Electronic medication management system available to improve medication adherence

Key Points

Reducing errors in drug identification and dosing can improve patient health. A 2006 Institute of Medicine report estimated that ≥1.5 million patients are harmed each year by medication errors, resulting in a cost of billions of dollars.¹

Many different devices are available to remind patients to take their medication, including pillboxes. However, disorganized and/or random use of these boxes can lead to dosing errors. According to one study, >75% of older adults who used pillboxes did not follow recommended practices.²

In June 2007, FDA approved an Electronic Medication Management Assistant (EMMA) device and electronic medication administration record (eMAR) to help combat these problems.^3,4

Each patient's medication regimen is programmed into the eMAR, and individual doses are then inventoried and tracked until patient delivery.⁵ Additionally, scheduling of all doses and the patient's compete medical history, including other medications not dispensed by EMMA (eg, over-the-counter [OTC] medications), can be programmed into the record. Through patient and physician access portals, the eMAR can also provide a patient's complete drug list, complete histories of medication deliveries, a dosing schedule/ calendar, complete histories of medication changes, compliance and adherence reporting, and professional procedural documentation.

The eMAR can electronically transfer critical information to healthcare providers, including initial medication schedules, dose changes, refills, and missed doses. The EMMA service provides continuous monitoring, as well as patient training and support whenever needed. Adherence or other related reports can be obtained through the service. Additionally, notifications (eg, medication reminders, refill reminders) can be sent via phone, e-mail, or text message. Alerts to remind patients to take OTC medications can also be sent.

Touching the EMMA screen on the dispenser results in the delivery of the correct medication. The system uses audio and visual alerts to notify patients when medications need to be taken. For vision- or hearing-impaired patients, reminders can be sent to a phone or pager.

The EMMA device is ordered through a prescription from a licensed prescriber. The system is not yet covered by insurance, but according to the manufacturer, this may change in the future. EMMA's estimated monthly cost is approximately $250. It is anticipated that EMMA will serve the long-term care, managed care, children's specialty hospital, and specialty pharmacy patient populations in the future.

According to Joel L. Zive, PharmD, Vice President of Zive Pharmacy and Surgical, Inc., in Bronx, New York, "Despite access to medications in the United States, adherence is a particularly vexing problem in the geriatric and HIV populations. Well thought-out and cost-effective technology applications can stem this tide."

SOURCES

1. Medication errors injure 1.5 million people and cost billions of dollars annually; report offers comprehensive strategies for reducing drug- related mistakes [press release]. Washington, DC: Institute of Medicine; July 20, 2006. http:// http://www8.nationalacademies.org/onpinews/newsitem.aspx?recordid=11623/. Accessed May 28, 2008.

2. Haphazard pillbox use can lead to errors. Con-sumer Reports OnHealth. 2007;19(9):3.

3. FDA clears 'computerized medication box' for US market [press release]. Washington, DC: Food and Drug Administration; June 21, 2007. http:// http://www.fda.gov/bbs/topics/news/2007/new01655.html. Accessed May 28, 2008.

4. FDA grants clearance to INRange System's Electronic Medication Management Assistant-EMMA. Virtual Medical Worlds. June 21, 2007. http:// http://www.hoise.com/vmw/07/articles/vmw/lv-vm-07-07-11.html. Accessed May 28, 2008.

5. INRange Systems website. http:// http://www.inrangesystems.com/. Accessed May 28, 2008.

Dr Kaufman is president of PRN Communications, Inc, a consulting/medical writing and editing firm.