Monday, December 31, 2007

iPhone Can Tell You Which Pharmacies Are Open in Germany

It seems as if everyone wants to do eHealth for the iPhone! From the Website eHealth Europe:

A new Web 2.0 iPhone service has been introduced in Germany, which shows what pharmacies are open during Christmas and a map of how to get there.

The new service details Christmas opening times and locations for nearly all of the 21000 pharmacies in Germany. The service is offered by, one of the biggest German-language pharmacy websites.

Opening the website prompts the user to enter their postcode, which then returns a choice of nearby pharmacies displayed, together with directions, using Google Maps.

As well as details and locations of pharmacies that are open, the service also includes details of GPs on duty, though this part of service is still under development and doesn’t yet cover the whole country.’s is one of the first iPhone specific medical services in Germany, where the iPhone has been available for two months. However, other online pharmacy services such as e-medication still remain at an early stage in Germany.

“Pharmacy networks and pharmacy marketing alliances are reluctant to even think about the possibility of using electronic medication services to help patients keep track of their medication electronically“, Harald Sondhof of the Tübingen-based health-IT company Careon, told E-Health Europe.

This, he stressed, was wrong because e-medication services not only improve medication safety and patient compliance but “also can be used to win or keep customers.”

Careon is offering a web-based, patient-centred personal health record (PHR). It is available in various forms dependent on the adoption scenario. One version focuses on medication issues, with services like interaction check or reminder functions for medication times. Pharmacists could offer it to patients as an additional service.

Sondhof managed to persuade ten German pharmacies to take part in a pilot project, due to start early 2008. The pharmacists will offer the e-medication PHR service to chronically ill patients. “It will be easy to use, because it is integrated into the enterprise resource planning software. So pharmacists can add medication to their customer's PHR almost automatically”, Sondhof said. The IT partner in the project is ADV, and with around 800 pharmacies as customers it’s a medium size provider of pharmacy IT in Germany.

Given their affinity with the iPhone, pharmacists might be persuaded of e-medication services as soon as PHR are offered in iPhone versions. Indeed, the Walldorf-based company ICW has recently presented an iPhone version of its PHR ‘LifeSensor’.

Another reason to consider the iPhone a perfect e-health-present for Christmas 2007?


Tuesday, December 18, 2007

Dr.First For The iPhone

With mobile platforms opening up to outside vendors more and more applications can be developed. For medication adherence, eprescribing plays a role - mostly with medication errors, which account for 12% of so of all medication non-adherence. Can you read your MDs handwriting? Dr.First is a great application and now an MD can send the prescription in while speaking to the patient and it will be ready for pick-up by the time the patient gets to the pharmacy. I am also a fan of tablet PCs, where MDs can also access their patients EHR, but I haven't seen any news about them lately.

This is right off the BUSINESS WIRE:
ROCKVILLE, Md.--(BUSINESS WIRE)--DrFirst™, the leader in electronic prescribing and medication reconciliation services, today announced that physicians will have access to an unparalleled e-prescribing experience on the Apple iPhoneTM through DrFirst’s RcopiaTM e-prescribing system. For the first time, physicians and their staff will be able to perform all of the essential functions of electronic prescribing in real-time on a mobile browser through a WiFi or wireless carrier’s broadband connection.

RcopiaMini is formatted for the smaller screen of today’s mobile devices and allows providers to easily navigate a full-featured version of Rcopia on this exciting new platform. DrFirst designed the application to provide a real-time interaction between physicians, pharmacies, and health plans, so there is no need to update or sync the device.

“Now physicians can quickly, safely, and securely prescribe from anywhere—through the always-on connectivity of the iPhone, the WiFi connection of the iPod Touch, or while seated at the desktop computer in the practice,” said Peter N. Kaufman, Chief Medical Officer of DrFirst, Inc.. “DrFirst’s goal is to ensure that its new web-based, mobile Rcopia experience delivers the same high levels of innovation and usability as the original Web version.”

To be useful to physicians, e-prescribing must be easily and securely accessible. With the addition of the iPhone and iPod Touch, DrFirst provides physicians with a broad set of eprescribing platforms, including Apple, Treo, and HP iPaq handheld devices as well as desktop and tablet systems.

E-prescribing on the iPhone with RcopiaMini allows physicians to provide a higher level of patient service and safety, streamline practice workflows, and save time and money through the efficiency of electronic medication orders, renewals and formulary checking. New prescriptions and renewals are sent electronically to the patient’s retail or mail order pharmacy.

RcopiaMini checks for patient insurance eligibility, formulary, and patient medication history. The application also offers clinical decision support tools to check prescriptions for drug-drug and drug-allergy interactions and appropriate dosing.

Busy doctors, large practices, and health systems require software that is adaptable to the practice workflow and that draws the practice staff into the prescribing process. To meet this need, RcopiaMini is designed to be accessible to all staff members, to be highly configurable and to accommodate workflow features that make it a perfect solution for
groups of any size.

Thursday, December 6, 2007

My Health

In February of this year, I was diagnosed with high Triglycerides and high Cholesterol. Mostly hereditary - have you seen the Vytorin ads? - and somewhat my diet. My doctor put me on Tricor, and I have been pretty adherent. In July, I stopped taking it for two weeks while I awaited a new script but otherwise everyday.

My new doctor (my old MD went back to research) didn't know if Tricor was the right drug, so he sent me for blood work.

He gave me the results today.

The good news is that all my levels went down: Total 247, LDL 149, HDL 38 and Triglycerides 301. The bad news is my HDL went down 10 points (very bad considering this is the "good" cholesterol and 40 or higher is recommended). The LDL went down 50 points (very good 130 is recommended), and my total is only 47 points out of the top part of the spectrum. So I am feeling pretty good about myself. I still need to eat better, lose more weight and exercise more effeciently - but who doesn't?

The point to all of this - other than letting you all know about my health, which is top of mind in your lives - is that within two minutes of questioning, my MD asked if I had been taking Tricor regularly. I said yes, except for that two week period, and he said "Everyday?" And I said, "Yes, everyday." I was going to tell him that I am the Director of Corporate Development for a healthcare technology company that focuses on enabling medication adherence and that a get daily text, voice and email reminders, but I didn't need to get into it.

It then occured to me that if I said I was taking the Tricor (see White Coat Adherence) and was not, that all of his diagnosees would be off. If he thought the Tricor wasn't working (technically it would not be working because I would not be taking it), and prescribed something else - it could really mess up my system. I never really thought about medication adherence this way, only that by not taking your meds, your condition gets worse.

My MD was happy to see my numbers and my weight go down and he gave me a choice: keep losing weight, eat better and exercise and see what happens in three months, or do all of that and take another medication in conjunction with the Tricor. He wanted to make sure I would stay adherent to another medication. Putting me on Niacin would increase my pills to 4 a day (I am on another med in the morning and bedtime). 32 million people are on 3 or more medications. Plus, he gave me an antibiotic to take for 10 days to knock a sinus infection out which I have had for two weeks.

So now, my total pill count is at 5 pills, 4 medications.

The better news is the rare blood disease he was worried about only needs to be checked every three months. So there is more time at the lab for me. If I stay adherent to the Tricor and the Niacin, and loose more weight (he said 10 lbs), and eat better (I do have the occational french fry, and ice cream) - I should have all my levels in the right range and not have to take any medications.

This would be optimal.

So, I will set up more reminders for myself, get into the routine of taking a new drug and everything should be right as rain.

As long as there are not any horrible side effects - he mentioned hot flashes - and the drugs fall into my formulary. By my son's 1st birthday, I will be a new man!

Wednesday, December 5, 2007

Aetna's Healthy Actions Rx-Savings

There is a signifacant correlation between the cost of a drug and one's adherence to the drug. eg. Drug X costs me $125 a month and after two months, I don't really see any results. I will stop taking that drug. Now my employer tells me they will pay for drug X, so I go back on it and stay the course until I see a change. That is if I remember to take my drug and the side effects are not too bad!

Marriott is doing a great service for their employees considering the majority of them most likely earn above minimum wage and are supporting a family with their healthcare benefits. They also will see the benefit with lower absenteeism, and higher productivity. Kudos to Aetna for their CareEngine System and offering so many programs to lower costs to their members.

This is straight off the BusinessWire press release:

HARTFORD, Conn.--(BUSINESS WIRE)--Aetna (NYSE:AET) today announced the launch of Aetna Healthy ActionsSM Rx-Savings, an incentive program under which co-pays for individuals enrolled in self-funded benefit plans who have high risk clinical profiles and are taking medications for chronic health conditions including asthma, diabetes, high cholesterol, high blood pressure, and heart disease are paid in whole or in part by their employer. The program is designed to encourage member compliance with medications shown to be essential, according to the evidence base, to the effective management of these conditions for high risk members.

“The use of evidence-based medicine in combination with pharmacy benefit design may significantly help to improve the overall quality of care for members with the targeted chronic health conditions by reducing the cost barrier to patient compliance with recommended drug therapies and treatments,” said Ed Pezalla, M.D., National Medical Director, Aetna Pharmacy Management. “This program is one of several value-based plan design initiatives we are deploying to our member population to help promote better health outcomes, reduce costs, increase satisfaction and over time, lower cost trend for the employer.”

Aetna Healthy ActionsSM Rx-Savings allows self-funded employers to offer a drug class co-pay discount to employees based on a member’s clinical risk profile and relevant evidence-based standards. Eligible members are identified through ActiveHealth Management’s CareEngine® System technology which can proactively identify at-risk individuals who currently use a drug covered in the program, as well as those who could benefit from use of a drug covered in the program. Once identified, an outreach mailing is sent to the member to notify them they are eligible for co-pay discounts. If the member is not currently using a drug covered in the program, an outreach mailing is conducted to both the member and his or her physician.

Marriott International, Inc. is a pilot customer for the program.

“Reduced co-pays resulted in increased adherence rates, which we believe may lower the number of costly medical emergencies and hospitalizations in our workforce, and ultimately help alleviate our health care costs over time," said Jill Berger, vice-president, Health & Welfare for Marriott International, Inc.

The drug classes and conditions applicable in this program include: anti-diabetic medications, inhaled steroids for asthma, beta blockers for cardioprotection, ACEI/ARBs when needed for cardiorenal protection and statins for those who have high-risk conditions such as diabetes and CAD; with a recommended discount of up to 100 percent off the co-pay for generics and up to 50 percent off the co-pay for preferred brands. This program has been piloted with certain self-funded employers and will be available more broadly to all self-funded customers January 1, 2008.

Clinical studies have shown that co-payments and deductibles can impact patients' compliance with medications and treatment plans. One example is a 2004 study tracking patients with high cholesterol that found patients who paid lower co-pays for statins were more compliant with their treatment regimen.1

In October, Aetna launched a groundbreaking study in partnership with Brigham and Women’s Hospital to follow drug compliance in members who have had a heart attack and who are on maintenance drugs such as beta blockers. In the study group, individuals’ co-payments, co-insurance or deductibles for certain drugs proven effective in managing their condition will be paid for by Aetna or the employer (depending on the nature of the coverage) rather than the member. The study is the first of its kind to test the impact of variable or no co-payments on the outcomes of certain chronic diseases.

Aetna has a unique combination of consumer-directed experience, member information and technology that can help provide better understanding of patient decision-making and potentially encourage them to better manage their condition with incentive-based offerings. With a number of programs in place including Save-a-Copay, available first-dollar coverage of preventive medications within its Health Savings Account-compatible high-deductible health plans, and pilot programs with its largest customers, the company is committed to building, evaluating and deploying value-based plan design initiatives.

"Lower costs have been shown to help improve medication adherence and we believe this will lead to improved care and reduce costs," said Pezalla. "Health insurers and self-insured employers partially offset their costs of insurance by requiring co-payments, coinsurance or deductibles; however, they incur the costs of illness if a patient suffers further complications from chronic illness. This program offers real opportunities for promoting better care and reduced waste while promoting consumerism. As we gain a deeper understanding of the effect of reduced out-of-pocket costs on member adherence to prescribed therapies, Aetna will apply these insights to future benefit design efforts.”