Tech Tools Tackle Medication Problems

Medication adherence is a multifaceted challenge that's getting a shot in the arm from technology developers. Glowing pill bottle caps connected to the Internet and a digital library of pill images with detailed data on drug interactions are just the beginning.

If a picture is worth a thousand words, how much could a picture of a patient's medications be worth?

A lot.

It could be worth $290 billion in healthcare costs, and 125,000 lives a year – the cost of medication non-adherence and medication errors, according to the New England Healthcare Institute.

Technology developers have not been idle. Vitality's GlowCaps, available since 2008, have made medication reminders a function of programming a pill bottle's cap to glow, and presages the coming age of the Internet of Things, when many objects of everyday living will periodically remind us what they are there for. It's definitely a space worth watching.

But the challenge of medication adherence is multifaceted. It's not just which medication is the right one to take. It's also knowing whether the patient took too much or too little, or if the medication is interacting with some other medication the patient is taking. As a result, other innovative solutions are proliferating.  

See Also : No Silver Bullet for Medication Adherence

One such solution is MedSnap, which premiered at HIMSS. MedSnap visually identifies prescription meds and comes along at a pivotal time.  

In June, by a 5-4 decision, the U.S. Supreme Court threw out a $21 million jury verdict involving a woman who suffered skin burns after she took a pill to relieve shoulder pain. A majority of the justices said the FDA had approved the drug, sulindac, for sale, and that federal approval trumps a state's consumer protection laws.

With this decision, the Supreme Court established that patients badly injured by a generic drug cannot sue the manufacturer.

So, more than ever, pity the poor emergency room physician, confronted by an incoming patient with a baggie full of pills, many of them generics, barely identified or distinguishable from each other.

Meanwhile, families may be taking home bags of medicines from pharmacies, and storing them together in a common place. Confusion is bound to result, and probably does.

Enter technology. MedSnap is an app for the iPhone 4S or 5 that identifies sets of pills in a single snapshot, checks against the patient's drug regimen, flags drug/drug and drug/disease interactions, and in the process improves a vast and growing collection of crowdsourced knowledge about the shape, imprints and textures of medications to improve future identification.

Initially aimed at emergency room and home health care personnel, MedSnap holds the potential for such an app to live on every smartphone, ultimately to be used by patients themselves.

It is possible to truly geek out on the cleverness of this system. The app takes great care to get a good picture. The MedSnap system includes a specially-printed card upon which users place the medications. This card offers proper measurement and corrects for color variations in the surrounding light. Just to be sure, the app requires the camera's flash also be used to reduce color variation. Fortunately, more and more smartphones are coming equipped with flash, and before too long it will probably be a standard feature on some tablets.

Because of slight variations between pills manufactured in the same batch, the app then asks the user to verify its findings, a momentary process I liken to the "are you sure" prompts one receives before deleting a file. "We find pills that have no imprints," says MedSnap CEO Patrick Hymel MD. "We find pills that have partial imprints that are slightly different in color. For all these reasons, the user needs to click each pill and sign off."

For pills that MedSnap knows, it correctly identifies them 97 percent of the time, which approaches the accuracy of appearance to which the pills themselves are manufactured, Hymel says. "Capsules might be 50 millimeters in length, but then you'll find some that are 60. You can look at six Adderall [pills] – this happened last week – and four of them will be dark gray. Two of them will be light gray. They're both gray. Which one is accurate? So there are limits to the specifications that you can depend on."

MedSnap ended an extended beta test period this spring, after being tested at Auburn School of Pharmacy, the Samford School of Pharmacy, and other similar institutions, involving more than 300 pharmacists. When the app discovers a pill it doesn't recognize, it asks the user if they want to donate images of the unknown pill to the MedSnap library, then adds it to the growing knowledge base.

App pricing is based on the number of admissions at a particular facility, and initial deployments have come in hospital emergency departments, home nursing, and pre-op departments, then eventually make its way into outpatient clinics, where it will be licensed on a per-physician basis, says Hymel.

One early MedSnap adopter is no stranger to me: Cullman Regional Medical Center. "The culture of our hospital is to utilize the latest technology to help us with better patient outcomes," says Cullman president Jim Weidner. Cullman was familiar with MedMined, a previous company Hymel ran, so was receptive to the new idea.

From its first use of the product, Cullman had convincing evidence that MedSnap could be useful, as it was able to distinguish an antipsychotic medication from a similar-looking common antibiotic, Weidner says.

Since then, Cullman has deployed MedSnap with its home health nurses as well as when patients present at the emergency department with bags full of their medications, Weidner says.

"It's improved accuracy, it's improved efficiency, it has improved quality in the way of identification of contraindications, and, what we hope to have it morph into is to actually have our patients have the application on their iPhones so that on a daily basis the patient can do their own MedSnap," Weidner says. The app would then be able to notify physicians or the hospital that the patient is not following what has been prescribed.

Hymel, whose own father struggled with a challenging regimen of medications while being treated for cancer, sees the power of technology to change a culture where patients were expected to recite what medications they are on, to one of where the patient simply brings in what they are taking and presents that history visually – a visual intervention, if you will.

"There have been studies that more than 50 percent of medication histories are wrong in some way," Hymel says. "[Patients are] taking too many of one or not enough of another. They've swapped their husband's pills with their pills in their medication organizer, so all of these little bugs in the system that are very easy for patients to make mistakes on become apparent when you say 'show me'."

Not everyone will have an iPhone 4S with a flash (or equivalent) in the immediate future, so the industry will continue to have a variety of different technological approaches to medication adherence. Some of them will be evolutions of the classic pill organizer.  

Two such examples are MedMinder and SentiCare. There are others. We're likely to see many such technological solutions contend for a permanent place in healthcare. But with so many lives at stake, and costs waiting to be cut like so much low-hanging fruit, the time is now for exploring what options exist.