Leveraging Consumer-Facing Technologies to Improve Health Outcomes

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Healthcare technologies and programs are improving health outcomes and patient care, including healthcare information technology (HIT), advanced analytics, accountabke care organisations (ACOs), electronic health records (EHRs), computerized physician order entry (CPOE), remote patient monitoring (RPM) and telehealth/telemedicine.

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Leveraging Consumer-Facing Technologies to Improve Health Outcomes

  1. 1. Leveraging Consumer-Facing Technologies to Improve Health Outcomes By applying advanced analytics, healthcare organisations can not only achieve healthy revenue gains but improve patient care. Executive Summary Healthcare spending will continue to rise, not only because of inflationary drivers but as a result of growing recognition by policymakers, worldwide, that improved health is inextricably linked to greater national wealth. Keeping the universal healthcare model throughout the European Union (EU) will require rationing of services and consoli- dation of healthcare facilities, as public resources fall short of demand. Consumer technologies, and consequently healthcare technologies, are becoming ubiquitous worldwide, changing the way we communicate, conduct commerce and provide care and services. Some of the most compelling benefits of healthcare technologies are in the areas of disease prevention, chronic disease management and improving healthcare delivery. In addition to these benefits, innovative medical technologies, by providing more cost-effective patient care, can also contribute to a more efficient and targeted use of resources in healthcare. This also means an increase in productivity. Difficult Times The pharmaceuticals industry is going through a time of dramatic transformation. The pressure to cut costs while maintaining effectiveness has never been higher. The prescribing behaviour of physicians is increasingly being influenced by integrated delivery networks (IDNs), account- able care organizations (ACOs) and government prescribing guidelines. These external influenc- ing factors are amplified by internal constraints, such as maturing portfolios, decreasing product margins, competition from generics, etc. European healthcare systems are the pillars of the continent’s social infrastructure. Although they differ in terms of operational and financial structure, they share common goals and priorities such as universality, access to quality care, equality and solidarity. More importantly, European states also share common challenges. The first is an ageing population that is having a direct impact on the overarching dependency factor and pathological map of Europe. It is also important to consider the rise of chronic diseases(forexample,diabetesandcardiovascular conditions) that are directly related to unhealthy lifestyles. At the same time, citizens as a whole are receiving better information on healthcare issues, indirectly pushing national health systems to provide them with better quality and safety. • Cognizant 20-20 Insights cognizant 20-20 insights | august 2013
  2. 2. 2 European Healthcare Systems Challenges European governments face a growing number of major health challenges that place unprecedent- ed pressures on public health systems. As main actors responsible for the delivery and financing of healthcare, generally based on the principle of social solidarity, national governments need to define policies to best address these challenges and mandate the relevant non-health sectors to implement them. Despite limited compe- tencies with regard to health, the EU can facili- tate change by encourag- ing cooperation among member states to fund health programs and rein- force internal market rules. The ageing population, health inequalities and the social determinants of health, however, present significant challenges to healthcare systems that in many cases go beyond medical ailments. Ensuring a multilevel and holistic government response will be important in tackling these challenges. The consideration of quality in healthcare requires an examination of the different dimensions of quality, the impact of rationing devices, professional organisations and new models of healthcare delivery. Equity of access remains a central tenet of Euro- pean healthcare systems but raises complex ques- tions on equity, compre- hensiveness and financ- ing, as well as placing the principle of social solidar- ity under increasing pres- sure. Healthcare costs have steadily increased in recent years — e.g., UK spend as % of GDP increased from 3.4% 50 years ago to 8.2% now, and is predicted to con- tinue to increase,1 although this is not necessar- ily driven by increased need. Cost-effectiveness, value-for-money considerations, pharmaceuticals pricing, new technologies and diversity of provi- sion are all important elements in exploring ways to reduce health costs. While states remain the main actors in healthcare policy in Europe, EU policies and law can influence healthcare delivery, particularly when considered in terms of the interrelation between health and other sectors. While internal market rules ensuring the free movement of people and services can challenge domestic health sectors, there are also tangible benefits and opportunities for collaborating at the EU level, not the least of which is the potential for coordinated policy. Patients are increasingly a major cost driver of healthcare systems. This occurs in two ways. First, access to online information about every aspect of health makes individuals more savvy healthcare consumers and more inclined to demand the latest (and likely expensive) medical innovations. Patients make these demands because they suspect that cash-strapped healthcare systems are unreasonably denying them the medical care they need. Second, the spread of unhealthy lifestyles is driving up medical costs. For example, a high- calorie, fast-food culture has fed an epidemic of obesity, which in turn provides fertile ground for other diseases to develop, such as type-2 diabetes. The Foresight Report (2007), a government study in the UK (where levels of obesity are already among the highest in Europe), predicted an increase in excess of 60% in obesity-related diseases between 2005 and 2030.2 Preventive measures will become more important as a way of promoting healthy behaviour. The World Health Organization (WHO) noted in 2005 that at least 80% of all cases of heart disease, stroke, and diabetes are preventable. This requires lifestyle changes, which can be influenced through a combination of public education, pricing, taxation, and various incentives and disincentives. In terms of prevention and early detection, most countries are trying to combat chronic conditions by experimenting with various programs. These approaches aim to reduce the burden of chronic disease through activities that avoid impairment to health, or make it more unlikely. Overall, prevention and early detection programs are promising, but far from well-devel- oped in most countries. Given the severe medical, social and economic consequences of chronic diseases, more effort and resources need to be invested in prevention. cognizant 20-20 insights The consideration of quality in healthcare requires an examination of the different dimensions of quality, the impact of rationing devices, professional organisations and new models of healthcare delivery. The spread of unhealthy lifestyles is driving up medical costs. For example, a high-calorie, fast-food culture has fed an epidemic of obesity, which in turn provides fertile ground for other diseases to develop, such as type-2 diabetes.
  3. 3. Healthcare Information Technology Healthcare information technology (HIT) can be defined as ‘technology used to collect, store, retrieve, and transfer clinical, administrative, and financial health information electronically’. Brailer and Thompson explained that HIT can be defined as ‘the application of information processing — through computer hardware and software — to the storage, retrieval, sharing, and use of health care information, data, and knowledge for com- munication and decision making’.3 In accordance with the increased attention to patient care, new devices and technologies have provided more accurate information about patients for better healthcare delivery. Informa- tion technology plays a significant and evolving role in managing information. During the last decades, various aspects of quality management have been introduced into healthcare organizations, and the notion of HIT has arisen as a way to dramatically change the entire healthcare landscape. Healthcare providers have applied diverse technological innovations that have influenced both clinical and administrative aspects of the delivery of medical services. HIT includes a variety of integrated data sources and has been shown as a solution that improves patient safety and reduces inef- ficiencies. Therefore, HIT has great potential to improve the quality of care, to support healthcare IT infrastructure and to save administrative costs. A recent NHS England report, ‘The NHS Belongs to the people: a call to action’, discusses a potential £30bn funding gap by 2020/21.4 This report cites the need to focus on prevention, and asserts that to be successful the NHS will need to focus on harnessing transformational technology, exploiting the potential of transparent data as other industries have. Benefits of HIT In recent years, greater attention has been paid to the quality of healthcare. Numerous complaints have been aired (publicly and privately) that patients often do not receive proven therapies or preventive measures, and that the rate of pre- ventable medical errors remains high. Healthcare organisations are now focusing on understand- ing how providers, patients and policies, and the factors they influence, can affect the quality of care. This includes the training of healthcare personnel, improving delivery system processes, and attention to systemic level factors such as technologies and medical records. The specific benefits of HIT are detailed below. Medical Error Reduction The Agency for Healthcare Research and Quality (AHRQ) noted that insufficient or improper point- of-care treatment information is a frequent and significant cause of medical errors.5 Com- munication problems and a lack of access to information can cause most medical mistakes. Therefore, new information management technologies must be implemented and smoothly integrated within the existing healthcare infrastructure. According to studies, HIT also decreased medical errors by improving medication dosing with such treatments as antibiotics and anticoagulants.6,7 Adherence Support HIT can improve the quality of care by increasing adherence to guideline-based care. Decision support functions that were embedded in electronic health records (EHRs) and computer- ised physician order entry (CPOE) are parts of adherent studies that show the effect of HIT on enhancing preventive healthcare delivery. Effective Disease Management In addition to the ben- efits mentioned above, HIT systems also offer enor- mous potential in improving clinical decision-making and disease management. Effec- tive disease management provides healthcare services with analysis of relevant data and cost-effective tech- nology to improve the health outcomes of patients with specific diseases. According to one article, for example, the use of HIT systems was found to increase documentation advice and recommendations for laboratory testing and treatment.8 Efficiency Saving The pursuit of efficiency has become a central objective within most healthcare systems. Efficiency mandates aim to achieve equivalent performance with fewer resources. Through 3cognizant 20-20 insights HIT includes a variety of integrated data sources and has been shown as a solution that improves patient safety and reduces inefficiencies. Decision support functions that were embedded in electronic health records (EHRs) and computerised physician order entry (CPOE) are parts of adherent studies that show the effect of HIT on enhancing preventive healthcare delivery.
  4. 4. cognizant 20-20 insights 4 the adoption of HIT, healthcare organizations can potentially reduce healthcare professionals’ administrative time such as documentation-relat- ed nursing time, the delivery of treatment through CPOE and reduced hospital stays resulting from increased patient safety and the coordination of patient care. Remote Patient Monitoring An increasing number of adults over 60 years of age are challenged by chronic and acute ill- nesses and/or injuries. A Center for Technology and Aging report explains that ‘chronic disease management, post-acute care management and safety monitoring are three important applications of remote patient monitor- ing (RPM) technologies for the older adult population’.9 RPM technologies have an important role to play in chronic disease manage- ment, slowing chronic disease progression and ensuring continued recovery after the patient is discharged from an acute care setting. RPM tech- nologies could be utilised with alert systems, to prompt intervention from the patient’s physician when preset disease management criteria are met. For example, if a patient’s blood pressure is above a predetermined dangerous threshold for three days running. The five steps of a remote patient monitoring system are: collect, transmit, evalu- ate, notify and intervene. RPM technologies are devices enabled with wire- less communication that are able to collect and send a patient’s clinical data. This may be an individual device, one that monitors blood glucose levels for example; an individual device that is able to monitor multiple physiologi- cal parameters, blood glucose levels and blood pressure for example; or a series of integrated devices, each able to record a different aspect of a patient’s physiological parameters. Data is then packaged, delivered and received by patient- selected providers, family caregivers and clini- cians via different modes of communication. Once the clinicians have evaluated the data and made decisions as to the actions needed, notifica- tion of those decisions and actions to be taken is transmitted to those who need to act. That may include the patient, other clinicians, family, pro- fessional caregivers or other parties. They can then take action if an intervention is needed. The Wonder of Telehealth and Telemedicine Telehealth is a healthcare service, consultation and expertise delivered via a telecommunica- tions medium, over any distance. Telehealth adds a new paradigm in healthcare, where the patient is monitored between physician office visits. According to a paper by Noel et al., telehealth has significantly reduced hospitalizations and visits to the emergency room, while improving patients’ quality of life.10 And the Whole System Demon- strator Programme showed that telehealth can deliver a 15% reduction in A&E visits, a 20% reduction in emergency admissions, a 14% reduction in elective admissions, a 14% reduction in bed days and an 8% reduction in tariff costs. More strikingly, they also demonstrate a 45% reduction in mortality rates.11 Telehealth also benefits patients where traditional delivery of health services is affected by distance and lack of local specialist clinicians to deliver services. The advantages of telehealth services include improvements in patient access to medical data, patient health outcomes and decision-making, and reductions in healthcare costs, travel time, redundant diagnostic procedures or tests and patient waiting time and eventually heightened early diagnostic, administrative, and communi- cation capabilities. Implementation of telehealth could have other non-health-related beneficial impacts. For example, telehealth can lead to reduced travel from both patients and physicians, thereby delivering a greener solution. The function of a telehealth network is to establish the link between the individual telehealth device and the decision-making unit. This will involve the electronic patient interfaces, repositories that will be required to store generated medical reports, the patients themselves and an amalgam of healthcare personnel, services and providers. For some time now, technologically advanced devices are increasingly being deployed for telehealth. Telehealth increasingly utilises technologi- cal advancements in physiological and clinical recording equipment, wireless communications and mobile phone capabilities (both hardware and software apps). Each advancement has led to enhanced telehealth services. The five steps of a remote patient monitoring system are: collect, transmit, evaluate, notify and intervene. Telehealth has significantly reduced hospitalizations and visits to the emergency room, while improving patients’ quality of life.
  5. 5. 5cognizant 20-20 insights Emerging Healthcare Technology: Supporting Patients Beyond the Pill Adherence to prescriptions is critical to optimal treatment and outcome. However, taking the right dose of the prescribed medication at the right time can be a challenge, particularly for older patients taking multiple medications. The World Health Organization (2003) defines adherence as ‘the extent to which a person’s behaviour — taking medication, following a diet, and/or executing lifestyle changes — corresponds with agreed rec- ommendations from a health care provider’.12 Poor medication adherence can have negative consequences for individuals, families and society because it significantly increases the cost and burden of illness. Wood highlighted that medication non-adherence contributes to 33% to 69% of medication-related hospital admissions and 23% of all nursing home admissions.13 McDowell and Barnett highlighted that in the UK medication contributes to 5% to 8% of hospital admission and readmissions, of which almost half (approximately 4%) are pre- ventable.14 A 2010 Department of Health report postulated that poor adherence to medicines contributed a significant amount of the estimated £150m wasted medicines cost the NHS each year. Moreover, the New England Healthcare Institute (NEHI) estimates that $290 billion of healthcare expenditures could be avoided each year if medi- cation adherence were improved.15 Medical and health experts have recognised the importance of improving medication adherence in delivering improved patient welfare and in decreasing health costs. Increasingly poor medi- cation adherence is often attributed to an ageing population with a parallel increasing occurrence of chronic conditions, and with many patients being treated for more than one condition. New healthcare technologies are seen as having a key role in improving adherence, leading to improved patient quality of life. Quick Take From a traditional baseline of transaction monitoring using basic reporting tools, spread- sheets and application reporting modules, an IBM Executive Report20 highlights that analytics in healthcare is moving toward a model that will eventually incorporate predictive analytics and enable organizations to ‘see the future’, creating more personalized healthcare and predicting patient behaviour. Medication Adherence Propensity Model • Business case: As earlier noted, data shows that as many as 50% of all patients do not adhere faithfully to their prescription-medi- cation regimens. The result is that significant money is spent on avoidable hospitalizations. Engaging and supporting patients to increase their adherence is critical for improving health outcomes and reducing cost. In today's system, however, there are neither the incentives nor the support systems to do so. Investments can be made to create a model that predicts the likelihood of patients not adhering to medication. Based on this, a personalised outreach program can be created that helps such patients. Predict Future Medication for Better Health Outcomes and Costs • Business case: Alerts are sent to a physician to inform him about a series of studies to dem- onstrate a connection between multiple rare mutations found in 10% of people and the likelihood that they might convert to type 2 diabetes. The physician has electronic medical records with the genome sequence of all his patients and runs a quick search (back-end analysis) and finds about 80 who are at risk. To 50% of patients, the physician sends a strong reminder and advice on diet and lifestyle choices they can adopt to avoid the disease. To the other half, whose medical records reveal pre-diabetic symptoms, he sets up appoint- ments to consider more proactive treatment with drugs that can prevent the onset of disease. Such accurate diagnosis, prognosis and treatment can save lives. Representative Analytical Use Cases
  6. 6. cognizant 20-20 insights 6 In a review of 102 articles, Jin et al.16 show that patients have many reasons for not taking medi- cations, such as cost, side effects, forgetfulness, cultural and belief systems, not feeling the need for medication, lack of concern for their condi- tion, poor family/social support and more. The NEHI report cited above states that reaching the improved health outcomes offered by medications depends on patients fol- lowing their prescription regimens. Patients with chronic conditions are especially vulnerable if they don’t adhere closely to these regimens. This is a huge concern for family member caregivers, who are charged with admin- istering and monitoring medications. Mobile-Enabled Diagnostic and Monitoring Devices Many diagnostic and monitoring devices are mobile-enabled — i.e., they communicate with mobile devices or have mobile capabilities them- selves. These peripheral devices can include sensors, accelerometers, remote patient monitoring technologies and environ- mental monitoring tech- nologies. Among other devices, mobile-enabled diagnostic and monitoring devices have more recent- ly been incorporated as part of current mobile devices (e.g., cell phones) or have been given the capacity to communicate with mobile devices. The Center for Technol- ogy and Aging highlighted that m-health devices and technologies with mobile components may aggre- gate multiple forms of patient health data or may provide a platform to access this data.17 These devices may also be used to send alert noti- fications based on patient health information or treatment needs. As health data and programs continue to move toward cloud-based systems, these mobile devices will become even more capable and convenient ways to view, access and enter health diagnostic and monitoring informa- tion, promoting anytime, anyway healthcare. The recent expansion of mobile and communica- tions technologies within health service provision has created a plethora of opportunities to deliver innovative, interactive health services to patients, clinicians and patient-caregivers alike. These technologies can assist all users with obtaining proper medication information, patient education, medication organisation, dispensing and dose reminders and notification when doses are missed. Technology Trends Influencing the Pharmaceuticals Industry Shifts in the behaviour of patients and healthcare professionals and emerging technologies are changing the relationship between pharmaceu- ticals companies and their traditional customers and creating new opportunities for collaboration — which will have a fundamental impact on the future success of businesses. Pharmaceuticals companies will be able to utilise emerging technologies — location-based capa- bilities and wide-scale use of smart phones and other 3G and 4G devices — to better engage patients and provide services and solutions that can improve their care and deliver better quality of life. For example, Merck Sharp & Dohme, the makers of Clarityn, created an application that forecasts the pollen count in a user’s vicinity, providing features such as an allergy calendar and store locator for anti-allergy medication — all with the aim of helping seasonal allergy symptoms.18 Beyond applications, technology can be used to collect patient data in real time — such as a blood glucose monitor that could detect dangerously high blood glucose levels and send this informa- tion to a smart phone. The devices could then sync and automatically make an emergency call to a specified healthcare provider, relative or patient-nominated contact. Fischer highlighted that there is a wealth of tracking, monitoring and outcomes behaviour that mobile devices such as smartphones and tablets will increasingly be able to collect, convey and aggregate.19 This data, coming in particular from medical apps, will represent a prosperous research resource that once anonymised can be mined for efficiency and effectiveness data by Merck Sharp & Dohme, the makers of Clarityn, created an application that forecasts the pollen count in a user’s vicinity, providing features such as an allergy calendar and store locator for anti- allergy medication — all with the aim of helping seasonal allergy symptoms. As health data and programs continue to move toward cloud-based systems, these mobile devices will become even more capable and convenient ways to view, access and enter health diagnostic and monitoring information, promoting anytime, anyway healthcare.
  7. 7. cognizant 20-20 insights 7 pharmaceuticals companies. Patients will be able to provide real-time data, with minimal inconve- nience that will aid patient care, research, efficacy and compliance. Increasingly, disparate streams of data, patient records and real-time patient data, health outcomes, financial infor- mation, genetic disposi- tion and at-risk factors will be brought together to deliver models and insights that will enable healthcare providers to make more informed decisions on which treatments deliver the most efficient and effective mode of care for both patients and the healthcare services that pay for the care. This information will be especially vital under healthcare reform and the current move to clinical commissioning groups (CCGs) in the UK, for example, which encourage better patient outcomes by enabling healthcare providers to commission services, based on quality outcomes and measures of that service. Using EMR data and e-prescribing information, physicians and healthcare providers can better track patient outcomes over the long term, a critical element for providers to demonstrate their performance and therefore the value they bring to the patient. Pharmaceuticals companies will need to collabo- rate on this front as well and use this targeted data to improve areas such as drug develop- ment, meet the needs of insurers and provide compelling evidence of a drug’s benefits. Opportunities for Pharma As we have discussed, healthcare technologies provide a number of obvious benefits for patients, healthcare systems and healthcare professionals; but what’s in it for pharmaceuticals companies? Pharmaceuticals companies face numerous challenges. Chief among them: increase revenues in an era of fewer blockbuster products. They also need to help governments reduce the cost of providing healthcare, deliver more support to healthcare professionals and demonstrate they are fully patient focused. If pharmaceuticals companies embraced new healthcare technologies and advanced analytics they could conquer all of these challenges. Pharma companies should look beyond existing patients and view the entire population as potential patients; moving their focus from illness, through wellness to well-being. To do this, they should develop, in partnership with specialist organisations, healthcare technol- ogies and advanced analytics that deliver multi- faceted benefits. These could help healthcare pro- fessionals identify citizens at risk of developing a disease; help these at-risk citizens manage their health so they don’t need drug intervention; ensure better compliance/health management for those patients already undergoing drug treatment, so the patient doesn’t need to be given a higher dose or more expensive medication; and provide healthcare professionals with real-time updates on the wellbeing of their patients, high- lighting potential needs for intervention. For example, a pharmaceuticals company may specialise in diabetes. Through the employment of healthcare technologies and analytics it could help keep at-risk citizens off diabetes medication both by helping healthcare professionals identify these citizens, and then by helping the citizens take preventive actions to minimize their risk of developing diabetes. It could ensure that those already on less expensive products, such as Metformin, don’t need to increase the dose or move to more expensive medication, and can reduce complications that would require expensive hospital visits. The above would meet all of the challenges previously identified, apart from increasing revenues for pharmaceuticals companies. These companies would then need to work with government healthcare agencies on ways to obtain payment when they can prove they have reduced healthcare expenditure — in other words, ‘outcomes-based pricing’. This isn’t as far-fetched as it might initially sound. Pharma- ceuticals companies already receive payment for certain drugs only when the drug has shown to have a benefit for a patient. Cimzia in the UK is one example. Under the Cimzia Patient Access Scheme, UCB will not charge the NHS for the first 12 weeks of treatment. Available data for Cimzia suggests that clinical response is usually achieved within 12 weeks of treatment. UCB will not charge the NHS for the first 12 weeks of Cimzia, so that the prescribing clinician can judge if a clinical response has been achieved and if continued therapy is appropriate. Pharma companies should look beyond existing patients and view the entire population as potential patients; moving their focus from illness, through wellness to well-being.
  8. 8. cognizant 20-20 insights 8 If pharmaceuticals companies adopt a stepwise collaborative approach — involving government agencies, healthcare professionals and patient groups — they could, through embracing healthcare technologies and advanced analytics, deliver what can initially appear as a disparate set of goals for all healthcare stakeholders. Looking Ahead Healthcare technologies are becoming ubiquitous, changing the way we communicate, collate infor- mation and provide care and services. A draft proposition paper by the Center for Technology and Aging17 proposes that some of the most compelling benefits of healthcare technologies are in the areas of disease prevention, chronic disease management and improving healthcare delivery. In addition to these benefits for patients, through providing more cost-effective patient care, innovative medical technologies can also contribute to a more efficient and targeted use of resources in healthcare, which also means increases in productivity. Other benefits of healthcare technology to the healthcare industry include much simpler access to data, and greatly enhanced storage capabilities for that data, statistically enhanced modelling and much greater insight driven by the ability to see patterns between what have historically been disparate data sources. Healthcare providers should also see the key benefit — that the infor- mation is patient-centric and should be accessible to all providers within a patient’s care pathway. Footnotes 1 Appleby, J. Spending on health and social care over the next 50 years. Why think long term?, London: The King’s Fund, 2013, http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/ Spending%20on%20health%20...%2050%20years%20low%20res%20for%20web.pdf. 2 Foresight, Tackling obesities: future choices—project report. London: The Stationery Office, 2007. 3 Brailer, D., and Thompson, T. , Health IT strategic framework, Washington, DC: Department of Health and Human Services, 2004. 4 NHS England, The NHS belongs to the people: a call to action, July 2013, http://www.england.nhs. uk/2013/07/11/call-to-action/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+ NHSCBoard+(NHS+England). 5 Agency for Healthcare Research and Quality,’Reducing errors in health care: Translating research into practice’, AHRQ Publication No. 00-PO58, April 2000. 6 Chertow, G. et al, ‘Guided Medication Dosing for Inpatients With Renal Insufficiency’, JAMA December 12, 2001, Vol. 286, No. 22, 2001, http://jama.jamanetwork.com/article.aspx?articleid=194455. 7 Evans, R. et al., ‘A computer-assisted management program for antibiotics and other antiinfec- tive agents’, New England Journal of Medicine, 1998; 338:232-8, http://medicina.med.up.pt/im/ trabalhos05_06/sites/Turma21/artigos%20-%20WEB/tiburcio%2010.pdf. 8 Shekelle P., Morton S.C., Keeler, E.B., ‘Costs and Benefits of Health Information Technology’, Evidence Reports/Technology Assessments, No. 132. Rockville (MD): Agency for Healthcare Research and Quality (U.S.), April 2006, http://www.ncbi.nlm.nih.gov/books/NBK37984/. 9 Center for Technology and Aging, ‘Technologies for Remote Patient Monitoring for Older Adults’, position paper, 2010, http://www.techandaging.org/RPMPositionPaper.pdf. 10 Noel, H.C., ‘Home telehealth reduces healthcare costs’, Telemed J E Health [Online] 2004 Summer;10(2):170-83, http://www.ncbi.nlm.nih.gov/pubmed/15319047. 11 Whole System Demonstrator Programme, ‘Headline Findings – December 2011’. Department of Health, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215264/dh_131689.pdf. 12 World Health Organisation. (2003) ‘Adherence to Long-term Therapies: Evidence for Action’, http://www.who.int/chp/knowledge/publications/adherence_report/en/. (accessed on 30 April 2013). 13 Wood, B., ‘Medication Adherence: The Real Problem When Treating Chronic Conditions’, U.S. Pharmacist [Online] 2012; 37(4) (Compliance suppl): 3-6, http://www.uspharmacist.com/content/s/200/c/33457/.
  9. 9. About Cognizant Cognizant (NASDAQ: CTSH) is a leading provider of information technology, consulting, and business process out- sourcing services, dedicated to helping the world’s leading companies build stronger businesses. Headquartered in Teaneck, New Jersey (U.S.), Cognizant combines a passion for client satisfaction, technology innovation, deep industry and business process expertise, and a global, collaborative workforce that embodies the future of work. With over 50 delivery centers worldwide and approximately 164,300 employees as of June 30, 2013, Cognizant is a member of the NASDAQ-100, the S&P 500, the Forbes Global 2000, and the Fortune 500 and is ranked among the top performing and fastest growing companies in the world. Visit us online at www.cognizant.com or follow us on Twitter: Cognizant. World Headquarters 500 Frank W. Burr Blvd. Teaneck, NJ 07666 USA Phone: +1 201 801 0233 Fax: +1 201 801 0243 Toll Free: +1 888 937 3277 Email: inquiry@cognizant.com European Headquarters 1 Kingdom Street Paddington Central London W2 6BD Phone: +44 (0) 20 7297 7600 Fax: +44 (0) 20 7121 0102 Email: infouk@cognizant.com India Operations Headquarters #5/535, Old Mahabalipuram Road Okkiyam Pettai, Thoraipakkam Chennai, 600 096 India Phone: +91 (0) 44 4209 6000 Fax: +91 (0) 44 4209 6060 Email: inquiryindia@cognizant.com ­­© Copyright 2013, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the express written permission from Cognizant. The information contained herein is subject to change without notice. All other trademarks mentioned herein are the property of their respective owners. About the Author Graham Parkinson is an Associate Principal within Cognizant’s Analytics Practice. Over his 16 years in the life sciences industry, Graham has led engagements related to promotional measurement; multichannel optimization and campaign management; BI requirements, consulting and solution design; and sales and marketing analytics. He holds an M.Sc. in operational research and management science. Graham can be reached at Graham.Parkinson@cognizant.com. Acknowledgment The author would like to acknowledge the contributions of Hemalatha A, a Senior Manager within Cognizant Analytics with over 10 years of experience in transforming data into meaningful and actionable insights primarily focusing on the life sciences and healthcare industry. 14 McDowell, A. and Barnett, N., ‘How improved medication adherence can prevent costly medicine waste’, HSJ [Online] February 2012, http://www.hsj.co.uk/resource-centre/best-practice/qipp-resources/how- improved-medication-adherence-can-prevent-costly-medicine-waste/5041067.article. 15 ‘Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease’, NEHI, 2009, http://www.nehi.net/publications/44/thinking_outside_the_pillbox_a_ systemwide_approach_to_improving_patient_medication_adherence_for_chronic_disease. 16 Jin, J. et al., ‘Factors affecting therapeutic compliance: A review from the patient’s perspective’, Ther Clin Risk Manag. February 2008; 4(1): 269–286, http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2503662/. 17 ‘mHealth Technologies: Applications to Benefit Older Adults’, Center for Technology and Aging, Draft Proposition Paper, March 2011, http://www.techandaging.org/mHealth_Position_Paper_Discussion_Draft. pdf. 18 Clarityn Allergy Pollen Forecast App, http://www.claritynallergy.co.uk/smartphone-landing.php. 19 Fischer, E., ‘Mobile revolution: how have drug developers embraced smart device technology?’, Phar- maceutical-technology.com [Online] May 2012. http://www.pharmaceutical-technology.com/features/ featuremobile-revolution-drug-developers-smart-device-technology. 20 ‘The value of analytics in healthcare: From insights to outcomes’, IBM Institute for Business Value Executive Report, 2012, http://www-935.ibm.com/services/us/gbs/thoughtleadership/ibv-healthcare- analytics.html.

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