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Managing medication adherence via mobile devices

July 17, 2015
The elegance of managing meds via mobile.
Manjinder Singh Kandola

“It’s just too difficult to sort through all of these medications.” I will never forget one of my first interviews as a medical student, and Joey’s telling of his difficult journey with congestive heart failure.

Throughout my first year, nothing felt more heartbreaking than listening to patients recount the difficulty of adhering to prescribed regimens, whether it was due to side-effects, competing priorities, or simply that they were too complicated to manage. Tragically, many of these patients would end up back in the hospital. I would come away fascinated from physiology lecture, excited by the incredible advances in drug developments, only to hear that much of this potential simply remained unharnessed. The pills weren’t actually getting to the patients.

Despite Drug Developments, Too Many Patients Are Dying

My experiences weren’t isolated. Indeed, 50% of patients in the United States either forget to take their medication or take the wrong dose, which increases preventable disease progression and otherwise-avoidable emergency room visits due to medical complications. As a result:

  • 125,000 Americans die annually due to poor medication adherence
  • Poor medication adherence results in up to 69% of medication-related hospital admissions in the U.S. at a cost of roughly $100 billion per year
  • Total potential savings from adherence and related disease management could reach $290 billion annually, or 13% of total U.S. health spending

Unfortunately, medication non-adherence is likely to only increase as the U.S. population ages and as patients take more medications to treat chronic conditions such as diabetes and cardiovascular disease. It is no wonder that medication adherence has been described as “the holy grail of primary care” for clinicians, healthcare systems, and other stakeholders, like payers and providers.
Our initial motivations thus formed organically through real-world interactions with patients and providers, inspired our inaugural service, PillPal, an automated web-based application that helps patients remember when and how much to take of each of their prescription medications using a text-messaging service. And it’s completely free to users.

The Elegance of Managing Meds Via Mobile

Filling scripts is easy. Providers, usually a nurse, medical assistant, or pharmacist, enter the patient's medication, dosage, and cell phone number into the application or pull the data from existing EHRs. The application then sends patients customized text message reminders, at the exact time they should be taking their medication, with the drug name and correct dosage.

It is a simple and elegant solution, and clinics have been eager to implement our service.

The team will be conducting a two-phase pilot trial to improve usability, establish product-market fit, and measure clinical effectiveness in improving patient care over the next year. We look forward to conducting Phase I trials at a Boston-area community health center and in Bangalore, India.

That is not to say that our journey has been an easy one. We have certainly dealt with our own share of inundated clinics and overburdened medical record systems.

Indeed, many quickly dismiss the plethora of recent technologies that seek to digitize and virtualize healthcare. And we don’t blame them. Too many tools entering the market are well-motivated and even sophisticated, but fail to gain traction due to a neglect of user and provider experience. Too many apps are intended for populations without smartphones. In an overburdened healthcare world in which clinicians already have too much on their plate, they simply don’t have the time to collaborate and integrate these interventions, and the digital divide only continues to grow.

It was, therefore, incredibly refreshing to participate in the Joy of Medicine Challenge, and to be in a room of like-minded individuals who are developing tomorrow’s solutions. To see heads nod as I discussed the problem of overloaded clinics and staff and eyes light up as I touched on our service gives confidence for overcoming the initial challenges we have faced. It shows us precisely where our opportunity lies.

Clinicians indeed don’t have time to monitor ever-more complicated medical record systems, inefficiencies in care, and structural gaps that not only provide barriers to effective care, but contribute to the very ailments which need them.

I was heartbroken in listening to Joey, let alone managing his care. Of course clinicians are frustrated, as many discussed in the challenge. But we can help.

Personalized Treatment and Improved Self Care

As we've continued to develop this focused service, our vision has grown.

PillPal has grown into Memora Health. We are a digital health company—founded by Nisarg Patel, a DMD candidate at Harvard School of Dental Medicine, Manav Sevak, Kunaal Naik, and Kurt Carpenter of Georgia Institute of Technology, and myself —developing an ‘intelligent’ mobile messaging and analytics platform to improve chronic disease management. Hospitals and clinics can use the platform to automate the process of helping patients remember their medication and appointment schedules, improve self-care of chronic illnesses, and receive transient feedback from patients on their well-being through personalized text messages.

Physicians can use the web-based analytics platform to personalize treatment plans based on patient feedback. Similarly, pharmaceutical companies can use the platform to run clinical trials and elicit patient feedback on drug side effects outside an isolated clinical setting.

Unlike current chronic disease management applications, Memora Health will be free to use for patients.

The technology runs on any type of phone, does not require setup on the part of the patient, and provides actionable advice to physicians about adjusting treatment plans personalized to each individual patient.

If You Dream It, You Can Do It

Imagine if clinicians didn’t have to spend time figuring out why patients weren’t taking their medications and worrying that they wouldn’t stick to their regimen. Imagine too, if they did not have to see the same patients over and over due to complications of chronic disease because the meds were simply too difficult to manage. Imagine if they could be confident that prescribed regimens would be followed by patients.

Now imagine if clinicians had intelligent analytics helping inform both personalized and population-level clinical decisions. If clinical trials could have much more accurate records of patients who were acting per-protocol, and the approval and implementation process could be far more insightful. If patients could be healthier and clinicians could truly focus on providing transformative care, all while cutting costs in this rapidly inflating healthcare system.

This is our dream. Let’s bring back the Joy of Medicine.