My mom called me crying recently. She’s 68 years old, overweight, inactive, and suffers from a litany of "old-age ailments" including high blood pressure, high cholesterol, borderline diabetes, arthritis, and hearing and vision limitations. Her situation probably sounds familiar to a lot of baby boomers and their kids.
Every Sunday evening, she loads her four-by-seven pill case with her 12 prescription medications, three vitamins, and two over-the-counter pain relievers. She can’t remember or even pronounce the names of most of these pills. She can barely recall which are for her heart and which are for her joints. Sometimes she skips taking her pills altogether. She figures if she’s feeling good, why mess with it? My mom is not alone.
When she called me crying, my mom was refilling her pill case for the week. But instead of her usual pills, she had a couple of new meds after a bad case of pneumonia put her in the emergency room for five days. Understandably, my mom felt overwhelmed. She had no idea what meds were in conflict with other meds, and based on the standard disclosure statements they speed-read at the end of TV commercials, it’s anyone’s guess whether the combination of meds were helping her or making her situation worse.
When Mom and I hung up the phone, I felt terrible. The U.S. health-care system is such a huge mess that no one person could ever fix the whole thing, but as a product development engineer with experience in the medical field, I’m qualified to at least help my mom sort out her specific situation.
The next day, I met with some people in the health-care team at Smart Design. We dug deep into the issues. Over a few weeks, we did research, spoke with patients and caretakers, met with product vendors, and concluded that there were four main facets to the challenge:
1. Medical Getting-to-Know-You
How does my mom know when she’s supposed to take X, Y, or Z pill, or what meds she’s supposed to take on any given day? The truth is she doesn’t know for sure.
The good news is that a piece of pending legislation will require all prescriptions to be entered into a central database, which will be accessible by both the pharmacy and physicians. This way my mom’s various doctors will know what the others have prescribed from their respective hospitals and treatment conflicts can be avoided. As of now, this is completely invisible.
Private companies such as SureScripts are building the infrastructure that will centralize much of this critical information. But the bad news is that this useful consolidation of information has been stalled by the great U.S. health-care debate, so there are no guarantees if and when people like my mom will ever benefit from its technology.
At the same time, Google Health and Microsoft HealthVault have made significant investments in helping individuals keep track of their overall health records, including their medication summary. The problem is it’s currently the responsibility of the patient to enter and maintain this information. I know that my mom — and many others out there — won’t take the time to keep this current, even if she has a personal incentive to do so.
Unfortunately, lack of widespread adoption has already hurt one of the main players. Google announced in June that Google Health will be discontinued on January 1, 2012. So it’s still unclear which service will own responsibility for maintaining and accessing medical records in the long term. For the moment, people like my mom are still relying on handwritten notes in their purses when they visit the doctor’s office.
2. Sorting Through the Chaos
The act of sorting and storing daily dosages is an arduous task for just about everyone involved: patients, caretakers, and even pharmacists. While some independent pharmacists are still working the front lines of patient care and offering a variety of services, the macro trend for chain pharmacies is simply to drive the cost down to a point where there is no expectation of patient service whatsoever. At Walmart, $4 buys you a 30-day supply of most generic medications, leaving no margin for service.
The widely publicized ClearRX pill bottles from Target were a huge step in the right direction. Launched in 2005, ClearRX was a series of color-coded pill bottles with large, legible labels that made it easier for patients to keep track of what was inside each bottle. Target’s emphasis on patient care was well received by both the press and patients, boosting pharmacy sales significantly. However, six years later, ClearRX still represents a very small percentage of the 3.6 billion prescriptions filled each year.
The everyday challenge of getting pills out of the tamper-proof bottles and into the daily dosage case remains a laborious task, both physically and mentally. There is a gaggle of simple plastic tools, including several generic pill-counting trays, but most still require significant manual dexterity or keen eyesight. None of these would help my mom with her situation.
3. Keeping Track of the Pills
There are literally hundreds of pill storage containers available, but it’s hard to beat the generic four-by-seven compartment cases that you can find in any pharmacy across the country. They serve the basic purpose of pill storage and provide accurate confirmation of compliance: If the tray is empty, then you must have taken them — even if you can’t remember.
Nevertheless, companies are providing alarms that remind patients when it’s time to take their pills (some with friendly but weird recorded voice messages). Some even incorporate data collection to confirm that pills were taken on a regular basis. Devices like MedSignals and Vitality Glo-Caps are good examples. But neither would help my mom; she takes multiple pills per day and wouldn’t have the patience or skill to program the system herself in the first place.
The fact is most patients who have settled into an active life with an illness don’t need to be reminded to take their pills at all. My mom has set up many resourceful reminder systems, such as putting her morning pills by the coffee maker and her evening pills on her night stand. She follows a well-practiced routine, and taking pills has become a regular part of her day.
The danger is what happens when that routine breaks down, which is what happened when my mom got pneumonia. She was thrown off her regimen. In these situations, friendly dosage reminders can help make sure nothing slips between the cracks. Sadly, one of the most common recommendations is an oversized wristwatch with bells, buzzers, and blinking lights that does nothing more than stigmatize the illness.
4. Communicating with the Doctor
Despite incremental improvements, the crux of the problem is still the same: When someone shows up at the hospital, the doctor has no way of knowing what medications the patient is currently taking. Health-care professionals are already overworked and held personally responsible for patient safety, so the idea of critical information like this floating in the cloud is perceived as a liability more than an asset.
Even if the patient brings in their crumpled piece of paper and tells the doctor that they have religiously been taking their meds (similar to telling the dentist that you’ve been flossing every day), doctors have no way to know whether the information is accurate. For example, my mom was taking two pills every day for her blood pressure, but she saw little improvement. After several revisions to the dosage, her doctor finally figured out that she was taking two pills each morning, rather than one in the morning and one in the evening. That one simple revelation about her dosing schedule had a tremendous impact on her treatment, and yet it took months to figure this out.
The MedSignals and Vitality devices have the potential to be useful ways to tracking medication and dosage — assuming they are designed in a user-friendly way. And if the reports can be printed or viewed online, we can minimize the burden on the physician.
Pulling Together All the Pieces
There are several interesting technologies on the horizon, but we are far — very far — from having one cohesive system. So what would be the ideal scenario for my mom?
Let’s start by putting her four-by-seven container to bed. It would be replaced by a clever service provided by Medicine-on-Time, which allows local pharmacists to collate various medications into a single blister pack, grouped by day and time. While the cost of this service is approximately $20 per month, a recent study showed this service resulted in a 66% reduction in the likelihood that elderly patients need to be moved to assisted living facilities, which could save billions of dollars annually.
Then if Medicine-on-Time could be coupled with something like the RFID-embedded technology provided by CYPAK, which automatically records when a particular blister pack gets used, we would actually be getting somewhere. Mom’s compliance data could be viewed by her physician and her collective caretakers, not to mention the pharma and insurance industries.
Of course, once this kind of compliance data is in the cloud, there are lots of things we could do with it. At a basic level, a patient report that combines the Vitality compliance data with the SureScripts medication summary would be hugely beneficial. Then at a more advanced level, if my mom forgot to take her morning medications, she could get a discrete reminder text, email, or phone call, eliminating the need for redundant alarms and flashing wristwatches.
Naturally, all of this data could be visible to her physicians and our family. We could opt-in if we wanted to keep a closer tab on things. And perhaps the pharmacy can keep track of when my mom may be running low on her meds and automatically fulfill next week’s order.
But the big question still remains: Who will pull together all of the pieces? Is this the responsibility of the large health-care providers? Or perhaps the insurance industry? Or should we continue to hold our breath for the federal government to provide some specific guidance?
Whatever happens, we’re having a hard time sitting idly by. At Smart Design, we’re excited by the opportunities to help people and our clients pull the threads together. We know design is a key factor in technology adoption, behavior modification, and patient compliance. If we can start by creating a better, more cohesive patient experience that will stop reminding the millions of patients of how sick they are, we can start empowering them to live healthier, happier lives.
Hang in there, Mom. Technology is on the way.
[Images by Lenny Naar. Research support provided by Nathaniel Giraitis.]