Emerging Technologies for
Medication Management:
Promoting the Independence
of 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
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© 2010 Center for Technology and Aging
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
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© 2010 Center for Technology and Aging
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
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© 2010 Center for Technology and Aging
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
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Opportunities for Medication-Use Improvement
3 areas of improvement that could be technology-enabled:
1. Medication Reconciliation

Accurate list of medications to avoid adverse drug reactions
2. Medication Adherence

Taking medications as directed
3. Medication Monitoring

Watching for warning signs, adjusting dose as needed
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Technologies to Optimize Medication Use
Medication Adherence
Medication Reconciliation
Prescribe
Assess
Dispense
Administer
Monitor
Goals
Goals
Goals
Goals
•Patient history
includes a
complete and
accurate
medication list
•Patient needs
are accurately
conveyed and
understood
• Medication
orders are
documented
and shared
with patients
• Medication is
• Individual dose
made available
dispensed
• Medication picked • Individual dose
up by patient
taken by patient (on
• Patient and
time, in the right
caregivers
does, and for the
understand
right length of time)
medication
instructions
Example
Technologies
Example
Technologies
•Medication List
Software
•Personal Health
Records (PHR)
•Medication List
Software
•Personal Health
Records (PHR)
Example
Technologies
Example
Technologies
Example
Technologies
•Teleconsultations
•Online Patient
Education
•Cognitive
Assessment Tools
•Pharmacy Kiosks
•Medication
Adherence Devices
(integrated and
standalone, simple
and advanced
function)
•Personal Biometric
Testing Devices
•Wireless
Communication
Devices
•Personal Health
Records (PHR)
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© 2010 Center for Technology and Aging
Goals
Medication Monitoring
• Routine dosing and
tracking of medication
• Reports and trending
information from
medication log
generated
• Clinician adjusts
medication as needed
• Prescriptions refilled
Technologies to Improve Medication Reconciliation Problems
One-time entry Medication
List – electronic or paper
• User adds medication
information for one-time print out
Name
My
Medication
Log
Universal
Medication
Form
Health and
Safety
Passport
Med List
My
Medicine
List
Pill Card
My
Medicine
Record
Organization
Cardiovascular
and Public
Health Detailing
Programs
McLeod Health
in Florence, SC
California
Pacific Medical
Center, San
Francisco
A statewide,
collaborative
initiative in
Massachusetts
ASHP
AHRQ
FDA
Description
A medication log for use in the Cholesterol
Action Kit
ihttp://www.ihi.org/IHI/Topics/PatientSafety/M
edicationSystems/Tools/MyMedicationLog.ht
m
A form where patients can enter medications
used, allergies, and immunization records
Patients list their medications, health history,
and other relevant information
Medication list to keep track of patient
medications and supplements. Also offers
tips for using medications wisely.
A tool where patients can develop and
manage their own medication list. The tool
can be found on the ASHP Foundation
website
Information on how to develop an easy-touse "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
Continuous Electronic Continuous Electronic
Medication List
Medication List
Integrated with Personal
Health Records
• Medication
information stored
online.
• Info can be updated
manually or
automatically if linked
to pharmacy.
• Print out required to
share information with
providers
Patients list prescription medicines, over-thecounter medicines and dietary supplements.
http://www.fda.gov/cder/consumerinfo/my_m
edicine_record.htm
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© 2010 Center for Technology and Aging
• Medication information
stored online.
• Info can be updated
manually or automatically if
linked to pharmacy.
• Medication list accessible
to providers through PHR
Medication Adherence Technology Functions
FILL
Patient fills
prescription
and
receives it.
REMIND
Patient is
reminded to
take
medication.
DISPENSE
Patient
removes
medication.
INGEST
Patient
ingests the
medication.
METABOLIZE
The
medication
is
metabolized
by patient.
* Technologies in blue are already available. Technologies in green are in development.
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© 2010 Center for Technology and Aging
REPORT
ADJUST
A report of
the patient’s
adherence
is given to a
clinician or
caregiver.
The doctor
adjusts the
patient’s
medication
accordingly.
Medication Adherence Technology Categories
Medication adherence
technologies
Integrated with
health management
capabilities
Standalone
technologies
Single
Function
MultiFunction
Advanced
Function
• Technologies can be divided by the complexity, type, and number of functions they perform
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© 2010 Center for Technology and Aging
Technologies to Improve Medication Adherence Problems
Category
Description
Sample Techs
Pros
•Lacks greater
functionality for more
comprehensive health
management
•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 onetime purchase
•Prices can vary
widely (less than
$100 to $1000+)
•Advanced
technologies allow
actual tracking/
adjustment/ingestio
n 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
•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
•iGuard
•Timex messenger
•Rex Pill bottle
•Gentle Reminder
Simplest and
easiest to use
technologies
MultiFunction
Performs two or more
functions currently
available within the
medication adherence
technology spectrum
•EMMA
•Philips Medication
Dispensing Service
•MedSignals
•uBox
•Dispense-a-Pill
Integrated
with Health
Management
Capabilities
Technologies that
integrate medication
administration with other
health-related
management functions
(i.e. monitoring, sensors,
independent living
assistance)
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•MagneTrace
•Xhale’s SMARTTM
•Med-eMonitor
•HealthHero
•Home HealthPoint
•Zume Life Zuri
•Intel HealthGuide
© 2010 Center for Technology and Aging
Economics
•Usually a onetime purchase
•Prices can vary
widely
•Relatively
inexpensive
Performs one function
currently available within
the medication
adherence technology
spectrum
Advanced
Function
Market
Stage
Many
technologies
out on the
market and
currently
used
SingleFunction
Performs one or more of
the currently available
spectrum functions and
can also perform one of
the more advanced
functions
Cons
•Combined offering
allows for broad
patient
management
•Many devices
likely to move
towards integration
of health tracking/
monitoring
Technologies to Improve Medication Adherence Problems
Single Function
Advanced Function
Integrated Function
• Performs one function • Performs one or more of • Technologies that
currently available
the currently available
integrate medication
within the medication
spectrum functions and
administration with other
adherence technology can also perform one of
health-related
the more advanced
management functions
spectrum
Rex Talking Pill Bottle
functions
MagneTrace
Source: www.rxtalks.com
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Health Buddy
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
Islet iPhone Application
Warfarin iPhone
Application
•
Source:www.princeton.edu/main/news/archive/S25/10/88K09/index.xml?section=featured
Devices to monitor medication are becoming more prevalent with wireless
capabilities and enhanced tracking and trending features.
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© 2010 Center for Technology and Aging
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?
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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
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© 2010 Center for Technology and Aging
Medication Optimization Diffusion Grants Program
RFP released Fall 2009
January-December 2010 grant period
Five grantees selected:
1. Association of Consulting Pharmacists Foundation
2. Caring Choices
3. Connecticut Pharmacists Foundation
4. Veterans Administration (Central Calif.)
5. Visiting Nurse Service New York
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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
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© 2010 Center for Technology and Aging
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
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© 2010 Center for Technology and Aging
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
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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
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© 2010 Center for Technology and Aging
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
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Center for Technology and Aging
www.techandaging.org
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Promoting the Independence of Older Adults