The phones will call or text patients at predetermined times with a personalized set of reminders and questions about their health status. If a patient is not taking medication at prescribed times or answers about their status indicate developing problems, a computer program will automatically contact a family member or nurse. Or, if the patient isn't taking medication because a refill is needed, the press of a button will connect the patient with a nurse or pharmacist.
The university will use mobile technology from GenerationOne Inc., Miami. The cell phone medication adherence program at the University of Miami will be a formal clinical trial with a set of patients receiving wireless-enhanced care and another set receiving traditional care. The hope is to prove that the cell phones will improve medication adherence and reduce emergency department visits - perhaps even hospitalizations. "The idea is to show this mobile technology will reduce health care costs and empower patients to participate in their disease management," says Bernard Roos, M.D., director of the medical school's division of gerontology and geriatric medicine.
The university's program is one of several ways providers are finding new uses of wireless information technologies. These projects run a broad gamut, suggesting that the potential of wireless is ample - if not unrealized. St. Joseph's Hospital Health Center in Syracuse, N.Y., for instance, is using radio frequency identification technology to wirelessly monitor temperatures in refrigerators and freezers.
Other hospitals are taking advantage of existing technologies to support efficiencies and improved care.
Clarian Health in Indianapolis, for instance, started going wireless in its six hospitals in 2005 and hooked up the last three a year ago. But the delivery system continues to expand its use of those networks, working with vendor MobileAccess, Vienna, Va. It's currently in the midst of deploying 3,000 Voice over Internet Protocol phones and will in the next year quadruple its current 600+ wireless bar code scanners.
Still, the hospitals are learning lessons with these newer projects, says Richard Johnson, CIO. "We underestimated the amount of signal strength tuning we had to do," he notes. "A stronger signal doesn't necessarily improve performance." Sometimes, it's better to dial down the strength to get smoother transmission of signals across access points, he adds. "You've got to spend time balancing those signals with the devices to connect to the closest source, not the strongest."
Readying a Clinical Trial
Participants in the University of Miami project to improve medication adherence can use their own cell phones and service provider. Or they can use phones from the vendor, GenerationOne, with cellular services from Firefly Communications Inc., Miami Beach. Some, particularly the most elderly, will use landline phones.
Patients using their own cell or landline phones will have a chip embedded in the phones to establish a wireless or wired connection to GenerationOne's database.
Researchers hope to receive a grant from the National Institute on Aging, Bethesda, Md., to fund the clinical trial. They expect to submit the application in April.
The trial will expand on a smaller research program done with the Veterans Administration in Miami. In that program, patients simply were contacted by their landline phone and reminded to take their medication. The result, Roos says, was better adherence and fewer hospitalizations.
One lesson learned in the VA program was that patients aged 80 or older "clearly are not comfortable with cell phones," he adds. "But a 60-year-old with congestive heart failure has a cell phone and doesn't go anywhere without it."
So, now researchers will test using cell phones to reach patients wherever they may be. Here's how the Miami program will work:
When called or texted, a patient will be asked if they took their medication today, and answer "yes" or "no" by voice or a button. If the answer is no, the patient will be asked if they are away from their medication or out of it. If they are away, the computer program will call back later. If they are out, the patient will be prompted to push a pre-set button to call their nurse or pharmacist. If the patient does not do so, a family member or nurse will be automatically notified. "We don't tolerate that, we do something," Roos says.
Once the question of medication adherence is settled, the patient will be asked a number of questions about how they feel. The smaller VA program helped researchers hone in on the best questions to ask, says Herman Cheung, Ph.D., a professor of biomedical engineering at the University of Miami College of Engineering.
The questions are framed to solicit a yes/no answer. Congestive heart failure patients will be asked, among other issues, if their weight is up three or more pounds in the past day, if they slept well, and if their breathing is better or worse. The computer program will not move to the next question until the previous one is answered, Cheung notes.
Data on all responses from patients, whether on landline or cell phone, by voice or button, will be captured and placed in GenerationOne's database for mining and analysis.
Researchers are asking for a $150,000 start-up grant for the first year, and $750,000 grants for each of the second and third years. They plan to use the first grant to determine if the project's design works, if patients can see or hear the questions and prompts, and to test the phone system and data collection and mining. The second- and third-year grants would fund randomized clinical trials in fee-for-service and pay-for-performance environments.
Tracking Assets
WakeMed Cary (N.C.) Hospital is kicking off 2009 with new capabilities on its existing wireless network.
The facility in February went live with a patient and asset tracking system that uses radio frequency identification technology that reads coded tags on equipment and patient wristbands.
The hospital is starting with tracking assets only, such as IV pumps, stretchers, cart-based computers and blood pressure/vital signs monitors.
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