they also can be held more accountable themselves to staying on a drug regimen, to being managed remotely, and the remote technologies, as you say, the consumer technologies, the patients are not as afraid anymore of using these technologies and relying and trusting technology to help them stay compliant on drugs, on drug formularies.             

How is the pharmaceutical community influencing the direction of development for provider-facing technologies, and in what ways are they working more collaboratively with companies like yours and with providers to develop new tools? Dale?

Dale: Well they’re making more demands on us to help collect the data, collect the patient information that can help them better invest, if you will, the research and development of the new products and also to manage the outcomes. The other thing is, as I mentioned it a little earlier, the government is asking a lot more stringent rules or stringent regulations of the manufacturers to register their patients on drug therapies and then follow and monitor as these patients continue on these specific therapies. And I think the manufacturers are now looking to companies like us to manage the registries to ensure that we can identify any sort of anomalies that may occur in the utilization of these respective drugs.  

Neil: And I certainly think this is a growing area as we’re looking at some of the REMS things that are occurring, the black box warnings that are coming out with the therapy. So the manufacturers, their focus is finding the cure, looking at new discoveries, looking at the new therapy possibilities for these patients, and how can they help and change society in general. So when it comes to compliance and data collection these are certainly opportunities for companies like ourselves to grow and develop in. So it is certainly a big opportunity and again I think the government has to play some role here in understanding how this all works and actually fund part of this. Just from a consumer perspective, one of the big issues that I see is a drug importation where patients are, because of the cost of the therapies, looking to buy these therapies outside the United States, which is certainly a concern. And think from a manufacturers perspective as well, because in the U.S., our R and D is what drives the world on the pharmaceutical side and as it is we pay for these therapies so that the rest of the world will find the cure and we certainly have a responsibility there, but at the same time the drug importation has a huge impact on the manufacturers. And part of our role is to manage that as well.

Dale: You know I’d like to also say is I’d like to also look at the manufacturers to help us achieve some of the standards that we’re looking for. They may have a lot more control, or at least exposure, to the companies like ours to influence us to standardize on how we deliver information back to them. And that can help with that R and D.               

So, what is in the foreseeable future for provider-facing technologies, and perhaps more importantly, what will it take to get us there? Neil?

Neil: That and sense certainly will take to get us there. Government understanding on how healthcare really works. It’s all very well throwing dollars at the system, but you’ve got to put it in the right places. Like I said earlier, communications between all of the parties, whether it starts on the payer’s side or all the way across to the manufacturers and the physicians and patients and distribution in the middle somewhere. I think we all have a responsibility. So what’s it going to take? I think we are all looking at the new thing that will help us get to the end result.  I would say the key highlight is electronic medical records, and I think one thing that has to be done is, we can’t get there all at once, it’s one step at a time. So we have great consumer tools, be it the internet, the smart phone. At the same time, I think there is a responsibility across the board to get us where we need to go and it’s slow. It’s a slow process and I think we can’t do it all at once. Let’s focus on one at a time, maybe it’s an electronic medical record, to start the ball rolling.

Excellent. Dale, your thoughts?

Dale: Yeah, I think what we’re looking for in the clinic and in the practice is also having some kind of turnkey system. A way in which we can combine and integrate all of the solutions we’re asking all of these providers to work on to manage their patient and their business. And so for the electronic medical system, having that integrated with the lab system with patient intake, and registration. And again, with the registration for these respective REMS modules, for electronic prescribing, and practice management billing. There are plenty of systems that are just inundating the practice and they’re struggling to manage that because they really aren’t expected to be technology proficient. So I think, what we need to do is get together as a community and to manage these systems as a single entity, as opposed to these just wayward systems and to look at ways in which to standardize the processes, to standardize on the data, and on the interfaces between them, so that we can provide the provider the tools that they can singularly use to deliver the best patient care.                

Gentlemen, it’s been a very enlightening discussion, but it looks like we are almost out of time today. Thank you so much for joining us and sharing your thoughts on this.

Neil: Thank you, Gina.

Dale: Thank you, Gina.

And thank you for joining us—we’ll be back soon with another webisode. Until then, if it’s on your mind, it’s In the Know.

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