Dig­i­tal pill­box aims to im­prove med com­pli­ance

Modern Healthcare - - INNOVATIONS - By Dar­ius Tahir

In the fall of 2012, Nick Valilis was di­ag­nosed with leukemia just as he was start­ing med­i­cal school. In treat­ment he found it dif­fi­cult to re­mem­ber to take his med­i­ca­tions at the proper time and in the right or­der.

“He strug­gled han­dling the sheer com­plex­ity,” said Rahul Jain, Valilis’ class­mate at Duke Uni­ver­sity. “He went from no meds to 10 meds a day. How is an 85-yearold can­cer pa­tient sup­posed to han­dle that same reg­i­men?”

Since then, Jain, Valilis and a few other Duke class­mates have formed a startup com­pany called Tow­erView Health with the goal of mak­ing it eas­ier for pa­tients to man­age their med­i­ca­tion reg­i­mens. Jain is CEO of the com­pany, which was in­cor­po­rated last year; Valilis is chief med­i­cal of­fi­cer. They are about to launch a clin­i­cal trial, in part­ner­ship with In­de­pen­dence Blue Cross and Penn Medicine in Philadel­phia, to test whether their tech­no­log­i­cal so­lu­tion helps pa­tients un­der­stand and com­ply with their drug reg­i­mens.

That could be an im­por­tant in­no­va­tion. Poor med­i­ca­tion ad­her­ence is es­ti­mated to cause as much as $290 bil­lion a year in higher U.S. med­i­cal costs, as well as a big chunk of med­i­ca­tion-re­lated hos­pi­tal ad­mis­sions.

Tow­erView has de­vel­oped soft­ware and hard­ware that re­minds pa­tients and their clin­i­cians about med­i­ca­tion sched­ules, and warns them when a pa­tient is fall­ing off track.

Dr. Ron Brooks, se­nior med­i­cal direc­tor for clin­i­cal ser­vices at In­de­pen­dence Blue Cross, said he thinks Tow­erView’s so­lu­tion is a no­table im­prove­ment over pre­vi­ous med­i­ca­tion-ad­her­ence tech­nol­ogy. “Most of the apps I’ve seen are re­minder apps,” he said. “It might re­mind you to take a med­i­ca­tion, but you have to in­put that you ac­tu­ally take it. There’s no closing of the loop.” By con­trast, Tow­erView au­to­mat­i­cally pro­vides re­minders and track­ing, with the op­por­tu­nity for clin­i­cian fol­low-up.

Here’s how Tow­erView’s sys­tem works. When clin­i­cians pre­scribe drugs and de­velop a med­i­ca­tions sched­ule for a pa­tient, the scrips and sched­ule are sent to a mail-or­der phar­macy that has part­nered with Tow­erView. The phar­macy splits the med­i­ca­tions into the sched­uled dosages on a pre­scrip­tion-drug tray. The tray is la­beled with the sched­ule and sent to the pa­tient, who places the tray into an elec­tronic pill­box, which senses when pills are taken out of each tray com­part­ment.

The pill­box sen­sors com­mu­ni­cate with con­nected soft­ware through a cel­lu­lar ra­dio when pa­tients have taken their pills and when it’s time to re­mind them— ei­ther through a text mes­sage, phone call or the pill­box light­ing up—that they’ve missed a dose. The sys­tem also com­piles in­for­ma­tion for providers about the pa­tient’s his­tory of missed doses, en­abling the provider to per­son­ally fol­low up with the pa­tient.

But some ques­tion whether tech so­lu­tions are the most ef­fec­tive way to im­prove med­i­ca­tion ad­her­ence. A 2013 lit­er­a­ture re­view in the Jour­nal of the Amer­i­can Phar­ma­cists As­so­ci­a­tion iden­ti­fied nearly 160 med­i­ca­tion-ad­her­ence apps and found poor-qual­ity re­search ev­i­dence sup­port­ing their use.

Ex­perts say it’s not clear whether apps and de­vices can ad­dress the un­der­ly­ing rea­sons why pa­tients don’t com­ply with their drug reg­i­mens. For in­stance, pa­tients sim­ply might not like tak­ing their drugs be­cause of side ef­fects or other is­sues. “I’d wa­ger that im­proved ad­her­ence—and a range of other health benefits—are ul­ti­mately more likely to be achieved not by clever apps and wire­less gad­gets, but rather by an em­pa­thetic physi­cian who un­der­stands, lis­tens and is trusted by her pa­tients,” Dr. David Shay­witz, chief med­i­cal of­fi­cer at DNAnexus, a net­work for shar­ing ge­nomic data, re­cently wrote.

Jain doesn’t dis­agree. He notes that his firm’s sys­tem em­pow­ers em­pa­thetic clin­i­cians to pro­vide bet­ter care. “This so­lu­tion al­lows more of a com­mu­ni­ca­tion el­e­ment,” he said. “We’ll be able to un­der­stand why pa­tients don’t take their meds.”

That sys­tem soon will be put to the test in a ran­dom­ized clin­i­cal trial. Tow­erView and In­de­pen­dence Blue Cross are en­rolling 150 di­a­betic pa­tients who are non­com­pli­ant with their med­i­ca­tion reg­i­mens; half of those par­tic­i­pants will re­ceive usual care. The goal is to im­prove com­pli­ance by at least 10% over six months.

If it works, Jain and his com­pany hope to sell the prod­uct to in­sur­ers and in­te­grated health­care providers work­ing un­der riskbased con­tracts. The idea is that pa­tients’ im­proved ad­her­ence will re­duce providers’ hos­pi­tal­iza­tion and other costs and boost their fi­nan­cial per­for­mance.

“This so­lu­tion al­lows more of a com­mu­ni­ca­tion el­e­ment. We’ll be able to un­der­stand why pa­tients don’t take their meds.” RAHUL JAIN, CEO

The pill­box com­piles in­for­ma­tion for providers about the pa­tient’s his­tory of missed doses, en­abling the provider to per­son­ally fol­low up with the pa­tient.

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