Prescriptly: Medication Adherence App - Medhacks Entry
In fall of 2017, I decided to compete in Medhacks, the world's largest medical hackathon. They had three categories of hacks, with one of them being focused on medication adherence. Medication adherence is one of the largest issues we're facing in healthcare today. Recent studies have shown that 2/3 of Americans with prescriptions don't take their medications as prescribed. Annually, this leads to 125,000 preventable deaths in the US and $300,000,000,000 (that's 300B) in total costs. Compounding the issue is that these people don't tell their providers that they aren't taking their medications correctly so their doctors can't do anything to help them. For the rest of us who do take our medications as prescribed, we end up paying higher health insurance rates to subsidize those who don't take their medications correctly.
There were a couple possible ways I thought of solving this problem. I could create a pillbox that monitors when people take their medicine. I could create an app that takes video of people taking their pills. I could create a transparent marketplace so that people could get the cheapest medications so that they can afford their drugs. I could create a database where people could search through to find out how and when to take their pills. In the end, I decided on creating an app that works alongside CVS's multi-dose packs. Part of creating a solution for medication adherence is creating something that anyone could easily get access to. A physical pill box would require people to pay additional money just to store their drugs in a smarter way. An app is instantaneous and free.
It's a little laggy when it refreshes the home screen because it grabs data from another Google spreadsheet every time the home screen is loaded. Also, the "phone number" I entered in the emergency contact info is a random 10 digit string (not my real number).
How would it work as a product?
Patients who normally take a few pills a day would enroll in CVS's multi-dose prescription program (CVS happened to be a sponsor of the hackathon). CVS would prepackage each day's pills into individual packets. These packets would have the date and time you're supposed to take those pills as well as which medications are in the packet. Also on the packets are unique QR codes.
I only had 36 hours to come up with a proof-of-concept, so in real life, those pill packets wouldn't be resealable and it would be in a roll like below:
Every time the patient takes his/her pills, he/she would scan the unique QR code on the pill packet to keep track of when they take their pills and for the providers to be aware if the patient took the medication on time. If the patient doesn't know the proper way of taking the medication or doesn't know why he/she is taking that specific medication, the app also has an information tab where they can find such information. There's another tab in the app for the patients to directly contact their doctors via email if they have any additional questions or complications while taking the medication.
Why would CVS want this?
CVS Health is in the unique position of being both the pharmacy and the healthcare insurer (via. their acquisition of Aetna). If they had data on if the patients are actually taking the medication correctly, they would be able to gauge patient risk more accurately. Patients who don't take their medication on time or at all are at higher risk and should be charged higher healthcare insurance rates. Patients who take their medication correctly should be charged lower rates because they are lower risk.
Why would the patients want this?
Since CVS is both the pharmacist and the insurer, CVS can offer lower insurance rates for those who take their medication on time. CVS can also offer discounts on the patient's prescriptions through this app if the patient takes their medications correctly. Also, this app enables communication between patients and their doctors and it gives the patients easily-accessible information about their medications. The multi-dose packets also makes it much easier to track which pills to take and if they've forgotten to take their pills.
Why would doctors want this?
The purpose of doctors is to cure/treat people's medical issues. Knowing if their patients are adhering to their medications would give doctors a clearer view of how to best treat their patients.
Pitch Deck - https://docs.google.com/presentation/d/12pD2vG8_Ksu-n6r4cuwaSbBp8PnEl1v7f75y5EbrQ9E/edit?usp=sharing
How I Built It:
I don't know/never tried to program an app before. I had 36 hours during this hackathon to build a prototype, so I wasn't about to begin watching app-building tutorials. Instead, I built this using Thunkable which is a similar app builder to MIT App Inventor.
Although Thunkable is technically "drag-and-drop", its interface is not exactly intuitive nor easily scalable. When there are a lot of components on the screen, the scaling in the preview isn't correct so what the preview shows is not what the app looks like. Further, because they tried to distill the logic behind the app into basic building blocks, it takes a lot of different blocks to do simple tasks. I think the next time I build an app, I will try to program it with Kotlin or something that's easily customizable.
Also because I only had 36 hours to come up with a proof-of-concept, my "back-end database" was a Google Spreadsheet. The spreadsheet includes every medication the user should be taking and when that patient should take the pills. When the user takes a picture of the QR code on the pill packet, a unique ID and time stamp are automatically sent to the spreadsheet, where the spreadsheet would then check if the user took the pills within 30 minutes of the correct time. The spreadsheet records this data and then updates its graphs so that the doctor always has up-to-date graphics on the patient's medication adherence behavior.
Some of the functions I had to make for the spreadsheet were nontrivial. Luckily enough, I had an internship once where I spent the majority of it using Microsoft Excel... Of course, if this was a real product, I would try to build an actual online dashboard and use a real database.