Medication adherence is defined as the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance. Medication non-adherence, or a failure to take prescribed medication costs the US Healthcare System over $200B per year. One culprit is a lack of a unified, real-time view of the patient information across the healthcare community of providers, pharmacies, health plans and other stakeholders.
In this blog post, we’ll introduce and briefly describe a proof of technology demonstration of how the Axway AMPLIFY™ platform can be leveraged by a Healthcare Provider to implement a medical adherence system. You will see how AMPLIFY can be the foundation to help keep patients engaged in their care plan and simplify the medication management and adherence process. The demonstration is also well suited to digital clinical trials to ensure that medication is being taken in a timely fashion and to coordinate sharing of eDiaries (a log of medication adherence kept by the patient). Be sure to read all the way to the bottom of the blog, where you’ll find the a video demonstration.
The roles covered in the demonstration are of the patient, family member, healthcare provider and pharmacy.
The demo includes the following AMPLIFY components:
- API Central for API security and governance
- API Builder and the Mobile Backend Service NoSQL Database for storing all data and exposing all APIs
- API Builder’s Twilio Connector for sending SMS notifications to the patient
- Titanium app for the Healthcare Provider to monitor and check on all patients
- Mobile Backend Service for sending Push notifications to the Healthcare Provider’s mobile app
- API Builder to create an Amazon Alexa Skill implementation so that the Family Member can use an Amazon Echo to check on the patient using their voice
- Syncplicity to store the e-diary for the Patient
The demo also uses an AWS IOT Button for emulating a Smart Pill Bottle.
In this demo, we leverage AMPLIFY to:
- Receive and log medication observations from a Smart Pill Bottle (represented by a AWS IOT Button)
- Notify patients via SMS of:
- When a dose was taken and logged
- A log of last 10 doses taken
- When a dose was missed
- When the prescription was automatically refilled along with providing an e-diary
- Notify the healthcare provider via Push Notification when the patient misses a dose
- Allow the family to check on the patients using the Amazon Echo
A diagram of the data flow is shown below:
Let’s review the roles in more detail.
The patient is provided a smart pill bottle or some means of electronically and automatically logging medication doses. In the demo, we are using an AWS IoT Button which connects to Wifi and has a button with three capabilities:
- Single click to log a dose
- Double click to get a list of the last 10 logged doses
- Long press to put the system into demo mode
The AWS IoT Button communicates with the medication adherence system via an Amazon Lambda function via API calls. In your application, you could use a bluetooth-enabled smart bottle or other intelligent monitoring device. There are a growing number of these in the market.
When a dose is logged, AMPLIFY sends an SMS confirming the dose to the patient’s mobile phone. SMS is chosen for its ubiquity, since elderly patients may not always have, or be comfortable with, SmartPhones and SmartPhone applications.
An example of the confirmation SMS is shown below:
When a list of the last 10 doses is requested, again AMPLIFY will send an SMS of the last 10 logged doses to the patient’s mobile phone.
An example of the SMS is shown below:
API Builder has a timer that checks each patient’s observation (logged medication dose) and compares the list to what is expected. If API Builder finds that the patient is late on a dose or that the patient is running low on doses, it will send an SMS in each case.
An example of a missed dose SMS is shown below:
An example of a low dose/refill SMS is shown below. Note that the e-diary URL is shared with the patient:
As you can see, in the case of a low dose, API Builder can automatically request a refill from the pharmacy and notify the patient that the prescription refill request has been submitted. Also, API Builder includes a link to the e-diary document that is stored in Syncplicity. If the mobile phone supports viewing files, then clicking on the link opens the shared e-diary document as shown below:
The family interacts with the Medication Adherence demo system using an Amazon Echo. This enables the family to check on the patient with their voice. The Amazon Echo Alexa skill implementation runs on API Builder.
The two main responses are that the patient is up-to-date on their medication or that the patient has missed their last dose and the family member should check on the patient.
A Titanium cross-platform mobile app enables the Healthcare Provider to check on their patients and their adherence status and observation logs. It also maps the patients for routing purposes in the event that wellness visits are required. Finally, the medication adherence system will send a push notification to the heathcare provider’s mobile app when a patient has missed their dose. Screenshots are shown below:
The pharmacy role is represented by the SMS sent to the patients after API Builder makes an API call to the pharmacy to refill the prescription and gets a success reply.
Conclusion and Video
As described above, Axway’s AMPLIFY platform can help a Healthcare Provider reduce cost and improve their patient’s health by implementing a medication adherence system that serves several personas, use cases and interfaces.
Now watch the video that puts it all together: