Michael Kennedy
Winston Jones
Lauren Potter
Ryan Lanes
LIS 4785
Dr. Sanghee Oh, Ph.D
September 22, 2015
Project Proposal
Who?
Medication adherence is defined as the extent to which patients take medications as prescribed by their doctors. Therefore, medication adherence applies to anyone being prescribed medicine, whether it is the patient or caregiver taking care of the patient. Medicine regimens are difficult for all patients and especially challenging for the elderly. As average life expectancy increases, so does the increase in chronic diseases in the elderly. According to the article, Ability of older people with dementia or cognitive impairment to manage medicine regimen, “impaired cognition has a significant impact on a person’s ability to manage their medicines.” Patients who have chronic diseases are taking multiple medications at a time so it is important to track the medications and make sure they do not counter-act with one another. In case the elderly cannot take care of themselves it is important that their caretakers know when to administer the medication properly and what medicines counter-act with the patient’s prescription. Beside the caretaker, the patient’s doctors needs to keep track of the medicine is they are prescribing. It is vital that the doctor does not wrongly diagnose or mix up medications for the patient. Any number of small errors can cause the patient great harm.

What?
The main issue that our research and project is directed towards is poor medication adherence. Poor medication adherence means that a patient is, for some reason or another, not taking all of their prescribed medication(s). This issue is widespread and can have a huge effect on a patient’s treatment. Some of the causes of this issue are forgetfulness, a misunderstanding of the prescribed medication regimen, and inability to afford the necessary treatment. Some of these causes can be helped using existing eHealth technologies.

When?
The sooner we can implement these functions into our daily lives the better. Users of this app would be able to access their personal health information at a moment’s notice thus saving them time and money. Many of the technologies required to achieve this goal have already been in use for several years. It now rests in the hands of application developers to design a fluid and simplistic way to self-monitor one’s personal health records from their computers and smartphones. Assuming that a digital health application did offer features such as accurate prescription auto-refills and text/e-mail notifications, this technology could potentially be used for decades, or at least until the next groundbreaking technology revolutionizes healthcare.

Where?
Proper medication adherence is a globally recognized issue which is the result of miscommunication between hospitals, health organizations, and patients themselves. With the help of a mobile device to organize and update a person’s health records, we can hopefully reduce the amount of unnecessary trips to the doctor’s office or pharmacy. This will also prove to be very beneficial to those who are unable to travel frequently due to health-related issues. Currently, the only areas in which this technology would not benefit society as a whole are places in which electronic health records simply don’t exist or have just recently started compiling digital patient information.

Why?
Current technology presents an opportunity to improve the quality of care received by patients. Medication adherence greatly affects patient outcomes. Patient’s adherence to prescriptions is always a positive. Creating this PHR application would allow the collection of of more information for public health record. The level of medication adherence can be monitored and and examined. This examination could lead to more discoveries about actual medication adherence and the quality of care that patients are not only receiving, but creating for themselves.


Problem Statement:
  • Poor medication adherence means that a patient is, for some reason or another, not taking all of their prescribed medication(s)
  • Poor medication adherence can increase likelihood of preventable disease progression, increased hospitalizations, avoidable doctor and emergency room visits, and other results from poor health.
    • o Approximately 125,000 Americans die per year because of complications from poor medication adherence
    • o Half of all patients do not take their medications as prescribed
    • o According to the NEHI, proper medication adherence and disease management could save up to $290 billion per year, which equates 13% of health spending in the nation

Evidence to support the problem:
According to our research, patients that are prescribed self-administered medications typically only take half of their doses (Nieuwlaat et al., 2014). Adhering to a prescription is critical in many treatment plans, especially those of patients with chronic illnesses. The results of poor medication adherence in patients with chronic illnesses can be a faster progression in the illness, improper medical treatment, and ultimately death.
One crucial thing to pay attention to when on multiple medications is the potential risk of the medications having an adverse effect on the patient. Adverse medication reactions account for a third of all adverse events in hospitals, and the issue is almost completely preventable. The government has taken action by spreading awareness and making health resources widely available in the hopes to decrease the amount of deaths due to adverse drug reactions (Harris, Hu, Lee, Mistry, York, & Johnson, 2015).

Potential solution (3-5)
Mobile Application with the following functionalities:
  • set medication schedules with alerts
    • store information about the user’s medication adherence (exportable)
  • create user profile to store information about them
    • sociodemographic information
    • physical information
    • medical history
  • provide access to community resources
    • connection to forums related to user’s health conditions/treatments

Feasibility of Each Solution
  1. This functionality is definitely attainable with some coding. We would need to format our data to allow it to be exported in multiple formats.
  2. This will be a bit more complex, but it will certainly be worth it as this information will help us understand our demographic and help with user feedback and forum posting.
  3. Providing access to community resources will be a bit more complex, but the feature is necessary as it enables the user to connect with others and share useful information with their groups

Most of our proposed solutions are very achievable with a bit of coding. Some of our functionalities will require some more complex code that is beyond our personal levels of experience, but that is resolved with outsourcing the coding. However, we need to take into account the security measures that are necessary to protect our users’ information. Another major thing that we have not yet taken into consideration are the HIPPA laws that would apply to our application. We would most likely need a lawyer specialized in this field to consult with, and we would definitely need to work closely with developers of EHR/PHR systems to make sure that we impose data standards on our system.

Research on existing / alternate solutions

Chosen approach (reasons)
  • We wanted to create an app that would help users track when and if they have taken their medication. After logging in, the user will be able to scan their prescription barcode and it will go directly into the system alerting them how much to take and any specific directions correlated with that prescription.
  • We also wanted to help the user track their doctor appointments. This is possible due to the calendar function in our app. They will be able to input their appointments and it will alert them 3 days in advance to make arrangements to attend their appointment.



Timeline for completion


August
September
October
November
December
Group formed
+++++++++




Topic Selection

+++++++++



Two page proposal

++++++++++



Wiki term individual assignment


++++++++


Research
++++++++++
++++++++++
++++++++++
++++++++

Application template demo



++++++++

Final presentation



+++++++++
+++++++++
Final Report




+++++++++

Team workload and roles
  • Michael Kennedy
    • created mockups
    • researched
    • presented
    • helped compile powerpoint slides
    • helped draft paper submissions
  • Ryan Lanes
    • created mockups
    • organized meetings
    • researched
    • helped draft paper submissions and powerpoint slides
    • presented
  • Lauren Potter
    • recorded meeting minutes
    • facilitated communication
    • presented
    • created mockups
    • helped draft paper submissions and powerpoint slides



Meeting minutes
  • September 9, 2015 : We came up with a topic for our project
  • September 20, 2015: We split up tasks for the two page proposal
  • November 10, 2015: Split up tasks to create mockups
  • December 1, 2015: Met up to complete presentation PowerPoint
  • December 3, 2015: Met up to practice PowerPoint
  • December 7,2015: Met up to complete final report

Solution prototypes


Final Solution
This application was created to help our users with their medication adherence. The app allows the user to create a medication schedule (or medication schedules) that will alert them when it's time to take their medication. Set up a user profile to store personal information securely and to connect with others with similar treatments or conditions.

December 3, 2015 Update
Downloading the new version of iPillBox will include the features listed below

The first is privacy. We decided to take out the social media forum because there are patients who do not want friends on Facebook knowing their medical history. Secondly, we added the option to scan their medication’s barcode. This will minimize human error and add automation to the process. This feature is mainly for the elderly or less technically savvy users. Thirdly, we added the option for the user to import the app calendar to their daily calendar. This will reduce the error of skipping doctor appointments or medications. The last feature we decided to add to the application is the messaging feature; this is a function that allows a patient to send messages directly to their caretakers within the application. This feature will enable uses to communicate with their care providers with ease with an email-like function.

Next steps
  • research HIPPA laws
  • integrate PHR systems
  • testing prototype
  • revise and test again
  • launch application

Citations
FAU, E. R., Goeman, D., Beanland, C. F., & Koch, S. (0904). Ability of older people with dementia or

cognitive impairment to manage medicine regimens: A narrative review.


Harris, Y., Hu, D. J., Lee, C., Mistry, M., York, A., & Johnson, T. K. (2015). Advancing medication safety:
Establishing a national action plan for adverse drug event prevention. Joint Commission Journal

on Quality and Patient Safety / Joint Commission Resources, 41(8), 351-360.




Nieuwlaat, R., Wilczynski, N., Navarro, T., Hobson, N., Jeffery, R., Keepanasseril, A., . . . Haynes, R. B.
(2014). Interventions for enhancing medication adherence.The Cochrane Database of Systematic

Reviews, 11, CD000011. doi:10.1002/14651858.CD000011.pub4 [doi]