Proscribe is a freely distributed software application to help eliminate antimicrobial resistance in countries (in Asia and Africa) that has lax antibiotic prescription and to protect patients from dangerous drug interaction.

About me:

I am a senior at Adlai E Stevenson High School in Lincolnshire, Illinois (Class of 2017). My major interests are in biomedical engineering and orthopedics. In my free time, I enjoy writing, traveling, and trying new food.

Why I built ProScribe:

I have been traveling to India (southern state of Kerala, the city of Cochin) with my parents ever since I was little, and I would constantly be in and out of doctors offices for sickness and severe allergies that result from the drastic climate change. As I got older, I noticed that the medical system I observed in Kerala is totally different from what we have here in the States. Hospitals are often crowded, and the wait to see certain doctors can take hours. Essentially, if someone is going to see a doctor, half their day is taken up. Consequently, people would opt to go visit the doctor at his home before he leaves for work or after he comes back from hospital after 6pm. Some doctors can be seen as late as 10pm. By visiting the doctor in his/her home clinic there is no burdening wait like the one in the hospital. Typically, the doctor has a consulting room with a door that opens to the foyer and patients will come and wait there to see the doctor one by one. The house also has another entrance for the family members, separate from the home clinic area. The doctor sits there with a prescription pad and after the consultation, he writes a prescription and hands it over to the patient. There are no copies kept in the doctor’s home clinic, while the patient takes that to the local pharmacy that takes the prescription and dispenses medication. I asked a local pharmacist what they do with those prescriptions and the answer I got was mind boggling. She said they throw out the prescriptions at the end of the month. I became curious on how people keep track of their health records. Another thing I noticed was that patients change physicians in a heartbeat and go to another physician for mundane reasons. Reasons like the medication that the first doctor prescribed was not effective or that they were in a different part of the city and it was more convenient to see another doctor. WIthout proper logs kept of prescriptions, patient would sometimes attempt at remembering names of medications they’re taking. Otherwise, the doctor would be unaware of what the patient had previously taken. Only a small minority of patients make their own file folder and save prescriptions.

In Kerala, lack of prescription monitoring and requirements makes getting your hands on antibiotics easy. This leads to antibiotic misuse such as not taking a full dosage or mixing different antibiotics without physician supervision. It was scary to think about what kind of new drug resistant bacteria were being incubated in these patients. Another risk is drug interaction as prescriptions are not kept track and people may be taking drugs that cause potential life threatening interaction.

I have two uncles and an aunt who are doctors in Cochin, and when I began to notice these differences in the health system in India, I started to ask them the questions that ran through my mind. When I inquired about why the doctors didn’t keep patient records, I got two answers: first off, a doctor’s salary isn’t not high enough to maintain a good standard of living, so they augment their income with consulting from home. They don’t want to keep track of the patients they saw as those visit records can be used to reconstruct the incomes for tax liabilities or for potential breach of an employment contract. Secondly, they work longer hours and treat more patients, thus there isn’t enough resources to keep track of all the patient records. Through my cousins in India, I started reaching out to more doctors and asked them why they aren’t using computers to easily track records, since there are inexpensive programs to aid with this. I was told that most of these programs require a lot of input and that it also requires the doctors to put down the accounting and billing information into it, which is an extra hassle. In addition, many current programs require desktop pc’s and cannot work on tablets, thus it’s inconvenient for some doctors who practice at different locations.

The observations and research stated in the earlier paragraphs led me in the path to design Proscribe—an easy to use, tablet friendly, windows program that doesn’t require additional billing information. Proscribe documents prescriptions, visit summaries, allergies, vitals, immunizations, procedures, labs, extra notes, and also includes a diagnosis tab. I wanted to tie patient records to cell/mobile phone numbers, as almost everyone seems to have a cell phone in this day and age. This way, if the patient ever goes and sees two different doctors, both doctors can access the medical records and prevent undesirable drug interaction.

Acknowledgements:

I want to thank the following individuals who helped me to bring my idea and design to a working software program