1. Using Wireless Technology and the Internet to Improve Patient Outcomes

2. Wireless Technology ADRIANNA FUSCO: What do we mean by Wireless Technology? Pagers Cell Phones Personal Digital Assistants (e.g. Palm Pilots) Other wireless devices Plus: Our communication software that connects them to the Internet

3. Treatment Team ADRIANNA FUSCO: Using wireless technology and the Internet, we create a Treatment Team that includes: Physicians Pharmacists Nurses Physicians Assistants Caregivers Case managers Call Centers

4. Benefits ADRIANNA FUSCO: The Benefits of wireless technology to the treatment team: An integrated team approach to patient wellness. 24/7 access to patients medication and treatment schedules. Account access can be as restricted or as networked as determined by an organization. Choice of devices and number and types of reminders. Affordable cost. Treatment team has an extended reach and is more effective.

5. Patient Outcomes Definition: The process by which a patients disease state is assessed at given points in time. Improving Patient Outcomes The process or steps a patient or provider takes in order to facilitate improvement within the patients disease state. From diagnosis to cure Asymptotic state Symptomatic disease states

6. Medication and Appointment Reminders Who Qualifies? 40 million patients who currently take medications for chronic conditions such as: Heart Disease Asthma Hepatitis C Depression Mental Illness Organ Transplant Epilepsy Women's Health ADD HIV/AIDS Cancer Care According to the AMA, less than 60% of patients take their medications properly.

7. Medication Reminders What can they include? Reminders for specific doses Updated medication schedules Prescription refills Educational messages Psychosocial issuesIndividualized Side effect management Reinforcement of pharmacists instructions Infinite possibilities…

8. Appointment Reminders What can they include? Case management follow-ups Physician appointments Nutritional/Holistic/Wellness appointments Upcoming diagnostic testing Lab work and scheduling Infinite possibilities…

9. MediMOM Demonstrates Results MediMOM is being evaluated in a clinical trial at the Fenway Community Health Center in Boston, MA. The objective of the study is to measure the influence of MediMOM on adherence levels of patients following complicated medication regimes. One half of the patients uses pill diaries, an adherence questionnaire and MEMs caps; the other half uses MediMOM. Preliminary results show that MediMOM improves adherence more than 20%. This Study has been accepted for presentation at the 8 th Retroviruses Conference, to be held in Chicago in February 2001.

10. Fenway Study Schematic MediMOM GroupComparison Group Monitoring Medications with MEMs Caps Pre-enrollment Monitoring Period Week 0: Enrollment, Randomize to Study Condition Week 2: Short-term Outcome Assessment Week 12: Follow Up Assessment

11. Adherence Increase in Fenway Study Fenway Community Health Steven A. Safren, William Johnson, Josh Gagne, & Elizabeth Salomon Harvard Medical School / Massachusetts General Hospital

12. Response Paging and the Internet Response Paging and the Internet provide Confirmation Response Confirmation The ability to confirm message receipt/compliance with therapy by using standardized responses of an alphanumeric pager or other wireless device. Identifies those patients who are at risk for non-compliance and immediately initiate intervention.

13. Response Paging and the Internet Response Paging and the Internet provide Confirmation Response The ability to send pre-programmed, customized responses to messages that apply to a specific disease state. Patient manager is alerted if the patient is at risk. Side effect management Adverse reactions Initiate intervention or alternate therapy

14. Percentage of Patients that Drop Out of Treatment in the First 30 Days Corporate data based on Hepatitis C Treatment Programs.

15. Average Length of Treatment Durability Corporate data based on Hepatitis C Treatment Programs.

16. Patient Monitoring Customized, Advanced and Proactive Identification of disease-based symptoms for proactive/preventative intervention. Examples: Heart Disease: Blood pressure, diet, exercise, weight maintenance Asthma: Peak flow Hepatitis C: Side effect management issues Diabetes: Glucose readings, symptoms and diet Organ Transplant: Identification of adverse reactions, i.e. signs of rejection

17. At Risk Patients 1.Identify at risk patients within a disease category. 2.Create proactive intervention. 3.Facilitate better patient outcomes.

18. Overall Benefits Better provider/patient communication Patient empowerment Increased adherence to treatment Improved patient outcomes

19. Valuable Lessons What lessons have we learned? Keeping the process simple: Utilize existing technology, including the Internet Infinite Scalability Confidentiality Use wireless device(s) patient may already own Create and administer program as part of an overall treatment plan

20. The Future Standard of care Critical pathways Automated healthcare