Using Healthcare IC Cards to manage the drug doses of chronic disease patients

https://doi.org/10.1016/j.compbiomed.2005.12.005Get rights and content

Abstract

In Taiwan's medical system, the Healthcare IC Card is used as form of secure data storage. This research applies the Healthcare IC Card to record the chronic disease patient's recent drug doses, diagnoses and prescriptions. With the Hospital Information System, this research combines the diagnosis records stored in the Healthcare IC Card to establish a platform which could simulate the procedures of a doctor in examining a patient and checking the circumstances of the patient's repetitive drug doses and drugs interactions. The experiment is based on a data log of about 22,000 items of drug prescribed to 43 diabetes patients and about 88,200 items to 192 high blood pressure patients. The results show that the proposed approach would have reduced the waste of medical resources, strengthened Taiwan's medical system and increased the public's health.

Introduction

According to the Bureau of National Health Insurance (BNHI) of Taiwan, the analysis of clinic medicine fee growth showed that compared to 1997, 80% of the medicine fee increase in 1998 was from medicine to treat chronic disease. Moreover, the chronic disease repetitive drugs doses for ingredient repetition and pharmaceutical repetition were 3.1% and 29%, respectively [1]. Repetitive drug dose not only waste a medical resources but also jeopardize patients’ health. Tarfeshi et al. [2] found that in America overdose was one of the factors for patients to go to the emergency clinic. Bjerrum et al. [3] applied the medicine database in Denmark and found out that 2/3 of the elderly aged over 70 took more than two kinds of medicines at the same time; and the odds ratio of those who had suffered from the coronary diseases, anemia, or respiratory problems to take more than five kinds of medicines was about 40%. Under the analysis of the BNHI, the average rate of applying multiple drugs in one prescription amounted to 4.13 [1]. Starfield [4] found out that the more drugs being taken, the more possibilities of drug interaction and bad effects, especially among the elderly.

When a patient visits a doctor, it is important for the doctor to explain the patient's condition, medical treatment, and general common sense health living. In Taiwan's hospitals, the records concerning the medicine-taking experience of a patient are insufficient to explain the patient's pathology and medicinal influence. It is important to provide a better health information system for the public.

Prescription errors are often associated with poor health information [5]. In order to reduce the risks caused by human factors, alert functions could be set up in the prescription systems to remind doctors to check the related information. Accordingly, doctors could be more accurate in prescribing. In America, medication errors have caused medical harm to about 1–2% of inpatients. Prescribing errors were the main category among the medication errors, and the major reason was human negligence [6]. Leape et al. [17] pointed out that the obvious cause of errors was medication errors, as there had been a lack of drug prescription information in the prescribing process such as “alert of interaction”, “adaptation illustration,” and ”alert for side effect.”

Adverse drug events (ADEs) are known to be a major health problem worldwide. ADEs were the fourth leading cause of death in US [8] with an estimated cost of 136 billions dollars annually [9]. In [10], [11], [12], they demonstrated the drug-ordering system coupled with decision support tools helpful to prevent prescription errors and ADEs. Many decision support systems use commercial drug knowledge databases, but these knowledge sources are known to generate many clinically insignificant alerts, hence decreasing the confidence of the end users [12], [13]. In [9], [10], [11], they pointed out that a small number of decision support systems developed by academic research teams have succeeded in decreasing ADEs and cutting hospitalization costs.

In order to increase the safety of the patients’ drug dose, many academic medicine centers have developed prescribing facilities in their Healthcare Information Systems (HIS) to prevent errors in the prescribing process as well as collecting and classifying the degree of safety of different drugs [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [17], [18], [19], [20], [21], [22], [23]. However, these related references cannot detect the repetitive drug doses and the drug interaction in real time while the patient is taking the drug. Therefore, in this research we applied the functions of the Healthcare IC Card to save the patient's medical diagnosis securely and we developed and integrated some tools to achieve the real time detecting program. The remainder of this paper is organized as follows: in Section 2, the proposed the prototype system is described. In Section 3, we analyze the study and conclude this paper in Section 4 with recommendation for further research.

Section snippets

The protype system

In Taiwan, the Healthcare IC Card is a type of Java Card. A program, or an applet, on a Java Card applies the Application Protocol Data Units (APDU) mechanism to interchange messages with a card reader in the Command-Response mode. When the applet finishes the task of an APDU command, issued from the card reader program, it sends the status code to Java Card Runtime Environment (JCRE), which then sets up a response APDU to the card reader. The Java Card only makes responses according to the

Analysis

The chronic patient's drug information was provided by the South Branch of BNHI. About 22,000 items of drugs were prescribed to 43 diabetes patients and about 88,200 items to 192 high blood pressure patients.

Conclusions

This research builds a prototype system and uses the treatment sample data of chronic patients provided by the BNHI for clustering the personal drug dose record database, to demonstrate the effectiveness of using the Healthcare IC Cards to help doctors in drug dose management and reduce drug interactions. In addition, a doctor would have more information about the patients’ medical history and be able to more conveniently track epidemic situation of infectious diseases. In using the prototype

Acknowledgments

Part of this research was supported by the Bureau of National Healthcare Insurance, Taiwan, ROC, under Contract DOH90-NH-008.

Ting Wei Hou received the B.S., M.S., and Ph.D. degrees all in Electrical Engineering, National Cheng Kung University, Taiwan, in 1983, 1985, and 1990, respectively. He has been an associate professor in the Department of Engineering Science, National Cheng Kung University since 1990. He was a visiting scholar of CSRD of the University of Illinois at Urbana-Champaign, Illinois, U.S.A, in 1994. He served as a consultant of Taipei Rapid Transit Corporation in 1995, of III (Institute of

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    Ting Wei Hou received the B.S., M.S., and Ph.D. degrees all in Electrical Engineering, National Cheng Kung University, Taiwan, in 1983, 1985, and 1990, respectively. He has been an associate professor in the Department of Engineering Science, National Cheng Kung University since 1990. He was a visiting scholar of CSRD of the University of Illinois at Urbana-Champaign, Illinois, U.S.A, in 1994. He served as a consultant of Taipei Rapid Transit Corporation in 1995, of III (Institute of Information Industry) in 1997, and of Taipei City Government in 2000. He was a consultant on National Healthcare IC card project of Bureau of National Health Insurance of Taiwan in 2002. His major research is in computer systems and system integration, which includes high-performance computing systems, high-speed networking, embedded systems, IC card (smart card) systems and internet appliances. He has been the project leader of the pilot project on Healthcare IC cards in Penghu, Taiwan from 1998 to 2003. The project evolved to the National Healthcare IC card project, which took place in 2002. He has been working on Java-based systems, Java virtual machines and Java cards since 1998. Currently, he is leading a project building a testing environment for the National Healthcare IC card project and projects on the security of MPEG-2 based DVR systems and MPEG-4-based internet appliances.

    Jiun-Tze Lai received the M.S. degree in Engineering Science from National Cheng Kung University in 2001. He is currently pursuing his Ph.D. in Engineering Science at National Cheng Kung University. His current research interests include information security, smart card technology and control theorem.

    Chiun-Lin Yeh received the M.S. degree in engineering science from National Cheng Kung University in 2001. He is currently pursuing his Ph.D. in Engineering Science at National Cheng Kung University. His current research interests include smart card technology and control theorem.

    Chien-Min Chao received the M.S., and Ph.D. degrees all in Aeronautics and Astronautics, Purdue University, USA, in 1968 and 1975, respectively. He has been a retired professor in Department of Engineering Science, National Cheng Kung University since 2002. He was a consultant on National Healthcare IC card project of Bureau of National Healthcare Insurance of Taiwan in 2001. His research interests include engineering optics, robotics, remote sensing, numerical controlled machine and smart IC card system.

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