Medication Adherence Telehealth Platform
The eMedonline platform engages patients in a real-time "conversation" about their medications which results in positive behavior change and significantly improved medication adherence to 98% in numerous randomized control studies among patients taking up to 27 medications per day. Patients find eMedonline to be useful, reliable, and engaging.
- Integrates cellphones, RFID, barcodes and behavioral informatics
- Works with the leading mobile devices that patients prefer
- Works for any medication—no special pill boxes, dispensers or repackaging required
- Closed loop system with feedback, alerts, incentives
- Mobile application and easy-to-use patient interface
- Web application and comprehensive clinical interface
- Use standard barcode and/or RFID prescription labels
- Deployed in SaaS model
- Minimal patient burden and high patient acceptance
- Maps adherence to outcomes
- Aggregates data for mining and predictive modeling
eMedonline controls and reports on medication events that occur in outpatient and ambulatory settings. A server-side application allows clinicians to configure, schedule, control, and monitor patient adherence and outcomes related to specific medication events.
Medication instructions and tailored content are downloaded to a patient's smartphone, iPad, or internet appliance, which can interface to other medical sensors and is used for behavior modification or intervention. Sensors can be integrated with the smartphone via expansion slot or wireless interface. Electronic validation of an appropriate medication or medical device can be made using barcode or radiofrequency identification (RFID).
At the completion of a medication event, patient adherence and outcomes data are transmitted to the server over the Internet. eMedonline extends the boundaries of patient care to anywhere cellular service or Internet access is available.
eMedonline is a fully integrated medication management system that is much more than a medication reminder on the user's cellphone. There are a number of notable differences.
The system design for eMedonline incorporates theoretical models that define health beliefs and behaviors relative to adherence, where adherence is defined as compliance plus persistency. Various models suggest that the primary factors that affect adherence are:
- disease state (perceived threat posed by the disease and belief that compliance will ameliorate the threat)
- therapeutic regimen (complexity, duration, safety, efficacy, convenience, cost)
- patient-doctor relationship (patient's sense of participation in decisions about the therapy)
The conceptual framework of medication adherence for eMedonline was derived from two models: Park's Model1 and the Health Belief Model2.
Above: Conceptual Framework of Medication Adherence Derived from Park's Model and the Health Belief Model
Applying this model practically, the adherence of an elderly man with severe hypertension could be predicted by three factors: (1) how seriously ill he thought he was and whether or not he understood that taking medication might prevent a stroke (illness representation); (2) his ability to understand and remember instructions associated with the medication (cognitive function); (3) his strategy for organizing and reminding himself to take the medication (external aids). In Park's model, if an individual does not believe he is ill or if the medication is perceived to be ineffective, nonadherence is likely regardless of symptoms.
eMedonline translates this theory into practice.
Above: eMedonline Translates Behavioral Theory Into Practice
eMedonline addresses cognitive functioning in several ways:
- Pictorial Cues —The mobile application makes full use of pictorial messages that reinforce text and voice instructions and enhance comprehension and recall.
- Medication Log — To achieve compliance, patients must remember if they actually took a medication at a given time, or if they merely thought about it—a documented problem in compliance. The application includes a Medication Log, similar to a cellphone Call Log, that keeps track all dosing events.
- Educational Content — Patients need to understand why it is important to take a specific medication, so voice and text messages remind patients of the purpose (i.e., what is being treated) as well as the name of the drug, its dose, and specific instructions.
- Tailored Messaging — The reasons for noncompliance go beyond remembering to take a medication. Some patients experience undesirable side effects and discontinue medication; others begin to feel better and decide that they no longer need medication. Predictive modeling and tailored messaging enable us to scale and tailor the delivery of messages based on the patient's stage in therapy. For example, we can acknowledge short- or long-term side effects at appropriate stages, while reminding the patient of the reason for the drug therapy and the importance of continuing with it. Similarly, we can acknowledge that the patient may be feeling better while encouraging the patient to continue with therapy. We can also tailor messages to the condition being treated and "push" other relevant health messages. For example, a patient on Lipitor for high cholesterol can be reminded to eat a low-fat diet.
The Theory of Planned Behavior suggests that in addition to attitudes, subjective norms and perceived behavioral control affect an individual's intention to engage in a specific behavior. Subjective norms are the extent to which individuals perceive that important others in their lives want them to engage in a specific behavior. Perceived behavioral control is the extent to which individuals feel that they have control over whether they engage in a specific behavior (self-efficacy). Patients in our studies reported that the technology "makes you feel confident that you're going to have the very best available opportunity to manage your illness—whatever it may be."
eMedonline engages the patient, creates a touchpoint between the patient and prescription, and establishes a relationship between the patient and the service:
- The patient gets the right information in the right way at the right time through structured messaging databases and other media.
- System offers the capability for message framing as some people respond better when messages are individualized or tailored to the way they personally process health information.4
- The messages help set patient expectations and illness representation.
- The patient's cellphone becomes a technological aid to help them manage their therapy.
- The patients feel more confident about their ability to manage their medication and disease.
- The patients feel that it is important to others that they do this.
References:1 Park DC. (1992) Applied cognitive aging research. In F.I.M. Craik & T.A. Salthouse (eds) Handbook of Cognition and Aging. 449-493. Hillsdale, NJ:Erlbaum.
2 Fishbein, Martin and Ajzen, I., Belief, Attitude, Intention and Behavior. Reading, MA: Addison-Wesley. (1975).
3 Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med. 1984;100:258-268.
4 Salovey, P., Schneider, T.R., & Apanovitch, A.M. Message framing in the prevention and early detection of illness. In J.P. Dillard & M. Pfau (Eds.), The persuasion handbook: Theory and practice. Thousand Oaks, CA: Sage Publications. (2002).