Healthcare In 2030: A.I. And The Shifting Role Of Your Pharmacist

The following is an article written by PrescribeWellness CTO Yesi Orihuela for the Forbes Technology Council and was first published here.

Imagine this: You wake up one morning with a sore throat and a fever. It feels pretty serious, so you decide you need some medical intervention. You open an app on your smartphone, access your electronic health record (EHR) and answer a series of questions. Based on your symptoms and visual evidence, the app determines that you likely have strep throat. It issues an order for a diagnostic test and sends you to the local pharmacy for a swab and treatment.

Or maybe it isn’t a sore throat. Maybe it’s a flu bug, or your child has a rash or an ear infection — you could still take the same steps as above. You don’t have to drive to the hospital and wait to be seen in urgent care. You don’t need to get your family doctor on the line. In fact, you may not even have a family doctor anymore — at least not in the way you do now. In this world, your local pharmacists are your frontline healthcare providers, and you see them often.

How and why could this happen?

Health care Costs Are Through The Roof

Compared to other high-income nations, health care in the United States is consistently ranked worst and most expensive by The Commonwealth Fund, particularly on measures of affordability, access, health outcomes and wealth equality. The average American spends more than $10,000 per year on healthcare — nine times what Americans spent on healthcare in 1960, adjusted for inflation. Out-of-pocket costs for individuals exceed $338 billion, and in spite of the fact that Americans don’t have universal healthcare, the U.S. government spends almost twice what the U.K. spends to run the National Health Service — the consistently top-ranking healthcare system.

A.I. Is Just As Good At Diagnosis As Human Doctors

While it’s safe to say that the future of medicine will likely never exclude doctors, their role in the future healthcare system may change dramatically. Earlier this year, Sebastian Thrun and colleagues published research in Nature, demonstrating that a deep learning neural network system was able to diagnose early-stage melanoma with comparable accuracy to that of human dermatologists. In terms of A.I. in health care, this is merely the tip of the iceberg.

Indeed, Thrun — a professor of computer science at Stanford perhaps best known for his work on self-driving cars — imagines a world, according to the New Yorker, in which humans are under near-constant diagnostic surveillance: “Our cell phones would analyze shifting speech patterns to diagnose Alzheimer’s. A steering wheel would pick up incipient Parkinson’s through small hesitations and tremors. A bathtub would perform sequential scans as you bathe, via harmless ultrasound or magnetic resonance, to determine whether there’s a new mass in an ovary that requires investigation.”

Some organizations, like the Human Diagnosis Project, are already using A.I. to get economically disadvantaged or otherwise underserved Americans virtual access to specialist medical care.

Community Pharmacies Are Already Important Healthcare Providers For Many Americans

About 30 million Americans — around 10% of the population under the age of 65 — lack health insurance according to CNN, and tens of millions more have inadequate coverage. Yet what all of these people do have is access to a local pharmacy. Indeed, community pharmacies already serve as the primary health care provider in many small towns across the U.S. This means that pharmacists are in an excellent position to not only play a more primary role in treating illness, but also in preventive care. The information, or “Live Data,” that pharmacists gather while having routine human-to-human interactions will work as a perfect complement to the technological monitoring processes outlined above.

Pharmacists consistently rank high in terms of patient trust according to Gallup (second only to nurses), and there are 36,000 independent and small-chain pharmacies across the nation (disclosure: is an app powered by, a startup I co-founded prior to joining PrescribeWellness) that already have the technology in place to deliver important preventive care services, such as: Diabetes prevention and maintenance, blood pressure monitoring and maintenance and immunizations and medication adherence (which is all by itself a $300 billion problem annually).

What’s more, a recent survey of more than 1,000 Americans over the age of 40 revealed that nearly half (46%) would prefer to pay cash for services at their pharmacy instead of a co-pay at a doctor’s office, and a full half would transfer their prescriptions to a pharmacy that provided preventive care services.

Obviously, some of the dots still need to be connected, as many Americans — and pharmacists themselves — still think of pharmacies as places where medications are dispensed and little else, and the technological infrastructure for how pharmacists can be reimbursed for important assessment, advice and other preventive care services is a work in progress.

The CVS Aetna Merger Is A Sign Of Changing Times

If anything signals the inevitable shifting role of the pharmacist from prescription filler to trusted healthcare provider, it’s the $69 billion acquisition of Aetna by CVS, which, as the New York Times reports, “would establish a new way of delivering care, with nurses, pharmacists and others available to counsel people about their diabetes or do the lab work necessary to diagnose a condition.” This is not CVS’s first move towards expanding its role and services to become a healthcare company — that happened back in 2007 when it purchased Caremark, a third-party pharmacy benefit manager program.

CVS has around 10,000 locations nationwide — just a fraction of the number of independent and small-chain pharmacies around the country. Imagine the impact of all of them continuing to expand their preventive care services and offerings. Imagine how convenient it will be when most non-acute medical problems you and your family face each year are treated right around the corner at the local pharmacy instead of at the hospital. Imagine a future health care system where you see your local pharmacist more than your primary care physician.

It’s right around the corner.


Why Community Pharmacies Are Not Susceptible To An Amazon Takeover

The following is an article written by PrescribeWellness CTO Yesi Orihuela for the Forbes Technology Council and was first published here.

In the 1990s, indie bookstores reeled as big-box booksellers like Barnes & Noble and Borders moved into towns from coast to coast. The David-and-Goliath struggle was even dramatized in the hit romantic comedy You’ve Got Mail starring Meg Ryan and Tom Hanks. In the movie, Hanks’ character suffers serious developer’s remorse when he simultaneously falls for Ryan’s character and — oops! — puts her family-owned bookstore out of business by opening one of his mega-chain bookstores around the corner.

The early to mid-2000s brought with them an even bigger Goliath: the internet and, more specifically, Amazon. One by one, the big booksellers went bankrupt, as e-reader and online book sales soared. But despite many doomsday predictions, the little guys stood. They’re still standing. In fact, they’re growing.

How is this possible?

Indie bookstores offer their customers something that neither the big bookstores nor Amazon will ever be able to offer: a personal connection with their customers. As a Publisher’s Weekly article put it, “Indie bookstores offer community, discovery and beauty; readers feel good about keeping their hard-earned money recirculating in their local communities.”

Likewise, many people are now predicting that brick-and-mortar pharmacies will go the way of the dodo as more and more Americans manage their prescriptions online and Amazon continues to eye the prescription drug and pharmaceuticals market. Chain pharmacies may pass, but, like indie bookstores, community pharmacies will stand. Here’s why.

Community Pharmacies Have Deep Relationships With Patients — And Amazon Never Will

Community pharmacies have what a drone can never deliver: face-to-face care.

Human interaction pays meaningful and irreplaceable dividends in improving a patient’s spirits and therefore their health. Whether that interaction comes in something as simple as a hug or handshake, there is no denying that injecting human touch into the health equation just makes patients feel better. Think of it as chicken soup for the soul … over the counter.

Interacting with a live person also uniquely positions community pharmacies to capture something I like to call “in vivo” or live data.

Live data is all of the information that pharmacists can gather in a face-to-face interaction that provides them with a broader portrait of the patient’s health. Instead of just remotely and facelessly filling prescriptions (like Amazon does), real-life pharmacists are in a position to ask whether or not a medication is resolving a patient’s problem, whether a patient is suffering any side effects (suggest ways to mitigate those effects), ask whether a patient is up to date on their vaccinations, and then even administer the ones they need.

An engaged pharmacist can also tell whether a patient is adhering to their prescribed medications and getting all of their refills on time (medication adherence is, incidentally, a $300 billion problem annually), and they can tell if a patient who sees multiple providers has been prescribed too many painkillers or prescriptions with potential drug interactions. More importantly, they can intervene.

Community pharmacists are on the ground, and therefore, they are able to help their patients manage chronic conditions — diabetes, obesity, smoking cessation and a host of other illnesses — as well as provide other critical preventive care measures that will keep Americans out of emergency rooms and out of debt. The importance of this cannot be understated, especially as the fate of the national health care system continues to remain in a state of uncertainty.

In short, community pharmacists, like indie bookstores, offer their customers a personal connection — they are more than just a means to fulfill a prescription.

Community Pharmacies Must Keep Going Beyond The Fill

This does represent a paradigm shift for many pharmacies.

Being local or family-owned is not enough to weather the storm. Pharmacies that will outlast the chains, mail order, shrinking profit margins and the Goliath in the wings (Amazon) must employ a business model that centers on its customer relationships and community contribution — not just on refilling prescriptions. In other words, community pharmacies must go “beyond the fill.”

The industry is shifting from a fee-for-service model (transactional refilling prescriptions and selling cough syrup) to a value-based one (i.e., How are your patients doing? Are your adherence levels going up?).

Despite the fact that many community pharmacies already offer direct delivery to patients, trying to compete with Amazon on strictly convenience (online ordering, for example) will not be enough. Amazon has an entire infrastructure in place to be the best at that sort of thing. Live data — that wealth of information that happens as the result of a human interaction and all of the opportunities to better serve the patient that arise as a result — is the thing community pharmacies have that Amazon never will.

Many community pharmacies already have deep roots in their communities and go beyond the fill every day as valued healthcare providers: those who don’t will want to consider how best to expand their role and shift to a patient-centric approach. As long as community pharmacies keep using human relationships to their advantage, there will always be a place for them — as there is for indie bookstores — even when Amazon comes knocking.

Aliso Viejo Town Center Envision Design Proposal

The City of Aliso Viejo has called for ideas to revitalize the Aliso Viejo Town Center. I’ve put together a design inspired by San Jose’s Santana Row and Los Angeles’ The Grove that include a Central Park, Train Trolly, plenty of walking areas, spaces for independent pharmacy Health Hubs and a dedicated bus route between Aliso Viejo and Laguna Beach.


My Proposal:

The Charret Design Videos:

Follow A Blog using Flipboard

I’ve written about how to follow a blog on flipboard before but wanted to do a single post for the HBX Core Blog as I’ll soon be starting HBX Core May 2016 cohort.

You can follow the HBX Blog or any other blog on your Flipboard app by searching for a blog’s rss feed url.

To find a blog’s rss feel url, either click on the blog’s rss link or icon if listed on the footer. If an rss link is not provided, simply right click on the blog and select View Page Source and look for “rss”.

You can follow me on Flipboard at


Top 21 VC Blogs Every Investor & #Entrepreneur Should Follow on @Flipboard


I ran into a great article on MostRead.In which provided a great list of must read vc blogs. However, with the article only supplying links to the blogs, I thought it would be great for Flipboard readers to have direct links to follow on Flipboard. Below are links to the blog’s hidden Feed URLs on Flipboard which I’ve created via the hidden trick to subscribe to a blog on Flipboad. Hope you enjoy!

  1. Fred Wilson – A VC
  2. Fred Destin: Open source venture capital
  3. David Skok – For entrepreneurs
  4. Jason Ball’s Techbytes
  5. Thomas Grota – A personal view on venture capital
  6. Jalak Jobanputra – The barefoot VC
  7. Chris Dixon –
  8. Tomasz Tunguz – ex post facto
  9. Paul Jozefak – Babbling VC
  10. Ciaran O’Leary – Berlin VC
  11. Christoph Janz – The angel VC
  12. Paul Graham – Essays
  13. First Round Capital – The Review – NO FEED URL
  14. Charlie O’Donnell – This is Going to be Big – NO FEED URL
  15. Mark Suster – Both Sides of the Table
  16. Ben Horowitz – Ben’s Blog
  17. Martin Varsavsky
  18. Bill Gurley – Above the Crowd
  19. Brad Feld
  20. Dave McClure – 500 Hats
  21. Brett Hurt – lucky7 – NO FEED URL

Google Mobilegeddon

On Apr 21, 2015 Google will update it’s search algorithm to score sites that are mobile friendly higher in search results than those that are not. The aim of course is to spur site owners to update their sites to include a mobile version. Updating a site is straightforward but in many cases doing so may require complete rebuilds. I highly suggest looking into using bootstrap to create a web responsive site that is both a desktop and a mobile version in one with no need to create a separate mobile site.

If you’d like to check if your site is ready, try using google’s mobile friendly test.

If your site is not ready:

If your site is ready:

What front-end web framework to choose, Angular, Ember, React?

I’ve been looking into what front-end development framework to use for future web work and thus far, the contenders include AngularJs, EmberJS and ReactJs. As I dig in more on my research, I’ve decided it best to collect my findings here while. In addition, I’ve also created a Flipboard magazine to collect related articles.

In an ideal world, I would love to learn one more front-end development framework that allows me to do both mobile and native mobile apps. For native apps, I’m looking to learn Swift and/or PhoneGap or build iPhone apps with Javascript in WebView

Great side-by-side comparison of Angular, Ember and React:

Great Quora Posts:
Facebook’s React vs AngularJS: A Closer Look
Is React killing Angular?
Should I choose React over Angular? Why?

AngularJS vs. Backbone.js vs. Ember.js

Flipboard Magazines:

View my Flipboard Magazine.
View my Flipboard Magazine.