April 4, 2016

Apollo Shrugged - Can Technology Improve Patient Adherence?


Can Technology Improve Patient Adherence?

In my last blog, On Being Unintentionally Non-Adherent, I left off proposing that there is a significant healthcare improvement opportunity if only we could increase the medication adherence amongst motivated patients, versus those who need serious behavioral modification. I also concluded that using technology to engage patients is the way to go. So… what are some of those technologies?

GlowCap-vitalityLet’s start at the turn of this decade. Vitality was a high-profile startup backe by MIT Media Lab founder Nicholas Negroponte that invented a smart pill bottle branded the GlowCap. Termed a “life-saving nag” by engadget, the idea was a pill cap that could detect when the bottle was opened and then use wireless technology to send adherence reminders. With this, you couldn’t absolutely confirm that the patient actually took the pill but it’s a pretty reasonable assumption. First introduced as a Wi-Fi product back in 2009 through Amazon.com for a one-time fee of $99, it’s been interesting to see the company’s journey and where the GlowCap is now. In 2011, the product was pulled from Amazon and offered through pharmaceutical companies and self-insured employers. In 2013, there was another shift to distribution, this time through CVS pharmacies at a discounted price of $59.99 plus a monthly fee as the product moved from Wi-Fi to AT&T’s cellular data network. If you check out the website today (seven years after first introduction), the GlowCap seems to be alive but it’s anything but obvious as to how you would get your hands on one.


Proteus Discover

Then there is the Proteus Discover. There have been a couple of recent announcements on the application of this invention, which is based on ingestible sensors. The layperson’s description of how this works is a harmless metal sensor is added to a pill that can be detected by a patch worn by a patient. The patch has enough smarts to communicate to an app on a smartphone or tablet when a pill has been taken. The app then takes over in engaging the patient as well as the patient’s care team. Like the GlowCap, this technology has had a long adoption cycle. First cleared by the FDA in 2010, it was only recently that commercial introduction was announced by pharma manufacturer Otsuka for its schizophrenia drug, Abilify, and also by healthcare provider Barton Health for their hypertension patients. Proteus Digital is heavily funded, having raised around $300M, yet their solution is still not generally available and the payment model is unclear.

I view both the Vitality GlowCap and the Proteus Discover to be somewhat heavy solutions more suited for engaging the patient’s caregivers, whether that is healthcare professionals, payers, or family members, rather than the patient. Cool solutions are much needed as we enter an era where tech-savvy millennials will be looking out for the health of their parent boomers, but not yet and maybe not ever generally available.

Now enter the category of wearables. This is where technology has a real potential to engage patients and impact adherence by encouraging a more active role in their overall health outcomes. Why am I so bullish on wearables? Maybe because I just ordered a WonderWoof for my dog but more thoughtfully because I can see clearly that wearables have “crossed the chasm” from early adopters to the early majority. The recent announcement of the new Fitbit Blaze smart watch is testament to the momentum behind wearables.

Where we are with the adoption of smartphones has a lot do with the growing uptake of wearables that need something to talk to. Remember that the first iPhone was only introduced in Canada in July of 2008. Seven years later, according to Catalyst, smartphone penetration in Canada in 2015 was at 68%. That’s phenomenal technology adoption. It took the Internet 15 years to get to the same level.

Another key enabler for wearables is the coming of age of technologies such as haptic, low power wireless (BLE, Wi-Fi, NFC), wearable chipsets (e.g. Intel Curie, Qualcomm Snapdragon, and Ineda Dhanush), and development platforms (e.g. Arduino, Raspberry Pi, Littlebits). It’s never been easier to bring your wearables idea to life. Doubt that? Just pick up a copy of the book “Be a Maker in a Week – Make IOT” by Myung Gwan Kim. I must be slow as it has been several months now and I’m stuck on day 2 (“Python Programming Using Smartphone). But is it really that easy to bring a new wearable to market?

I decided to do my own research and looked at the class of 2013 “Gadgets of the Month” from wearable-technologies.com. The first thing I expected to discover was that the primary source of funding for wearable startups seems to be crowdsourcing sites like Kickstarter and Indiegogo. Not venture capital. Pebble raised $10M via Kickstarter in 2014 and has subsequently shipped over a million watches. Scanadu raised $1.6M in one month on Indiegogo for their promising Scanadu Scout (now called the Scanadu Vitals) health measurement device. There seems to be an insatiable early adopter consumer demand for these cool new devices. Thank you hipsters.

The second thing I was not surprised to discover is that of the 12 wearables profiled as the best of the best in 2013, only one of them, the Samsung Galaxy watch, is generally available today. Three years later, some of them are still in beta mode, some never got off the launch pad, and some seem to have just disappeared. That may be good as otherwise, we’d all be walking around wearing our Durex Fundawear vibrating underwear.

In talks and presentations I’ve given on this subject, inevitably someone makes the comment that wearables today are for the rich and thus won’t have an impact on the general population. Yes, my Apple Watch cost me almost $600 (and that was the cheap version). But I paid US$628.95 for my first iPhone back in June of 2007 and yet smart phone penetration is approaching 100%. There will be more than one Android in the wearable world that will drive prices down for the masses.

Back to why wearable technology will improve medication adherence? I recently adopted the #1 ranked adherence app, Medisafe, to manage my prescriptions. Medisafe engages me on a daily basis on both my iPhone and my Apple Watch with timely reminders and adherence measures. I thought I was a good patient but my first week clocked me in at a measly 63% adherence. By example, I’m 100% adherent on my MS med. That’s great but I’m only 50% adherent on my Vitamin D and even worse on my neuropathic pain med at 42%. The good news is that I am now more engaged and paying more attention to my adherence. Thank you technology for making me more aware of my adherence in real time. I believe this will result in an improvement to my 63% rating. In my next blog, I will discuss how shared funding models between patients and drug companies can also help improve adherence.

I’m excited to see some Made in Canada innovations in the wearables arena, from Montreal’s OMsignal and Hexoskin and their smart clothing to Halifax’s Photodynamic and its OrthoClean dental product.

Adherence is not a complicated problem to solve. Patient engagement through technology is becoming mainstream. If you are developing a new drug or medical device, think hard about how to integrate adherence into your therapy. If you are an investor, have a look at those life sciences companies that have recognized that technology and adherence are as equally important as the drug’s active ingredients. I’ll leave off with the words of MonsterSamz from an online 5 star review of the Medisafe app: “This is a great tool to have when dealing with forgetfulness! I use (sic) to have the habit of skipping days of my med because I couldn’t remember if I already took them or not!”


[The author and his immediate family members may have long or short positions in the shares of some companies mentioned in or assessed during the preparation of this blog. Past share price performance may not be an indicator of future share price performance. This blog does not consider the investment objectives, financial situation or particular needs of any particular person. Investors should obtain professional advice based on their own individual circumstances before making an investment decision.]

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