Transcript Using Wireless Technology and the Internet to Improve Patient

Using Wireless
Technology and the
Internet to Improve
Patient Outcomes
ADRIANNA FUSCO:
Wireless Technology
What do we mean by Wireless Technology?
• Pagers
• Cell Phones
• Personal Digital Assistants (e.g. Palm
Pilots)
• Other wireless devices
• Plus: Our communication software that
connects them to the Internet
ADRIANNA FUSCO:
Treatment Team
Using wireless technology and the Internet,
we create a Treatment Team that includes:
• Physicians
• Caregivers
• Pharmacists
• Case managers
• Nurses
• Call Centers
• Physicians Assistants
ADRIANNA FUSCO:
Benefits
The Benefits of wireless technology to the
treatment team:
• An integrated team approach to patient
wellness.
• 24/7 access to patients’ medication and
treatment schedules.
• Account access can be as restricted or as
networked as determined by an
organization.
• Choice of devices and number and types of
reminders.
• Affordable cost.
• Treatment team has an extended reach and
is more effective.
Patient Outcomes
Definition:
The process by which a patient’s disease
state is assessed at given points in time.
Improving Patient Outcomes
The process or steps a patient or provider
takes in order to facilitate improvement
within the patient’s disease state.
• From diagnosis to cure
• Asymptotic state
• Symptomatic disease states
Medication and Appointment
Reminders
Who Qualifies?
40 million patients who currently take
medications for chronic conditions such as:
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Heart Disease
Asthma
Hepatitis C
Depression
Mental Illness
Organ Transplant
• Epilepsy
• Women's
Health
• ADD
• HIV/AIDS
• Cancer Care
According to the AMA, less than 60% of
patients take their medications properly.
Medication Reminders
What can they include?
• Reminders for specific doses
• Updated medication schedules
• Prescription refills
• Educational messages
• Psychosocial issues—Individualized
• Side effect management
• Reinforcement of pharmacist’s instructions
• Infinite possibilities…
Appointment Reminders
What can they include?
• Case management follow-ups
• Physician appointments
• Nutritional/Holistic/Wellness appointments
• Upcoming diagnostic testing
• Lab work and scheduling
• Infinite possibilities…
MediMOM Demonstrates Results
MediMOM is being evaluated in a clinical
trial at the Fenway Community Health
Center in Boston, MA.
The objective of the study is to measure
the influence of MediMOM on adherence
levels of patients following complicated
medication regimes. One half of the
patients uses pill diaries, an adherence
questionnaire and MEM’s caps; the other
half uses MediMOM. Preliminary results
show that MediMOM improves
adherence more than 20%.
This Study has been accepted for
presentation at the 8th Retroviruses
Conference, to be held in Chicago in
February 2001.
Fenway Study Schematic
Monitoring Medications
with MEMs Caps
Pre-enrollment Monitoring
Period
Week 0: Enrollment,
Randomize to Study
Condition
Week 2: Short-term
Outcome
Assessment
Week 12: Follow
Up Assessment
MediMOM Group
Comparison
Group
Adherence Increase in Fenway Study
20
15
10
5
0
-5
MediMOM Comparison
Group
Group
Fenway Community Health
Steven A. Safren, William Johnson, Josh Gagne, & Elizabeth
Salomon Harvard Medical School / Massachusetts General
Hospital
Response Paging and the Internet
Response Paging and the Internet provide
• Confirmation
• Response
Confirmation
The ability to confirm message
receipt/compliance with therapy by using
standardized responses of an alphanumeric
pager or other wireless device.
• Identifies those patients who are at risk
for non-compliance and immediately
initiate intervention.
Response Paging and the Internet
Response Paging and the Internet provide
• Confirmation
• Response
Response
The ability to send pre-programmed,
customized responses to messages that
apply to a specific disease state. Patient
manager is alerted if the patient is at risk.
• Side effect management
• Adverse reactions
• Initiate intervention or alternate
therapy
Percentage of Patients that Drop Out
of Treatment in the First 30 Days
100
80
60
40
20
0
Without
With
Adherence Adherence
Program
Program
Corporate data based on Hepatitis C Treatment
Programs.
Average Length of Treatment
Durability
12
10
8
6
4
2
0
Without
With
Adherence Adherence
Program
Program
Corporate data based on Hepatitis C Treatment
Programs.
Patient Monitoring
Customized, Advanced and Proactive
Identification of disease-based symptoms for
proactive/preventative intervention.
Examples:
• Heart Disease: Blood pressure, diet,
exercise, weight maintenance
• Asthma: Peak flow
• Hepatitis C: Side effect management
issues
• Diabetes: Glucose readings, symptoms
and diet
• Organ Transplant: Identification of
adverse reactions, i.e. signs of rejection
At Risk Patients
1. Identify “at risk” patients within a disease
category.
2. Create proactive intervention.
3. Facilitate better patient outcomes.
Overall Benefits
• Better provider/patient communication
• Patient empowerment
• Increased adherence to treatment
• Improved patient outcomes
Valuable Lessons
What lessons have we learned?
Keeping the process simple:
• Utilize existing technology, including the
Internet
• Infinite Scalability
• Confidentiality
• Use wireless device(s) patient may already
own
• Create and administer program as part of
an overall treatment plan
The Future
• Standard of care
• Critical pathways
• Automated healthcare