Architecture of a Medication Adherance System

Presented by Darcy Rayner

A joint project with Peter MacCallum Cancer Centre

Chronic Myeloid Leukemia Cancer of white blood cells, builds up over time.

Occurs in roughly 1 – 100,000 people[1]

Three phases of disease[2]:

Chronic Phase - 85% of patients are in this stage at diagnosis. Very few symptoms, if any. Treatable, patients can have normal life expectancy with regular medication.

Accelerated Phase - Symptoms become prevalant. Drug treatment becomes less effective.

Blast Crisis - Final stage of disease, short life expectancy, little to no treatment options.

Medication must be taken on a regular basis, to prevent build up of cancer.

Side effects from medication often worse than symptoms, patients may become reluctant to take medication. [3][4]

Remind Project Goals:

Discover whether a smartphone reminder system is affective at improving patient outcomes.

Aid patients in remembering to take their medication.

Allow health professionals to collect medication adherence data.

Survey patients regularly about occurring symptoms.

The Basic Use Case

Stages of Project Development

Stage 1 – A small ”proof of concept” prototype, for pilot trials conducted by Peter MacCallum Cancer Centre, written using PHP and Java. (Pilot spans March - May)

Stage 2 – A larger, flexible and scalable web portal and database application, written using C# and ASP.NET. (Trials later 2012)

Stage 3 – Further development if larger project, bug fixes, additional features etc.

Stage 4 – Internationalisation, deployment to multiple sites (2013 and beyond).

System Context Diagram (Remind)

Source - Project Remind SRS V1.0

System Components (Remind)

Database library, (Microsoft SQL + Linq/C# wrapper)

SMS Gateway wrapper library (Essendex Api + C#)

Web portals for each user type + Mobile Web Portal (ASP.NET / C#)

Windows Service to periodically send messages (C#)

Installer / Setup program (C#)

My Contributions Created rule set based reminder schedules.

Allows flexible scheduling of reminders, based on start date and period.

Added support for per-user time zones.

Allows greater independance of server time, more clarity for users.

Rewrote Remind Service to work with rule sets.

Once a day, service creates all reminders for the following, then wakes up every fifteen minutes.

Refactored code to improve reuse.

Improved file configuration options.

Hunted down and fixed bugs!

Possible Future Features Blister pack notification API integration.

When pill is removed from blister pack, remote signal to server is sent, no reply to SMS needed.

Better support for different medication regimes, patients with different needs.

Weekly mail outs summaries of patient data, to relevant professionals.

Allows health professionals to be alerted directly whenever an issue arises.

Allow SMS responses to be sent to adherence reminders,( currently done through mobile web portal).

A robust user defined permissions system.

Allows fine grained control of responsibilities.

Bibliography [1] http://www.virtualmedicalcentre.com/diseases.asp?did=599&title=chronic-myeloid-leukaemia

[2] http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Leukaemiachronicmyeloid/Symptomsdiagnosis/Phases.aspx

[3] http://www.nlm.nih.gov/medlineplus/druginfo/meds/a606018.html

[4] http://www.medicinenet.com/interferon/article.htm