E-ARMOR: An Online Tool to Evaluate Polypharmacy in Elderly Persons

E-ARMOR GroupJacob Brown – Domain ExpertJordan Fish – Project Manager

Kajal Miyan – FacilitatorYang Yang - Configuration Manager

PART I: OVERVIEW

Project Overview

• Motivation for project– Many prescriptions by many Doctors– No longer needed– Wrong dose

• System Goals– Evaluate prescribed medications– Optimize prescribed medications

Overview of Features

• Given patient data…– Compute

• Ideal Body Weight• Creatinine Clearance• Glomerular Filter Rate

– Assess drug impact– Without storing data

• Limit system access

Domain Research

• Polypharmacy tools– ARMOR– Physician’s Desk Reference– Mosby Drug Reference

• Formulae– Cockcroft-Gault– Devine formula

Risk Analysis

• Risks– Data protection– Result integrality

• How to mitigate risks?– Secure Web Server– HTTPS– Don’t store patient data

PART II: MODEL-BASED VIEW OF SYSTEM

Description of Use Case Diagram

• Generate Drug Report– User enters data

• Vital Stats• Prescriptions• Basic Lab Panel

– System• Computes stats of

interest• Looks up drug data• Reports results to user

Description of Class Model

Single Access Point

Proxy

Interpreter

Singleton

Behavior Model:

Sequence Diagrams Normal

Exceptional

E-ARMOR State Diagram

DrugDataProxy State Diagram

Related Work

• START– Set of rules used to determine omitted drugs in

elderly patients• STOPP

– Set of rules used to identify inappropriate drugs

• Both tools are non-electronic like the ARMOR tool

Lessons Learned

• Design principlesoClient-Server architecture

Inherent for web application Central Control

oSingleton proxy Easy to maintain the medication

information Provide access control and

uniform interfaces

Lessons Learned (cont.)

• In retrospect -oClean requirements documentoMore efficient Customer

interaction for procuring Domain Knowledge

oTime managementoPrototype can be a huge

temptation

Lessons Learned (cont.)

• Future workoCommunicate with EMRsoSmart phone applicationo Identify potentially

redundant medicationsoThreshold values to

immediately notify dangeroEncrypted connection

PART III: DEMONSTRATION

Prototype: Login

• Provides Access controls

Prototype: Main Page

Prototype: Results

Video demonstration

• http://www.cse.msu.edu/~cse870/Input/SS2010/E-ARMOR/video/demo_natural.mp4

• http://www.cse.msu.edu/~cse870/Input/SS2010/E-ARMOR/video/demo_natural.html

Live Demonstration

• Workflow– Login– Enter data– View/print results– Logout

• http://www.cse.msu.edu/~cse870/Input/SS2010/E-ARMOR/web/

References• Barry, P. J., et al. "START (screening tool to alert doctors to the right

treatment)—an evidence-based screening tool to detect prescribing omissions in elderly patients." Age and Ageing (2007): 632-638.

• Gallagher, Paul and Denis O'Mahony. "STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria." Age and Ageing (2008): 673-679.

• Haque, Raza. "ARMOR: A Tool to Evaluate Polypharmacy in Elderly Persons." Annals of Long-Term Care (2009): 2-6.