Today I spent a couple of hours with a physician colleague now working for a restart company designing an app for iPod/iPhone fitted with a medical grade bar code reader shell. The design is to replace the tethered bar-code readers used in medication administration in the hospital to improve patient safety. It was well designed and compared very favorably to other similar applications. But ...
... the bottom line is the whole time I was thinking that if this company's goal is patient safety they are targeting the wrong population.
Sure, medication errors occur in the hospital but when comparison to the medical errors that occur in total outside the walls of a medical facility, hospital based errors maybe insignificant. At least in the hospital there's a medically trained nurse selecting and delivering medications that are packaged and delivered by a pharmacist in the building with relatively clear instructions and tools on when and how to deliver them. Not only that the patient is observed taking the medications.
There are roughly 9000 hospitals in the United States and estimating the average beds per hospital at 100 we're looking at 900,000 beds. At any given time there might be 900,000 medications being administered.
In contrast there are roughly that many allopathic physicians probably averaging 20 patients a day and writing prescriptions on at least half of those patients so if my arithmetic is correct somewhere around 9,000,000 patients get prescriptions daily (some illegible). These patients go to the pharmacies receive their prescriptions, take them home and begin taking them without any medical supervision.
Now, I'm a physician and even I have difficulty taking my one medication daily as I'm supposed to. In casual conversations with my golfing buddies I know many of them rarely follow directions closely, even for pain medications where they may take many more than prescribed or skip doses. Others experiment intentionally or unintentionally in delivery methods, others have difficulty remembering, can't differentiate between pills or have work schedules that prevent them from taking medications as directed. Many also add over-the-counter medications without giving any thought to potential interactions.
I would venture to say that on any day there are as many patient safety medication errors in the home than there are in all of the hospitals in a given year.
Instead of an iPhone app for the hospital nurses what this company needs to do is write one for all of the millions of patients who take medications at home. We need a very simple app that makes it easy for the physician, pharamacist, nurse or patient to either download or enter their prescriptions, number dispensed and have it do the following:
1) alarm when a medication is due to be taken
2) show a picture of the pill(s)
3) either have two buttons beside each pill labeled "Taken" "Not Taken" or just press the pill if taken and have a second button (X) if not taken.
That's it. In the background the application would store the medication, time of administration and advance the counter. When completed the device would automatically notify the physician or pharmacist the medication prescribed was completed or if a continuous medication that a refill or renewal was needed.
This app would also provide the patient with drug to drug interactions so if they stopped by the counter to pick up Claritin, ibuprofen, whatever, they could photograph the UPC code and it would automatically be added to their medication list, alert the patient if the new medication would interfere with what they were already taking.
It would also link to important drug information leaflets so they could review as often as they wanted by clicking on the picture of the pill how to take it, etc.
Finally, as mentioned above when the prescription expired the medication would drop from their list so they would always have a current, up-to-date list of medications to show their physicians (or better yet upload it) at the next visit along with a history of the administration over time (important for medications like warfarin).
By targeting medication administration applications at patients rather than nurses or physicians and designing the applications for home use we might actually affect patient safety effectively AND lower physician office visits, admissions to hospitals and GASP begin to lower the cost of medical care.
Continuing to focus on health care providers might be seen for the waste of time it probably is.
Uh, dibs on the patent!
