Meet the Digital Apothecary

Pharmacy companies are an important part for Spencer Health Solutions, and pharmacists are an integral part of fulfilling our mission to serve patients in their homes. Hi, I'm Tom Rhodes, CEO, Spencer Health Solutions. We have had the opportunity to bring patient pharmaceutical and digital health thought leaders to previous podcasts. However, today we're speaking with our first pharmacist, digital health advocate and analyst, Timothy Aungst, also known as the digital apothecary. He joins our host Janet Kennedy for an insightful conversation and a call to action to the pharmacy industry on the People Always, Patients Sometimes podcast.

Janet Kennedy: (00:45)

Welcome to People Always, Patients Sometimes. I'm very excited that today's guest is Timothy Aungst, the digital apothecary. He is an associate professor of pharmacy practice and also a clinical pharmacist. Timothy, welcome to the podcast.

Timothy Aungst: (01:03)

Thank you, Janet, I'm really excited to be here today to talk about, you know, all this stuff that's been going on.

Janet Kennedy: (01:08)

It's been a crazy couple of years and that's one of the things that I wanted to talk to you about. I found you because I read your primer, "Digital Health Primer for Pharmacists." You published it in February of 2019. At that time you wrote, "after being involved in the digital health space for almost a decade, I can say with complete sincerity, that the topic is still relatively out of the realm of the general pharmacy profession grasp." Okay. You put a challenge out there. 10 years you've been involved in digital health and you're saying pharmacy is still not up to speed. Would you say that that's true two years later?

Timothy Aungst: (01:52)

Yes. I still would stand by that. I would argue that we have seen entrepreneurship within the pharmacy profession gravitate towards digital health at large, but I would also conversely say that as a profession for pharmacists, we have not really actually actively engaged in this area. We still lack a large number of educational roles and trying to get people aware of the space. There is a lack of discussion around it. Most of our public organizations that provide guidance on what our next steps for the profession don't really think about it in, I think it's for that reason, I still would say the gap is there. Now that is changing. I would say that there has been a semi call to action amongst several pharmacy organizations, whether it's say PHA, ACP and several others who are now trying to get the profession up to speed on what digital health is.

Timothy Aungst: (02:44)

And that's been a big focus of mine serving as so-called subject matter expert or key opinion leader to help get information out there regarding the topic. But very, at this time it's quite topical just because we are not actively highly engaged with it. I would probably say we're maybe like two or three years behind other healthcare professions, such as the medical community. The American medical association has an active digital health component that they've been pushing, I would say probably for about two or three years at this point, have reports coming out, organizations associated with it. And I think pharmacists have to play catch up to that. And depending on key stakeholders at this current time that may or may not go fast or may go slow. And that's one thing I'm actively keeping my eye on.

Janet Kennedy: (03:27)

Well, I'm curious about whether pharmacists or the pharmacy is even included in some of this digital health development.

Timothy Aungst: (03:36)

I'm always a person who would've actually separate the two. The pharmacist and the pharmacy, I think are no longer synonymous organizations. You don't need a pharmacy to have a pharmacist. I think it's going to be what we see in the 2020s or 2030s at this point. I think those two things will actually diverge and that will just come down to logistics and also some legal parameters I think people are pushing right now. Technicians will be empowered to take on most of the stuff on site and pharmacists will probably feel remote. That being the case then to accomplish that, and also to get pharmacies up to speed where healthcare is going, I think the pharmacy businesses will engage in digital health activities. For good or for bad. The big news right now, right, is that Elizabeth Holmes is in court with Theranos. And if we look at Thernos, who was one of the biggest backers? That was Walgreens. And I always looked at what happened with Walgreens being burned there is a reason why they actually had a huge number of digital health initiatives back in the 2010s. And I think they pulled back because they got burned so heavily.

Timothy Aungst: (04:31)

In the meantime, we see, let's say a business like CVS Health going down a whole vertical pipeline. Now we got Aetna involved, we got long-term care stuff, we got them pushing to go into kidney disease with dialysis treatments. They are partnering up with digital health companies all over the place. One of the biggest ones, for example, was Sleepio for a digital therapeutic that they've been piloting out there, which has actually initial positive results I'm actually reading through right now. So some of these companies are more involved than others. And I think it's going to come down to, you know, what assets they have to really push that. Whether they see the market going a certain way and they want to meet consumer demands because they are also aware of that, with the changing dynamics within healthcare, pharma is going down the digital health path. Payers are looking at this. Employers are looking at this and even the big tech companies are pushing this stuff out there. So are they going to let other people dictate to them the incumbents of what to do, or are they going to be the drivers themselves? And I think that's going to be something that's going to be interesting to watch.

Janet Kennedy: (05:34)

Well, so you mentioned the need to separate the pharmacist from pharmacy. So speaking from the individual's perspective, do you hear pharmacists talking about wanting more and better tools to be able to help their patients or are they just basically the Amazon employee at the warehouse where they're just cranking out the work?

Timothy Aungst: (05:57)

See, I used to think we're still on the razor's edge between two possibilities: one was pharmacists finding some kind of clinical services they pay for under some, say, value-based care agreements. And by providing clinical services would receive renumeration that would allow them to be so-called clinicians in health care. Or the other one was being fully remote and being consigned to these activities, to these virtual workshops where they basically just review medications that have been turned out by Amazon or other companies like true pill, et cetera. There might be a third path, which is a mix between the two. And that's kind of where I'm more leaning towards right now from a pharmacist perspective. Yes, there is a huge interest in digital pathway as a means to basically call back clinical services and kind of like be able to provide services that could then actually have objective feedback in terms of what they did, that they could then bill for services and, you know, make money from it.

Timothy Aungst: (06:51)

But I don't know if that's going to be enough at this current point to actually say, "oh, well, you're now a remote clinical pharmacist that overviews these data's on people's adherence or their information on disease states, and you get this much," because one of the issues is actually even though they're like remote patient monitoring services that we're seeing CPT codes being pushed up by CMS and such, they're in the physician still. So the pharmacist almost has to still be partnered with someone else in order to receive the renumeration. And then at that point in time, you know, it was kind of like, what slice of the pie are you going to get? And I think that's really what concerns me is that from a healthcare perspective, the pharmacist is still really trapped in their other engagements, which has traditionally held us back. And I think this is because we again have very little stakes in digital health and we were coming to the table kind of late. The other people have already kind of figured this out and have already been making inroads. Making propositions to other organizations to get themselves ahead. And we're kind of almost, I don't want to say asking for crumbs, but we're going to have to really do our best claw back some of this stuff for ourselves. And that's going to delay, I think those aspects.

Janet Kennedy: (07:56)

And do you see the trade associations being the ones that should be leading this charge?

Timothy Aungst: (08:01)

I think the trade associations unfortunately all have different stances out why they would want to engage in this stuff. The trade associations value pharmacists to different extents. And within a pharmacy community, we know with the alphabet soup of different pharmacy organizations, they don't all have one central voice. They don't all have one central take on what is the role of pharmacists. I've heard some people say we have a pharmacist practice at the top of their license. I don't know what that means. To be quite honest, whenever I hear that I kind of have to roll my eyes, because what is the top of their license? I think in their eyes probably is just, you know, sending off for prescriptions. So that's great. That's what they see as the business that they have to focus on. I could see definitely some trade associations making an argument to empower technicians, to move back at scale back the role of the pharmacist as a, you know, as a rate limiting step in terms of evaluating prescriptions and getting them out the door.

Timothy Aungst: (08:53)

And also because there are high cost margin right there, and that would reduce the overhead versus some other trade associations are definitely more clinically focused and would push that down too. So within pharmacy, the unfortunate thing right now is there are some tenuous arguments going on about, you know, who has the right step for the profession or which to be used, how to utilize them. And I think those are the conversations, the hard conversations to have to occur now versus later, because this whole approach of them to let's say digital health and such could become very fragmented. You could see some people that operate large corporations would probably want to use digital health for alternative means versus maybe some smaller companies. And I think that's going to really, for me, I have to bemoan them is that's gonna really muddy the waters and I guess, slow down the process of any adoption by the profession. So yes, I think the trade professions will probably be key here, but I would also, or you, because historically they don't always get along or had the same thought processes that this is going to be another area. That's going to be a sticking point where argue about how to do this.

Janet Kennedy: (09:57)

You know, I find that health care was still slow to come to digital tools and platforms. I'm curious to know whether, with your ear to the ground, do you find that patients are pushing their desire for digital health into the healthcare system? And do you find that that's being impacted or felt on the pharmacy side?

Timothy Aungst: (10:21)

And this is a good question because you know, who's the drivers for change. I think it's one of the things that always comes up. Patients are often said to be one of the major drivers, and I do believe that to a certain points payers are probably one of the biggest drivers I would argue though, overall, because they ultimately are paying the money. Patients themselves are vocal population that can dictate those favorable or unfavorable role, lots of different programs and services at the end of the day. So from that perspective, I think with the ongoing pandemic, we saw this huge push for, you know, delivery of services for the ability to have a so-called digital front door. And you know, what was in the news the other day was that Walgreens got in trouble apparently because they're whole vaccine signup and testing site wasn't secure. And the data is now - someone's getting into it. And this, I think is going to give some feedback to people like, you know, if we have to do remote practice, sign up and go through an app or make an account and et cetera, but you can't even keep my data secure - Is that good or bad?

Timothy Aungst: (11:17)

You know, is that a company I'm going to trust? And those are the things that they're hitting people now it's not so much like, oh, you know, I have a brick and mortar business. People come and buy things and they leave. I just had to worry about the credit cards now I have to worry about their online accounts. I have to worry about health history that's been uploaded or shared. This is definitely a new area I think people are considering. Hospitals and health systems have been dealing with this for years. They've been getting hit by malware attacks for a long time. Now people will ask you for cryptocurrency just to unlock their systems, for goodness sake. And because of this, the population does expect a digital front door, digital services. And I think ultimately businesses have had to pivot to address an answer to that.

Timothy Aungst: (11:57)

But I don't think they traditionally had that as a, you know, as something that is a high concern for them in the pandemic was a force multiplier that really had to make them rush into, this for good or for bad. I mean, the pandemic is going to go on for awhile. We're going to see this go up in waves, in different parts of the United States. So these companies are going to have a long time to pilot certain programs, but I think many of them have recognized, no matter what, post pandemic, this is going to be a status quo. So whatever works now has to work in the future as well.

Janet Kennedy: (12:27)

Well, certainly the pandemic has made a lot of things happen faster; that we have seen an acceleration of the interest in some kinds of digital health, particularly tele-health, which sounds new to a lot of people, but it's been around for 20 years. And I know you've been around in the digital health space for over a decade. So let's step back for a second. Could you tell me a little bit about the digital apothecary and why did you start it?

Timothy Aungst: (12:54)

Sure. So the digital apothecary was kind of like just a little passion product, a little thing that I spread out based on my interests. So I started off as a resident during my PGY1. I got an iPad in 2011. So keep in mind the iPad came out 2010. So one of the things that I did was I actually started processing orders in the hospital using my iPad through Citrix. And this is funny because this is a period where we had so-called COWs, or computers on wheels, or WOWs, workstation on wheels, as they're often called now, and people would argue over these things to process orders in the hospital, et cetera. And I just basically started using my iPad to do all this stuff. And people started catching attention, like why is he doing this stuff faster? He's looking for information faster in there and blah, blah, blah.

Timothy Aungst: (13:36)

And I was like, yeah, cause I had this device that can do this. I start thinking of something, what is a good app? What is a good thing? And so I started reviewing and looking at stuff and then I joined another group called iMedicalApps and we start reviewing mobile apps. We actually wrote a bunch of papers about how to quantify what is and what is not a good app and to use clinically for patients in patient care. And we gave presentations all over place on this topic. And that was a huge thing for me. And this was when it was mobile health that was my focus. And then circa 2014-15, I moved on to just the bigger digital health space and started writing for different organizations and serving as a speaker advisor consultant for different companies actually were asking a lot of these questions. The years I started thinking with remote patient monitoring, questions about tele-health, pharmacy, how to adopt medication adherence is a big one for me as well.

Timothy Aungst: (14:20)

And it kind of really changed my thought process in terms of like, you know, this stuff's just kind of adjunctive to care versus, okay, this is going to be actually part in driving care. Eventually digital health, I kinda thought to myself, is just a interim term. I think digital health eventually turns into just health. It's kind of the same period we went through with like digital banking. We don't call it digital banking anymore, we just call it banking. When you go onto your app cash or check or use Venmo, like no one calls it really digital banking. I think that's where healthcare is at. So I noticed there wasn't that many people around the space. There is one person I look up to is Kevin Clawson, who's now into blockchain for healthcare down at Lipscomb. He was a great mentor for me early on. And it was a few other people I've talked to them such as Brent Fox about this too.

Timothy Aungst: (15:01)

And, but the reality is in the academia circles, that generally there was not a lot of pharmacists, I think, into digital health or into this technology thing. So I kind of got into it, talking about it. I had a lot of people say this was like a waste of time. And I really had to take a thought for myself academically - do I really want to dedicate all my time towards investigating and research in this space. Or should I start moving towards something else as an academic? And I chose to keep on it. And I'm actually pleased because now with the, you know, things are really changing the payment like that, people really want to talk more about it. People aren't real into telehealth. And they were like, who even knows about this in pharmacy? Then my name comes up because that's been something I've been talking about for so long.

Timothy Aungst: (15:39)

People are looking at different digital health technologies and like, okay, who's in digital talking about, oh, Timothy's talking about it. Timothy's been talking about it for so long now. So it's kind of just in many ways for me, unfortunately, the pandemic has been a driving force around trying to actually get my message out more than it was in the past. I think if the pandemic had not happened digital health would not have seen the rampant advancements that it has, and probably would have been towards the tail end of 2020s that I foresee that would have taken off in versus the early 2020s at this time.

Janet Kennedy: (16:09)

One of the things you mentioned in your primer was that digital health definitely isn't informatics. Can you tell me what you mean by that?

Timothy Aungst: (16:20)

Oh, this is, this is, this is a good one. Okay. So this is unbearably one of the hardest questions I had to deal with in terms of talking within my community. So there's always been a push in pharmacy, informatics, you know informational management information, using different data streams and such, EHR management, et cetera, et cetera. And that's been a group that's been around for decades. I would probably say early two thousands, 1990s. We saw them out there and there's always been pharmacy informatics people. And it's the, you know, the American informatics Association and such, or AMIA. But you know, when, when I started talking about digital health, one thing that I actually got in trouble with early on was people like, isn't it just informatics. I was like, what do you mean? Like this is technology. I was like, "technology is not synonymous with informatics." Informatics definitely plays a role in digital health and managing all the data streams that come down.

Timothy Aungst: (17:04)

But I would argue that the traditional informatics thought processes around management of health. It does not mean lik,e this whole digital health kind of ecosystem. And that's actually where I would have conversations with people like, oh, they'll get all this person, their informatics person, we have the conversation and people will talk about, you know, KPIs, C-Colon and different things in programming. And they'll be like, "Yeah, I don't do any of this stuff. That's not my business. I'm more interested in the clinical workflow design associated with this stuff and how to actually evaluate one technology versus another and blah, blah, blah." And so that does overlap. Yes, it does. But I think some people have assumed that, especially in pharmacy and for pharmacists, that informatics would subsume and take over digital health. And that's one area I'm not too sure on. I think some people may want that. And some people don't. I for one don't. I think informatics works within digital health space in that it's definitely a conversation and there's been other publications around this that kind of delved into a little bit more different therapeutic areas like oncology. But early on, It was very, very difficult actually to separate the two. I think at this time, most of it is separated, but I, that was a early conversation I had had with people.

Janet Kennedy: (18:13)

Okay. I'm interested in the amount of data that could be available through digital health apps and how a pharmacist might actually interact with that. So I'm really getting around to a conversation about adherence. Right now, when we think of adherence, it's the next fill - did you get the next prescription filled? But there's 30 or even 90 days in between those fills. If you had that data and it was daily, would a pharmacist be able to actually manage that information, and would they want to?

Timothy Aungst: (18:48)

So here is a loaded question. And I mean this, cause this is an area that I'm fully invested - I love this topic. It is too many stakeholders, I think we can go over in detail about maybe some, the big ones like, you know, who cares about adherence at the end of the day? You know, is it, the patient, is it the clinician, is the payer? I would argue payers recognize there's enough research out there saying that on average, a patient takes for medications, hopefully their diseases won't progress and they'll get better. Same with the clinicians and same with the patients who probably think that to a certain extent. But when we look at adherence data, if we look at HEOR and stuff like that, like what do they use as their metrics? Half the time it's like medication possession ratio, right? And I am not convinced that thing is actually really, really useful.

Timothy Aungst: (19:29)

I think globally? Yes. I think scalable factor for most organizations, that is the go-to way to doing this. And yet I think about all the patients that I visit in their homes that have boxes of medications still stacked away. And it's like, why are they getting it? Well, you know, I just buy it because I'm told I have to buy it. So you buy your medication and then you store it away, but you're not taking it? And you know, I can't help it go walk away and thinking back my head, like, you know, what? If they show up in a report, people are going to say they're adherent. I just walked into their house and they had like 12 Advair discuses sitting there, and their COPD is still not doing good. Why? No, they're not probably taking and using it correctly, right? But anyone else would probably see that and not make that tie together.

Timothy Aungst: (20:10)

So I think the biggest problem we've focused and seen in adherence is there's been no way to actually really assess if people have been taking their medications. So we argue about a topic that is potentially anywhere between $300 and $500 billion, which is really, I think, around medication optimization - which adherence is one of those things. But we've had very little quantitative data to back up our arguments. We've had qualitative data; but from a quantitative side, we've never really been able to scale. Even pharma has struggled with this in their clinical trials. You know, we've seen things like MEMSCAP and everything else out there for years trying to make a market here, and they've never really blown up. And then the 2010s, we had a flood in the market of all these different digital health devices because they recognize that stuff, but not all of them have been successful.

Timothy Aungst: (20:54)

And the question is why? And I think it's because we've come to realize that adherence is very, very, very challenging. Human behavior is very challenging. I think humans are very chaotic in terms of adherence and such. So it comes back to the key stakeholders, you know? Why does the pharmacy care about, you know, adherence? To me, if pharmacy cares about adherence, instead of talking about value for the pharmacy, is the more prescriptions that are dispensed equal more profits. So if a patient's taking their medication on time, theoretically and filling on time, then that profit margin, at least is correct - 12 refills a year for a monthly supply versus if they're not, then they're not refilling and then you're not billing and you're not making money from it. So as a pharmacy, clinicians I think also have kind of a mixed feeling around adherence. To be honest, I think this might be actually one of the biggest conversations that should occur is there are therapeutic areas where we want a hundred percent adherence or at least above 90%.

Timothy Aungst: (21:47)

There are therapeutic areas where I think we could be fine if people were not truly adherent. If you miss your Metformin a few days a month, am I going to care? Probably not? Your statin, and probably not? You know, and this comes down to, you know, how maybe severe a patient is, you know, how high their co-morbidity is. But there's certain diseases where, you know, what if I miss getting a biologic therapy by a day or two? Is I can really ruin me? Some day, we'll say yes. Some day we'll say no. But there's other therapeutic areas. Like let's say schizophrenia; you know, if they miss your medication, will it be problematic? Yeah. Probably. And the payers are going to be concerned about that. Cause that increases ER visits and hospitalizations, right? So often when we talk about adherence I feel like it's such a global issue that people focus on when it's very granular and it's really around different sensitivities associated with therapeutic areas that I don't really see a lot of people talk about, at large, associate with that technology.

Timothy Aungst: (22:40)

That technology always seems focused just on trying to solve adherence from a very global perspective. While I think clinically we've had a lot of research talking about adherence from a very small perspective in terms of what diseases and such does it really impact. And so there isn't this mismatch behind there. So there's a financial aspect, there is the clinical aspects I think. And then there's some design aspects, you know, solving adherence, you know? What does it take to do that? And is actually the money invested really worth it? I think it's one thing that's often not discussed like, you know, just because we can solve adherence; should we? And again, they come back to the fact that we blocked a lot of objective information in many ways. If this goes to your question, would we want to actually have this data?

Timothy Aungst: (23:21)

We are opening Pandora's box. We now know more about people's habits than we have in the past. So to gives some examples would be, let's go with inhalers. Propeller both have this interesting study where they evaluated people's utilization of inhalers and found them, I think they found 60, 80% of people were using their inhaler or Saba rescue inhaler incorrectly. Okay. That's actually really, really concerning, right? Because that's higher than what we probably have historically noted in research. Secondly, if these are patients that we've been signing off saying that they've been adherent or a technique is good, this really calls into question what and how well we've actually been approaching this area for decades. And I think that's actually one of the big things I'm actually concerned about. And I think many companies are kind of thinking about is, you know, we're getting a more objective information about people's habits than we ever had a past.

Timothy Aungst: (24:09)

And in many ways this could be good, or it could be downright terrible if we're not prepared for the ramifications that everything we thought we knew may be wrong. And I think that's actually an area that most of us may be concerned about because that calls in attention like; okay, we find out that we've been wrong and we've not doing things perfectly. That's great. Well now we've got to fix it. No fix is going to come out overnight. So solving adherence also probably means finding out this data and understanding it while also trying to solve the underlying questions about how do we address some of these issues? Thinking about it clinically, thinking about our workflow. So when pharmacists want to see adherence on a daily basis, I don't think that'd be a problem, but I would throw back then this, what is the value of it? What is the value knowing if someone took their medication on a daily basis? Do they skip through the center pro clinically, is that meaningful? Maybe, maybe not depending on how bad their hypertension is, right? Or maybe heart failure or some other condition? From a peer perspective then maybe yes. And then along with that though, could also be focused on the money that you get for people not refilling on time. So these are the things I think that need to really be questioned.

Janet Kennedy: (25:17)

Well, it's also the question of the firehose or the very specific stream of data that's relevant. So yes, any digital solution is going to gather all the information, but you wouldn't need all the information. What you would need is the alert that says based on the parameters for this patient, with these meds, now we need to worry about adherence and it could be on day four or five for a lesser impactful drug. It could be on day two for something that is of imperative nature that they take it. So that's the benefit of course, of being overwhelmed by analytics and informatics is that you can also then design the algorithm that sets the actions.

Timothy Aungst: (26:02)

And that is the biggest issue then at this time, because who decides what the algorithm looks like? And this is a question that I throw most companies. And when I actually hear back, is well do it. But do you actually have the clinical staff and know how to do it? That's the issue. So I'm actually very curious if a company will come along, and actually would build this in their backend. You know, like we already have drug information databases out there, right? You know, is someone going to make something like this that they could then sell out to other companies to then utilize? Are they going to build it in-house, or would these alerts be optionable for a clinical site or a business? That would be nice. But you know, if you gave me a package deal and say, "you know, we could default this or you can change it, whatever you want."

Timothy Aungst: (26:46)

Then I think that might change the conversation because it's just, you know, how many medications are out there? It's like, you know, NDC codes sitting on the shelf in pharmacies, enormous. So from a theoretical perspective, yes, this could be very possible. For practical perspective, who's going to build it and the timeframe it's going to take to build that is going to be enormous because the fact of matter is we can't build it because we don't know the data around some of this stuff, these questions. And that's the, that's a factor with Pandora's box. It opened up this huge conversation because we have the objective data to back it up now, compared in the past. But we don't know really, you know, what is the right answer? We don't know. If you go through like the literature and start like, you know, going into like pubmed and other things, how many days can you go without skipping his medication? It's not like there's gonna be a publication saying, oh, you can do this, this, this. That stuff doesn't exist, because we've never known.

Janet Kennedy: (27:34)

All right. Well that sounds like the call to action to the industry, is we've got to start talking about, you know, when you have this data from digital health, how are you going to apply it and make it be not just an endless stream of numbers, but something that is actionable that supports the patient's health journey?

Timothy Aungst: (27:53)

Actionable data is key. The when to have an action is the unknown. And this is where I think companies could freak out users; because it's easy enough for a patient to call me and say, you know, I've missed my medication past three days, and be like, okay, well you should take your medication or titrate back up, or let's have you in the off spot. And having the patients take that on. All right. Cause they self activated and they chose to do this. I didn't know that until they told me, right? So my liability or whatever we want to call it is limited on a patient discretion, because they own what happened to them. The minute you start putting this subjective information out there, that means the ownership and responsibility shifted to some group that never was responsible in the past. So to expect that people like selling them, want this data and use it, you may hear people say, no, not really.

Timothy Aungst: (28:43)

And if you peel back the layers, you'll probably eventually find out it's this trepidation around, "I don't know what to do with this data." And I don't really trust the company to tell me what to do with this data, because I don't know where they're pulling that from. So there's gotta be some kind of evidence-based approach around there, but where is the evidence? And then this is where the ground falls out from all of us is, that Aetna says it exists. And that to me, I think is the overwhelming issue around truly objectifying medication here is the fact that we don't know what to do with it this time. And it's very troubling. So for me personally, I think this is great. This is what we should do. Are we there yet? I don't think so. And I think one of the biggest problems has been, it's not the technology. It's not even like the process of logistics; I think it's the overloading clinical scenarios that we never really hadn't think about in the past, and who's going to be responsible for what?

Janet Kennedy: (29:37)

Okay. You have now laid some pretty big questions that could take us down another rabbit hole for at least an hour. So I'm going to hold those thoughts for our next conversation. And Timothy, just thank you very much for joining us on People Always, Patients Sometimes. Would you mind sharing how they can find you online?

Timothy Aungst: (29:58)

You can find me on LinkedIn, you can find me on Twitter. Usually just my name. If you look it up, you'll find it. My website, thedigitalapothecary.com is also out there where I write about a lot of stuff. A lot of it is theory crafting, a lot of it is focused on next steps and such or issues I see in the industry. So you're welcome to come and contact me and reach out.

Janet Kennedy: (30:17)

Excellent. Well, I think we're going to have a part two of this conversation. So I look forward to seeing you on the podcast again soon.

Timothy Aungst: (30:24)

Thank you very much for having me.