EHR-based Medication Monitoring and Control

22.04.2003

Abstract

Many senior citizens are using several types of medicine on a daily basis. As the population is getting increasingly older, a lot of effort is made to keep the health of this population well. As much as 25% of the senior population may have more than 4 prescriptions daily. When taking several medications, perhaps several times a day, it is perhaps less than surprising that timing and dosage of medication becomes an issue. When memory impairments increase with age, and some medications also make you forgetful, the problem becomes very clear to many.

A lot of research has gone into solving the problem of non-compliance and many solutions exist in reminders, dispensers and monitoring devices. We have looked into the issue of using information systems to not only remedy non-compliance, but increase the quality of health care for the individual patient. A lot of information is created when a patient is to get his/her prescribed medicine and flows between several parties – the MD, the pharmacy, the (home care-)nurse, the casualty clinic, the patient and friends and love ones (who administer medication). Making sure medication is correctly dozed and taken as prescribed is a time-consuming and error-prone process.

The EHR of tomorrow will contain information on medication and we have looked into the possibility for medical equipment, like an automated medicine dispenser, being sensory input into this document. We have built a system that uses an automatic pill dispenser to aid patients in complying with their prescription. The patient will be reminded when to take his/her medicine and dispense it. The dispenser is equipped with a modem that calls caregivers and a service centre when doses are not taken. This information is stored in a prototype health record and can be retrieved via web interface. The missed doses will also appear along a timeline in a patient observation screen, along with other health information, like heartrate, bloodpressure and patient observations. We have also tested the ability to remotely control some aspects of the dispensing via the patient record, like the number of on-demand medications, like painkillers, that the patient is able to display a day.

The system has been tested at a patient home, where the medicine dispenser was placed for one month. The woman trying the system had no record of previous problems with taking her medicine, and therefore no immediate benefit was reported after the test. What we did experience during the testing was that a generally somewhat sceptical attitude towards the new technological equipment seemed to change somewhat underway towards relatively positive.

Some of the conclusions we have come to is that the technology for medication follow-up seems to be in its infancy. Many of the solutions that exist on the marked today are a bit ad-hoc in functionality and approach to the problem of non-compliance with medical prescriptions. There is an obvious potential and need for the technology, both in medical dispensers/reminders, but mostly in the organization of personal information on medical treatment and the flow of such information. Electronic Health Records are still not standardized and structured for such use. When they are, the technological equipment and –infrastructure is already capable of contributing to increased health care.