Problem Statement-
There is a certain amount of difficulty that arises in the provision of medical care when miscommunication creates a chasm between patient and provider. This miscommunication is particularly detrimental to treatment when prescription medication is the medium, and prevalent in patients living with a chronic illness.
  • WHO- Chronically ill patients who have been prescribed dynamic medication regimens have the most imperative need to address. Should they take an inappropriate dosage, their recovery becomes sluggish. A patient’s healthcare provider also has to gain from rectifying the communication gap. By keeping an accurate record of patient medication through an internal means of measuring physiological reactions to drugs, physicians can overcome the hindrance of an inaccurate prognosis.
  • WHAT- There is an exigence for communication reform between medical providers and their patients because medical errors, both patient and provider, are responsible for more fatalities than some of the largest recipients of research funding, such as breast cancer and AIDS (Institute of Medicine, 2000). Also, the inaccuracy of an external means of measuring physiological reactions to prescriptions can be coerced through a revolutionary means of internal measurement.
  • WHEN- Improper quantities of medication are problematic when a prescribed patient becomes separated from the immediate instruction of a provider. When they become responsible for their own medication, at remote locations patients are susceptible to taking the incorrect prescription dosage, affecting their treatment. Further, the need to invest resources into research for intelligent medication sensors must become a priority to eradicate prescription error.
  • WHERE- Primarily, this becomes a problem when patients are separated from their healthcare providers in remote locations. While at home, prescription dosages can be mistaken or neglected because instruction that was already unclear is forgotten. A more accurate and reliable method of measuring physiological process could also find application in health care facilities and assisted living facilities, to measure if disorders are in remission or if further action would be beneficial.
  • WHY- The urgency behind resolving this issue is twofold. First, because prescription error is fatal and avoidable. Second, because internal measurements of physiological reactions and its effect on vital signs are more reliable than are external ones. Further, a physician’s measurement of a patient’s physiological reaction to a prescribed medication is predominantly done externally (save for a timely blood test); meaning, less accurate and unreliable than could be done internally.

Statistical Evidence-
As of 2012, ingestible sensors for internal monitoring of physiological reactions to medicine have been approved by the Food and Drug Administration. These minute microchips are orally administered and have the capability to record bodily processes, fluctuations, and vital signs in real-time, allowing for more accurate and reliable data for physicians to work with. In an experimental study of measurement accuracy for tuberculosis patients, the ingestible sensor correctly measured medication intake and physiological reaction 95% of the time, and the sensor was detected by the external wearable sensor through 100% of the trial (Belknap et al, 2013).

Since the data accumulated using ingestible sensors is both reliable and accurate, it can be used as a single procedure to measure and test physiological reactions that chronic disease patients have to their drugs, removing the need for multiple, unreliable tests and guiding treatment through a confident diagnosis (Lee, Erdogan, & Rao, 2014).

According to the World Health Organization (WHO), “about half of all [chronically ill] patients fail to take their medicine correctly”(Connor, 2012). Often times, a chronically ill patient will take an incorrect dosage of prescribed medication not out of a fallacious neglect for their own care; rather, due to their narrow medical literacy and a lack of provider interpersonal communication (Surman, 2013). Patients who live without a caregiver and are responsible for regulating their medication are particularly susceptible to fuddled instruction and prescription misuse (Connor, 2012).

Resolve for the miscommunication gap and inaccuracies of external measurement procedures should be addressed immediately because medical errors result in around 98,000 deaths annually (Institute of Medicine, 2000).

Potential Solutions-
Since the research regarding ingestible sensors is still in its relative genesis, a definitive solution to the eradication of prescription error is strenuous to furnish; however, there is indicative evidence surrounding chronic disease management to suggest that it is a plausible course of action.
As discussed, this new generation of digital medicine is proving accurate and feasible, showing reliable measurement results in current research (Belknap et al, 2013; Lee, Erdogan, & Rao, 2014). This would allow for physicians to make an accurate prognosis of a patient’s treatment/disease remission by matching physiological reactions to real-time vital signs and distinguishing if medication is being administered properly and effectively by employing the use of ingestible sensors. In short, ingestible sensors would help a doctor determine if a patient is taking a dynamic medication regimen correctly.

The ingestible sensors also have the capability of improving doctor-patient communication. Since a majority of patient-error medication is due to unclear instruction, an ingestible sensor would be able to be able to inform the doctor that their patient is improperly taking medicine, signaling an exigence for more coherent instruction (Surman, 2013).

By using the digital sensor as a measurement of patient self-care outside of a healthcare facility, the error that results from in-home medication administration can be coerced. Chronic disease patients, especially if they live without a caregiver, can take better charge of their own treatment and improve their quality of life (Connor, 2012). By staying connected to health care guidance with the help of intelligent medicine, any fallacious prescription behavior can be rectified in a timely manner.

Ultimately, a sharp decrease in the number of medication-error related deaths could be expected with the universal application of ingestible sensors. As the evidence adamantly suggests, intelligent medicine such as the FDA approved ingestible sensor yields solutions to the doctor-patient communication gap that results in improper administration of prescription medicine and goes unscreened, resulting in hindered treatment and many times fatality.

Current Research-
In the clinical study conducted by Belknap et al. (2013) referenced above, ingestible sensors function effectively. Seeing as they are only FDA approved for clinical use as of 2012, the current research literature is lacking and there is not an established, ‘household’ brand running the market; this is to say the success of current solutions is still unknown. But as Belknap found, the ingestible sensors are 95% accurate in reading physiological processes and the data they scribe is receivable 100% of the time. This alludes to the potential benefits and success that ingestible sensors will have on the new-age intelligent medicine market, building confidence that our application could be both marketable and yield humanitarian results.

Feasibility of Solutions-
Since chronic disease management is often hindered by medication errors on the side of the patient, ingestible sensors can help rectify inappropriate habits through doctor consultation. With a tablet application that showcases for the physician a patient’s physiological processes, they would be able to determine if that patient is or is not taking an appropriate dosage of particular medication correctly. This would be done with an interface that displays adherence to medication.

The dangers present with dynamic medications can lead to slower recovery, less reduction in symptoms, and even death. The physician application would employ an interface to help identify adverse physiological reactions to a particular medication or combination of medicine (i.e. lower heart rate or blood pressure).

To keep better track of a patient’s vital activity through the course of a medication dosage, the physician would be able to chronologically follow physiological activity in a patient. This would help unbiasedly measure the effects of medication on a patient.

Our Chosen Approach
Rather than engineering a microchip, we decided to design a tablet application that would be used, in conjunction with the sensors, by physicians to monitor and evaluate patients. Our electronic interface would be marketed with a particular brand of ingestible sensor. It would be no small endeavor to create our own ingestible sensor, so the group decided the most attainable goal was to create an application interface that could allow doctors to monitor patient’s health in relation to prescription adherence. This is to say the application will be used by physicians to interpret the data received from a patient’s sensor; exhibiting doctor notes, patient information, and a clinical decision support system.

Timeline for Completion-
Screen shot 2014-12-06 at 2.46.28 PM.png

Workloads and Roles of Team-
The team never officially appointed roles, however the workload was distributed relatively evenly amongst its members. It should be noted that the team started out with 4 members and the fourth member contributed to some of the proposal as the first group assignment. All members contributed an even proportion to the final report.

Khaled Issa
Khaled was an appointed presenter of the interfaces to the group’s application, he contributed to research, improved upon the application’s interface and salvaged feedback report from the application demo.

Joel Leone
Joel was an appointed presenter for the ethos and logos behind the group’s application and presentation, he contributed a significant amount of research and edited as well as submitted the proposal.

Bradley Prior
Bradley was not an appointed presenter, he contributed to research, and developed the original wireframe for the application.

Meeting Minutes-
9/17/14-
Old business
  • Formed our group and brainstormed topics for the semester project.
  • We confirmed our group’s topic, an application for ingestible sensors.
New business
  • Start work on our proposal, mainly the research.
  • The group needs to address the 5 W’s
  • Gather statistical evidence
  • 3 or 4 potential solutions our application can offer.
  • Submit to the Wiki page before the 24th
Everyone was present for our meeting. We do not plan to meet again until next Wednesday during class, because we planned the majority of our proposal this meeting and will collaborate on Google Docs to share research and format the proposal. Joel will submit the final draft to the Wiki page.

10/29/14-
Old business
  • Created a proposal for ingestible sensors application that was submitted to the class’ Wiki page.
  • Individual assignment work for Wiki term postings.
New business
  • Each member needs to create a mock up interface of the application. (using wireframes)
  • Presentation should include an introduction to our problem, suggested solutions and an application template demo.
  • Submit a written report that includes the above presentation requirements.
  • Feedback will be given from classmates, use the feedback to submit a separate report.
Everyone was present for our meeting. We do not plan to meet again until next Monday before class to briefly practice the presentation. Joel will submit the application demo presentation slides and Khaled will submit the demo feedback report.

11/24/14-
Old business
  • Created mock-up interface for application.
  • Created a PowerPoint and a report addressing our problem, suggested solutions and the application demo.
  • Feedback report written from class’s feedback.
New Business
  • Final report due December 8th
  • Final presentation due December 3rd
  • Presentation requires improvement as well as feedback changes.
  • Final report requires improvement as well as a timeline, workload, prototypes, final solution, and a future outlook.
  • After Turnitin submission gives the green light, group members must individually fill out peer evaluation.
Everyone was present for our meeting. We are keeping in touch through text messages and email, as well as establishing meeting times through Google calendar. First and foremost we are going to improve upon the presentation, which we are in the process of doing this meeting. The day after the presentation, Thursday, we will reserve time around 5:00 until 9:00 to address the requirements for the final report and hopefully finish the same day. As with all other assignments we will work together collaboratively through Google Documents and Google Presentation.

Application Wireframes-
Vital signs.pngAdverese.pngAdherence.pngCDSS.png

Next Steps-
The next steps for our ingestible sensors physician application will be to develop the application into Alpha and Beta models until release. The application will go under a scrutinous build to ensure confidentiality, integrity, and availability of the medical data it will hold during patient-doctor meetings. The application will wipe every time there is no input from a designated patch, ensuring there is no corrupted data. Doctors will have real time views of the medical data transmitted from a sensor-patch relationship.

When built, the application will be partnered with an established and respected brand in the medical field under contract, that has created a detailed and effective sensor. However, the field of ingestible sensors is still new and therefore there has been no clear front-runner in the selection process for a sensor brand. So our application can help a brand stand out and become marketable.

Once our partnership with a sensor builder is contracted, we would run usability focus groups that will test the application over an extended period of time to dictate if the application is a success or requires further testing, as well as run usability tests and focus groups for the functionality of the physician interface. We are confident that the ingestible sensors will be a success, due to the reductions of cost for further visits from patients to doctors, ease of use on patients compared to other intrusive forms of monitoring, and the specific use of ingestible sensors for medical practitioners world-wide.

Citations-
Belknap, R., Weis, S., Brookens, A., Au-Yeung, K. Y., Moon, G., DiCarlo, L., & Reves, R. (2013). Feasibility of an ingestible sensor-based system for monitoring adherence to tuberculosis therapy. PloS One, 8(1), e53373.
Connor, S. (2012). The Chips That are Good for Your Health. The Independent. Retrieved from __http://www.independent.co.uk/news/science/the-chips-that-are-good-for-your-health-6290700.html__
Institute of Medicine (US) Committee on Quality of Health Care in America. (2000). doi:NBK225182.
Lee, Y.Y., Erdogan A., & Rao S.S.C. (2014). How to Assess Regional and Whole Gut Transit Time With Wireless Motility Capsule. Journal of Neurogastroenterology and Motility, 20:265-270.
Surman, O. S. (2013). Informed consent: What the patient heard. Transplantation Proceedings, 45(9), 3155-3156.