Calvin Knowlton, B.Sc.Pharm., Ph.D., CEO, Tabula Rasa Healthcare

We have many published studies, and internal studies, that show lowering the science-based MedWise Risk Score effectuates reductions in medical costs and morbidity. The first major study, which was undertaken by an external nonprofit research group (DARTNet), was published using our MedWise platform. The study, “Longitudinal Association of a Medication Risk Score With Mortality Among Ambulatory Patients Acquired Through Electronic Health Record Data,” was peer reviewed extensively and published in the Journal of Patient Safety.

We know that medication adverse drug events (ADEs), if they were a disease, would be the third or fourth leading cause of death over the past decade in the United States. We have shown that reducing the MedWise Risk Score lowers the incidence of preventable ADEs, which reduces falls, emergency room visits, hospitalizations, and rehospitalizations. Now we have the first study that demonstrates a further association — that is, the higher the MedWise Risk Score the higher the hazard ratio for premature deaths.

Our Precision Pharmacotherapy Research & Development Institute leaders have been working on the simultaneous, multidrug interaction risk for decades. In this study, using our MedWise system, researchers at the University of Colorado demonstrated that the MedWise Risk Score platform was able to identify medication regimens that put individuals at high risk for premature death. This was limited to Rx medications — thus, if OTCs (over-the-counter medications), herbals, and recreationals were included, the risk results would have been even higher. The hazard ratio for those over 65 was 2.42, and even higher for the age group of 50–64, of 4.95. Surprisingly, the hazard ratios for those 20–30, and those >30, was 7.04 and 7.83, respectively.

Having the MedWise Risk Score to help predict who is at risk for an adverse drug event empowers pharmacists and physicians, working together, to improve the safety of medication regimens and improve outcomes of participants, reducing utilization total costs and enabled life-extension. The MedWise Risk Score is sentinel. Having certified MedWise pharmacists apply the science to reduce a person’s MedWise Risk Score is what we do a hundred times a day at Tabula Rasa HealthCare (TRHC). This is accomplished in collaboration with participants (e.g., separating time of day when metabolic competitive inhibition is detected) and with prescribers (e.g., when metabolic collisions need to be addressed using therapeutic substitution).

Along with using pharmacogenomics, this is one more step toward precision, personalized pharmacotherapy, and one step back from traditional trial-and-error medication regimens. CT

Calvin Knowlton, B.Sc.Pharm., M.Div., Ph.D., is CEO, chairman and founder, of Tabula Rasa HealthCare. He can be reached at