Pharmaceuticals (15)

Tracking and stocking essential medication are challenges for many African countries. People living in rural areas often don’t have access to primary health care facilities, and even if they do, facilities frequently run out of essential medicines. To address this problem, Kaduna State Ministry of Health, the third most populous region in Nigeria, Vodacom and Novartis have implemented SMS for Life 2.0, an mHealth programme.

SMS for Life 2.0 isn't a new concept. It builds on the SMS for Life programme launched by Novartis in 2009, which used cell phones to manage stock-outs of malaria medicines in more than 10,000 healthcare facilities across sub-Saharan countries says an article in eHealthNews.

Pharmi web has the Novartis press release. It says SMS for Life 2.0 uses smartphones and tablet computers to improve access to medicines and increase disease surveillance, helping to provide better care for patients. It also builds on its success and introduced eLearning for local health workers.

SMS for Life 2.0 allows healthcare workers to track stock levels for  HIV, TB and leprosy treatments, and antimalarial vaccinations. It also allows them to send notifications to district medical officers when stock levels are low, ensuring adequate and timely supplies of all essential medicines.

SMS for Life 2.0 will also:

  1. Monitor disease surveillance parameters of maternal and infants deaths, malaria, yellow fever and cholera
  2. Improve stock visibility which will improve supply chain management, by allowing authorities to improve demand forecasts for the treatments
  3. Facilitate health workers’ training in local facilities using eLearning modules
  4. Improve healthcare by better access to essential medicines so reducing disease prevalence in communities

Zambia’s Ministry of Health has recently signed a Memorandum of Understanding (MOU) with Novartis to roll out SMS for Life 2.0 to some 2,000 health facilities. It’ll start in 2017.

Online pharmacies in India could soon be registering on a portal. A report in India’s Economic Times says India’s Drug Consultative Committee (DCC) has recommended the Central Drugs Standard Control Organization (CDSO). It’ll regulate online medicine sales and online pharmacies. The proposed national portal’s a nodal platform to monitor sale of drugs across the internet. Online pharmacies will need to mandatorily display the portal link on their homepage for authenticity verification by patients or consumers.

The committee, which submitted its report to the central drug regulator recently, stated that only e-prescriptions or electronically generated and digitally signed prescriptions should be considered by online pharmacies to check misuse.

A significant share of the responsibility for the sale of medicines through online pharmacies will now be on doctors. As per the committee report, doctors will have to create electronic prescriptions or paper prescriptions that can be scanned and uploaded to cloud by the doctor or patient through the intermediary link. These prescriptions may be linked with the Aadhaar card.

The prescriptions will have a unique identification number, name of the patient, phone number of the patient, name and dosage of the medicine, compounding and drug formularies and information on how many refills can be allowed.

As part of the broad framework, the committee has outlined that "all e-pharmacies that plan to sell, offer or exhibit for sale of medicines over the internet will need to be registered with Central Drugs Standard Control Organisation (CDSCO) under the Drugs and Cosmetics Rules, 1945." It added: "No unregistered entity shall be permitted to undertake online sale of medicines." The fee for registration of an online pharmacy has been fixed at Rs 1 lakh.

Besides, it said online sale of drugs may be permitted only on e-prescriptions that are in compliance with the provisions of the I-T Act, 2000, and other rules under the said Act. Electronic prescriptions, the report added, are medical prescriptions generated via the electronic mode, gadgets, devices that are verifiable, printed and transmitted. The authenticity of the prescription will be crucial.

There’s no denying that healthcare has undergone dramatic changes in the last ten years. New technology and innovations available to patients enables them monitor and take responsibility for their own health, and improved devices and tools available to doctors and other health professionals can make more informed decisions. Healthcare technology keeps moving along. An article in The Guardian looked at the top eight technologies that’ll keep transforming healthcare. For Africa, the balance and pace of investment in the eight technologies will be different to developed countries.

The smartphone

Although not new, it’s clear that the smartphone’s healthcare potential’s yet to be realised. Smartphones can serve as the hub for new diagnostic and treatment technologies. We’ve seen apps developed to support a wide range of healthcare activities, such as healthier life-styles, diabetic patients, treatment adherence and depression. Patients can also use tools like the AliveCOR ECG, embedded in a smartphone case, which helps interpret heart test results via an app and facilitates sharing with clinicians. They’re also ideal for gathering large amounts of data to improve understanding of diseases in populations.

At-home or portable diagnostics

Clinicians can now bring hospital-level diagnostics devices to patients’ homes, such as portable x-ray machines, blood-testing kits and other technologies.

Implantable drug-delivery

Drug adherence is a big problem, especially for patients with long term conditions. It’s estimated that between a third and a half of all medication prescribed to people with long-term conditions isn’t taken as recommended. Several technologies are already under development to address the problem. There’s sensor technology so small it can be swallowed and combined with drugs in smart pill form. When the pill dissolves in the stomach, the sensor’s activated and transmits data through a wearable patch to a smartphone app. Patients and clinicians can see how well they are adhering to their prescription, though it raises important questions about patients’ privacy and autonomy.

Digital therapy

Digital therapeutics are health or social care interventions delivered using a smartphone or a laptop. They embed clinical practice and therapy into a digital form to provide computerised cognitive behavioural therapy (CBT)

Genome sequencing

Advances in genome sequencing and the associated field of genomics will give doctors a better understanding of how diseases affect different individuals and populations. These genetic profiles of people’s diseases and knowledge of their response to treatment, it should be possible to predict their response to treatment and prognosis more reliably.

Artificial intelligence

Machine learning is a type of artificial intelligence that enables computers to learn without being explicitly programmed, meaning they can teach themselves to change when exposed to new data. Enlitic, IBM’s Watson division and Google’s Deep Mind have started to explore potential applications in healthcare.

Blockchains

Blockchains are decentralised databases that keep records of how data’s created and changed over time. They’re trusted as authoritative records without a single, central authority guaranteeing accuracy and security. Electronic health records are widely used, but they are usually centralised, provided by a small number of suppliers. Some commentators have described how records using blockchain technology would bring benefits like resilience and encourage interoperability, with patients and clinicians given encryption keys to control who sees the data.

Online communities

Social networks bring together people with interests in healthcare to support each other, share learning and provide platforms for tracking health data, helping people manage their condition and contributing to research. 

New technologies bring new opportunities for Africa’s health systems. They can help to improve the accuracy, reliability, availability and add value of information gathered, change how and where care’s delivered and offer new ways to prevent, predict, detect and treat illness. The numerous choices makes rigorous strategies, plans and investment decisions challenging, but essential.

A study reported in the Journal of the American Medical Informatics Association found that ambulatory diabetic patients had fewer Adverse Drug Events (ADE) when their physicians used ePrescribing. It also results in fewer hospital or ED visits for hypoglycaemia. The gains are mainly attributed to the impact of ePrescribing from sending accurate and legible prescriptions to pharmacies as  decision support and drug interaction alerts.

There are a few caveats:

  • The physicians treated fewer patients from disadvantaged populations
  • Patient’s characteristics, such as comorbidity and low income, affect ePrescribing’s impact on ADEs.

African countries can use these findings as part of the business case for their ePrescribing initiatives. It sets a direct benefit they can match to other types of patients and other settings. The full range of functionality, such as sending ePrescriptions to local pharmacies, is likely to be more limited than the USA services. This doesn’t prevent African healthcare from matching the scale and cost of ePrescribing to its outcomes.

Big pharma may not be too good at apps. This is one of the results of the new report “Pharma App Market Benchmarking 2014” released in October 2014. A Mobile Health Economics, a Research2Guidance website, has a blog that says that most pharmaceutical companies  haven’t had  a significant impact on the mHealth app market. Some have published more than 100 apps using iOS and Android, but have generated limited downloads and use.

The average number for a big pharma company is about 60 apps in Apple App Store and Google Play. It’s hugely above the average for a typical mHealth app publisher, which releases between one and two mHealth apps. The data’s in mHealth App Developer Economics 2014, a free report from Mobile Health Economics, and summarized by eHNA.

Of twelve pharmas’ apps, three pharmas’ are performing above average. Most of this success seems to come from a small number of apps.

The pharma app publishers are clustered into three groups:

  • Niche players using apps to support their core products, so have a higher share of apps for healthcare professionals and which sometimes require doctor’s identification
  • First Success, which have large app portfolios that have gained above average download numbers, mostly in private users’ mass market of private users
  • Still Trying, which have apps which target large private user segments, but with low download numbers.

Lessons from the survey are that these apps are:

  • Not globally available
  • Built around pharma’s core products, not around market demand
  • Limited by no cross-referencing or common and recognizable design
  • Too many different app publishing entities.

If you’re considering app development as part of your engagement with patients, carers and communities, it’s worth applying the survey’s findings. They could help you reach you audience.

Iowa-based TelePharm uses cloud-based mobile apps to connect pharmacists to each other and to patients. It’s raised US$2.5 million to help scale its business.

TelePharm has several different businesses that enable pharmacists to spread their expertise across multiple pharmacies. This allows local chains to reduce their overheads significantly. One branch under the TelePharm umbrella is TeleCheck. The platform allows remote verification of medications, an important and time-consuming job for pharmacist.

“They have two different responsibilities: verifying it’s the right drug for that patient and basically making sure the patient will be safe with that drug, and making sure what the technician dispensed was the right drug,” TelePharm CEO Roby Miller said to MobiHealthNew“What TeleCheck does, is it takes that workflow and puts it in the cloud. So a pharmacist has an image of the drug they’re dispensing, the label on the bottle, and the [prescription] as well. So they can compare those images and make sure the drug is the right prescription for that patient.”

TeleCounsel is another TelePharm service. This actually allows pharmacists to interact virtually with patients directly.  It’s being used in hospitals which have pharmacists on their staff and supports pharmacists in providing discharge counselling for patients leaving the hospital. The counselling is informal, and talking with patients before they leave hospital leads to better medication adherence. Counselling is often difficult to facilitate because it needs pharmacists to be in many different places simultaneously. TeleCounsel allows pharmacists in one location to talk to many patients and even counsel them when they’re at home.

TelePharm is relatively new. It was founded in August 2012. Its software is in eight small, regional pharmacy chains in three USA states: Iowa, Illinois, and Texas.

Similar technology could be used in other parts of the world. It could be especially valuable in countries where there’s a shortage of healthcare professionals. Many African countries could benefit from this or similar technology.

As the size and cost of chip technology continues to fall dozens of companies and research teams are rushing to join the race to make ingestible or implantable chips that will help patients track the condition of their bodies in real time and in a level of detail that we have never seen before. I wrote about one family’s experience of this in Smart pills anybody?

According to an article in the Washington Post’s Health and Science section, we have only just began to see what this kind of technology is capable of. It says that “Scientists are also working on more advanced prototypes. Nano­sensors, for example, would live in the bloodstream and send messages to smartphones whenever they saw signs of an infection, an impending heart attack or another issue — essentially serving as early-warning beacons for disease. Armies of tiny robots with legs, propellers, cameras and wireless guidance systems are being developed to diagnose diseases, administer drugs in a targeted manner and even perform surgery.”

While the technology may be within reach, the idea of putting little machines into people makes some of us uncomfortable. It also creates scientific, legal and ethical questions that need answers.

In 2002, when silicon chips containing their medical records were injected into some Alzheimer’s patients, it was extremely unsettling to privacy advocates. Several states later passed legislation outlawing the forced implantations, and the technology never took off.

“There’s something very troubling about a chip being placed in a person that they can’t remove,” said Marc Rotenberg, executive director of the Washington-based Electronic Privacy Information Center.

But then again, Eric Topol, Director of the Scripps Translational Science Institute in La Jolla, Calif, has an equally valid point. “The way a car works is that it has sensors and it tells you what’s wrong. Why not put the same type of technology in the body? It could warn you weeks or months or even years before something happens.”

Personally, I’m still on the fence about having my every move monitored and swallowing small computer chips. But the fact remains that these devices could potentially save countless lives and billions in unnecessary medical bills.

Sharing scarce resources can be beneficial, but it can be hard to assess. Antonio Porchia, the Argentinian poet, summed it up when he said “I know what I have given you … I do not know what you have received.”  The EU-project eI4Africa Pharmacology Science Gateway (PSG) seems clearer on the benefits of sharing.

Its e-Science platform simplifies collaboration and sharing resources in Africa. The specific goals are to promote and implement African medical science collaboration on biomedical and pharmacological sciences and clinical trials and clinical drug studies to improve healthcare in Africa.

The platform makes accessible open sources software for study designs, biomedical data processing and facilities for sharing data and discussing scientific and technical topics. It enables stronger north-south and south-south capacity and capability building as African researchers and their international collaborators have easy access and links to people dealing with similar challenges.

PSG has six main activities:

  1. Genomics and bioinformatics
  2. Bioanalysis, drug analysis and metabolism
  3. Pharmacokinetics and pharmacometrics resources
  4. Clinical trial sciences
  5. Digital library
  6. Multimedia contacts and eLearning tools.

The network includes the African Institute of Biomedical Science & Technology (AIBST), seven universities from six African countries. The PSG website lists them and the e14Africa supporters. They seem to know much about Antonio Porchia’s ideas, like “We become aware of the void as we fill it.”

We have all heard of smart phones, and smart TVs, but what about smart pills? According to Ariana Eunjung Cha, in Health & Science, many predict that smart pills will be at the forefront of a “revolution in medicine powered by miniature chips, sensors, cameras and robots with the ability to access, analyze and manipulate your body from the inside”

Mary Ellen Snodgrass, is a 91 year old school teacher who swallows a computer chip everyday. It’s embedded in one of her pills and roughly the size of a grain of sand. When it hits her stomach, it transmits a signal to her tablet computer indicating that she has successfully taken her heart and thyroid medications. The smart pill technology allows her to view an hourly timeline of her day with images of white pills marking the times she ingested a chip.

Snodgrass’s son, Doug Webb, a 62-year-old electrical engineer, can track his mother’s progress. He recently brought up a web page with his mother’s name with a multitude of charts and numbers. “Sometimes I see very strange numbers and I’ll call her up and say, ‘What’s going on?’ ” he said.

This was the first smart pill to be approved by the Food and Drug Administration (FDA) and the European Union, in 2012 and 2010, respectively. It is still being tested by a handful of doctors and hospitals, as the company continues to refine its software. Proteus Digital Health, who developed the technology, hopes to make it more widely available within the next few years.

Health workers have practical, simple ideas for sharing information to improve healthcare. Last week I was in Botswana, participating in eHealth strategy consultations. Sitting next to me was Mmatalenta Maphosa, a pharmacist with the Ministry of Health. She is charming and humble, and plays a key role in expanding eHealth in Botswana. She has been pioneering innovative ways to use everyday ICT to improve drug availability. She is the kind of eHealth innovator steadily transforming the African eHealth landscape through practical innovations.

Early this year, she established an initiative that enhanced pharmacists’ ability to manage and share pharmaceutical supplies across the country and serve patients better. She set up email support to improve medicine availability and prudent utilization of scarce resources. Previously, if government pharmacies had excess stock, stocks with short expiry or needed something urgently faxes would be sent to other facilities to advertise or request pharmaceutical supplies. The system was slow and did not reach all facilities, so Mrs Maphosa decided to send email lists. “With a simple push of a button, I was able to get in contact with almost all the facilities and cut down their response time dramatically”, she says. As long as someone has an email address at that facility, then information flow is possible.

Many facilities benefit from the service as information on slow moving or short-dated items can be shared between facilities, allowing stock to be moved to other pharmacies across the country, helping the government save money and helping to meet patients’ needs. Facilities in dire need of essential medicines can simply send email requests and are able to get the much needed supplies from pharmacies that have excess stocks.

The use of ICT in the healthcare system in Botswana revolutionized their drug redistribution programme. It shows how simple ICT solutions can change healthcare, with benefits for health workers and patients. Mrs Maphosa is an important type of eHealth activist, changing the healthcare environment wherever she can, to make life better for herself, her colleagues and the patients she serves.

When she starts overseeing optimization of the pharmacy, materials management and billing modules, she plans to report cost savings to the government achieved by using ICT. Currently, each facility has to meet targets of 97% drug availability and <3% expiries on inventory value. Her reports aim to show cost savings by utilizing stocks redeployed from other pharmacies. These would have otherwise expired, so wasted.

She sees more benefits in using a central government server so that pharmacy personnel throughout the country can log on and check the availability of drugs in other facilities. This way, it may be possible to apply the First to Expire, First to go Out (FEFO) principle nationally.

Mrs Maphosa is impressed with the way pharmacy personnel in Botswana embraced this idea and believes that this team spirit will take the pharmacy profession to phenomenal levels of growth and development.