Transcript Med-eXpert

Bruce A. Kehr, M.D.
Founder and CEO, InforMedix, Inc.
Mary Gardner, RN, MA, CCM, CDE
Program Manager, High Risk Diabetes and COPD
XLHealth
InforMedix, Inc. - Confidential and Proprietary
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Too many medications at home
Old medications not destroyed
New prescriptions received: new dose, different
medication, generic vs brand labeling
Inconsistent communication between multiple
providers: pharmacies, PCP, Hospitalist, Specialist
Which pill is which?
?
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“What medication do I take?”
“What did the doctor say?”
“What is the correct dose?”
“What is the correct time?”
“What do each of these medications do?”
“Why are they important?”
“Why do I need them, I feel better”?”
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Disease Prevalence
Reported rate of non-compliance
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Proprietary
Source: Manhattan Research 2004 data
Failure to take medication as prescribed:
 Causes 10% - 28% of total hospital admissions
 Causes 33% of CHF hospital admissions
 Causes 75% of Schizophrenia admissions
 Causes 68% of NNRTI resistant/mutated HIV
virus
 Results in $100 billion/year in unnecessary
hospital costs
 Causes 40% of nursing home admissions
 Costs the U.S. economy $300 billion/year
(N Engl. J Med 8/4/05, National Pharmaceutical Council, Archives of Internal Medicine, NCPIE,
American Public Health Association, AIDS 2006 20:223-232)
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Senior Citizens with Diabetes and Co-Morbidities
Disease State
Est. U.S.
Prevalence
Annual Total
Health Care
Costs @
$16,500 Per
Patient (1),(2)
Est. Annual Cost
with 25%
Improved
Adherence (1),(2)
Annual Net
Savings
Diabetics
over age 65
10,000,000
$165 Billion
total
$87 Billion total
$78 Billion
$16,500 per
patient
$8,700 per patient $7,800 per
patient
(1) Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes
mellitus; a longitudinal cohort study; Balkrishnan R, et. al. Department of Public Health and Sciences, Wake Forest
University School of Medicine, Winstons Salem North Carolina, USA
(2)American Association of Clinical Endocrinologists (AACE)
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Congestive Heart Failure – The #1 Cost to Medicare
Disease State
Est. U.S.
Prevalence
Number of
Non-Adherent
Heart Failure
Patients = 50%
Annual Hospital
Costs of NonAdherent
Patients (1),(2)
Annual Hospital
Costs of
Adherent
Patients (1),(2)
Annual
Savings
Congestive
Heart Failure
7,500,000
3,750,000
$46 Billion total
$11.5 Billion
total
$34.5 Billion
total
$12,270 per
patient
$3,068 per
patient
$9,202 per
patient
(1)Outpatient Management program of patients with chronic heart failure; Cacciatare, G. et. al; Servizio Centrale di Cardiolgia
(2) Cost of hospitalizations for heart failure: sodium retention versus other decompensating factors; Bennett SJ, et. al.; Indiana University,
Indianapolis, USA; PubMed index for MEDLINE 10076109
InforMedix, Inc. - Confidential and Proprietary

InforMedix is a source and repository of critical intelligence around how individuals are
adhering to their prescribed medication and care plans

Our patented Med-eXpert™ information system provides real-time, customizable , and
actionable information on the medication adherence and health status of chronically ill
outpatients .
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Two portable appliances used by patients to follow their medication and care plans, and to
record and transmit medication adherence and health status information to the Med-eXpert
System over telephone lines:
 The Med-eMonitor™, a robust, portable, interactive, “smart pillbox,” which stores
and/or manages up to 25 medications, while tracking patients’ adherence to their
medications and care plans.
 The Med-ePhone™, which prompts, monitors and records medication adherence and
health status assessment delivered to patients over mobile phones and landlines using
Interactive Voice Response Systems (IVRS).

Mission-critical information can be uniquely customized for each customer’s and patient’s
needs at both individual and population levels to more effectively and efficiently reduce
healthcare costs, improve health outcomes and increase patient satisfaction.
InforMedix, Inc. - Confidential and Proprietary
Patient Interface Devices
Med-ePhone™
Med-eMonitor™
Third Party
Care Givers
Patients
Medical Professional
Med-eXpert™ Information
Repository
Pharmacist
Monitoring Center(s)
Family Member
InforMedix, Inc. - Confidential and Proprietary
♦Med-eMonitor reminds the patient to take their medications from the exact bin or
bottle as required (e.g. “Sunday PM,” “Bin 17,” “Specific number code or color of
blister card,” “Specific Prescription Vial”)
♦Med-ePhone prompts medication use at specific times, assesses reasons for nonadherence, asks simple health status questions
♦The patient will confirm that they have taken these medications so that adherence
can be monitored and reported
♦Important notifications sent out to Care Givers and/or the health care team
Confidential and Proprietary
Population Level
Participant Level
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Export Datasets to XML, Word, Excel, RTF, PDF, CSV
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Designed for Easy Interface with Legacy Systems
InforMedix, Inc. - Confidential and Proprietary
1
4
Managed
outcomes
information to
evaluate program
effectiveness; used
by health insurers,
disease
management
companies,
Medicare,
Medicaid, and
pharmaceutical
manufacturerscro
level health
Additional Repositories
Storing: DiseaseSpecific Information;
Health Claims/Cost,
Physician Encounter,
Hospital/ER,
Laboratory,
Radiographic Data
Patient/
Appliance
Interaction
Data
Patient interacts with appliance of choice to
receive and record medication and care plan
adherence information
2
Population
Data
InforMedix
Urgent
Alerts
Repository
Med-eXpert™
Monthly
Reports by
Individual,
Population
3
Urgent alerts provided
if medications missed
or health declines, to
enable rapid, targeted
interventions by care
managers, pharmacists,
or family members
Monthly trend analysis reports available on the
Web, using graphics to present medication
adherence and other health information; to be
used by physicians, and incorporated into
online patient-accessible personal health record
Confidential and Proprietary
InforMedix, Inc. - Confidential and Proprietary
Government Funded Research Programs Using Med-eXpert
Disease State
Academic
Center
Funding
Source
Number of
Programs
Number of
Patients
Duration of
Research
Program
Medication
Adherence
Results
Care Plan
Adherence
Results
Presentations
and
Publications
HIV+ with drug
abuse and
severe mental
illness
University of
California,
San Francisco
SBIR/STTR
1
76
Six months
89.5%
N/A
2008
International
Association of
Physicians in
AIDS Care
(IAPAC) , and
submitted for
publication
Stroke
prevention using
Coumadin
(Warfarin) and
automated
lottery system
University of
Pennsylvania
PA Tobacco
Settlement,
Aetna
Foundation
NHLBI
Phase 1
20 patients
Six months
Phase 2
100 patients
Phase 3
268 patients
In first 20
patients,
adherence
increased from
78% to 97.7%
Out of range
INRs
decreased
from 35% to
12%
Multiple lay
publications and
insurance
company
publications
Schizophrenia
in “Wounded
Warriors”
Baltimore
Veterans
Hospital
SBIR/STTR
1
22
Three months
The MedeMonitor
System
provided for
compliance
enhancement
with
medications
and protocols.
Ease of
central
evaluation by
treating
professionals,
additional
education,
and reduced
on-site
evaluation
Feasibility of
Using the MedeMonitor
System in
Monitoring and
Enhancing
Research
Protocol
Compliance and
Health Status in
Schizophrenia,”
Drug
Information
Journal, 37 (281289), 2003
Confidential and Proprietary
Government Funded Research Programs Using Med-eXpert
Disease State
Academic
Center
Funding
Source
Number of
Programs
Number of
Patients
Duration of
Research
Program
Medication
Adherence
Percentage
Care Plan
Adherence
Percentage
Presentations and
Publications
Schizophrenia
University of
Texas Health
Science
Center San
Antonio
NIMH
Phase 1
Phase 2
20
100 of 230
enrolled
One Year
94% in
Phase 1
N/A
“The Med-eMonitor™
for improving
adherence to oral
medication in
schizophrenia”, Bendle
S, Velligan DI, et.al:
Schizophrenia
Bulletin, 31(2): 519,
2005;
International Congress
of Schizophrenia
Research 2005;
“Intervention to
Improve Adherence to
Anti-psychotic
Medication”, Velligan,
DI, Weiden, PJ:
Psychiatric Times,
August 2006, Vol XXIII,
No. 9 ;
The Clinical Handbook
of Schizophrenia
Confidential and Proprietary
Government Funded Research Programs Using Med-eXpert
Disease State
Academic
Center
Funding
Source
Number of
Programs
Number of
Patients
Duration of
Research
Program
Medication
Adherence
Percentage
Care Plan
Adherence
Percentage
Presentations
and
Publications
Congestive
Heart Failure
in a Veterans
Population
Wayne State
University,
Detroit
Veterans
Hospital
NIH
1
18
Three
Months
94%
96%,
improved
physical
quality of
life
“Pilot Study of a
Web-Based
Compliance
Monitoring Device
For Patients with
Congestive Heart
Failure,”
Artinian,N,
Harden,J,et.al.,
Heart & Lung,
2003: 32, 226233;
“Telehealth as a
Tool for Enhancing
Care for Patients
with
Cardiovascular
Disease” Artinian,
N, Journal of
Cardiovascular
Nursing, Vol. 22,
No.1, pp 25-31,
2007
Confidential and Proprietary
Government Funded Research Programs Using Med-eXpert
Disease State
Academic
Center
Funding
Source
Number of
Programs
Number of
Patients
Duration of
Research
Program
Medication
Adherence
Percentage
Care Plan
Adherence
Percentage
Presentations
and
Publications
Diabetes
St.Vincent/
University of
Pennsylvania
Center for
Healthy
Aging/
Federal
1
20
Three
Months
92%
HbA1c
dropped
18.7%
(p<.002)
Remote
Monitoring and
Management of
Rural Diabetic
Patients Using a
Web-based
Medication
Adherence/ePRO
Monitoring
Device” Farberow,
B, Disease
Management
Congress, 2005
Confidential and Proprietary
Tennessee Medicare Program – Real-Time Communications
InforMedix teamed with XLHealth and ADT to deliver a real-time medication and care plan
communications program to participants with diabetes and heart failure in a Medicare program
in Tennessee.
InforMedix/XLHealth/ADT Paradigm
InforMedix, Inc. - Confidential and Proprietary
Tennessee Medicare Program (continued)
Communicating the Medication and Care Plan for Diabetics with CHF
♦
Prompt and record adherence to medications using Seniors’
existing medication storage containers (e.g. plastic pillboxes,
blister cards, standard prescription vials)
♦
Prompt and record glucose levels
♦
Prompt and record systolic, diastolic BP, daily weights
♦
Reminders about proper care per ADA guidelines
♦
Meal plan
♦
Schedule annual eye exam
♦
Check feet for cracks or sores and use temperature probe
♦
Check Lipid levels
♦
Schedule quarterly doctor visit for HbA1C blood test
InforMedix, Inc. - Confidential and Proprietary
Tennessee Medicare Program (continued)
Care Plan for Diabetics with CHF
Reminder to wear protective shoes.
Questionnaires:

Prodromal signs of stroke

Change in medications

Hospitalizations

ER Visits

Depression inventory

Patient Satisfaction Survey
InforMedix, Inc. - Confidential and Proprietary
Tennessee Medicare Program (continued)
Medication Adherence Rates and Health Status Monitoring Results
Using Med-eXpert Information System:
♦ 153 seniors with heart failure and diabetes were enrolled into the twelve month
program, many with fifth and sixth grade education levels
♦ 97% retention rate once participant began using the Med-eMonitor
♦ 90% rate of medication adherence
♦ 93% response rate to answering health status questionnaires
♦ 90% response rate to reminders about self-care checks and healthy behaviors
♦ Program terminated after 12 months on 7/31/08 due to end of MHS Program
InforMedix, Inc. - Confidential and Proprietary
Tennessee Medicare Program (continued)
1480 Real-time, actionable alerts provided the opportunity for rapid,
targeted interventions by ADT and XLHealth staff:
Description of Alerts to XLHealth
Hospitalized this month
ER this month
Blisters, redness, cracks or cuts on feet new this week
New, severe pain in your legs that is so bad you can't bear it,
even when resting?
Lack of Device Acceptance
Blood sugar > 299
Number of Alerts
52
48
63
2
7
37
PHQ#1: During the past month, have you often been bothered by
feeling down, depressed or hopeless?
41
PHQ#2: During the past month, have you experienced a loss of
interest or pleasure in daily activities?
39
Not using temperature probe (for feet) provided
14
Overall Medication Compliance Low (<85%)
Single Medication Compliance Low (<85%)
InforMedix, Inc. - Confidential and Proprietary
223
90
Tennessee Medicare Program (continued)
1480 Real-time, actionable alerts provided the opportunity for rapid,
targeted interventions by ADT and XLHealth staff:
Alerts to ADT and XLHealth
MS1: Missed Medication due to Side Ef f ects
308
MS2:Glucose too high (> 299)
36
MS3: Blood pressure too high (Sys> 130, Dias>80)
44
MS4: Warning Symptoms
Sudden numbness, or w eakness of the f ace, arms or legs,
especially on one side of the body?
43
23
6
Sudden conf usion, trouble speaking or understanding?
Sudden trouble w alking, dizziness, loss of balance or
coordination?
14
1
Chest Pain
20
MS5: Foot Changes
MS6: Medication Change
109
42
Nonactivity
262
Noncommunication
1,480
Total
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INFORMEDIX, INC.
Georgetowne Park
5880 Hubbard Drive
Rockville, MD 20852
Telephone:
301-984-1566
Website:
www.informedix.com
Med-eXpert™ System
Med-ePhone™
Med-eMonitor™
InforMedix, Inc. - Confidential and Proprietary