Can Medication Compliance & Quality-of-Life Support Go Hand in Hand?

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Interview with UK healthcare tech entrepreneur Jack Bowman (CEO & Founder of Handle My Health)

One of the challenges in evaluating new technologies in the healthcare space is that key outcomes, functionalities and clients (who use, pay etc.) have a habit of overlapping. A good – and highly topical – example is medication adherence, which is of extreme priority for pharmaceutical companies, desirable for healthcare providers and ultimately good for patients. If you search in your favourite App Store for pill reminder services you’ll be deluged with options. In the UK established players include MyMeds and MediSafe.

However, in terms of a business model, pill reminders are by no means the only option. True value (both financial and clinical) lies in:

  • Depth of participation by the user and information given
  • Useful qualitative assessment of the lived experience which can be derived from that information
  • Statistical or quantitative results

One of the platforms that is currently trying to cover all these bases is Handle My Health (HMH)’s ‘Miami’ product, a clinical intelligence platform that in the words of CEO Jack Bowman, ‘supports patients from discovery through to recovery through medication management and improves health literacy’. It’s Bowman’s third health-tech startup.

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“Search your favourite App Store for pill reminder services, and you’ll be deluged with options”

With over 50,000 active invited users across 7 long-term conditions or therapy areas, Miami is currently in private beta phase in order to prove the efficacy of the platform. Patients can use the service on their smartphone or on the web. The app manages their medication reminders and also allows for a quality-of-life diary – for example, how patients are responding to treatments; this can be private, shared with specific caregivers, or public.

So far, so standard. But Miami has some tricks up its sleeve. Firstly, we hinted above that the weak link in adherence is always the patient. Miami’s approach is to exponentially reduce the barriers to participation. A clear example is their multi-database back-end system that allows patients to scan their meds (no typing required), from which the app will decipher dose frequencies and restrictions and construct a timetable of reminders automatically. With this initial barrier removed, the chances of long-term engagement are significantly improved.

Secondly, with some secret-sauce algorithms, Miami offers advice to both patients and their clinicians. “We track the patient’s progress across time”, says Bowman. “We look at the peaks and troughs in journal entries, and then we have algorithms running over the data to detect if the patient is at risk of a complication or relapse; and of course that can be shared if desired.”

Early results are eye opening. Whilst HMH is not presenting official results yet, the initial trial for cancer patients (mainly a bias to 50-70 year-olds, less tech-savvy, and from hard-to-reach demographics likely to default on adherence early) saw an increase in adherence of 70%. Preliminary results for a later study (depression, general population) saw a 60% increase in compliance.

Perhaps more importantly, whilst participants were asked to log in weekly, the majority were on the platform daily – for an average of around 30 minutes per day. That’s stickier than Facebook. As well as positively entering their meds activity and completing quality of life diaries, they would then progress to learning from a curated track of relevant information from trusted sources (e.g. NHS Choices). Whilst trial participants are often motivated above the norm, this still represents a powerful degree of engagement.

“Miami’s approach, … a multi-database back-end system allows patients to scan their meds…”

It’s worth mentioning Facebook, because whilst healthcare is not necessarily social, the participation models for these platforms undoubtedly are. As with search engines (Altavista to Google), and social platforms (MySpace to Facebook), there are two facts to remember:

  1. Once a user is on a platform, they tend to stay there because of the amount of information they have already entered.
  2. But once a user has decided to leave that platform, it is practically impossible to get them back.

It’s a one-way road, with many competitors, no outright leaders, and, as we saw at the outset, overlapping requirements. The only certainty is that the funnel of users into the service is a high priority. Bowman states that, “Our bread and butter is engaging with the user, so even version 1.0 of Miami involved conversations with 250 patients with varying LTCs and their associated healthcare professionals and carers. Then, we created a product, which is not just good for the patient, but also good for the clinical professional. It provides tangible quality-of-life results that can be used as actions in clinical practice, and deliver data that translates into knowledge and processes that help GPs meet their CQC criteria – thereby attracting reward.”

HMH is also establishing partnerships. The company is currently in early negotiations with two global health ICT infrastructure providers, who, not surprisingly, have rock-solid tech skills but are less adept at engaging effectively with patients. In this sense, HMH’s ambition is to be the source of valuable data into the developing health-tech ecosystem, and also to visualise how patients and clinicians can use this data to best benefit. Facing in the other direction, having secured N3 accreditation, HMH is also offering its technologies via an SDK/API to other start-ups with complementary services. As well as N3-grade tech and security, HMH also offers a large and growing community of users.

All of the above leads us back to the patients: are they ready? Bowman is in the midst of another round of financing at the moment, and it is fair to ask: outside of trials, are patients ready to push the button on digital healthcare? Are we at a crucial point of inflection in citizen take-up of digital services? Bowman view is that, “The NHS proposed its Digital First way back in 2011. But patients will never be ready for it unless we help them break down those barriers. At the moment the big problem is that lots of systems rely on users to take that first step, to invest time and effort upfront without seeing any reward or benefit. That’s why we want the support of clinicians and carers, and why we make life easy, with med scanning, for example. Then there’s the media scaremongering, whether it’s over digital data security or a lack of regulation in digital health; and that’s precisely why we’re working with other providers and experts to create an e-Health Alliance to press for self-regulation of the sector.”

Bowman is honest about the future being open. “It may be apps, it may be big data, it may be a platform as a service.” As we said above, smart businesses in this space have to cover a lot of bases. “But at the core, it’s about empowering patients to understand their illness better. And that’s certainly a global play.”

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Ben Heubl is a Health 2.0 advocate and an expert in the innovation business consulting arena of this industry. His main interest is how to use technology to make an impact for patients and hereby targeting the intersection between entrepreneurship, open innovation, technology and large corporations. Ben co-organized TEDMEDlive Bologna and is TEDMED delegate, is non-for-profit founder of Health 2.0 Copenhagen, Medstartr (EU division) and MyHealthInnovationBlog. Meanwhile he is a mentor at HealthXL, works with ICG and supports KairosSociety and its student's engagements in healthcare innovation. You can follow him on Twitter (@benheubl)