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Ward Medication Management takes falls risk reduction to dizzying heights - updated 29/05/17

Through our multi-dimensional approach to assessing falls risk, we aim to offer tailored medications plans to those at most risk of falling.

Photo of Duncan Yorkston
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Who is your idea designed for and how does it enable older adults to live their best possible life by preventing falls?

Our idea is designed for older adults who are taking medications that may be inadvertently elevating their risk of falling. As a team of pharmacists, our idea is not based solely on medication use but also a host of other factors which may increase the risk of falls. The concept involves a multi-dimensional analysis to identify ways in which these factors can directly and indirectly predispose an older person to falling, or whereby the individual may be at risk of adverse outcomes after a fall.

The Problem

It is well known that many medications have the potential to increase the risk of falls. These risks are particularly apparent in older adults who are often sensitive to the adverse effects of medications. There are a variety of complex mechanisms by which medications and other factors can contribute to falls including effects on cognition, blood pressure, posture, muscle strength and eyesight. The World Health Organisation reports 30-50% of residents in long-term care will experience at least one fall each year and of those who suffer a hip fracture from falling, 20% will die within 1 year. Beyond the immediate impacts, there may be long lasting implications for those who suffer from falls. Detrimental effects to confidence and quality of life may occur and many individuals find themselves forced to shift to a higher level of care following a fall. 

Our solution

By analysing pharmacoepidemiological data gathered from thousands of comprehensive medication reviews, we can quantitatively assess and stratify falls risk. Using this method, we can assign a level of falls risk based on a combination of factors including age, gender, genomics, medications, pathology and medical conditions. We are currently developing a system to assess these variables and this will enable us to produce specific, tailored medication regimens for the elderly. We envisage that our approach will be able to highlight for prescribers, situations whereby their chosen approach to the management of an individual may confer extra risk of a serious adverse outcome such as a fall. The key to our approach is anticipating risk in advance and delivering proactive advice to prevent adverse outcomes before they occur. As well as delivering better clinical outcomes, we feel that this will be reflected in improved quality of life, reduced health care costs and diminished medicolegal risk.

Market Opportunity

We believe that our multi-dimensional approach to providing highly specific medication recommendations is unique in the market. Recommendations offered by current prescribing software are often not user specific and typically only assess direct medication-medication interactions. By analysing multiple different variables, our system will provide evidence-based, age-specific recommendations which are tailored to each individual patient. 

App Journey

Version 1 - Cloud based app built for pharmacoepidemiological data 

Version 2 - Cloud database used for business analytics 

Version 3 (current phase) - Auto-notification enabler aka "rules" engine built, DNA genotyping and pathology markers added

Version 4 (future phase) - Prescribing decision support with machine learning capability 

Web-based App Flow Diagram

User Journey Map

http://0bb.ad7.myftpupload.com/wp-content/uploads/2017/05/Jericho-System-Flow-Diagram-v1-1.pdf

About Us

'Ward Medication Management is the largest provider of clinical pharmacy services in the Australian aged care setting, and we are experts in medication analysis.’

http://wardmm.com.au

Accomplishments

Ward Medication Management is part of the Texas Medical Center (TMCx) Accelerator Digital Health 

http://medcitynews.com/2017/02/texas-medical-center-accelerators-giant-digital-health-cohort-includes-australian-contingent/ 

I understand that the following is what the TMCx is looking for from the startups in its cohort:

Companies that meet the following requirements should apply for consideration:

- You have at least one full-time founder 

- You have a working prototype 

- We have a preference for pre-revenue companies with previous pilots or early-revenue companies, but it is not required.

“We are in TMCx to validate, refine our system design and formulate a go-to market strategy in the USA with the hope of creating a global footprint for our company,” said Stuart Ward, CEO, Ward Medication Management.

Feedback and Questions

1. Would this be a situation where the patient takes a genetic test and using your tool they receive personalized advice on multiple medication?

Genomic testing allows us to understand an individual’s expression of certain hepatic enzymes which are responsible for the metabolism and therapeutic effects of many medications. By testing this variable, we can predict the response and risk of adverse effects from some medications and offered tailored advice specific to that person.

2. How would you identify patients suitable for the tool especially in the context of fall prevention?

Any person taking 5 or more medications is usually a good starting point for considering a medication review. For every medication which is added to a regimen, the risk of drug interactions and adverse effects increases exponentially. In relation to identifying those particularly at risk of falls we can specifically look at known risk factors and target these patients. There are many complex mechanisms by which medications can contribute to falls and our goal is to identify these and add them into our algorithms for detecting adverse events.

3. Have you thought about how the information from the tool could be communicated from the pharmacist to the older adult/caregiver?

Our primary goal is to proactively alert prescribers to medication risks and offer prescribing decision point in a primary prevention setting. Our app would also aim to provide the patient or carer with a simplified version of the doctor's report/recommendations.

4. Is the customer the pharmacist or the older adult/caregiver?

The customer of our app is the doctor.

5. Would your medication tool keep medical lists for older adults current and deal with the ‘lag’ in documenting up-to-date medication lists?

Our app would be able to store medication lists for patients and these lists would be accessible to the patient via a patient interface on the app.


6. Is Ward Medication Management specific for fall prevention or for multiple physical side effects from medication?

Ward Medication Management aims to prevent all types of medication related harm with falls prevention making up an important component of our work.


7. How do pharmacists currently give fall prevention advice to patients taking multiple medications?

In our specific field, we provide falls prevention advice directly to the doctor in the form of medication recommendations in our comprehensive medication reviews. We also provide education sessions to nursing staff which can help to reduce the incidence of medication-related adverse effects.

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

Our experiment would involve collecting data relating to the incidence of falls and correlating this with a variety of influencing factors including age, gender, medications, pathology, medical conditions and genomics. Using this data, we could then quantify and stratify an individual's risk of falling and use the result to proactively highlight the risks to prescribers. Implemented actions could then be followed up over a period of time to assess the impact on the incidence of falls.

What skills, input, or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

The OpenIDEO community would be instrumental in helping our team to refine and scale our idea to produce a commercially viable product that could be used to assist prescribers around the world. The larger the number of older adults we can apply this methodology for, the more powerful the evidence we can assemble to demonstrate the effect of the interventions.

How long has your idea existed?

  • Over 1 year

This idea emerged from

  • A group brainstorm

Tell us about your work experience:

Myself and our team of clinical pharmacists work collaboratively with other health professionals conducting medication reviews in the community and aged care sector. Our team has extensive experience in being able to identify and minimise the risk of medication misadventure in older adults.

How would you describe this idea while in an elevator with someone?

Imagine that there was a tool that could calculate, with ease, the potential for serious medication-related adverse outcomes based on any given combination of set patient characteristics (age, weight, kidney function etc). Imagine that this system was widely available and accessible to doctors everywhere and could generate highly specific medication recommendations with the touch of a button.

How does your idea demonstrate our Criteria of Affordability?

For a GP to be able to plug in online the conditions, medications and biological profile to ascertain precision medication management, the cost of this analysis is only $10 a record using AI. We envisage that our tool will greatly improve prescribing efficiency, reduce inappropriate medication use and minimise potential harm to the patient.

How does your idea demonstrate or plan to demonstrate scalability?

We plan on using an online, web based application accessible from almost anywhere which can also serve as an electronic medical record holder and can be plugged into any system with API.

How do you plan to measure the impact of your idea?

To measure the impact of our idea we plan on assessing the number of medicines de-prescribed and recommendations followed by the doctor. This data could then be studied in relation to the incidence of adverse effects ie falls. We also have the capacity for our data to be published in medical journals for critique and the feedback then used to further refine and improve our "rules" engine.

What are your immediate next steps after the challenge?

After the challenge we plan on building the algorithm "rules" engine and adding auto notifications and data visualisations as we move towards version 4 of our web-based app.

Attachments (1)

Wardmm App Flow Diagram.pdf

Prescriber Decision Support Web-based App

51 comments

Join the conversation:

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Photo of An Old Friend
Team

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Photo of Stu Ward
Team

https://www.americannursetoday.com/preventing-polypharmacy-in-older-adults/

Photo of kamran zia
Team

What a terrific idea, particularly given the recent media coverage about falls contributing to 80% of deaths in aged care facilities. A simple and cost-effective tool to guide prescribers in tailoring medication plans for high risk patients. Well done and good luck!

Photo of Duncan Yorkston
Team

Thanks for your comment Kamran

Photo of An Old Friend
Team

Hi Duncan

Great idea, I'm really looking forward to see where this is going in the future! :)

Photo of Duncan Yorkston
Team

Thanks Alex!

Photo of Kate Rushton
Team

Hi Duncan,

Thank you for all your hard work in this challenge and dedication.

All of the ideas posts are locked but the comments section is still open, so please feel free to look at other ideas and comment on them, seek feedback on your idea etc.

I know I have asked many ideators this question but I am asking again as some ideas pivoting in the challenge. Would you say your idea is Most Viable or Most Promising? How would the incentives associated with that Award (Most Viable/Most Promising) be helpful for you?

Photo of Kate Rushton
Team

Hi Duncan,

We’re impressed! Over 40 comments?! We want to point out that not everyone will have time to read all the comments, so make sure you've included information that has helped shape or pivot your idea in the description of your idea above. Keep up the amazing collaboration!

Photo of Duncan Yorkston
Team

Thanks Kate!

Photo of Chris Ashford
Team

Goday Duncan this is a great idea. In our idea, we have a questionnaire that asks, "Yes/No - I take medication that often makes me dizzy. " A yes causes a referral but wouldn't it be nice if the patient could no right away... I'd like to stay in touch, if that is appropriate. My email is in the meeting invite.

Photo of Duncan Yorkston
Team

Hi Chris,

Thanks for your comment. Are you part of the community pharmacists team? I would be happy to connect with you over professional networks.

Cheers

Duncan

Photo of Kate Rushton
Team

Hi Duncan,

Chris is part of the team behind this idea - https://challenges.openideo.com/challenge/fall-prevention/ideas/health-in-motion-education-empowerment-and-collaboration

Photo of Kate Rushton
Team

Hi Duncan,

We are half-way through the refinement phase and I can’t wait to see continued updates on your idea. More information can be found in the refinement toolkit which can be found at the top of the refinement phase page.

An easy first step is to complete the refinement questions which can be found by logging into your OpenIDEO account and selecting the ‘Edit Contribution’ button on the top left hand corner.

If you scroll down to the bottom, you can see the five added questions with a character limit (including spaces) to help you focus your answer. The questions start with "How would you describe this idea while in an elevator with someone? (what's the elevator pitch for this idea?) - 400 character limit"

In addition to answering these questions it would be helpful if you could mention how your solution fits in the market in the ‘full description’ section of your post. Who are your competitors and how is your idea unique?

If you have any questions, please feel free to reach out to me, my email address is krushton@ideo.com

Hope to see you on the refinement call this Friday at 9 am PST.

Photo of Kate Rushton
Team

Hi Duncan,

Would this be a situation where the patient takes a genetic test and using your tool they receive personalized advice on multiple medication?

How would you identify patients suitable for the tool especially in the context of fall prevention?

Have you thought about how the information from the tool could be communicated from the pharmacist to the older adult/caregiver?

Is the customer the pharmacist or the older adult/caregiver?

Would your medication tool keep medical lists for older adults current and deal with the ‘lag’ in documenting up-to-date medication lists?

Is Ward Medication Management specific for fall prevention or for multiple physical side effects from medication?

How do pharmacists currently give fall prevention advice to patients taking multiple medications?

Photo of Kate Rushton
Team

Hi Duncan,

It is great to see all the comments on your idea post.

Would you say your idea is in the category of most viable or most promising idea?

Also, welcome to the refinement phase!

There are three finalist ideas from past OpenIDEO challenges you may want to check out.

Rightsize (a finalist idea from our financial longevity challenge) has a really good user journey outlining how the user would find out about Rightsize and how she might use the tool - https://challenges.openideo.com/challenge/financial-longevity/top-ideas/rightsize

Full Cycle (a finalist idea from our food waste challenge) - a pre-existing startup - has a video of the company pitching at an event to explain how the idea works without going into too much detail therefore protecting IP -
https://challenges.openideo.com/challenge/food-waste/top-ideas/full-cycle-converting-waste-into-a-fully-compostable-bioplastic

Sidekick (a finalist idea from our higher education challenge) - a pre-existing startup - has a good example of user personas. They also produced a prototype user interface of their app to test the concept without explaining the AI or data behind it, just how the product might look for the users - https://challenges.openideo.com/challenge/future-of-highered/top-ideas/sidekick-learning

If you have any questions, please reach out to me on krushton@ideo.com or tag me here using ‘@‘ and Kate Rushton

Photo of Duncan Yorkston
Team

Thanks Kate! I would say we are in most viable.

Photo of eldy wullur
Team

Hi Duncan,

In the elderly poor, many sad stories. When I visited and saw that there was a family that gave the drug expired and not for the illness. For example, the surgical wound is given a nerve drug. Terrible indeed. But that's poverty.
Your brilliant idea, hopefully helps many elderly people who rely on drugs in healing but bring negative consequences on the other hand.

Photo of Duncan Yorkston
Team

Hi Eldy,
Thanks for commenting. It's sadly very true, there are lots of cases of medications causing serious falls. Hopefully this may soon be a thing of the past!

Photo of eldy wullur
Team

I really hope, Thank you.

Photo of Chris
Team

This idea from a team of clinical pharmacists presents an excellent opportunity for us to address and rectify the long standing issue of medication-related falls in our elderly populations.
Well done!
Dr Chris Alderman

Photo of Duncan Yorkston
Team

Thanks Chris. I like your comments ;)

Photo of Wei Jin
Team

An exciting opportunity to do some good

Photo of Duncan Yorkston
Team

Thanks Wei Jin, looking forward to working with you further!

Photo of Stu Ward
Team

Using DNA genotyping, precision medicine algorithms. All beyond concept stage and using an eleven step clinical scale to anaylse falls. What's not to love about this concept.

Photo of Duncan Yorkston
Team

Indeed Stu! Cheers :)

Photo of Livia
Team

Hi Duncan, this is a fantastic idea and I believe this will greatly benefit the older people. Well done and good luck to you!

Photo of Duncan Yorkston
Team

Thanks Livia!

Photo of Siew Lim
Team

Hi Duncan
Your vision to translate data from your medication reviews into a software tool to support our time poor doctors to de-prescribe at the point of prescribing  warrants serious consideration. As a pharmacist myself I have had many first hand experience with our older folks being continued on sometimes at least 3 anti-hypertensives and to see them months later with a fracture and non ambulant and in high care.  Your vision needs to proceed with urgency.

Photo of Duncan Yorkston
Team

Thanks for your comments Siew!

Photo of Csilla
Team

Fantastic opportunity to really make a difference to the quality of life of older people using proactive approaches.

Photo of Duncan Yorkston
Team

Thanks Csilla :)

Photo of Leah
Team

Older people especially the 65+ age group, are at a higher risk of falling and of sustaining serious injury as a result of those falls, the worst being fatality. All falls that lead to a fatality in RACF in Australia are now investigated as a coroners inquest.
Often these falls are a result to pharmacological interventions that negatively impact on the persons mobility and dexterity, as well as their quality of life.
The causes are many and varied but can be broken into area’s in which preventative action can be implemented to lessen the probability and risk of falls and serious fall related injury to the elderly.
It seems reasonable to link falls and impaired mobility in the elderly to many factors, and one of these area’s of concern, is the destructive effects of polypharmacy and sedative effects that are a side effect of many medications that older people take daily.
Great work guys. An area that has for too long been neglected.
If I can assist let me know.
Leah Bisiani - RN.1/Dementia Consultant/MHlthSc

Photo of Duncan Yorkston
Team

Thanks Leah!

Photo of Bettina Fliegel
Team

Hi Leah and Duncan.
It is interesting to learn that all falls leading to fatalities are investigated by a coroners inquest. Do you know if they look into medications as cause? I wonder if they might have data that can be useful in terms of thinking about where within the healthcare ecosystem, and also maybe regionally, your initiative might be of most use to start?

Photo of Duncan Yorkston
Team

Hi Bettina,
Thanks for your comment. I'm almost certain that medications would be considered as part of this investigation and you're absolutely right, this information could be very useful to us! Thanks for the tip :)

Photo of Josh
Team

Duncan,
Great Stuff!
If you don't mind me asking, can different types of medications affect bone density? If so, could this be another risk factor to include in your data? Any adverse events or medications that can lead to a loss in bone density, or lead to osteoporosis could have a dramatic effect on an elderly patient's susceptibility to falling risks. If I am correct in this assumption could you characterize how Ward MM could aggregate that data in order to put in place a proactive approach to mitigating the risks of bone density loss, which may further prevent fall risks due to micro-fractures?

Photo of Duncan Yorkston
Team

Hi Josh, that's a great question and yes there are medications which can affect bone density such as corticosteroids and some anti-epileptic medications. As part of our approach we aim not only to identify factors which may increase the risk of falls but also factors which may affect the outcome of a fall ie fracture, major bleed etc. After analysing all of these factors, we aim to be able to quantify the level of falls risk and falls related adverse outcomes.

Photo of Trevor
Team

Hi Duncan,
I really like this approach and think it has a lot of merit and the potential to revolutionise the treatment and prevention of falls, something which remains to be a significant issue for health practitioners.

What I find really appealing about this approach is that it is based on actual clinical data and is not merely a proof of concept not backed up by actual data. Hence the outcomes using the clinical data will be
practical and evidence-based, I think the causal factors of falls and other health-related events in an individual's life are so much more than just the "one size fits all" or "trial and error" approach which is
currently the approach to treatment in our healthcare system. Based on our genetics and biological make-up we all react totally differently to the next person with regard to treatments and medication.

In our current healthcare system the "one size fits all" approach to medication and health management is clearly ineffective and very expensive for our healthcare system, not to mention the adverse drug reactions
which result from this approach and negative impact on one's quality of life which is sad to see. I believe this new approach to preventing falls will pave the way for new, innovative and more effective treatments
which will lead to an overall better health outcome for patients and quality of life which is paramount.

Photo of Duncan Yorkston
Team

Thanks for your input Trevor. You raise some valid points about the 'one size fits all' approach that is current practice.

Photo of Robert Brown
Team

Hello Duncan, I believe that incorrect medication is largely responsible for falls in older people so this is a great initiative. Well done.

Photo of Duncan Yorkston
Team

Thanks Robert

Photo of Fiona
Team

Great concept from a talented and inspiring team. Love seeing clinical pharmacists thinking creatively about how their talents can help solve some of the most challenging clinical issues.  

Photo of Duncan Yorkston
Team

Thanks for commenting Fiona

Photo of Nita Lakhani
Team

Hi Duncan! Your research post helped inspire my idea. I have a pharmacy background and am personally interested in falls prevention given that older adult family members have fallen recently. These falls were unrelated to medications, but as you say there may be multiple risk factors at play.

Will you be using pharmacoepidemiological data from medication reviews conducted by your team of pharmacists in Holbart, Australia, or will you be including data from med reviews across the country? What about medication reviews in other countries? Do you think that the risk factors would be very different within and across different healthcare systems?

I'm also curious about the types of interventions that you envision to prevent falls once risk is identified and stratified? Thanks.

Photo of Duncan Yorkston
Team

Hi Nita,

Thanks for commenting. We would be using data from thousands of medication reviews completed by pharmacists in our team working around Australia. We don't have access to review data from other countries but I would predict similar results across developed nations. One interesting factor that may vary across countries is the ethnic differences in the expression of cytochrome P450 enzymes responsible for drug metabolism. This may have implications on falls risk for certain medications and our use of genomic data would likely help to address this.

Photo of Bettina Fliegel
Team

Hi all.
Duncan - The cytochrome P450 issue, as it relates to ethnic differences, sounds really interesting. How far along is your group in this project?
Do you envision a tool being developed from this research that will be integrate into an EHR in hospitals and also in the community, in primary care clinics? Would the tool be able to recommend an alternative drug, or combination, if it found a high risk for fall based on current regimen?

Are there other groups doing research or product development in this area?

Good luck with your research!

Photo of Duncan Yorkston
Team

Hi Bettina,

Thanks for commenting, you raise some good points. We are currently in the process of developing a tool which will be able to predict the potential for adverse outcomes of a medication regimen based on multiple factors. The program would also recommend alternative treatments that may be better suited to the specific individual. Once we have the program developed, we hope to have it implemented into primary care clinics. I'm sure that there are other groups doing research in this area however I don't believe anyone has developed a tool to assess and stratify the risk of adverse outcomes in this way.

Photo of Kate Rushton
Team

Hi Duncan!

Great to see you in the ideas phase!

Would you be able to elaborate more on the ‘proactive advice to prevent adverse outcomes before they occur’?

I noticed that you are based in Holbart, Australia. Are you a team of pharmacists working on this project as part of a startup, through an association?

Photo of Kate Rushton
Team

Would you be able to confirm that this is your website - http://wardmm.com.au/ and your company is part of the Texas Medical Center Accelerator - http://medcitynews.com/2017/02/texas-medical-center-accelerators-giant-digital-health-cohort-includes-australian-contingent/ ?

Photo of Duncan Yorkston
Team

Hi Kate,
By using our compiled data to assess falls risk and then applying this at the prescribing level, we envisage that we could prevent a significant number of falls.

Yes, I am based in Hobart but we have a small team of pharmacists all around Australia. Other members from the group are helping me with our submission.

Photo of Duncan Yorkston
Team

Yes that's us!!!