HealthTap is a pretty cool site (and phone app) I discovered a while back and have been using on occasion and also recommending others to when they have health problems.
HealthTap offers a bunch of services – but the one I find most interesting and exciting is the “Ask Doctors” option. They have a huge number of doctors (thousands?) who are willing to answer questions.
The doctors answer the questions for free within a few hours. You can also donate $.99 to a non-profit cause via HealthTap and your question is “expedited.” The doctors I’ve had respond provide real answers – not just, “Go see a doctor.” Though that is oftentimes part of their advice (and they usually suggest a specialist for whatever the likely issue is).
So, if you don’t have health insurance, don’t want to try getting hold of your doctor, and for just b/c you are curious – HealthTap is a great and free option…I’m excited to see where innovative companies like HealthTap will take healthcare in the next few years. I have a lot of hope that innovations will result in healthcare reduction costs and improvements in healthcare that will reverse our trend of out-of-control increases in health care costs.
The day starts off great. In spite of only a few hours of fitful sleep I’m up and about and off to a breakfast meeting. Towards the conclusion of my breakfast meeting it occurs to me, “I didn’t take my medications.” I make a mental note to take them as soon as I get home – but forget (yup, I’m a forgetful person). Soon enough its time for my lunch meeting – which is just grand as well – but by the time its over I can feel that something is off. What is going on? Why do I feel so something? It isn’t fatigue – though it kind of feels sleepy, it isn’t depression – though it is a bit angst-ridden. “You didn’t take your medications.” As soon as the thought enters my head I know the cause of my distress and I understand why I’ve felt sluggish between meeting this morning – and while I am feeling sluggish now. I drive home and as I enter the house I scold myself, “No! Don’t do anything…no bathroom, no mail, no taking off your coat – go take your medications!” I know I have a long day ahead of me and if I don’t take my medications now I will be miserable for the rest of the day – which in turn makes me less-than-optimally-productive.
All this to say – its time for me to get a smartphone app (yes, I live by my smartphone – which has my Bible, calendar, email, internet, text messaging, weight loss, todo list, gps, and yes, even solitaire, to keep me going throughout the day) that will annoy me until I take my medications each day. So, as usual, I’ve decided to share my research with the world wide web – and hopefully others will find this research helpful and we can all get back about our more-productive and wholesome days.
The first medication adherence application I came upon is amazing (there website including links to downloading the app is www.medisafeproject.com). I’ll probably do more research eventually – but for right now I already have the app. installed and am using it and it is working wonderfully. It is available for both the iPhone and Android and has a low-tech solution in the works (to be released this year) for those who don’t have smart phones. Lets talk for a moment about the app’s awesomeness:
Can handle multiple medications per day at different times of the day.
Allows you to setup a refill reminder that will automatically warn you a few days before you run out of pills.
Allows you to add a caretaker who will be notified if you fail to take your pills.
Offers a barcode reader which can read many medications and add them automatically.
Is highly customizable:
How many minutes between snoozing each reminder alarm?
How many are the maximum number of alarms you should receive?
What sound do you want to use? Do you want the phone to vibrate?
Create and manage caretakers.
Create and manage additional users – e.g. if you have children who you want to track medications for in addition to self.
Offers reporting on compliance which can be exported to an excel document.
This app is so awesome it stands on its own, but if I could have a few dream improvements they would include:
The upcoming low-tech feature, as a lot of elderly people don’t have smartphones and oftentimes really need this sort of application.
The ability for bi-directional communication with the pharmacy (if desired) so that refills are available for pickup / mailed to ensure no lapses in medication.
Option for phone lockout until medication has been taken.
Option to lock the settings so that individuals who might accidentally or purposefully misconfigure settings would be unable to do so.
Ability to share on Facebook. Yeah, I don’t really want to share if I take my medications on Facebook every day – but once in a while I would to help promote medisafe.
Finding a good Primary Care Physician (PCP) can make a huge difference in one’s ongoing health. Many practices, for whatever reason, seem to be little more than pill dispensaries. You visit when you have aches and pains and need a prescription…but you shouldn’t really expect a lot of help with really maintaining good health.
I finally found a PCP I love and I refer people to all the time – Newtown Medical Group. If you live in the Langhorne, Middletown, Newtown, Penndel, Hulmeville, Levittown area and are looking for a high quality primary care practice – Newtown fits the bill. If you are currently surviving with mediocre PCP care – there are better opportunities available..not every practice offers the sort of sub-standard care you are experiencing: give NMG a try.
When I switched to Newtown Medical Group I did so b/c I was looking to improve my overall health – not because I was struggling with any major health issues. Unfortunately (or fortunately?) I switched around the same time my health took a jump off a high cliff – and it has been in free-fall ever since.
In the summer/fall of 2011 I was exposed to rabies, received a vaccination and at the same time was exposed to the flood waters of Hurricane Irene (which flooded our entire crawl space under the house, lapping at the doors). Soon thereafter I experienced what I thought was poison ivy on my left leg until four weeks later when not only had it not cleared up but it jumped to my hands and swelled them up like small balloons. My first annual physical at Newtown turned into, “quick, find out what is wrong with me” as life became quite miserable.
Newtown Medical Group did fairly extensive blood work, a biopsy, and sent me out for various consultations, eventually eliminating the rashes on my hands and legs. I continued to suffer leg pain while exercising which was mysterious and which would eventually (this spring) become constant and require me to take a medical leave from my employment at Cairn University. Once again, I’ve been put through batteries of tests, referred out to specialists, and had a bazillion appointments – and while I’m not better, I have full confidence in the team at Newtown Medical Group and at each step of the way have been pleased with their professionalism.
Lets talk a little more about what exactly impresses me about Newtown Medical Group’s practice:
Friendly – Call in to the receptionist to setup an appointment or ask a question and the nurses are friendly and patient…much different than my experience at other PCP’s where they are oftentimes rushed, impatient, and indifferent with lots of blaring background noise.
Timely – Don’t expect to spend large portions of your day sitting in the waiting room – Newtown is a timely organization. They can usually fit you in quickly for emergencies yet at the same time manage to keep the waiting room relatively low key – quickly moving patients into rooms with doctors arriving soon after nurses complete the preliminaries.
Technological – Okay, there are some areas (::cough:: the website ::cough::) that could use some work – but overall, I’m very happy with Newtown’s commitment to technology adaptation in its practice. Each room is equipped with a computer which they use to record vital statistics and which contains comprehensive medical records of their treatments and interactions with each patient.
Intelligent – I’ve only had the pleasure of meeting Dr. Matthew Kulka twice, I’ve seen more of Dr. Suzanne Kettler Kelly than she’d probably prefer, and briefly met Dr. Jane Tantum when Dr. Kulka, Dr. Kelly, and Dr. Tantum all came in to consult on my condition during one visit last fall. I have been impressed with all of their professionalism and intelligence as I have had opportunity to interact with them.
Patience – Don’t expect much chit chat during your appointment – at least that is my experience – but that doesn’t mean the doctor won’t spend as much time as necessary with you. While very business-oriented (talking about symptoms, etc.), the doctors also take the time to hear you out and think through what is going on – something I really appreciate. I’ve been in far too many offices where I’ve been pushed out without a full consideration…which only results in more return trips.
One Stop Shop – Newtown does blood tests on site, making life a lot easier. They also have a cardiologist come in on a regular basis and are near St. Mary’s Medical Center – so if tests need to be referred out, they are usually nearby.
Referral Network – The doctors refer you to specific providers they prefer working with and give you copies of the office’s business cards…this makes it really easy to find quality practitioners when you need to see a neurologist, rheumatologist, urologist, etc.
Seriously, they are that good. I really do refer people to them all the time…and I haven’t had anyone come back to me and say, “Dave, I’ve tried Newtown Medical Group and they disappointed me.” I’ve only had folks say, “Dave, I’m going to Newtown Medical Group and here is how they’ve been helping me with x condition I thought I was just going to live with forever.”
It appears this solution is already well under way by several capable companies. You can read about eight companies in Jonah Comstock’s article over at MobiHealthNews. The last two, by e-Pill and Phillips are not particularly impressive or appealing to me, being based on older technology, but the rest appear quite interesting.
Vitality GlowCaps – Being sold out of CVS for $60. First a light, then music, and finally a phone call notify the individual to take their medication. This is a reasonably priced product, though eventually I’d like to see every pill bottle come with this technology built-in and prices drop for separately purchased bottles come down to $5-$10/ea. This apparently requires a base station and also a monthly AT&T service charge.
MedMinder – This product is impressive and available. It appears that you do not purchase the device outright but “rent” it. The cost is between $40-$60/mo., which IMHO is a bit expensive, I’d like to see maybe $10/mo., but hey, for those who are taking a lot of pills and especially for the elderly with memory problems, this is probably a worthwhile investment.
If I was the Obama administration, this is one area I’d be looking to foster growth with the expectation that it can significantly reduce healthcare costs. According to Abiogenix’s site non-adherence costs over $300 billion in wasted spending in the United States each year. How about cutting that down by 80-90%?
I struggle with overpowering daytime sleepiness. This may be compounded by the fact I take Adderall XR for Attention Deficit Disorder (ADD). I recently went to my psychiatrist and discussed this issue with him and he gave me a supplemental Adderall prescription. This is not an uncommon method of dealing with this increased sleepiness once the medication wears off. I take the supplemental pill later in the day when the first one runs out. In addition to all this, I also take Prozac (fluoxetine) – 60 mg (three 20 mg tablets). I filled my prescriptions and went home.
The next morning I went into my usual auto-pilot mode – taking medications and vitamins, brushing teeth, showering, deodorant and so on. It wasn’t until I had taken my medications that I realized I had accidentally taken three 20 mg Adderall tablets instead of three 20 mg Prozac tablets. Thankfully, this was not a critical overdose for me…but had it been another medication, it could have been.
But my personal mixup one morning is fairly simple compared to those faced by many others. I’ve worked a bit with the elderly, including those who are suffering from various forms of progressive brain degradation. These individuals find themselves in a dangerous place when they cannot remember during the day whether they have already taken their medications for the day or not. Many of them don’t want to move into assisted living homes just yet, and apart from this sort of minute detail are still capable of living independently…but an inability to remember when medications were last taken can quickly remove this independence.
Lets throw a few more problem areas into consideration. For example, I take vitamin supplements in addition to my medications – Vitamin B complex, Vitamin D, Daily MultiVitamin, Omega-3, and so on. It gets old very quick popping open eight or so different pill containers to get these pills out each and every day (and I know that many take many times more pills each day than I do). Some days I will just my medications and maybe one vitamin supplement and dash off to work…
Then there is the issue of regularity, especially for those with mental illness or who suffer side effects from taking a medication. It is always tempting to skip one day – a few – a week or two, a month. The efficacy of most medications is greatly reduced when taken in this haphazard way and for individuals with mental illness oftentimes results in a significant relapse.
And these are just a few of the challenges facing those who take medication and/or supplements on a regular basis. Sure, they are surmountable by willpower and self-discipline…but when technology can make our lives easier I prefer to spend my willpower and self-discipline on more substantive areas.
We’ll talk more about the complexity and cost of this solution later, but I want to note at this point that I believe this could be an extremely affordable solution. In early stages I wouldn’t want to see its cost exceed that of the Raspberry Pi computer at $35…and with wide utilization I would see this being a commodity product that would replace traditional pill containers at no-cost to the consumer.
If you know me, you know I’m not an artist, but here is my attempt to depict visually what the solution would look like…I’ll step through it as we go on…
The automatic pill dispenser is expandable. The above figure represents a dispenser with six individual dispenser units. If one had only one medication, one would need only one dispenser. Each additional dispenser can simply be connected (think legos) to the next. Dispensers could vary in size – but the goal is that they be as small as possible, allowing for a good number of them to be connected together without consuming significant space.
Each dispenser would have a small display which would show the number of pills remaining in that dispenser.
Below that another small display showing the quantity an individual programmed the dispenser to give each day.
The Give button would dispense the above desired number of pills – if they had not already been dispensed for the day.
Holding down the Give button for ten seconds would force it to release an additional pill (e.g. if for some reason the system malfunctioned and dropped only one pill when it should drop two, this would allow one to “force” the system to drop another).
The + and – keys would be used to change both the number of pills in the unit and the quantity to be given each day. You’d hold down the plus key until one of the displays above began blinking. Whichever display was blinking indicates the display you would be changing for the value of.
Ideally, eventually pill boxes would no longer be distributed – each pill box would be one of these dispensers. It would come pre-programmed with the correct number of pills and dosage. Until such a time it doesn’t make sense to have the pill dispensers be disposed after each use – so they would be refillable. One would dump the new medications when received into the dispenser and reset the dosage and number of pills.
A Little More to It…
This in and of itself would be extremely helpful…but I’d like to take it a little further. Did anyone wonder why the units lock together? Besides making it orderly there is another reason. Each unit would have its own “intelligence” (that powers the display, etc.), but one would also have a lock-on extra unit that would contain a central brain. Really this brain would be very weak (and inexpensive). It would consist of a WiFi chip that would relay information from the pill dispensers to a central hosted server transparently.
Individuals could open up their web browser, type in the website (say davesamazingpilldispenser.com) and login using a username and password they select. Once inside they would be able to (a) set values from a web console rather than on each dispenser (this would be much quicker for those who have lots of pills), (b) determine accountability partners who would receive email alerts when the dispensers were not decrementing at the expected rate (e.g. someone stops taking their pills for x number of days perhaps the doctor, spouse, or family friend is notified via email or text message), (c) view (and share if desired) charts indicating their history of medication use (this would help, for example, when a medication needs to be taken 3x a day…the dispenser would mark each time the pill was taken and this could be analyzed by the individual or a doctor for issues).
Now, all of this can be done fairly simply and initially. Further on one might add the ability for the pill dispenser to automatically order refills of medications/vitamins via integration with online pharmacies / amazon for vitamins.
Talking About Price
The dispenser boxes are using fairly simple circuits and mechanisms. I don’t see any reason why these could not be manufactured very cheaply. I’ll work on putting together some figures – but my goal would be that each dispenser would not cost more than $5 and the WiFi component $5-$10. Thus, if one takes six medications and wants WiFi one might make an investment of $35-$40. Factor this out over a year and it is an expense I think worthwhile…and there is no reason the dispensers could not last for multiple years – especially if the web console is used instead of the buttons (which, over time, may wear out).
What It Won’t Do
There are a few things the initial pill dispenser wouldn’t do – though I think these features could be added over time. The biggest of these is that it won’t keep people from abusing it. That is – someone will be able to break open the pill dispenser, tell it to give more than they should be taking, or have the dispenser release pills and then throw them away. I believe the vast majority of issues with medication adherence are related more to accidents and forgetfulness than to deceit or other maliciousness. Creating safety mechanisms in the initial device would raise the cost significantly – and unnecessarily – for the vast majority of users.
Doesn’t Somebody Already Do This?
There are a few companies I found who build automatic pill dispensers. These include MedReady and ePill. However, I was disappointed in these units as they all lacked various features…and most significantly, they are quite expensive (anywhere from $100-$900). I think this industry is ready for disruption.
I’m not sure. This is an idea I think is simple enough to be accomplished. I guess I’ll put out a call to see if anyone is interested. Maybe you are? I’d love to hear thoughts and contributions from the MAKE and Kickstarter communities and from those who would be interested in using/purchasing such a product. I see the components necessary to undertake this project and build a prototype as follows:
Manufacturing: We’d need to manufacturer the automatic pill dispenser. This would mainly be a simple pill box but with the addition of a mechanism to release pills.
Circuitry: We’d need to develop the circuitry to operate the machinery, interlock with other dispensers, and allow changes to the values stored by the dispenser.
WiFi: We’d need to create the wifi unit.
Web Console: Data would need to be parsed and displayed via a secure web portal.
If you work or are a hobbyist in any of these arenas, I’d be interested in hearing from you. The web console I could fairly easily take care of myself…but I do not have significant experience with building circuitry or manufacturing. I do have a good bit of programming experience, but not much in the area of device automation…
We can discuss how any revenues – should they arise – would be distributed…but at this juncture I am largely interested in creating a prototype. I’m willing to donate time and effort to the cause and are looking for others interested in doing so…but there isn’t any money here to start with, so no need to contact if you want to be paid up-front for your work…maybe someday there is a hope you might be…but, its just that a hope – for you and me.
If it comes down to it I’d rather see it implemented with no profit margin than derive profits with only limited distribution.
Diagram.ly deserves a big thanks for their sweet and free online diagramming software I used to create my artistically challenged 2D diagram above.
My daytime sleepiness predates taking medication for ADD, so there isn’t a causative link. The Adderall does help me stay awake and focused, but when it flushes out of my system it may cause an additional “crash” in addition to the regular sleepiness struggle.↩
Yes, I see a psychiatrist on a regular basis and have for a number of years. I feel a bit embarrassed about it – which is funny, as I talk about my mental health issues all the time…I guess saying one sees a psychiatrist makes the problems more “real” and “severe.” But I committed to reducing the stigma surrounding mental health issues, so I’ll leave this in the article.↩
For those who would suggest that I may have a sleep disorder – e.g. sleep apnea or etc., I agree…though oftentimes the treatment for these disorders is similar to ADD. I have undergone a sleep study at Abington Hospital and am looking forward to an upcoming discussion regarding the results of that study with my primary physician.↩
Yes, that does seem high…it is. Depression generally responds to significantly lower doses, but Obsessive Compulsive Disorder (OCD) does not and requires higher doses before it provides substantive relief.↩
When it comes to discussions about nationalized healthcare, cost reductions, and other major political issues – I generally don’t feel qualified to comment. With this post I’m stepping out on a limb – and my qualifications for doing so are probably still lacking. I welcome your feedback. I’m more than happy to be proved wrong – this is just want seems logical (and obvious?) to me.
In this post I am not going to argue for or against nationalized healthcare, rather I am will discuss alternative methods of reducing costs/improving treatment. This is not because I disagree with nationalized healthcare but rather because I see these steps as being a natural starting point in any attempts at cost reduction/treatment improvement.
Each year I (try to) go for a physical with my doctor. I don’t enjoy it – but it allows me to find out if there is something major and obvious wrong with me. It takes a lot of time to see a doctor. After setting up the appointment one generally has to leave work and travel to the doctor. Being the anti-travel person that I am, that isn’t too big of a hazard – my doctor is five minutes drive from my house, ten from work. Still, its a nuisance.
Once I arrive, no matter how early or late, I always end up waiting and waiting (and waiting and waiting). Generally I am surrounded by others like me who are healthy and present for routine maintenance as well as those who are ill. Unfortunately, this means I am in a enclosed space with several individuals who are hacking and sneezing – throwing contagious germs around the room. I don’t harbor any hard feelings – I do the same when I am ill and I go to the same place to get treatment…but still, the risk is that I will leave with more wrong with me than when I entered.
The doctor’s examination includes fairly routine processes. He checks my height and weight. Checks my blood pressure, listens to my heart beat, pays attention for any abnormalities in my breathing, checks my mouth, ears, and nose – amongst other questions and proddings. Much of this process is actually carried out by one or more nurses (including the occasional bleeding for blood tests).
Now, my suggestion is simple, why not work on devices like the Zeo which can perform most of this sort of monitoring automatically? Granted, the Zeo is only for sleep – but why can’t we make multi-functional devices that can monitor our blood pressure, heart rate, breathing, and any of dozens of other health factors? It seems that both the Apple iPhone and the Verizon/Motorola/Google Droid would be able to serve as perfect multi-functional devices for such a purpose (in addition to their many current uses). I’m not a big fan of having something implanted in me but I see no reason why such devices could not be used once a day/week in a few moments or with a small wireless band-aid type patch to monitor our health.
This automation would provide us with numerous benefits such as:
Reduced visits to doctors for regular physicals, increasing our work productivity/time off for recreation.
Increased monitoring of our vitals – alerting us to health issues in days instead of weeks or months.
Reduced exposure to environments with significant amounts of communicable health issues.
Advanced analysis of our health vitals to determine patterns of health that are disconcerting and need review.
Let me give a few examples of how a device like this might function:
Jane is fairly healthy. She uses her multi-function device once a week. It gives her peace of mind that her main vitals continue to operate within normal bounds. She doesn’t spend as much time worrying about whether this or that minor issue might be part of a bigger dilemma.
John uses his device daily. The device notes over a months time that John has significant blood sugar spikes around noon every Friday and this is accompanied by extreme bouts with sleepiness throughout the day. The device alerts John and John is able to change his dieting habits to reduce the sugar intake reducing his sleepiness.
Mary has chronic heart problems. While family bought her one of those devices that calls 911 if pressed they still worry about her constantly…until she received a multi-function device. She keeps a wireless patch on her all the time – which covers her vitals. It lets her know when she is working too hard and in danger of bringing on a heart incident and will even call 911 if she keels over – without her interaction.
I know some people are afraid of having their records kept electronically. I could explain why I don’t think this is a major concern but perhaps another time. The keeping of electronic records instead of traditional paper records would offer several significant benefits:
Medical offices could (with permission) share information instantaneously. No more waiting days or weeks to get paperwork transferred from one office to another.
Medical offices could communicate with one another electronically and share results to coordinate better treatment plans.
A significant reduction in the amount of paperwork could be made. Individuals could give HIPAA consent via an e-sign form rather than through the useless bundles one receives at each doctor.
The data could be analyzed anonymously to garner important health information and to look for patterns invisible to the naked human eye. Think about it – we could find that individuals who now live in every state in the union and are suffering from stomach cancer all originally lived in the small town of sometown. While this might not solve their health problems it could launch an investigation to discover that (name toxin) is present in (name location – e.g. elementary school).
Further, the efficiency of treatments, the possibility of causes, the analysis of diseases could all be significantly expedited by such a process. The data could be anonymized and then made available for legitimate researchers to utilize in performing research (e.g. such as World Community Grid projects).
A lot of expense and time is caused by the inability to discover issues before they occur. What if we could monitor our health? What if we could be alerted (and allow our medical professionals to be alerted) before a major issue arises? If our spiking cholesterol levels were managed before they became a crisis? If our hearts failing functionality was noted before it resulted in a heart attack? If our liver and kidney function could be monitored?
I get sick somewhat often with minor bugs – a stomach bug, a cold, a virus. Annoying but not life threatening. In my line of work (IT) sometimes its really important to get a project done and while I personally am of the opinion that it is better to stay home and heal before returning to work many others in my field (and the American culture in general) are not. Sometimes even I succumb to the pressure to be present when feeling under the weather. What if I could cough into a small device attached to my multi-function and receive feedback on what sort of cold or virus I have? If its just the common cold I take some dayquil and am good to go – but if its strep, bronchitis, or the flu – well I stay home and see a doctor. How many epidemics could be prevented or reduced?
I am not arguing for or against nationalized healthcare. I do wonder why there is not more effort in the areas I have outlined above – by governmental and private agencies – to utilize technology to solve these issues. I recognize that these solutions will have minimal effect on what some are especially concerned about (I am concerned as well) – the masses who are unable to receive affordable healthcare coverage. I suppose my thought is that if we can reduce the burden on the overall system, reduce our costs overall, this would provide more time and finances to direct towards those who have a need (whether that is on a governmental, religious, local, or personal level) while creating a sustainable system for future generations.
I eagerly await your thoughts and feedback. Thanks for your time and consideration of my ramblings!
In this instance my qualifications consist in their entirety of (a) reading Newsweek weekly, (b) keeping current on major headlines [including healthcare] via Yahoo, and (c) reading/skimming a wide variety of rss feeds covering a gamut of tech/health topics.↩
I disagree with those who utilize (Christian) Scripture as a argument against socialized medicine. I see no such impetus in Scripture. On the other hand, I find myself less optimistic about the effectiveness of governmental organizations than many more liberal minds (in Christian circles, Jim Wallis comes to mind).↩
In brief, (a) privacy is an illusion – our information is already available, perhaps just not centralized and (b) I have nothing to hide – so why hide it? You want to know I struggle with Obsessive-Compulsive Disorder? Now you know. Finally, as outlined above I think the benefits are huge (and outweigh the negatives).↩