eHealth System for Oral Anticoagulation Therapy (Tele-Warf)

Update

The intervention in this project will not be carried through. The technical solution for collecting sensor data is carried on in the Diabetes projects in the NST.

Background

Near patient testing techniques for measuring of INR in primary care settings have shown to be reliable, accurate and popular among the patients. Several studies have emphasized the importance of regular, systematic external quality control. The computerized decision support improves the laboratory quality of anticoagulant treatment, both during long-term maintenance and in the early, highly unstable phase of treatment, and it significantly reduces the number of scheduled laboratory controls.

The following table summarizes different therapy options and time within therapeutic range. There is a big correlation with time within therapeutic range and number of complication.

Goal

Patient self-testing or self-management may provide the greatest degree of decentralization. Adding computerized decision support system (CDSS) will be useful and helpful. Patient analyses himself with his own blood using self-testing equipment. The measured INR-value will be sent directly to the thrombosis service at the hospital or primary healthcare. At the hospital or primary care, a physician at the thrombosis service with the help of CDSS can respond with a new dose.

Problems

To prevent under-treatment or overdoses, regular laboratory control of the intensity of anticoagulation and dose-adjustments are necessary. This management of oral anticoagulant therapy is often executed by a specialist at the hospital or the patient’s primary doctor. Although this type of management is thought to be superior to less well-organized management of oral anticoagulation, and despite a strong organization, laboratory quality control, and automated, computerized dose-adjustments, for many patients the intensity of anticoagulation does not fall within the “therapeutic target range” for long periods. Besides, the visits to the anticoagulation clinic are rather time consuming and, for some patients, inconvenient.

Methods

In this project, we want to implement a telemedicine system for reporting INR-values automatically into the hospital. The measurements of INR-values are done by the patients itself using self-testing equipment. The INR-values will be sent into the hospital using a short message service (SMS). In the hospital, we want to develop a computer aided management tool that supports healthcare personnel in dosing Warfarin. The suggested dosage will be sent back to the patient as SMS and an automatic pillbox shall generate the dosage accordingly.

Project manager

Geir Østengen, NST

Project members from the partners

Telenor: Thore Syversen, Alf Sollund, Arne Munch Ellingsen and Gunvald Svendsen
UiT: Trude Giverhaug (Institute of Pharmacy), John-Bjarne Hansen from UNN (The department of clinical research), Arne-Munch Ellingsen from Telenor and UiT (Institute of computer science).
UNN: John-Bjarne Hansen (The department of clinical research)
NST: Daniel Nygård Johan Gustav Bellika, Vedad Hadziavdic, Harald Øverli Eriksen, Ragnhild Varmedal, Eirik Årsand, Eva Henriksen, and Geir Østengen.

The TeleWarf project will cooperate with The ICT lifestyle and health motivation project  to co-ordinate the development of similarities.

Project start/stop

January 2007 till 2009.

Contribution to health care

The contribution will be a more efficient and secure system for the patients to control and measure their INR-values. The system will enable the healthcare personnel to follow up the patients much closer. The patients does not need to visit the primary doctor every 6th week as today. Instead the patient measures its own INR-values and our platform will handle the communication to the healthcare professional.

Through our platform this patient group is thought to have more stable INR-values, causing the risk of complications to be reduced considerable. Through different studies it has been shown that there is a huge correlation between stable INR-values and number of complications.

Contribution to new industry

The contribution will be together with ICT lifestyle and health motivation project a prototype platform enabling developers to attach different sensors and their data to the platform.

Contact info

e-mail: Geir Østengen, mobile phone: +47 951 70 246

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