Moore, J. "CollaboRhythm: New Paradigms in Doctor-Patient Interaction Applied to Medication Adherence in HIV Infection"

Abstract

Despite astounding advances in medical knowledge and treatment in recent decades, health outcomes are disappointing and costs continue to rise. The traditional paternalistic and episodic approach to medical care is not meeting the needs of patients. CollaboRhythm is a technological platform that is being developed to enable a more modern collaborative and continuous approach to care by facilitating new paradigms in doctor-patient interaction. It asks the question: Can a system that allows patients to become active participants in their care, through data transparency, shared decision making, education, and new channels of communication, improve patient outcomes?

To begin testing the principles of CollaboRhythm, a system to support medication adherence for Human Immunodeficiency Virus (HIV) infection was created. It includes custom applications on a patient cell phone and an interactive device for the home called a Chumby as well as a collaborative workstation in the clinician's office. The applications allow the reporting of medication adherence, viewing of adherence performance including a personalized and dynamic simulation of HIV, and sending of supportive video messages. The system is novel in that it abandons the typical alarm-based method of supporting adherence and instead focuses on a multifaceted approach to generating motivation through awareness, self-reflection, education, and social support. Transparency of data and new communication channels allow efficient and socially engaging collaboration in real-time.

The HIV medication adherence system was evaluated in two stages. In the first stage, twelve patient interviews were conducted. The response to the principles of the system was positive with eleven of the twelve patients willing to share their adherence data with their clinician and all twelve agreeing that the HIV simulation and encouraging messages would motivate them to take their medications. Overall, eleven patients were interested in using the system. In the second stage, a one-month pilot deployment was conducted with four patients collaborating with an HIV medication adherence specialist. This stage also yielded encouraging results with three patients maintaining greater than 95% adherence all four patients confident that the system helped them improve their adherence. Important lessons were learned about its limitations, including ramifications of inaccurate reporting.

The results from the HIV adherence study suggest that there is merit in the new paradigms in provider-patient interaction facilitated by CollaboRhythm and that some patients are receptive to the idea of becoming more active participants in their care. Evaluations at a larger scale and for a number of clinical scenarios are warranted.