September 8, 2016
Calvin Knowlton, BScPharm, MDiv, PhD, is the Founder and CEO of Tabula Rasa HealthCare, based in Moorestown.
At Tabula Rasa HealthCare, you focus on ways to use technology to improve health care, particularly in the area of medication risk mitigation. How big a problem is this?
The elephant in the room in pharmacy is adverse drug events. CMS and the CDC have data showing that adverse drug events lead to more than 100,000 deaths each year. The problem worsens as people, many of them elderly, take five, six, ten or even 15 medications a day. And often these medications have been prescribed by more than one physician. The risk for complications can be high. We have to solve this problem.
So what does Tabula Rasa do for these patients?
We have proprietary, technology-enabled products and services for medication management and risk adjustment. Many pharmacists today use software that is decades old. The pharmacist can check for interactions only between one drug and one other drug. At TRHC, we can analyze how multiple drugs work together and how together they can cause problems. We can assess multi-medication prescribing. We can also use an individual’s genetic profile for insight into how he or she would metabolize certain medications.
What are the adverse reactions you are looking for?
We may look at the combined sedative effect. Or the combined dryness effect. Sometimes the patient will complain about dry mouth and the doctor may prescribe another medication to combat dryness without examining how the patient’s prescriptions may contribute to the problem. Medications that contribute to dryness may have serious health consequences for patients, impacting cognitive ability and, often, contributing to falls and hospitalizations. We try to get to the root of medication-related problems and work as advisors to the prescribers.
You also can create genomic profiles for patients. How does that help in combating adverse drug events?
When the body takes in a medication, it is like a poison the body must water solubilize, or make water-soluble. The drug with the highest affinity for a gene will be water solubilized first and the other medications will circulate around the body, perhaps creating an unintentional overdose. Something as simple as changing the time of day a person takes a particular medication can make a big difference. Or maybe you can switch to another class of medication that does not use that particular enzyme. It is all very complex. In most cases, our platform will assume a patient has a normal gene profile. In the highest risk patients, however, a cheek swab test will show us their specific DNA, as it relates to drug metabolism. This DNA test allows us to assess medication activation and metabolism at a much more precise level. We have teams of scientists, clinical pharmacists and software developers working on how to uncover and then mitigate the risk.
The focus in health care today is often on improving care while also reducing costs. Is that the case with Tabula Rasa?
Yes, absolutely. Sometimes we can reduce how many medications the patient is taking. But we also can reduce costs by improving care for the patient. Often there is no quarterback overseeing a patient’s entire medication regimen. The gastroenterologist may not want to change a medication prescribed by a psychiatrist, say, or by a neurologist. We know that by applying a novel, science-based approach to the medication-use process, we can help reduce ER visits, falls and hospitalizations. A patient with better care costs less. We think in several years that our software will be in every pharmacy school in the nation. What we are doing is part of the migration toward patient centricity in health care.
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