Wednesday, November 21, 2012

The Managing Meds Video Challenge: Where are the seniors? And can we get usability please?

If I had to pick one area in which I thought tech solutions could offer the maximum bang for the buck in improving healthcare for seniors, it would be medication management. (If you want to know why, see further below.)

So I was thrilled to notice a few weeks ago that the Office of the National Coordinator for Health IT was sponsoring a Managing Meds Video Challenge. In this challenge, people were invited to submit videos demonstrating "how one can use technology to manage meds effectively and improve health and safety."

Yeah! I was sure this would help me find technologies to improve med management among elders. (I have a list of my technology priorities for med management at the bottom of this post.)

Well, I just viewed the six winning videos. I have bad news, and good news.

The bad news for GeriTech:

  • Not a single older person (aka Medicare beneficiary) in the winning videos!
  • Nobody taking more than 3-4 meds! One young person seems to be taking two meds, and then has to increase to four because of her wisdom teeth. Sigh. Where are the people taking 6-12 chronic meds (aka high cost Medicare beneficiaries)??
  •  Smartphone apps require laborious typing in of the medication name and dose. Crummy usability, in my mind, especially when one has more than 2-3 medications.
  • In other words, nothing that I'd think of prescribing to my patients.

 

The good news for GeriTech:

I was on the point of thinking that NOTHING here is going to help me and my patients with med management, when suddenly, I saw one of the things I've been looking for:

The patient uses smartphone to take a picture of the bar code on prescription bottle.

Ding! Ding! Ding! Ding! We may have a usability winner! There it is, folks, the technology I said I wanted for outpatient med reconciliation: something where you can scan the bottles and get the info on the prescription, instead of laboriously entering it yourself.

There's a catch though, and it's a big one: This technology is used by Walgreens and CVS as part of their prescription refill app. As far as I can tell, it doesn't help you enter the medication into your reminder system, or into a list that can be shared with other providers and pharmacies. It just helps you buy more medications from these big pharmacy chains.

Bummer. 

Still, if Walgreens can use that technology, so can some other app developer. Maybe someone is even working on this now?

In a nutshell:

The solutions proposed by the winning Managing Meds Videos don't look very usable for patients with significant med management needs (i.e. the ones who stand the most to gain from tech helping them with med management).

Perhaps ONC should consider a video challenge specifically addressing the needs of seniors and caregivers...they are also known as the Medicare population and I hear their needs are of grave concern to the federal goverment these days.

I do love the concept of using smartphones to scan prescription bottles. This would be a better way to enter prescription info into apps that are meant to track and organize medications.

More on why medication management is so important to improving geriatric care:

Because:
  • Meds are a prime source of adverse events in elders. In elders, falls and confusion are especially common, as are dangerous interactions due to polypharmacy.
  • Almost every clinical problem we address relates in some ways to the medications a person is (or isn't) taking. High blood pressure? Make sure you know everything that has been prescribed, AND what the person is taking. Ideally you'd know what had been prescribed and discontinued in the past too.
  • Clinicians often do not access an accurate list of what has been prescribed, and what the elder is taking. This is especially true in the case of those many elders who see multiple prescribers.
  • Meds cost a lot of money, both to the system and to the individual elders.
  • Many medications, upon careful review, should be discontinued or reduced (or occasionally even increased). For patients and caregivers to request a good medication review, you need to start with a good accurate list. Ideally this would include when the medication was started and for what purpose.
  • Taking multiple medications is burdensome! It's a huge logistic effort for the many elders who must take meds at three or even four times of the day, and turns into a major effort for caregivers.
  • Medications taken PRN must be properly tracked, for elder and clinician to make effective progress in managing the symptom at hand. In practice though, I've found this hard. ("Tell me again: how often did you use this medication? You don't remember? Do you remember how you felt afterwards?" )
  • Medication reconciliation after hospital stays currently is difficult. It's confusing to elders (and their primary care doctors) when medications aren't properly reconciled after a hospitalization or other major event. 

I could go on, but I won't right now. Suffice to say that I think we sorely need technology that does the following:
  • Allows elders and caregivers to easily maintain an up-to-date list of medications, regardless of prescriber, pharmacy, or hospital used.
  • Allows all providers to easily access the above list.
  • Helps elders take all their medication.
  • Spots medications that aren't taken as prescribed, so that clinician and patient can discuss and work out a solution. (Facilitate engagement!)
  • Makes it easy for primary care providers to reconcile what the patient is taking with what has been prescribed (see my prev post for why it's currently so darn time-consuming)
If you know of any tech or tools that work well for the needs above, please comment or send me an email (drlesliekernisan AT gmail).

Tech developers (if any of you happen to be reading): can you integrate zapgun entry (i.e. smartphones taking pics of prescription bottle codes) for your med management apps?

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