VCU news

By Greg Weatherford
School of Pharmacy

The digital divide is cutting many people off from health care. A group of Virginia Commonwealth University pharmacy students aims to bridge that gap.

“We’re trying to help and make an impact,” said Emily Ko, a first-year Pharm.D. student at the VCU School of Pharmacy and co-founder of the student group Pharmacists for Digital Health.

They’re off to a fast start. Formed less than a year ago, the group was named runner-up this May in the national 2020-21 PQA Healthcare Quality Innovation Challenge by the nonprofit Pharmacy Quality Alliance for creating a process that allows patients to more easily share health updates with a medical practice by using a mobile phone. Recently the group’s student founders and university advisers won a VCU REAL Challenge grant to expand their work into an Advanced Pharmacy Practice Experience module.

From telehealth visits and apps to Fitbits and databases, digital tools are transforming medicine. But the future of health care is unevenly distributed. Ko compares the dearth of digital health tools among low-income people to the food deserts that can keep some neighborhoods from fresh, healthy groceries. “Access to health care equals access to data,” she said.

Patients with lower incomes are less likely to have access to high-speed internet, while Black and Hispanic families are less likely than white families to own desktop or laptop computers, according to a 2020 survey by the online medical networking company Doximity.

Many common health problems, such as high blood pressure and diabetes, can go untreated or undertreated in patients who are low-income, uninsured or who come from underrepresented groups, health experts say. Often, poorer patients can’t easily go to appointments. Low-wage and hourly jobs can force a choice between getting paid and going to a doctor. Limited transportation can make it difficult and time-consuming to get to clinics or medical offices.

“Their medication management and therapy management is disjointed from how their real life works,” Ko said.

Another issue is that many patients stop taking medications between appointments. This is particularly true of patients who have no health insurance, said group co-founder Amir Behdani, also a first-year pharmacy student.

We have these existing technologies that are not connected for some reason. We’re just connecting the dots.

A more subtle concern is that, by leaving low-income patients out of the databases that increasingly are driving health care decisions, medicine could be leaving them behind. Last fall, VCU and VCU Health joined a national effort to reach more patients to prevent this shortage of data, but the challenge of these patients being underrepresented goes beyond the U.S. alone. The illnesses and complications these patients face will be overlooked if they are not included in the data.

For example, lower-income patients often face multiple health problems, partly because of their jobs and living situations and partly because of lack of access to health care. “They have to manage that on top of everything else,” said group member and first-year pharmacy student Briton Vanmaanen.

Access to online appointments, virtual office visits, health tracking and other digital health tools could help alleviate many of these problems. Automated text message reminders could help patients better manage medication. But commercial products and medical devices are often priced out of reach for the patients who arguably need them the most.

The student group is working to build tools to help these patients and the low-cost clinics that serve them.

VCU School of Pharmacy professor Evan Sisson, Pharm.D., described how during the COVID-19 stay-at-home order the Richmond clinic for the uninsured where he volunteers as a care provider, the Center for Healthy Hearts, shifted to virtual visits. The clinic adopted a system from the American Heart Association that let patients text blood pressure readings to a dashboard.

That system has been helpful but is limited to tracking blood pressure, Sisson said. Then the heart association discontinued the system. The clinic looked into more sophisticated options but found they were too expensive.

After meeting with Sisson to learn about the clinic’s needs, the students in Pharmacists for Digital Health worked with a graduate student from the VCU da Vinci Center for Innovation, Singith Nawagamuwage Perera, to create a process that would allow patients to text health updates to a medical practice using any mobile phone. This data would be encrypted to ensure medical privacy and sent to a dashboard where it could be reviewed by the patients’ health care providers.

If the dashboard were integrated with an automated artificial-intelligence based chat system like those used by e-commerce sites, the students added, patients could receive prompts based on the data they submit — encouraging responses for improved glucose readings or reminders to keep taking medication, for example.

The students’ detailed plan was built on free or low-cost interfaces and widely available software to make it affordable. “We have these existing technologies that are not connected for some reason,” said Behdani. “We’re just connecting the dots.”

The Center for Healthy Hearts will start testing the system in June. The plan gets high marks from Sisson.

“I’ve been impressed,” Sisson said. “It demonstrates the role of pharmacy. Our curriculum is based on the unique interface between science and patient care.”

The students single out for praise the group’s faculty mentor, Dayanjan “Shanaka” Wijesinghe, Ph.D., an associate professor at the School of Pharmacy, for his support of their interdisciplinary and entrepreneurial approach. “We were extremely lucky finding Dr. Day,” said Ko, using the students’ affectionate abbreviation of Wijesinghe’s first name.

“The true power to me is that we are building it ourselves,” Ko added. “Digital health tools will change and evolve. What we’re learning is how it works at the base, the fundamentals that underlie all digital health tools.”

Behdani agreed.

“This is a skill set a lot of pharmacy schools are not focusing on,” he said. “When they [VCU School of Pharmacy] say ‘Welcome to the future,’ it’s true. They care a lot about the future and our place in it.”