The National Coagulation Centre (NCC), based at St James’s Hospital Dublin, is world renowned for its treatment of haemophilia – a group of genetic disorders that impairs the body’s blood clotting abilities. Patients with haemophilia lack the coagulation factor, most often factor VIII or Factor IX, which is crucial for enabling the blood to clot. Without this, sufferers can bleed severely from the slightest of injuries, which can be fatal.
This initiative commenced in 2001 in response to the 1980’s medical catastrophe when significant fatalities were caused as a result of blood products, used in the treatment of haemophilia, became contaminated with HIV and Hepatitis C. Not only had the blood products become contaminated, but the infected stock was impossible to track and trace. Even after a batch recall was initiated, patients continued to become infected due to self-medicating with the contaminated medication which remained in the supply chain because of the ineffective manual recall process.
The challenge for healthcare providers
Individuals suffering from the most severe forms of haemophilia are required to self-treat in their own homes 2-3 times a week (prophylaxis). To manage their disorder, patients self-infuse with Clotting Factor Concentrates (CFCs) to replace missing clotting factors. In addition to prophylaxis, patients might also need to self-medicate to counteract the effects of any unexpected haemorrhages (known as a “breakthrough bleeds”). In these instances, immediate treatment is necessary in order to prevent long-term health complications, disability or even death.
To avoid a repeat of the 1980’s catastrophe, NCC wanted to implement an electronic medication track and trace system that would help ensure that patients could verify the safety of medication before self-infusion. Since speed of treatment administration is crucial, NCC needed a system that would quickly confirm to patients that the medication they were about to use matched their prescription, was in date and wasn’t on a recall list. Furthermore the system needed to be easy to use and capable of being deployed on a smartphone or any other smart device. Security surrounding the transmission and storage of the captured data was also a very high priority for NCC.
The solution: World’s first smartphone medication scanning app for patients with haemophilia
In response to NCC’s objectives and specifications, Crimson Tide developed a smartphone app (mpro5Hx) that enables individuals with haemophilia to verify the safety of their medication before use. The mpro5Hx app checks everything from the prescription, lot number and expiry date of the medication, through to the alerting of healthcare professionals if a patient self-medicates for any unexpected “breakthrough” bleeds.
The app is accessible across all operating systems (iOS, Android and Windows 10) and can be used on smartphones and tablets. Also included in the mpro5Hx solution is a unique website and database, hosted in the cloud by Microsoft Azure, where all patient data, relating to treatment and bleed frequency, is synchronised and securely stored. This data is then transferred and integrated into the patient’s Electronic Patient Record (EPR) from where healthcare professionals and patients can review it in real time – allowing them to easily analyse bleed history and modify treatment plans accordingly.
How the mpro5Hx app works
Harnessing mobile and barcode technology to develop a track and trace smartphone app:
A globally unique ID, in bar code format, is assigned to every patient, as is each unit of medication [GTIN] and each location [GLN] in the supply chain, using the industry standard GS1 track-and-trace bar code
Every time a patient needs to infuse with CFCs, they can use the mpro5Hx app on their smartphone to scan the global standard 2D barcode (GS1) on their medication package. This will confirm whether the medication:
- is in date
- matches their prescription
- is on a recall list
An automatic date and time stamp captures exactly when the medication was administered, and the patient also has the ability to record further details about their treatment, such as:
- Reason for infusion (e.g. prophylaxis, breakthrough bleed):
- Bleed location and severity
Cloud storage for real time visibility of patient treatment and bleed data:
All of this data is then sent and stored on NCC’s central mpro5Hx website and database. Clinicians can view the information from within the EPR and patients can also access this data via a secure web portal. From here both parties can review and track treatment history in real time, leading to improved management of the patient’s condition. Should a patient record a severe bleed on the app, an alert is sent to the patient’s treatment centre and prompts the individual to contact their treatment centre immediately.
“The concept of traceability of medication administration within the patient home is considered the Holy Grail among healthcare providers, regulators and drug manufacturers, and provides the final piece of the supply chain jigsaw. Working with Crimson Tide has allowed us to achieve exactly this and its success can be measured by the global interest in this project from both healthcare providers as well as the Pharma and supply chain industries” – Feargal Mc Groarty, NCC Project Manager.
Integration of mpro5Hx with NCC’s stock management system reduces medication wastage:
Building on this initial success, the mpro5Hx system now integrates with NCC’s stock management system, built by Valentia Technologies, which captures patient medication delivery data. This integration has allowed additional features to be deployed on the app including;
- Stock checking – the patient can view the exact quantity of medication they are holding in their fridge stock from within the app. This helps to prevent over ordering and therefore potential medication wastage.
- Alerts for the existence of shorter dated stock – should a patient attempt to use a medication vial that has a later expiry date than other medication batches in their fridge stock, the app will alert the patient to use the vial with the shortest expiry date. This also helps reduce the possibility of stock wastage.
Improved patient care and safety:
Since all treatment data captured on the patient’s smartphone is automatically sent to a secure web portal (for patient access) and into the EPR (for care provider access), healthcare professionals and patients can analyse bleed and treatment frequency in real time – leading to improved care because treatment plans can be altered accordingly. Additionally, should a patient record a severe bleed on the app, an alert is immediately sent out to staff at NCC. The patient can also be reminded to contact their local treatment clinic for advice and guidance.
Patient satisfaction, as measured using an evaluation questionnaire was overwhelmingly positive. In particular patients valued:
- The automatic recording of treatment
- Not having to manually complete treatment sheets
- Real time verification of medication against their treatment of choice
- Ability to view their own treatment history via a secure web application
Significant cost savings through reduced medication wastage:
Via integration of the mpro5Hx app with NCC’s stock management solution, built by Valentia Technologies, the centre can further reduce costs by minimising medication wastage. The app alerts patients if they are not using the medication with the earliest expiry date and patients can monitor exact stock which should help reduce over ordering of this expensive medication. Monitoring of compliance (both timeliness and prescription) in fact led NCC to achieve cost savings in the region of €70,000 in the first 4 months post implementation alone.
Improved productivity and efficiency of internal processes:
Before NCC implemented the mpro5 solution, patients had to laboriously complete paper forms with details of medication names, batch numbers and the dates of administrations, which they then posted back to the hospital. This process and associated tasks were time consuming, retrospective and highly prone to human error. As all data is now captured on the patient’s smartphone and synchronised back to EPR, this process is now entirely automated – removing the need for manual data entry. Clinicians no longer have to wade through treatment sheets in order to spot infusion trends. This allows for timely intervention by the caregivers, helping to improve quality of life, reduce the need for hospitalisation and decrease the potential over use of this expensive medication.
“Crimson Tide developed the solution in conjunction with NCC and a patient focus group. We realised that we were embarking on an innovative and ground breaking journey which is a risk, but we took comfort in the fact that Crimson Tide has treated this as a partnership and has shared the risks all the way. To our knowledge this project is a world first and there are so many additional uses for this, both within haemophilia, but also for any chronic disease group that is required to self-medicate in the home.” – Feargal Mc Groarty, NCC Project Manager.
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