Technology to Improve Patients' Adherence to Medication

I will like to share with you as promised, a technology based initiative that I believe will help improve patient adherence. This program will involve a combination of periodic text messages or e-mails informing patients of the time to take their medication coupled with an alarm fitted on the medication packet that can only be stopped after the patient takes the pill.

Description: the pills will be in an electronic container that will beep like an alarm clock at the time the drug is due to be taken. The alarm only stops when the pill is removed. At the same time, a text message or email will be sent daily to remind the patient. For multiple pills, a computer program can be used.

The initiative has two potential disadvantages: one is that the patient can develop alert fatigue, that is, gets “numbed” to the alerts and might develop an aversion to the system. This can only be solved by a patient education program which must run concurrently. The other is that the system does not actually tell if the patient takes the medication, it only tells if the pill was removed.

Options: The patient will be placed in the program by default but can only opt-out if the physician decides that the patient is not at risk of default, evidenced by writing a letter of undertaking on behalf of the patient.

The mechanism involves active choice by the patient. The patient can only opt out after showing a record of adherence for a period of time, say 3 months after which the doctor can vouch for him/her.

Consequences of default were described by Martin et al. (2005) and include development of worse symptoms, progression of disease to more fatal stages, higher cost of treatment, increased risk of infecting others, time wasting seeking treatment, inefficiency of health systems etc

The program does not preserve the choice of the patient to a large extent. However, with the concurrent patient education program, the patient can be made to understand that the risk of default are too great and that if he complies, he does not have to get an alarm ring and he can be out of the program after 3 months if he complies. The program would be cost effective in that it would save the health system from bearing the cost burden of non-adherence

Reference

Leslie R Martin, Summer L Williams, Kelly B Haskard  and M Robin DiMatteo (2005). The challenge of patient adherence; Journal of Clinical Risk Management, September; 1(3): 189–199.

Future of IT in Hospital Care

I asked a question in my last post, “What will the future of healthcare look like?” I could also ask that question in another way: “How will information technology impact the way we practice medicine and interact with hospitals? I will attempt to answer the question in different domains:

Source: nyp.org

1.     Disease Diagnosis:  The emphasis on disease management might change in the next 50 years to the development of “diagnostic supercomputers” that can scan the individual, take the vital signs, check important chemical substances like electrolytes, hemoglobin, bicarbonates and other biomedical markers and come up with a diagnosis in a matter of minutes. The role of the doctor might then be to “discuss” with the machine about the rationale for making that diagnosis as well as explore other potential differentials. This goes a step ahead of the currently used clinical decision making systems in that the decisions might be made by the computer and doctors then help to serve as checks and balances.

2.     Patient Treatment: This means that almost no human contact will be needed to prescribe and dispense drugs for patients. The risk of wrong prescription or dispensing will be minimized and pharmacists will only need to monitor the computer programs, much as is being done in hospitals like Bumrungrad today. However, in the hospital of the future, the computer will send the drug prescription directly to the dispensing computer that will ensure that the drugs are given directly to the patient. This system could be expanded to involve medication adherence systems. I will discuss this in a later post.

3.     Streamlined electronic health records: in the health care system of the future, humans will have one unique medical record which they will have access to anytime, anywhere. This can be pulled up at accident scenes, operating theatres, outpatient facilities, etc. This personalized health record will be totally “virtual” and will carry a unique ID much like the social security number. It is personal to the patient and then, patient notes do not need to be carried about they are stored and retrievable but can be accessed remotely anytime

4.     Voice Recognition: There might be no need to write notes by the physician as systems of that day but the system will have automatic voice-recognition software. This will enable the doctor to save money and time because the computer will have the ability to write the notes for the doctor.

5.     Others: There are so many things that will change which cannot be foreseen at the moment but I think that most of it will be beneficial as it has been shown now. However it is important to remember that all innovations in technology might have unintended consequences and it is important to weave-in monitoring and evaluation as an important part of the utilization of new technologies.

Discussion on the Transformational Effect of IT on Health Care

The story of Oleg drives home the importance of quality in health care- which everyone seems to agree about. It also more importantly, stresses the value of information technology in helping to push the frontier of quality in the healthcare industry.

It is important to step away from the patients' point of view and focus instead; in this post on describing the various dimensions that quality in health care might take. It is a futuristic look at the various roles that health information technology might take in the hospital of the future, say 200 years from now.

The advantage of looking into the future is similar to the benefits derived from making sci-fi films which depict scenarios that might happen light years ahead of them. In an uncanny way, these movies seem to come to pass because they open up the imagination to think of the possibilities that might arise from new discoveries and these imaginations drive us to create the realities.

What will the hospital of the future look like? This question could be answered both regressively (looking backwards) and prospectively (looking forward). If that question were answered in the early 1800s, many people might not be able to predict so accurately, the role that information technology has played in our lives thus far. In the early 1800s with the prevalence of so many deadly communicable diseases like the plague or the black death, cholera, small pox and bacterial infections, surgery must have been very limited, however with the advent of the microscope many year later, we could see gems and Alexander Fleming discovered antibiotics. These discoveries changed the way we practice medicine and opened us up to brand new ways of providing healthcare.

I would like to postulate that on an even keel, one of the best discoveries to impact people’s health in this day and age is- you guessed it- the personal computer. With the advent of modern computing and the internet, technology has encroached in our lives in so many ways than we could ever predict. It has changed the way we manufacture, live, run our businesses and even interact with each other. After all, before these inventions, we would not be able to communicate in this way and we might not be able to share information as rapidly about the ever changing world of diseases and their management. So, what does the hospital of the future look like and what will health care look like many, many years from now? I will discuss that shortly.