The pandemic is an uncertain, often scary, time for all of us – including our elderly population. In our experiences working with various communities, we have learnt the best way to support someone is by empowering them to support themselves. So when first confronted with our track, we knew we needed to develop an app that would restore autonomy to our target population, rather than take it away from them - COVID has already done plenty of that. This pandemic has affected each one of us in personal unique ways. With over 20 million cases in the world, out of which more than 5 million are in the US, more and more individuals and families are being personally affected by this ongoing pandemic. We can only imagine how terrifying and unsettling this time must be for our elderly – no longer allowed to visit their grandchildren, no longer allowed to host dinner parties, no longer allowed to visit the local library, no longer safe to shop for themselves - the list goes on, and on. We empathize with the loss of normalcy elderly adults are experiencing.
The elderly are most prone to chronic diseases or other acquired illnesses, and social isolation makes it increasingly difficult and unsafe for them to interact and strengthen bonds from which they derive social, and often medical support. Family members and friends may not be as readily available to remind patients to take medications, and access to in-person medical appointments is highly limited as of right now. In such a situation, self-control of medical adherence is even more important, and thus we decided to tackle this challenge.
Medication adherence is defined as taking medication correctly. This includes filling prescriptions, remembering to take the medications, and understanding how to take them, which includes how many pills to take, when to take, and if they should be taken with food or otherwise. Medical non-adherence not only results in adverse health effects and otherwise avoidable hospitalizations, but also devastatingly impacts our economy. Non-adherence costs the United States $100 billion per year (Hughes, 2012), and in an economy already hit by the ongoing pandemic, $100 billion can save the lives of many underserved and minority individuals. Thus, medication adherence is a vital problem to tackle. Initially, we conceptualized MEdherence as an alarm for medications. However, we wanted our app to highlight and especially capture the social support around a patient. Social support leads to emotional resilience which often precedes physical resilience. Hence, we created an intuitive app to address medication adherence, that empowers elderly individuals to comply with treatment, for a higher quality and independent life.
What it does
MEdherence is an app aimed at encouraging medication adherence. When someone first registers for the app, they can register as a patient, pharmacist, or practitioner.
If registered as a patient, MEdherence has an automatic alarm that reminds one to take medication. The alarm tone is a speech of the medication name to take, how it looks, and how the pills should be taken. Further, when this alarm rings, a picture of the pill also pops up on the patient’s phone screen, along with pictures indicating whether it should be taken with food, and if alcohol should be avoided. The patient has two options at this point - to hit the “taken” button or the “Snooze” button. The app internally records the number of times either button is pressed in a day. Further, the patient has access to information about their medication, it’s usage and side-effects. The app also takes care of refill and delivery by keeping track of the number of pills issues initially and pills taken per day.
If registered as a pharmacist, the app enables one to add, modify, or delete medications from a registered patient’s profile. To do this, the pharmacist simply types in the patient’s username, and enters the pin displayed on the patient’s app screen. The pharmacist can then use their mobile’s camera to scan the medication barcode to transfer drug information, such as number of pills to take per day, and quantity of pills issued to the app.
If registered as a practitioner, you have access to the names of your patients and their phone numbers. On your screen, patients that are regularly missing their medications by hitting snooze are highlighted red, to indicate a prioritization to reach out to them, and support them. Further, the practitioner can also send positive affirmation messages to the adherent patients, the ones not highlighted, to encourage them to keep going.
With an automatic, but adjustable, alarm system that both pops up a picture and provides voice directions even when the app isn’t open, MEdherence has the unique ability to interact with elderly adults including those who might be hearing impaired, visually impaired, have low-English proficiency levels, or have low-technology usage levels. Further, the app is made to be extremely user-friendly with no redundancy of information or extraneous information visible to the patient. In accordance with user-ease, both the app itself is streamlined for all parties involved, and the app streamlines taking medication for a patient, and contacting non-adhering patients by a practitioner. The contact channel established by the app between the practitioner and patient also establishes a support system, developing the patient’s emotional resiliency which often precedes physical resiliency. Further, MEdherence empowers patients to re-take control over their health and a multitude of studies have established self-empowerment is the first step to long-lasting change. In addition to these features, MEdherence also automatically refills medications for patients by keeping track of initial quantity issued and daily dosage.
By filing patient’s prescriptions and refills, reminding patients to take their medication, and informing patients of how many pills to take, and how to take them - MEdherence clearly tackles the three issues of adherence, enabling a patient to worry less and live more.
How we built it
We wanted our app to be both accurate in the prescription yet intuitive. We understand how technology can be difficult, we did not want the patient to have to go into the app unless necessary. Hence, we decided early on that we would design an alarm that speaks to give all of the information automatically. To make the app additionally simple for the patient, we did not want to display information outright that is not essential for taking the prescription. Hence, it will not be overwhelming. We first outlined all of the essential information needed for a prescription on both the patient and the pharmacist side. Such information included the prescription name, refill, pharmacist name, side effects, and more. We narrowed down the most essential information for a prescription: the name of the drug, quantity, how to take it, what it looks like, when to take it, and any warnings. We envision that the app will automatically speak all of this information. The other detailed info such as side effects will be in the settings icon if needed to make it less complicated. We used Dynamed, a database of prescription drug characteristics, to create a list of 19 drugs for some of the most common diseases in older adults. We also found images of these 19 drugs and provided descriptions. This list and pictures were used to test our app.
In terms of programming, we used Android Studio to build our Kotlin project, with Github for version control. We set clear goals and created branches to construct the app’s main features. Dipak was responsible for the Android text-to-speech / speech-to-text functionality. Francis was responsible for the navigational elements and organizing the flow of our app’s pages. Yiying was responsible for the front-end GUI elements. We tried to integrate Firebase and Google Cloud’s Text to Speech API but found difficulty adapting it to Kotlin.
Challenges we ran into
- Integrating prescription scripts to Google Text-to-Speech API
- Finding Firebase integration documentation for the Kotlin language
- Assessing trade-offs between features
- Understanding navigation screens in Android Studio
- Limited documentation for Kotlin and Google Cloud integration
- Using a language (Kotlin) for the first time
- Making it intuitive yet still maintaining info
- Simplifying the app while including a variety of functions
- Respecting HIPAA laws
One of the challenges we found was creating an app that was functional yet intuitive. Technology is in itself difficult to learn, and we did not want to create an additional burden on the elderly of learning how to use a new app. At first, we wanted to include a lot of information, such as everything printed on the side of a pill bottle. But, we soon realized it would overwhelm the patient and that only the pharmacist really needs the information. We cut out a lot of information, and we began thinking about what ways we can include all of the information easily while separating the necessary information. We then merged our idea of the alarm clock that does not require one to open an app and decided that this would in itself contain all of the information. The rest of the information will be visible when opening the app, but this will only be needed if the patient wants more details. The necessities would thus be concise, available, and intuitive.
Accomplishments that we're proud of
- Making the alarm clock work with Android Alarm Clock
- Implementing an Android Text-to-Speech and Speech-to-Text feature
- Learned how to make calls to Google Cloud Text-to-Speech API and convert response into an mp3 file that can be used as an alarm sound
- Coming up with something simple
- This was the first time any of us used Kotlin - we learned a lot about the language throughout the project
What we learned
- What is involved in prescription medication
- Problem solving skills - need to think about social aspect, thinking in different perspectives
- Navigation, UI Screens in Android Studio
- More exposure to general programming in Kotlin
- As a first time hackathon, how to combine different areas of expertise to approach a solution
One of the main aspects of healthcare we learned about is prescription medication. We learned the essential parts of prescription medication and the necessary information required for a patient to be able to obtain the treatment. Moreover, we learned about factors that go into why a patient may or may not want to take the treatment. Some of those reasons include forgetting, not knowing which prescription to take, and side effects. We tried to counteract as many of these reasons as possible by creating a support group and making sure the app is simple in design.
Moreover, we continued to develop our problem solving skills. Medication adherence is not simply a black and white concept. Many factors play a role in why a patient may or may not take a prescription. With these social factors on an individual and systemic scale, we wanted to make sure that the individual ultimately feels like they are in control. They can get through the treatment. Hence, this required us to wear their shoes to understand this and to think about how to make the app simpler than what we may have imagined. We also understand that pharmacists and practitioners are extremely important in the process of patient prescription. Thus, we tried to wear their shoes and come up with ways that could save their time while increasing how much they can help the patient. We definitely learned how to think about a variety of perspectives and consider what functions would be best depending on the person.
What's next for MEdherence
Going forward, we’d like to expand MEdherence to iOS users in addition to Android users. Further, patients will be able to choose their in-app practitioner. A past Mobile Health study demonstrated racial and ethnic disparities in outcomes. By letting the patient choose a practitioner from a list, which displays the practitioner’s name, photo, and pronouns, we hope to reduce this racial and ethnic disparity. It has been shown that older adults prefer someone of their own gender and race, and thus by letting patients choose someone as such, we hope to strengthen the patient-practitioner relationship and increase medical adherence.
In the future, we’d like the app to also include information about vitamins and nutritional supplements that users can take to reduce the severity of their diseases, in addition to including holistic medicine supplements in our database of medications. We understand that culture is significant to many adults, especially older ones, and thus we hope this app can include medicinal practices from various cultures. On a similar note, we’d also like to develop the app for other languages such as Spanish, Mandarin, and Hindi - the top three spoken languages besides English. In addition to all of this, we’d like to augment our medication database by linking it to DynaMed, which has a dictionary of all drugs prescribed in conventional medicine.