May 28, 2010When patients are released from the hospital, they are typically given one or more drug prescriptions that they must then fill and keep track of on their own. In some cases, patients fail to take the medications as prescribed and, consequently, end up back in the hospital. Nyack Hospital hopes to address that problem with an automated solution that uses a mobile phone with an RFID interrogator, as well as tags to be attached to medication bottles, and a Web-based server that remotely manages an individual's prescription regimen. The hospital's goal is to ensure that fewer discharged cardiac patients return due to not having adhered to their prescribed medication regimen.
The eMedonline system—provided by Leap of Faith Technologies, an e-health company based in Crystal Lake, Ill.—is being tested by Nyack Hospital on up to 20 patients. If the system proves successful during the next six months, says Nicholas Tsirkas, the hospital's director of clinical research, it will be implemented in multiple departments.
After being discharged from the hospital, patients with pneumonia, congestive heart failure or myocardial infarction (MI) can typically have a dozen or more medications to take at varying times and doses. The regimen often changes repeatedly as well, as physicians review an individual's response and side effects, and then make adjustments accordingly. Consequently, staying on the appropriate medication regimen can be difficult, at best, for a patient in a clear state of mind, but for many who struggle with multiple health problems, it can be nearly impossible for them to accurately comply with their medication schedule. In addition, many patients live alone, with no one to assist in administering their medications. The federal government is now involved in the problem as well. Due to the Healthcare Reform Act, hospitals in the future may be penalized with a 2 percent Medicare reimbursement reduction for patients who are discharged and then readmitted shortly thereafter for the same condition.
To address the problem, Tsirkas, along with Joseph Pinto, Nyack Hospital's director of pharmacy, began seeking a technology solution to help the facility monitor its patients' medication compliance following discharge from the heart unit. The hospital had considered using a manual phone-calling system, whereby the clinical pharmacist would place calls to patients on the first day after release, as well as on the seventh, 14th, 21st and 30th days. That process, however, seemed too time-consuming and cumbersome for the staff. The hospital then discovered eMedonline, and launched a pilot on May 13, beginning with two patients.
The system consists of a Web-based server, hosted by Leap of Faith, on which each patient's medication compliance can be tracked, along with a mobile phone with an attached RFID reader, and NXP's I-Code SLI 13.56 MHz passive RFID tags, compliant with the ISO 15693 standard.
Upon being discharged, a patient is provided with an eMedonline RFID-enabled mobile phone, which comes loaded with an eMedonline software application, and connects to the eMedonline Web-based server. The patient also receives a package of RFID labels (either from the hospital, or mailed directly from Leap of Faith), each with the name of a prescription drug printed on the front. Each label's embedded tag is encoded by Leap of Faith using a Zebra Technologies printer, with an encrypted unique ID number that corresponds with information the hospital has provided about that patient, all medications being taken, and the prescribed regimen for each. That data is stored in the eMedonline server.
The patient then places the tagged prescription bottle within a few inches of the reader on the phone, which reads the tag's unique ID number. That ID is transmitted to the Web-based server, via a GSM cellular connection, and the eMedonline software determines whether the tag ID matches that of the drug she should be taking at that particular moment. The software also causes the phone to display a photograph of the pills, which the patient can refer to as confirmation that she is taking the appropriate medicine.
The eMedonline software, residing on the server, collects and stores information related to the patient's compliance rate, compliance time (for example, when the drug was actually taken, compared with the time it was supposed to be taken), health status and behavior (as reported by the patient), such as side effects, weight gain or mood—all of which the user inputs into the system by responding to questions at the time each call is received.
If an individual appears to have failed to take the prescribed medication, Pinto says, a message can be sent to the hospital. For example, he notes, "We get an e-mail indicating that patient 1234 missed an 8 a.m. dose." If the patient has a caregiver, such as a neighbor or family member, who can assist with regimen compliance, an e-mail or text message can be sent to that individual as well, letting him or her know that the patient has not taken her medication as prescribed.
Leap of Faith developed the eMedonline solution after researching the behavior of individuals receiving health-care treatment. "We discovered that people invariably had difficulty managing their medications, particularly as they age and as regimens became more complex," says Barbara Rapchak, Leap of Faith's founder and CEO. "We had been monitoring the use of cell phones, and had been interested in the potential of RFID. The end result was the systems innovation that is eMedonline. We were able to put together existing and emerging technologies in an innovative way, leveraging the capabilities of each."
The hospital intends to test the system with up to 20 patients at a time for the next six months, and then to determine whether it was a success. If Pinto and Tsirkas find, in fact, that the system has helped them manage patients' medication regimen, and ensure that they continue to take their medication, the two hope to permanently deploy the technology in multiple departments.
