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Global Trends in e-Health and Medication Adherence by Yuri Quintana, Ph.D. 11-11-2014

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This presentation provides an overview of global health trends and medication adherence challenges. A review of some mobile medication adherence solutions is given. A discussion is provided on some early observations from usability studies. Future design considerations for medication adherence systems are discussed.

Published in: Healthcare, Health & Medicine
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Global Trends in e-Health and Medication Adherence by Yuri Quintana, Ph.D. 11-11-2014

  1. 1. Global Trends in e-Health and Medication Adherence Yuri Quintana, Ph.D. Division of Clinical Informa8cs BIDMC and Harvard Medical School An Academic Division of the Dept of Medicine at Harvard Medical Faculty Physicians at BIDMC, Inc. TM 11/11/14
  2. 2. AGENDA o Global health trends o Global m-health trends o Evaluation of medication adherence systems o Design and evaluation considerations o Road ahead Global E-Health and Medication Adherence 11/11/14 2
  3. 3. Global Health Trend 1 – Aging Population • The global popula8on age 60 or above is expected to more than triple by 2050 Source: Deloitte 2014 Global health care outlook https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/dttl-lshc-2014-global-health-care-sector-report.pdf 11/11/14 Global E-Health and Medication Adherence 3
  4. 4. Global Health Trend 2 – Cost and Quality • 5.3% annual spending increase in health costs expected globally over next five years Sector: Deloitte 2014 Global health care sector outlook www.deloitte.com/2014healthcareoutlook 11/11/14 Global E-Health and Medication Adherence 4
  5. 5. Global Health Trend 3 – Access to Care • There will be a shortage of 230,000 physicians across Europe in the near future. • The number of caregivers in 36 countries in Africa is inadequate to deliver even the most basic immuniza8on and maternal health services. Source: Deloitte 2014 Global health care outlook https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/dttl-lshc-2014-global-health-care-sector-report.pdf 11/11/14 Global E-Health and Medication Adherence 5
  6. 6. Global Health Trend 4 – Technology • New technologies (m-­‐health, cloud, wearable) are driving change in the way physicians, payers, pa8ents and stakeholders interact Source: mHealth in an mWorld - Delloitte Center for Health Solutions http://www.deloitte.com/view/en_US/us/Industries/life-sciences/2545b66b8dc4b310VgnVCM2000003356f70aRCRD.htm 11/11/14 Global E-Health and Medication Adherence 6
  7. 7. Global Medication Adherence Trends Source: Economic aspect of medication adherence using mobile medication reminder in French Health System http://www.medetel.lu/download/2014/parallel_sessions/presentation/day2/Economic_aspect_of_medication.pdf 11/11/14 7
  8. 8. Global m-Health Trends • 247 million Americans have downloaded a health app • In 2013, 95 million Americans are using mobile phones as health tools • 77% of U.S. seniors own a cell phone and their smartphone ownership has increased 55% in the past year • 42% of U.S. hospitals are using digital health technology to treat pa8ents • Mobile remote pa8ent monitoring expected to save the U.S. $36 billion in health care costs by 2018 • Wireless pill bo^les helped increase medica8on compliance • Mobile health is a $1.3 billion industry and by 2018 is expected to reach $20 billion Source: Mobile Health Tools Make Big Impact by Jonathan Spalter http://mobilefuture.org/mobile-health-tools-make-big-impact/ 11/11/14 Global E-Health and Medication Adherence 8
  9. 9. Drug information ✓ ✓ Drug interactions ✓ Multiple user profiles ✓ ✓ ✓ ✓ Profile sharing via ✓ ✓ ✓ ✓ ✓ email Sharing across multiple ✓ devices Evaluation of Mobile Medication Systems Figure 1. Screenshots of the mobile medication management applications included in the assessment. Source: Phansalkar S, Zachariah M, Seidling HM, Mendes C, Volk L, Bates DW. Evalua8on of medica8on alerts in electronic health records for compliance with human factors http://principles. mhealth.jmir.J Am org/2014/Med 1/e11/ Inform Assoc. 2014 Oct;21(e2):e332-­‐40. doi: 10.1136/amiajnl-­‐2013-­‐JMIR 002279. Mhealth Epub Uhealth 2014 2014 | Apr vol. 2 29. | iss. 1 | e11 | p.3 PubMed PMID: 24780721; PubMed Central PMCID: PMC4173170. http://www.ncbi.nlm.nih.gov/pubmed/?term=(page number 24780721 not for citation purposes) XSL•FO RenderX 11/11/14 Global E-Health and Medication Adherence 9
  10. 10. wheelchair and okay, she wasn’t computer literate. But had she been, you know, if she’d had it with her, in her chair, she could’ve looked at it and said ‘yeah hey I need to take this pill’ or there’s a reminder, or ‘no I can’t’, somebody’s making lunch for her, ‘no I can’t have grapefruit because I’ve taken Lipitor’ or something like that. I’m sure that kind of information more useful, if you’re concerned, if you’re lot of medications. Because I know some people are taking seven or eight a day. [Female, Most also felt it was only appropriate for professionals to recommend an mHealth application used it themselves and if the patient was willing, was technologically literate. User Perceptions of Mobile Medication Systems Table 5. Participants summarize the experience of trying mobile medication management applications in one word. Negative Words (Count) Neutral Words (Count) Positive Words (Count) Frustrating (5) Different (1) Fascinating (2) Challenging (3) Perplexing (1) Fun (2) Overwhelming (2) Enlightening (1) Stressful/nerve-wracking (2) Doable (1) Confusing (1) Interesting (1) Exhausting (1) Useful (1) Complicated (1) Informative (1) Functionality Mobile medication management applications can be conceptually separated into two categories: adherence (MyMedRec, Pillboxie) and information (DrugHub, PocketPharmacist). An “ideal" application was described as including both features: Source: Phansalkar S, Zachariah M, Seidling HM, Mendes C, Volk L, Bates DW. Evalua8on of medica8on alerts in electronic health records for compliance with human factors principles. J Am Med Inform Assoc. 2014 Oct;21(e2):e332-­‐40. doi: 10.1136/amiajnl-­‐2013-­‐002279. Epub 2014 Apr 29. PubMed PMID: 24780721; PubMed Central PMCID: PMC4173170. http://www.ncbi.nlm.nih.gov/pubmed/?term=24780721 When asked to estimate the cost of applications, participants valued drug information applications I found MyMedRec covers everything, it’s ordered properly. But it did miss the other little features, the Something like drug interactions? I don’t bothered by anything like that. I mean I know but I want my pharmacist to say to me when don’t take this or do take that. You know what I didn’t go to school, I don’t want to responsibility of worrying about that... Group 1] 11/11/14 Global E-Health and Medication Adherence 10
  11. 11. of a task in Pillboxie, users had to tap outside the task window. felt this should be standardized, So ultimately, you’d want a universal language, and a universal kind of, you know, this is where the back button is, this is where the forward button is. But if that doesn’t happen, then every app has its own unique way. [Female, Group 2] Evaluation of Mobile Medication Systems I’m impatient as hell. So when it comes to an app, it’s got to be simple. See…it wasn’t easy for me to find the prompts, you know, partly from [my] glasses, but also I’m impatient and I quit looking. And I said ‘Oh I’ve spent all this time entering the stuff but if I put Table 6. Application actions and features identified by participants as being nonintuitive or difficult to interpret. Action/feature Description of challenge Though typically used to add a new item, the symbol had little meaning for first time users. Also, because it is often found in the top corners it is easily missed. A “+” to add a new item The back arrow is used to return the user to the previous screen but instead of testing the button, the research team was often asked, “How do I go back without losing my information?” Go back The word “cancel” typically means “undo” but many participants felt it implied finality and described how they “cancel” social or service contracts such as memberships, subscriptions, and appointments. Cancel Scrolling Without a scrollbar, participants rarely looked for additional information. Audio reminders The audio alarms were inaudible to many participants, especially males. When typing, many participants focused on the keyboard and missed the autocorrect feature that would change drug names or dosage units (eg, “mcg” to “mg”). Autocorrect Inconsistent terminology led participants miss features. For example, reminder features were called “schedule,” “dose re-minder,” or “first dose” in each application. Inconsistent terminology Greyed text was used to provide examples of data that could be entered into a field, but participants typically misinterpreted the grey text to be the information of another user. Sample text Participants associated a black frame as being outside of the application and noninteractive, thus overlooking peripheral buttons completely. Peripheral buttons Accessibility One of the challenges faced by participants was that the adherence features we examined (dose reminders, refill reminders) made assumptions about the end user. For example, the reminder strategies (alarms, notification boxes) assumed users were “attached” to mobile devices. Participants said, for This is an important distinction because though the tablets are less portable, they are more accessible to individuals with age-related vision loss. In one case, a participant with severe low vision noted that touchscreen devices were surprisingly accessible, Source: Phansalkar S, Zachariah M, Seidling HM, Mendes C, Volk L, Bates DW. Evalua8on of medica8on alerts in electronic health records for compliance with human factors principles. J Am Med Inform Assoc. 2014 Oct;21(e2):e332-­‐40. doi: 10.1136/amiajnl-­‐2013-­‐002279. Epub 2014 Apr 29. PubMed PMID: 24780721; PubMed Central PMCID: PMC4173170. http://www.ncbi.nlm.nih.gov/pubmed/?term=24780721 11/11/14 Global E-Health and Medication Adherence 11 I was always afraid to even look at them or try them,
  12. 12. User Interface Design Problems • Simple Screen Design -­‐ Linear Naviga8on • Most used features must be simple to use • Avoiding feature creep and clu^ered design • Design for Seniors – font size, color, naviga8on • Need to follow User Center Design Process • Need more coordina8on and itera8on between user requirements, wire framing and usability tes8ng 11/11/14 Global E-Health and Medication Adherence 12
  13. 13. m-health Evaluations • Global case studies demonstrate that mHealth solu8ons for NCD management are feasible ..but.. there is li^le evidence about the costs and savings of these technologies Source: dx.doi.org/10.1145/2093698.2093868 • A review found 18 of 29 mobile systems using text messaging improved medica8on adherence. Nega8ve studies tended to have more basic and repe88ous content with a simple medica8on reminder, while posi8ve studies delivered a variety of educa8onal and mo8va8onal content with ‘tailored’ or ‘personalized’ SMS Source: dx.doi.org/10.1111/jan.12400 • Diversity and mul8modal reminder methods should be considered to increase usability for seniors Source: www.ncbi.nlm.nih.gov/pubmed/?term=25099993 11/11/14 Global E-Health Conference 13
  14. 14. Global Design Considerations • Care coordina8on needs to be considered in design of systems – engagement with family and care providers • Cultural and language customiza8ons needed • Health literacy needs to be considered in each popula8on • Deep integra8on with local healthcare IT systems is key • Training of staff and pa8ents needs to be planned • Evalua8on and ROI needs to define the metrics for adherence, u8liza8on, and costs that relate to local business models 11/11/14 Global E-Health and Medication Adherence 14
  15. 15. Road Ahead • Need to define evalua8on metrics and ROI models for compara8ve analysis • Need to have more outcome evalua8ons of implemented systems • Need to understand the modifica8ons need to adapt systems to other healthcare networks and countries for global deployments • Need to have best prac8ces on design for user interfaces, implementa8on, cultural and language localiza8ons 11/11/14 Global E-Health and Medication Adherence 15
  16. 16. References Health literacy http://www.nlm.nih.gov/medlineplus/healthliteracy.html mHealth in an mWorld - Delloitte Center for Health Solutions http://www.deloitte.com/view/en_US/us/Industries/life-sciences/2545b66b8dc4b310VgnVCM2000003356f70aRCRD.htm mhealth Competence Center - Barcelona http://www.mobilehealthglobal.com/catalogue/ Mobile Health Tools Make Big Impact by Jonathan Spalter http://mobilefuture.org/mobile-health-tools-make-big-impact/ Deloitte 2014 Global health care outlook https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/dttl-lshc-2014-global-health-care-sector-report.pdf Emerging mHealth: Paths for growth http://www.pwc.co.nz/healthcare-industry-sector/publications/emerging-mhealth-mobile-health-from-patients-payers-and-providers/ The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature http://www.ncbi.nlm.nih.gov/pubmed/22534082 Economic aspect of medication adherence using mobile medication reminder in French Health System http://www.medetel.lu/download/2014/parallel_sessions/presentation/day2/Economic_aspect_of_medication.pdf Adherence to medication among chronic patients in Middle Eastern countries: review of studies http://apps.who.int/iris/bitstream/10665/118131/1/17_4_2011_0356_0363.pdf?ua=1 Experiences in mHealth for Chronic Disease Management in 4 Countries http://www.ghdonline.org/uploads/Piette2011-ExperienceMHealth4Countries_1.pdf A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence. http://www.ncbi.nlm.nih.gov/pubmed/24689978 Evaluating User Perceptions of Mobile Medication Management Applications With Older Adults: A Usability Study http://mhealth.jmir.org/article/viewFile/mhealth_v2i1e11/2
  17. 17. Thank you! Yuri Quintana, Ph.D. Director, Global Health Informa8cs Division of Clinical Informa8cs BIDMC and Harvard Medical School yquintan@bidmc.harvard.edu An Academic Division of the Dept of Medicine at Harvard Medical Faculty Physicians at BIDMC, Inc. TM http://www.hmfpinformatics.org Global E-Health and Medication Adherence 11/11/14 17

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