How Complicated Is It to Simplify Medication Adherence?

Posted on November 17, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site ( and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Of all the things that irrationally inflate health costs, one of the top concerns is people who just don’t take their prescribed medications. Medication adherence doesn’t sound like a high-tech issue, but a lot of interesting technology is being thrown at the problem.

One pharmacist (obviously harboring an interest in increasing orders) estimated that we’d save 290 billion dollars a year if everybody took the medications prescribed for them. But don’t dismiss their claim as self-serving–the Centers for Disease Control suggests they may be right. It also says that half of all medications are discontinued too early. As the “fee for value” movement starts extending to the performance of medications, concerns that patients actually follow through on prescriptions will increase.

At the recent Connected Health Conference I talked to several companies taking on the difficult adherence problem from different angles. Medisafe aids patients in self-monitoring, Insightfil creates convenient packaging that groups pills the ways patients take them, and Dose doles out medication at prescribed times.

Medisafe is one of a wave of firms that address medication adherence, representing an advance over jotting down daily practices in a paper journal. These services share a good deal in common with other solutions in the marketplace that carry out patient monitoring, care planning, and the patient-centered medical home. In all these areas, services boast of tracking behavior, providing feedback to both patients and clinicians, promoting communication, and similar aspects of the connected health vision.

Medisafe handles patients’ nonadherence in multiple ways, including importing the patient’s medication list, along with vital signs such as blood pressure. Visualizations help both the patient and the doctor see the relationship between taking medication and the relevant vital signs. Patients can manage their doctor office visits or when they have been assigned a change in medication, and monitor the effects of such events on adherence through Medisafe. Finally, doctors will be able to compare data on patients within their practices, grouping them by condition, by medication taken, by demographics, or by behavior traits.

Other medication solutions try to reduce the burden of compliance that falls on the patient–or to look at it in another way, reduce the patient’s discretion. At something of an extreme, Proteus inserts a tiny radio device into each pill and makes the patient wear a patch that can detect the presence of the pill in the body. People have suggested one or two use cases for this intrusive system (for instance, during a drug trial, to guarantee accuracy) but in general, treating patients like criminals doesn’t encourage healthy behavior.

A lot of people, especially the elderly and those with the most severe medical conditions, need so many pills and capsules that it’s hard to remember which ones to take, and when. I’ve seen relatives loading little pillboxes every Sunday morning with the pills for the upcoming week.

Insightfil hopes to take all the manual labor, and consequent chances for error, out of this process. It ships each person a customized blister pack with a week’s worth of medications, offering up to four compartments per day to cover different times. This may seem like a simple problem, but it’s actually a major logistical feat.

First, according to founder and CEO Ted Acworth, his company had to develop a robot that could recognize different pills and accurately load them into the blister packs. Then they had to find a pharmacy with nationwide reach and room in its warehouse for the robot.

Dose solves the problem a different way, through a dispenser into which a patient or caregiver can pour bottles of pills. The dispenser, which has been configured to know the patient’s medication regimen, can automatically separate the pills and release them at the right time.

Once the pills are in the box, control can be removed from the patient. This can be important for doling out opiates or other drugs that can be dangerous or that patients have a tendency to abuse.

Dose’s dispenser is a very smart machine, supporting some of other goals of connected health I mentioned. Clinicians, caregivers, and patients can get alerts about doses taken or missed. The device has bi-directional programming capabilities with a web portal and mobile app, and clinicians can change regimens over the Internet. Biometric devices can be attached to let users map medication adherence to vital signs, or to report a user’s exercise and eating habits. The device’s forward facing camera can be used for scanning the barcode of a pill bottle, as well as for video consultations with a clinician. Along with these features, the device is integrated with an FDA Drug Database and therefore an accurate drug list, along with information about potential drug interactions is readily available.

On many levels, then, advanced technology can help patients with the apparently simple problem of opening a bottle at the right time and popping a pill in their mouths. This article has been a limited look at the problem–I haven’t dealt with over-prescription or side effects, but just the question of how to get patients to take the drugs that are understood to improve their health. We’ll see over time which of these solutions–perhaps all of them at different times–can help of hundreds of millions who regularly take prescription drugs.