How a Canadian Pharmacist Is Planning to Overthrow the Tyranny of Doctors
Roger Simard wants to monitor every patient with smart wearables.
Roger Simard likes wearables. When I met the digital health entrepreneur and pharmacist at a downtown office building in Montreal, he was wearing four on his right arm: two name-brand fitness trackers and two prototypes. After showing off his wristbands, Simard unbuttoned his dress shirt and pulled it apart, Superman-style, to reveal a form-fitting tracking top underneath. It's the same kind that astronauts wear, he told me.
Despite appearances, Simard doesn't have a bizarre attachment to redundant data. Rather, he's searching for the best tools to use with his medical tracking software, Pharmacie 3.0, which aggregates patient information from multiple different devices, wearable and otherwise, so pharmacists can track their biometrics remotely on an iPad app. After completing a pilot project in 2015, the program has launched in 15 pharmacies with 300 patients across Quebec. Simard, who made his fortune selling TheHeart.org to WebMD for $20 million in 2005, is now planning to roll-out to 350 pharmacies province-wide in September, and possibly across Canada shortly after.
On the surface, Pharmacie 3.0 functions as a compliance program. If a patient forgets to take her medication, the pharmacist will quickly spot the anomaly in the datastream from a connected device, such as a glucometer or a blood-pressure monitor. The pharmacist then contacts the patient or sends a notification.
But Pharmacie 3.0 is also part of a broader trend in healthcare that proposes to shift power away from the physicians by giving patients more tools to manage their own health.
Traditionally, if you have a concern, you take it to your doctor and let her take care of it. As a patient, your job is to do as you're told and not ask too many questions. But, with the advent of new health tracking technologies, the model of handing your problem over to a physician has become obsolete, Simard claims. "It doesn't work…You need people to be empowered with their data," he told me.
And it's a well-known fact that many people abandon their trackers after only a couple months, but Simard argues that when a healthcare professional is involved, such as with Pharmacie 3.0, it keeps people engaged. "You need a pharmacist or a physician in the equation," he said.
Being able to visualize your health on a dashboard also helps. "You can tell somebody that their cholesterol went from 2.4 to 4.3, and it means fuck all," Simard said. "But when you show them that they went from green to yellow to red, and that's what happened when they stopped taking their medication, then they're going to start taking that medication again."
Tracking software holds potential beyond patient engagement. Sometimes, it can replace the doctor entirely. Simard told me a story about how his data analyst identified a condition called atrial fibrillation (a type of heart arrhythmia) in one of the program's participants, based on blood pressure data collected from a wrist monitor. The man's doctor had failed to make the diagnosis, and it wasn't until he went for a second opinion based on Simard's findings that he was prescribed the appropriate medication. "I can't make medical diagnoses as a pharmacist, but we were able to do it anyway," Simard told me.
The Quebec government supports these shifting dynamics. In June 2015, a law came into effect that allows pharmacists to do certain jobs that used to be the exclusive domain of doctors, such as prescribing medication for already-diagnosed conditions, or ordering and interpreting lab results. The new bill lets pharmacists adjust patients' medications based on whether or not they are reaching their therapeutic targets—that is, if their bodies are spitting out the kind of numbers the doctor wants them to.
"Most healthcare professionals are opposed to change, because the status quo is really lucrative."
But in order for pharmacists to fulfill this role, doctors have to share those target metrics, and Simard has found that many physicians prefer to keep the numbers to themselves. In fact, physicians often don't even reveal those quantified health goals to the patients who are supposed to achieve them, Simard says, which he compares to driving without a speedometer.
The digital health futurist Fard Johnmar calls this the Information Divide. "The physicians have the information traditionally, and the patients have not been able to get it," he told me over the phone. Historically, this divide was created as physicians tried to distance themselves from quacks and con artists by building a rigorous system of accreditation and expertise, he argues.
Today, doctors sometimes take a defensive stance against patient data for roughly the same reason: because apps and devices can be the digital equivalent of snake oil. The data generated by a FitBit, for example, is meaningless from a clinical perspective, says Johnmar. (For now, anyway.) The last thing a doctor wants to do is argue with a patient about why some internet-derived diagnosis is a load of crap. But there are plenty of FDA-approved wearable devices that offer medical-grade data, and a whole lot more are on the way.
Ideally, patient engagement with data will free physicians to do what they do best. "If you accept a model where the physician is really considered the pinnacle expert in the system, then they're only dealing with stuff that requires their attention," Johnmar said. This way, everybody practices at the peak of their licence, and patients don't have to deal with long waits for a tiny time-window with a doctor to deal with a simple problem, which a pharmacist could solve.
"We don't want to do this in a vacuum," Simard told me of his plan to make healthcare more digitally connected. "We want to do this collaboratively with the physicians and nurses."
But Simard hasn't found the transition to be smooth. "Most healthcare professionals are opposed to change, because the status quo is really lucrative," he said. "Empowering patients with their own data means they will need you less."