MEMOTEXT - University of Toronto Masters in Health Informatics guest lecture - Amos Adler change management, patient adherence and mobile health / health IT.

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Health & Medicine

Published on February 27, 2014

Author: AmosAdler



MEMOTEXT-University of Toronto Masters in Health Informatics guest lecture - Amos Adler change management, patient adherence and mobile health / health IT. Speaking to a group of students about change management and how to deploy their mobile health app projects. Resistance to change from stakeholders and mindshare in health behavior.

Improving the bottom line for healthcare by increasing medication compliance. Amos Adler M.Sc. President, Co-founder @memotext 1877.Memo.Txt (636.6898)

The cost of non-adherence: 1/3rd of medication-related hospital admissions are related to poor Rx adherence $290billion/year in avoidable treatment due to medication non-adherence With every 10% increase in Medication Possession Ratio (MPR) there is a 9-30% decrease in annual total healthcare costs. Dr. House 30 second on video on adherence 1. 2. 3. CVS State of the States: Adherence Report. 2012, CVS Caremark Value Health. 2009; 12(6): 915-922 2012 Patient Adherence and Compliance: Improving Outcomes through Patient Engagement Programs- Cutting Edge Info (PH166) 2012

MEMOTEXT solution MEMOTEXT builds a patient profile and delivers evidencebased, interactive, selflearning reminders, education and motivation personalized to patient needs, regimen and media choice. Rx History Health literacy Side effects Self efficacy Stage of Change Symptoms Depression @memotext

The MEMOTEXT effect Johns Hopkins Trial "The Impact of Automated Dosing Reminders on Medication Adherence using HealthVault". By Michael V. Boland, MD, PhD Results presented at Stanford Persuasive Behavior Lab and Kaiser Permanente Gallery of Innovation N=428 Recruitment Channel: JHU Research / MS Healthvault Chronic Condition: Glaucoma (Travatan/Xalatan) Results: Significant improvements in medication adherence with daily medications: Intervention group increase adherence from 51% to 67% adherence p. 0.003 (Electronic Monitoring of Dosing) 31.4% Adherence increase in intervention group. Control 49-50% p 0.83 @memotext

RECRUITMENT ASSESS INTERACT MEASURE Best practices in program recruitment • Channels (US, Canada, EU) Pharmacy, Co-Pay, Stakeholder & Provider (point-of-care) partnerships. • Multiple media for recruitment • 15-30% conversion rates

Demo/ Walkthrough ASSESS INTERACT MEASURE Self-learning from patient responses. • short frequent questionnaires at enrollment and on-going. • condition specific literacy and behavioral questions • securely administered for privacy If you miss your Metformin, what is the most common reason? a) I don't like the side effects of my medicines b) I just forget! c) I’m just too busy and it's a hassle d) I don't understand why I need it.

Personalized Content by Voice ASSESS INTERACT Patient Responses MEASURE Claims Data EMR data Hypertension medication compliance call Rx History : New Start less than 3months Condition Literacy Message Personalized interactive, education, motivation & support. 7 @memotext

Personalized Content by Text and Mobile 2.0 IVR SMS Mobile Web Condition: Type 2 Diabetes Rx History: Rx = > 6months Medication: METFORMIN Diabetes Anxiety/Stress Scale: Med/High 8

Analytics + Data Results, ROI, Insights ENROLL ASSESS INTERACT MEASURE HIPAA secure – real time data collection and analytics 67% Avg. participation rates Self-Report Data – Valid and Real-time 55% Upto Objective Data Validated / Correlated changes in MPR 88 % retention rates Intervention Data & Insights @memotext

Select Clients Select Programs Hypertension & Cholesterol End-Stage Renal Disease Type 2 Diabetes Contraception Multiple Sclerosis Glaucoma Idiopathic Pulmonary Fibrosis Actinic Keratosis Pharma Mfg. Genzyme Canada Merck Canada + confidential Insurance, Provider, PBM Accountable Health Connect Health Inc. Green Shield Canada Genzyme Canada PerformRx St. Michael’s (Toronto) Academic Arizona State Univ. Univ. of Toronto Immunotherapy Medical Device Integration Asthma 10 @memotext

How did we get here? Started as a reminder app, pivoted to SASS (algorithm) engine MEMOTEXT Top 10 1. Pain, more pain 2. Methodological approach (not features) 3. Balance scientific rigour with commercialism 4. Design oriented thinking 5. Pivots as product expansions 6. Get involved! Academic partnerships, grants, accelerator programs 7. Data, data and more data. 8. Cash-flow management 9. Intervention Recruitment 10. Figure out who’s paying? 11 @memotext

Case Study #nochangemgmt Case study: End-Stage Renal Disease Text & IVR Support – Client Pharma Manufacturer Failure-Pivot-Success - Evidence based-driven project Proxy input not enough Language barriers Nomenclature barriers Content Stakeholders parachuted in saved the day Analyze •Stakeholder input (CATWOE) •Meta-Analysis •Study design Methodology added Design •Requirements •Data Integration •Segmentation Deploy •Measure •Pivot? 12 @memotext

Intervention Success – pharmacy intervention Sustained increases in MPR over 18 months 0% 10% 20% 30% 40% 50% Low existing MPR, 35% 60% Personalized medicines Reminder services METFORMIN Trial 70% 80% 90% 55% Med Natural Rate, 55% High existing MPR >, 80% 79% of patients rate programs very highly 17% + change in patients rating confidence in self management (over 18 months) 76% of patient self-report feeling better, healthier and happier since starting a T2 Diabetes program (over 18 months) 35% 10% Patients with the lowest previous MPR increase the most significantly. @memotext 100%

You are Competing for mind-share: - Professional Marketing Overwhelmed and overloaded by apps, iTunes Natural resistance No silver bullet – just plain old hard work What works: • Distribute and situate recruitment • multipoint/multichannel • Cross-organizational buy-in • front-line champions • Internal communications rigour • Measure, monitor, pivot • Time to measure results • Ability to iterate • Stakeholder Communications Planning

Critical success factors in system success Change Management • Stakeholder input from outset provides • • • • • • Gauge as to interest and stakeholder/HCP/front-line engagement Opportunity to identify champions Opportunity to create champions Opportunity to identify where clinical guidelines ≠ real-life Gap identification • Create more buy-in • Workflow points of contention Change management also highlights liability to be mitigated • • • Patient’s are hungry for tools and hungry to provide input but… Patient’s are also very defensive Test persuasive language, recruitment tactics 15 @memotext

Bad Design Although… “Most technology needs to go to finishing school” - David Rose

Lessons learned The biggest challenge is: Behavior Change Ground ZERO RECRUITMENT/ADOPTION We Want YOU to: - Comply Download our app Like our page Sign up to our program Buy more stuff Give us your data Admit that you need help!

RECRUITMENT/ADOPTION hierarchy Despite best efforts to enrol patients in mobile/text programs, patients get defensive when approached. Perceived as medical advice by the patient 1:5 recruitment ratio by “I think you should consider this support program - try it Physican/Clinician out ” 1:20 recruitment ratio by Pharmacist “I think you should consider this support program try it out ” Perceived as “what are you trying to sell me?”

Parting thoughts • • • • • Identify and prioritize stakeholder input early and often Data, data and more data Everyone is different and people change ~ technology should adapt to patient needs. Understand your audience (business vs. science) Don’t take attacks on product and study design personally The holy trinity of the health IT business • • • Efficacy of intervention = 1/3rd Workflow integration = 1/3rd Who’s paying? 1/3rd 19 @memotext

THANK YOU! Questions for me? @memotext Office: 647-430-8233 #104 @memotext

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