MANTRA: Mobile Anticoagulant Therapy Management Barbara Rita Barricelli, Yanet Devis, Jose Abdelnour-Nocera, Jennie Wilson, John Moore University of West London London, UK {barbara.barricelli, jose.abdelnour-nocera, jennie.wilson, moorejo}@uwl.ac.uk, ydevis@gmail.com Abstract—The MANTRA (Mobile for ANticoagulant TheRApy) project is aimed at introducing mobile devices and innovative interaction design in anticoagulant therapy practice to improve the quality of life of patients and to support doctor- patient communication. This would have the benefit of saving both patient and healthcare workers time and resources and facilitate the monitoring of this therapy. The project is an on- going usability study and proof of concept and this paper presents the results of a heuristic analysis performed to identify the potentials of this research. Keywords—mHealth; mobile communication; self-testing devices; telemedicine; oral anticoagulant therapy I. INTRODUCTION Anticoagulant oral therapy is aimed at preventing the formation of thrombus. People at risk of developing thrombosis have to take anticoagulant treatment once a day in a dosage that varies depending on the results of an INR (International Normalised Ratio) test [1]. The two main reasons for coagulation therapy are venous thromboembolism and atrial fibrillation. Venous thromboembolism (VTE) [1][2] is the presence of coagulated blood, a thrombus, in a major blood vessel. VTE has the potential to cause significant harm by blocking blood flow to major organs and tissues. Atrial Fibrillation (AF) [3] is a cardiovascular disease that is associated with an increased risk of thrombus formation and risk of stroke in patients that are affected by it. The management of both VTE and AF requires treatment with Warfarin, an oral anticoagulation drug, in a dosage that needs to be adjusted on the basis of the INR test results. The INR test measures how long it takes for the blood to clot, i.e. the prothrombin time. The dose of anticoagulant is adjusted (increased or decreased) in order to maintain the INR result within an appropriate range. The INR is tested every 2-3 days on the commencement of treatment but once the levels have stabilised the interval between tests will change to between 7 and 20 days. INR tests are usually performed in clinics or laboratories therefore patients have to make frequent visits to have blood taken and for the doctor to make the decision about the appropriate anticoagulant dose. The patient must then take exactly the dose prescribed by the doctor. This can be difficult for elderly or disabled people and disruptive to their daily lives. In this paper we present MANTRA (Mobile for ANticoagulant TheRApy), a project aimed at using mobile technology and innovative interaction design to improve the quality of life of patients with coagulation diseases. MANTRA proposes the introduction of digital solutions for the management of anticoagulation therapy in order to support remote doctor-patient communication. This would have the benefit of saving both patient and healthcare workers time and resources and facilitate the management of this therapy. The intention is to provide the patient with an INR self-testing device and a mobile device (an iPod) that transmits the INR result to the patients’ doctor/clinic. The doctor is then able to review the result and transmit back to the patients the correct dose of anticoagulant that they need to take and when they need to repeat the INR test. In this setting, the goal is to provide patients with a testing device to be used at home to reduce the frequency of visits at the hospitals or clinics. Through the device and an iPod, the patients would be able to send their INR test results to their GPs and to receive back their prescriptions details. The focus of MANTRA Project is on studying the feasibility of using the proposed approach, and the patients’ acceptability of using an interactive system. The project is a proof of concept and the objective is the development and evaluation of two interactive prototypes, one for doctors and one for patients. The usability evaluation is aimed at investigate the quality of the service offered by the applications and to understand how it may be improved. In the next section, the state of the art of INR self-testing devices and INR tracking mobile applications is presented. Section III describes the MANTRA Project and its objectives. In section IV the evaluation of four mobile applications for iOS and Android is described and in the final section their results and the future developments are discussed. II. RESEARCH BACKGROUND A. INR Self-Testing Devices INR self-testing devices are freely sold but not currently integrated into the systems for managing anticoagulant therapy adopted by the hospitals/clinics.