Text Messaging's Healthcare Applications

One of the topics I enjoy talking about in regards to Health 2.0 is the effect text messaging will have on healthcare. Intelecare already uses (and has used for 3 years) text messaging as one of the delivery methods for our patient /caregiver created medical adherence reminders. BJ Fogg at Stanford held a Texting4Health conference in February, where a number of uses for texting in healthcare were presented, such as texting for AIDS testing clinics, and a smoking cessation program. Other companies, such as WellSphere, are also using texts as way to transmit health related information - such as where you can find a health food store or gym in your immediate area.

I have been looking at trends in mobile advertising and text usage, but I didn't really think that it had reached this point.



According to eMarketer: "The average mobile subscriber in the US sent and received more SMS text messages than mobile telephone calls during Q2 2008, according to Nielsen. This was the second consecutive quarter in which the average number of text messages was significantly higher than the average number of phone calls."

This is simply outstanding. As you can see from the chart, it is not just the tweens and Millenials using texts. My X Generation still sends more texts, and the 56 + crowd even does it. The US is also still way behind the rest of the world.

Quick Story: In 1999 or 2000 I was on a ski trip with my half-brother, Ricardo, who grew up and lives in London. He was looking at his phone and punching buttons (he was 18 or so at the time). I asked what he was doing, and he said "texting my friends". I asked what that was, he explained, and I said "why don't you call them"? His answer was that it was simpler, cheaper, and he can do it on "the sly".

It took me up until last year to really embrace sending text messages. I started with simple texts like "running late" or "what are you up to", which led to more complicated answers to queries, directions, twitter updates, etc... Now instead of "call me" it is "text me".

The uses in healthcare, for me, are most readily available for tracking information like glucose readings (I think SugarStats uses this), blood pressure monitoring, etc... I don't think texting your physician will catch on so rapidly, but it can happen.

AJ Fortin has a great post from this spring: 101 Things to Do With A Mobile Phone in Healthcare.

What are other uses you can think of for texting in healthcare? Please add your comments!

Found Around the Web Today

It has been awhile since I have posted a "What I am Reading" or "What I have Found" post, so here you go. Some interesting stuff out there that sparked my interest.

From Reuter's Health, a report on Sex Bias in Control of Cancer Pain:

"How well pain is managed in people with cancer apparently differs between men and women, new research hints. Dr. Kristine A. Donovan, of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, and colleagues examined pain severity and the adequacy of pain management in 131 cancer patients newly referred to a multidisciplinary cancer pain clinic." Full Story

From LifeScript, a study that shows 1 in 5 Diabetics do not take their medication as prescribed. "Too many diabetics are neglecting to take life-saving prescription medicines regularly, one study warned. Published in the Archives of Internal Medicine, the study estimated that 21% of diabetics fail to adhere to their prescription schedule." Full Story

Allan Showalter, MD from AlignMap discusses the Implications Of The Redundant Patient Compliance Review. I like to post abstracts and some compliance reviews, but his blog posts are always more insightful, biting and from an MD's perspective. Full Story

And lastly, from the International Journal of STD and AIDS: Factors associated with lack of antiretroviral adherence among adolescents in a reference centre in Rio de Janeiro, Brazil. Full Story.

Wal Mart and Caterpillar Team Up for No-Copays

I have said it in meetings, in emails and on Twitter: Wal Mart can revolutionize healthcare in this country. They have the power to change the way patients get and pay for their medications. Already, Wal Mart has changed the pharmacy industry by introducing their $4 generic drug program in the fall of 2006. This program made every pharmacy, from Target and CVS to Farmer Joe and Hannafords, also offer $4 generics to compete.

This program has saved Wal Mart customers $1 BILLION already. THAT is impressive.

One of the programs for aiding the US healthcare system and helping patients become healthier is employer /health plan sponsored lower co-pays and free medication for chronic diseases. This is not my original idea, as several companies have offered these services to their employees, but one that I fully support and believe will make a difference in medication non-adherence. As we know, forgetfulness is the #1 reason, with drug prices, side effects and drug education being the other factors that contribute to this pandemic.

Wal Mart and Caterpillar are taking this idea a step further by offering no co-pays for employees taking Tier-1 generics.

"Caterpillar Inc. and Wal-Mart Stores Inc. have embarked on a pilot drug program that could revolutionize the prescription drug industry, officials from both companies said Monday.

Select salaried and management employees of Caterpillar as well as its retirees and surviving spouses can get Tier-1 generic drugs filled for no co-payment at all Wal-Mart, Sam's Clubs and Neighborhood Market stores now through Dec. 31, 2009, as part of the program that began earlier this month.

The co-payment for the generic drugs is $5 at other pharmacies.

While about 70,000 Caterpillar employees are affected now, that could expand to include union-represented employees who opt into the company's HMO plan beginning Jan. 1, 2009, said spokeswoman Rachel Potts. Open enrollment begins in November."

I think this is another fantastic program and shows the real power Wal Mart has to influence the US Healthcare industry.

"The goal of the pilot program, on which Caterpillar and Wal-Mart negotiated for several months, was to remove unnecessary costs from the health care equation, said Todd Bisping, Caterpillar's pharmacy benefits manager.

It does that by eliminating the middle man, so to speak, in the pharmaceutical management process. Most companies contract with an outside pharmacy benefits manager to set rates on prescription drugs, rates co-payments are designed to cover to defray the company's costs.

Caterpillar negotiated directly with Wal-Mart on the rates, saving it money and enabling Caterpillar to then waive the co-payment for its employees and retirees, Bisping said."

You can read the full story from the Peoria Journal Star.

Personal Voice and other Medication Adherence "Scams"

I subscribe to a number of Google Alerts regarding medication non/ adherence /compliance. For the most part they are pretty spot on regarding articles with my chosen keywords, new research, blog posts etc... At least once a day is a link to a faux blog that simply lists keywords with advertising and links to other spam sites.

Once such site came up today, but also revealed some useful information - ie. NCPIE is promoting October as Talk About Prescriptions Month (more on this in another post) but they have a broken link to the site.



The text isn't well written, but they do promote the importance of medication adherence and the role of the caregiver. It mentions a service called Personal Voice with a link to the website Family Focus Working Caregivers that has broken links and some healthcare information. Overall a horribly designed site, but offers the Personal Voice service which will call your loved ones for you in case you do not have the time to make sure they are taking their medications.



I called the number provided to get an information package. The voicemail thanked me for calling and asked me to dial the extension I wanted. I dialed "0" and got a voicemail that simply stated "Personal Voice". I did a Google Search for "Personal Voice Inc." and here is what I got:



At first I thought it was just a problem with them managing their online reputation - since the first four results are negative. I then read the posts and they all describe the service as a scam. They deduct money from one's checking account monthly, yet do not provide a service. They are tied to another company which is a debit-for-credit-card scam as well.

This just makes me mad. A company using medication non-adherence rates to scare caregivers into signing up for a service that is simply a scam to make money. Luckily they are now being investigated by the FBI. I have encountered a number of email phishing scams this year, and other online attempts to get information, but this is the first I have seen involving medication non-adherence.

Caregivers out there, be careful with the services you sign up for. Make sure they are legitimate and will provide a beneficial service for your loved ones. Check with the better business bureau and do a Google Search to check the company's reputation.

I have not included any links from this post on purpose.

Adheris Study Finds First 30 Days on Antidepressants Critical for Medication Adherence

I had a call a few months back where I was pitching Intelecare's Services. The prospect asked "who are your competitors". I gave the answer, "well, no one". I know it is not the proper VC answer, however, at the time (March) there wasn't anyone in our space doing what we do.

No one has a robust, web-based proprietary medical messaging platform that sends patient and caregiver created reminders via email, text and voice messaging. No one offers our hosted and enterprise solutions to industry. No one has 3.2M users and sends out 4M reminders daily. No one has a pro bono program that gives away their technology. No one is developing the next generation in Adherence 2.0 applications like we are.

Since that call, a handful of competitors have emerged offering similar products. In fact, one such competitor even used the same phrasing we have used on our website for two years to describe the services they offer and the industries they serve.

Competitors aside, Intelecare is still the gold standard - no matter how many other companies come into the space.

Even though our competitors charge for their reminders, we still offer a free service to patients and caregivers to ensure that they are helped with the #1 cause of medical non-adherence, forgetfulness. We still integrate our reminder platform into any existing web portal - both as an out of the box hosted solution and as a fully customized enterprise solution. We still offer our hosted email reminder platform pro-bono to non-profits that specialize in chronic disease states.

That being said, I found a press release from Adheris today announcing a study which results "showed that patients new to antidepressant treatment and those who had restarted therapy after a lapse of 6 or more months were twice as likely to discontinue therapy in the first 30 days of treatment versus patients previously dispensed an antidepressant."

This is significant because the first 30 days of therapy are integral to a patient continuing their therapy. "The practical implications of this study are that while all patients lapsed at an alarming rate over time, increased patient follow-up and education within the first 30 days of therapy in newly treated and lapsed patients restarting therapy are critical to help improve adherence and patient outcomes."

Adheris is a fantastic company that has been in the space for over 9 years. They are focused on increasing patient adherence and education at the pharmacy level. Several times I have been asked to compare our services to theirs - however it is apples and oranges. We are both trying to get to the same goal - increasing patient medication adherence - we just have two distinct ways of doing it.

Medication non-adherence costs the US $300 BILLION annually in unnecessary health care costs and lost revenue. 1 in 2 patients does not take their medications as directed with 84% of them citing forgetfulness as the reason.

I think this market is big enough for a few players with different ideas of how to end this pandemic. It not only takes reminders, but education and lower drug costs to help eradicate the problem which affects us all in one way or another.