Issue link: https://www.e-digitaleditions.com/i/1032386
12 OctOber 2018 Inhalation cerns may be addressed through effective notification systems, patient stratification methods and the use of central monitoring. Examples would be personal emer- gency response systems (PERS) such as Philips Lifeline and others, which have designed algorithms to help call center agents handle urgent situations efficiently. 14 Pharmaceutical manufacturers, distributors and phar- macies may be concerned that their competitors (including traditional stakeholders and new entrants like Amazon) could use data from medication manage- ment systems to secure commercial advantages. 15 In addition, connected inhalers may be impacted by the complex issues of data ownership, methods and security of data storage and additional data usage, as part of the larger issue of governance of person medical informa- tion. ese parameters vary widely in the US and other countries. No consistent or unified approach has yet been adopted. 11, 12, 16 Conclusion Patients who use inhalers and other stakeholders are eager for better solutions to improve outcomes. The most obvious and important benefit of connected inhalers is providing assistance for patients, which may increase their adherence. Connected inhalers may also help improve communication and treatment while reducing costs. Disclaimer and disclosures is article reflects the author's personal opinions and analysis. It is not a professional interpretation of any medical, regulatory or legal requirements. e author, the licensees to his intellectual property and his clients have interests in telemedicine and medication telemanagement. References 1. Elsivier. Respiratory Medicine. Inhaler competence in asthma: Common errors, barriers to use and recom- mended solutions. https://www.sciencedirect.com/ science/article/pii/S0954611112003587 (accessed June 20, 2018). 2. NCBI. Dove Press. Medical Devices. Inhalation drug delivery devices: technology update. https://www.ncbi. nlm.nih.gov/pmc/articles/PMC4334339/ (accessed June 20, 2018). 3. NCBI. Springer. Translational Behavioral Medicine. Self-report measures of medication adherence behavior: Recommendations on optimal use. https://www.ncbi. nlm.nih.gov/pmc/articles/PMC4656225/ (accessed June 20, 2018). 4. RDD Online. Connecting professionals and patients: How technology can support asthma self-management. https://www.rddonline.com/publi cations/articles/article.php?ArticleID=2285 (accessed June 20, 2018). devices prescribed for individual patients. is capabil- ity may assist manufacturers in obtaining real-world data to comply with post-market surveillance requirements. In turn, such data may provide proof of improved out- comes and support claims of inhaler value. Value-based purchasing and service models, which are becoming more widespread in healthcare, can be facili- tated by connected inhalers. A subscription model such as Amazon Prime could help suppliers in targeting prod- uct offers and managing products already purchased. An obvious objective for a pharmaceutical manufacturer is having patient and prescriber loyalty to the company's inhaler and brand once they have been prescribed. Con- nectivity may assist pharmaceutical manufacturers in better securing and maintaining loyalty, countering competition and competing more effectively. For payers Insurers, employers and patients are working towards solutions that improve outcomes and reduce the use of expensive medical services. Connected inhalers can help improve patient outcomes, in turn reducing emergency room visits, hospitalizations, face-to-face physician and healthcare facility visits, co-pays and other out-of-pocket expenses, thereby further decreasing the costs of care. Connectivity may also facilitate pay-for-performance models, which are becoming more prevalent for high- cost specialty pharmaceutical products. Possible concerns All stakeholders want assurance that connected inhalers will help improve patient outcomes. Articles are demonstrating that well-designed systems and the com- munications among stakeholders that they foster are achieving better outcomes. 7, 8 Improved outcomes can help decrease costs, which in turn, may address con- cerns about,"Who pays for connectivity?" Successful use of connected devices relies on users' abil- ities as well as their acceptance of technology. While this may be a greater concern for some patients in "older generations," articles are showing that those over age 55 (the average onset age for COPD) are becoming more knowledgeable about use of smart phones, 9, 10 which could increase their comfort and proficiency using connected inhalers. Patients, as well as family members and additional care- givers, may be concerned that their identities or per- sonal information may be stolen. ey also may worry that information generated by connected devices will be used inappropriately, for instance by insurers to unfairly penalize them. However, stakeholders in many fields are working to prevent unethical use of data and social media. 11 For example, the EU General Data Protection Requirements have recently gone into effect. 12 Healthcare providers may be concerned about receiving too much information from patients about their usage of connected inhalers, which can result in "alarm fatigue" or inefficient use of providers' time. 13 ese con-