E-ARMOR: An Online Tool to Evaluate Polypharmacy in Elderly Persons 04/26/10 E-ARMOR: An Online Tool to Evaluate Polypharmacy in Elderly Persons E-ARMOR Group Jacob Brown – Domain Expert Jordan Fish – Project Manager Kajal Miyan – Facilitator Yang Yang - Configuration Manager

04/26/10 PART I: OVERVIEW

Project Overview Motivation for project System Goals 04/26/10 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… Limit system access Compute 04/26/10 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 Formulae ARMOR 04/26/10 Domain Research Polypharmacy tools ARMOR Physician’s Desk Reference Mosby Drug Reference Formulae Cockcroft-Gault Devine formula 5

Risk Analysis Risks How to mitigate risks? Data protection 04/26/10 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 04/26/10 PART II: MODEL-BASED VIEW OF SYSTEM 7

Description of Use Case Diagram 04/26/10 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 04/26/10 Description of Class Model Single Access Point Singleton Proxy General layout of class model Why model is constructed this way Identify the design patterns used for system (use color or other means to distinguish design patterns). Explain the rationale for the design pattern use Interpreter 9

Behavior Model: Sequence Diagrams 04/26/10 Behavior Model: Sequence Diagrams Exceptional Normal

04/26/10 E-ARMOR State Diagram

DrugDataProxy State Diagram 04/26/10 DrugDataProxy State Diagram

Related Work START STOPP 04/26/10 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 screening tool to alert doctors to the right treatment 13

Lessons Learned Design principles Client-Server architecture 04/26/10 Lessons Learned Design principles Client-Server architecture Inherent for web application Central Control Singleton proxy Easy to maintain the medication information Provide access control and uniform interfaces

Lessons Learned (cont.)‏ 04/26/10 Lessons Learned (cont.)‏ In retrospect - Clean requirements document More efficient Customer interaction for procuring Domain Knowledge Time management Prototype can be a huge temptation

Lessons Learned (cont.)‏ 04/26/10 Lessons Learned (cont.)‏ Future work Communicate with EMRs Smart phone application Identify potentially redundant medications Threshold values to immediately notify danger Encrypted connection

PART III: DEMONSTRATION 04/26/10 PART III: DEMONSTRATION

04/26/10 Prototype: Login Provides Access controls

04/26/10 Prototype: Main Page

04/26/10 Prototype: Results

04/26/10 Video demonstration http://www.cse.msu.edu/~cse870/Input/SS2 010/E-ARMOR/video/demo_natural.mp4 http://www.cse.msu.edu/~cse870/Input/SS2 010/E-ARMOR/video/demo_natural.html

Live Demonstration Workflow 04/26/10 Live Demonstration Workflow Login Enter data View/print results Logout http://www.cse.msu.edu/~cse870/Input/SS 2010/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.