Emerging Technologies for Medication Management: Promoting the Independence of Older Adults

1. Emerging Technologies for Medication Management: Promoting the Independenceof Older Adults David Lindeman, PhD John Feather, PhD, CAE Lynn Redington, DrPH, MBA Valerie Steinmetz 16 March 2010, Chicago Aging in America, NCOA/ASA Conference

2. Introduction to Today’s Speakers • David Lindeman, Lynn Redington, Val Steinmetz • Center for Technology and Aging Staff • John Feather • CEO, American Society of Consultant Pharmacists • Chair ASA board

3. Introduction to Today’s Discussion • Medication management for older adults • Importance of medication use in older adults • Opportunities for improvement • Technologies to optimize medication use • Diffusion of medication technologies • Examples of medication technology diffusion programs • Response and discussion

4. Importance of Medication Use in Older Adults • Medication use is ubiquitous in older adults • 90% use 1 or more prescription medications per week • 41% of older adults take 5 or more medications per week • Suboptimal medication use . . . • Can increase the burden of illness • Result in higher costs to families and society • Poor medication adherence doubles risk of hospitalization and generates $290 billion/year of avoidable health costs

5. Opportunities for Medication-Use Improvement • 3 areas of improvement that could be technology-enabled: • Medication Reconciliation • Accurate list of medications to avoid adverse drug reactions • Medication Adherence • Taking medications as directed • Medication Monitoring • Watching for warning signs, adjusting dose as needed

6. Technologies to Optimize Medication Use Medication Monitoring Medication Adherence Medication Reconciliation Monitor Dispense Administer Prescribe Assess • Goals • Routine dosing and tracking of medication • Reports and trending information from medication log generated • Clinician adjusts medication as needed • Prescriptions refilled • Goals • Patient history includes a complete and accurate medication list • Patient needs are accurately conveyed and understood • Goals • Medication orders are documented and shared with patients • Goals • Medication is made available • Medication picked up by patient • Patient and caregivers understand medication instructions • Goals • Individual dose dispensed • Individual dose taken by patient (on time, in the right does, and for the right length of time) • Example Technologies • Medication List Software • Personal Health Records (PHR) • Example Technologies • Medication List Software • Personal Health Records (PHR) • Example Technologies • Teleconsultations • Online Patient Education • Cognitive Assessment Tools • Pharmacy Kiosks • Example Technologies • Medication Adherence Devices (integrated and standalone, simple and advanced function) • Example Technologies • Personal Biometric Testing Devices • Wireless Communication Devices • Personal Health Records (PHR)

7. Technologies to Improve Medication Reconciliation Problems Name Organization Description My Medication Log Cardiovascular and Public Health Detailing Programs A medication log for use in the Cholesterol Action Kit ihttp://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/Tools/MyMedicationLog.htm Universal Medication Form McLeod Health in Florence, SC A form where patients can enter medications used, allergies, and immunization records Health and Safety Passport California Pacific Medical Center, San Francisco Patients list their medications, health history, and other relevant information Med List A statewide, collaborative initiative in Massachusetts Medication list to keep track of patient medications and supplements. Also offers tips for using medications wisely. My Medicine List ASHP A tool where patients can develop and manage their own medication list. The tool can be found on the ASHP Foundation website Pill Card AHRQ Information on how to develop an easy-to-use "pill card" for patients, parents, or anyone who has a hard time keeping track of their medicines at http://www.ahrq.gov/qual/pillcard/pillcard.htm My Medicine Record FDA Patients list prescription medicines, over-the-counter medicines and dietary supplements.http://www.fda.gov/cder/consumerinfo/my_medicine_record.htm • Continuous Electronic Medication List Integrated with Personal Health Records • One-time entry Medication List – electronic or paper • Continuous Electronic Medication List • User adds medication information for one-time print out • Medication information stored online. • Info can be updated manually or automatically if linked to pharmacy. • Print out required to share information with providers • Medication information stored online. • Info can be updated manually or automatically if linked to pharmacy. • Medication list accessible to providers through PHR

8. Medication Adherence Technology Functions METABOLIZE REPORT FILL REMIND DISPENSE INGEST ADJUST * Technologies in blue are already available. Technologies in green are in development.

9. Medication Adherence Technology Categories Medication adherence technologies Standalone technologies Integrated with health management capabilities Single Function Multi-Function Advanced Function • Technologies can be divided by the complexity, type, and number of functions they perform

10. Technologies to Improve Medication Adherence Problems Category Description Sample Techs Pros Cons Market Stage Economics Single-Function Performs one function currently available within the medication adherence technology spectrum •iGuard•Timex messenger•Rex Pill bottle•Gentle Reminder Simplest and easiest to use technologies •Lacks greater functionality for more comprehensive health management Many technologies out on the market and currently used •Usually a one-time purchase•Prices can vary widely•Relatively inexpensive Multi-Function Performs two or more functions currently available within the medication adherence technology spectrum •EMMA•Philips Medication Dispensing Service•MedSignals•uBox•Dispense-a-Pill •Mostly easy to use•Integrates multiple functions for better health management •May be complex or require greater caregiver involvement•Lacks functionality for more comprehensive management Many technologies out on the market and currently used •Usually a one-time purchase•Prices can vary widely (less than $100 to $1000+) Advanced Function Performs one or more of the currently available spectrum functions and can also perform one of the more advanced functions •MagneTrace•Xhale’s SMARTTM •Advanced technologies allow actual tracking/ adjustment/ingestion of medication•Integrates multiple functions •Considerably more complicated than single/ multi function without clear benefit understanding•In some cases, may lack comprehensive management functionality Most technologies still in development •Currently unclear - most technologies still in development•May be relatively expensive Integrated with Health Management Capabilities Technologies that integrate medication administration with other health-related management functions (i.e. monitoring, sensors, independent living assistance) •Med-eMonitor•HealthHero•Home HealthPoint•Zume Life Zuri•Intel HealthGuide •Combined offering allows for broad patient management•Many devices likely to move towards integration of health tracking/ monitoring •Relatively complicated, may require caregiver involvement•May require greater tech knowledge •Some techs currently on market and used•Other techs in development •Usually upfront cost plus a monthly fee (service-oriented model)•Upfront cost can be relatively high

11. Technologies to Improve Medication Adherence Problems • Single Function • Performs one function currently available within the medication adherence technology spectrum • Advanced Function • Performs one or more of the currently available spectrum functions and can also perform one of the more advanced functions • Integrated Function • Technologies that integrate medication administration with other health-related management functions Rex Talking Pill Bottle Health Buddy MagneTrace Source: www.rxtalks.com

12. Technologies to Improve Medication Monitoring Problems • Medications that place patients at risk for adverse reactions are especially important to monitor • Point-of-care testing devices are available to monitor blood pressure, peak flow (for asthma), blood glucose (for diabetes), warfarin dosing and a host of other health conditions • Devices to monitor medication are becoming more prevalent with wireless capabilities and enhanced tracking and trending features. Islet iPhone Application Warfarin iPhone Application Source:www.princeton.edu/main/news/archive/S25/10/88K09/index.xml?section=featured

13. Diffusion of Medication-Use Technologies Many technologies wither on the vine . . . Social-cultural factors—readiness vs. resistance Economic factors—who pays, how? Political/legal factors—laws, policy that favor or impede Technology factors—ready for broad use or tech enthusiasts only?

14. Center for Technology and Aging Research and Grantmaking • Research: what medication problems are important and have technology solutions? • Grantmaking: what programs can we fund to help. . . • Older adults better use medications • Improve health and independence • Reduce the cost and burden of care • Chronic disease self-management • In the home or other community setting

15. Medication Optimization Diffusion Grants Program • RFP released Fall 2009 • January-December 2010 grant period • Five grantees selected: • Association of Consulting Pharmacists Foundation • Caring Choices • Connecticut Pharmacists Foundation • Veterans Administration (Central Calif.) • Visiting Nurse Service New York

16. Diffusion Grants Program Veterans Administration of Central CA • Home self-management and medication adherence • Veterans that are home-based with chronic heart failure • Remotely located internists and allied health professionals • 5 central California rural and medically underserved counties • The Health Buddy® system plus weight scale, blood pressure monitor, assessment algorithms and clinician alerts • . . . VHA is a leader in telehealth coupled with care coordination Health Buddy

17. Diffusion Grants Program Caring Choices - Chico, CA • Improve medication monitoring and adherence • Philips Medication Dispensing Service technology • Will be introduced to four home health and senior living organizations in four new rural and urban areas of CA • Partner, Home Health Care Management, has successfully deployed medication dispensers for the past 10 years

18. Diffusion Grants Program Connecticut Pharmacists Foundation - Long Beach, CA • Culturally and linguistically appropriate Medication Therapy Management (MTM) services • Community health workers and remotely located pharmacists will use videoconferencing, EHR, and spoken format technology to deliver MTM services to Cambodian-American older adults

19. Diffusion Grants Program • Visiting Nurse Service of New York • A multi-faceted, IT based intervention designed to better support nurses, as well as cognitively impaired patients and their caregivers, in the challenging process of managing multiple medications in the context of multiple co-morbidities • 4 Boroughs of New York City • Technology: medication complexity algorithm, electronic clinical alerts and decision support tool, and caregiver support materials for CI elders with complex medications regimens

20. Diffusion Grants Program American Society of Consultant Pharmacists Foundation • Pharmacists will use Monitor-Rx, a web-based patient medication assessment tool, to optimize the medication regimens of older adults • Implementing in 3 Southern California organizations; • OASIS Older Adult program • University of CA, Irvine Senior Health Center • Alzheimer’s Family Services Center

21. Center for Technology and Aging www.techandaging.org