A recent reader comment about SMS security and reliability issues, dovetails nicely with the presentation that Barbara Rapchak, CEO of Leap of Faith Technologies gave last week at the TEPR conference in Palm Springs. Her company conducted a medicine compliance pilot study that sent text messages reminding users to take their medication on-time--but the texts were not sent over a wireless carrier's network. They weren't sent at all.
The general consensus is that patients follow directions and take their medications as instructed about 50 percent of the time. To drive the point home, Rapchak reminded us of former Surgeon General Dr. Everett Koop's famous line: "Drugs don't work in people who don't take them." Even cancer patients aren't completely adherent: Compliance in cancer patients is estimated to be about 80 percent, Rapchak said. Leap of Faith Technologies found a way to increase adherence from an average of 50 percent to 96 percent.
The goal of the pilot was to "integrate and leverage existing and emerging technology to optimize medicine compliance, automate data collection and accurately track medicine events automatically and remotely to reduce administrative costs," Rapchak said. Her group programmed the customized messages into the user's mobile phones before they left their doctors' offices. In effect, a simulated SMS arrives on the patient's phone when it's time to take the medication. Rapchak realized early on that relying on a carrier's network to deliver the reminder on time was a headache not worth trying to solve. Rapchak also realized that pre-loading the reminders onto the phone would soothe some HIPAA compliance worries.
Patients worked with their caregivers to choose the time they wanted to take their meds. The application on the phone allowed them to anchor a medication event to a lifestyle event, i.e. always taken with lunch, so if your lunch schedule changes the medication reminder can, too. Rapchak said patients did not want to carry another device so the team worked to put the application a mobile phone. Participants also stressed that they want some flexibility and wanted the service to adapt to their lifestyle.
When it was time for a medication event the patient's phone would ring, a message would appear on the screen when answered that asks the patient to touch the mobile phone to the medication bottle. The bottle has an embedded RFID chip, which can transfer information to the phone. The phone then asks the patient if "X" is the medication they are taking and once confirmed, proceeds to instruct the patient on how to take the meds. Every time the patient interacts with the application it records the event and confirms each event for clinicians to review from a Web portal in real-time or at a later date.
Given the boost in adherence (96 percent for the pilot, as noted above) Rapchak counted it a great success. She also suggested the technology could help pharma companies looking to increase compliance in clinical studies. She said there are about 20 million patients currently registered in Phase 1-4 clinical trials, and noncompliance costs pharmas anywhere from $200 to $1000 per patient in data collection, recruitment costs and associated delays.
While there are some USB RFID readers out there that users could plug into their smartphones, few phones have RFID readers already built-in. That aside, the technology for this solution seems ready to go.
