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

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

2. 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-adherenceWith 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 3. 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 4. The MEMOTEXT effect Johns Hopkins Trial "The Impact of Automated Dosing Reminders on Medication Adherence using HealthVault". By Michael V. Boland, MD, PhDResults presented at Stanford Persuasive Behavior Lab and Kaiser Permanente Gallery of InnovationN=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 5. RECRUITMENTASSESSINTERACTMEASUREBest 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 6. Demo/ Walkthrough ASSESSINTERACTMEASURESelf-learning from patient responses. short frequent questionnaires at enrollment and on-going. condition specific literacy and behavioral questions securely administered for privacyIf 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) Im just too busy and it's a hassle d) I don't understand why I need it. 7. Personalized Content by Voice ASSESSINTERACTPatient ResponsesMEASUREClaims DataEMR dataHypertension medication compliance call Rx History : New Start less than 3months Condition Literacy MessagePersonalized interactive, education, motivation & support.7 @memotext 8. Personalized Content by Text and Mobile2.0IVR SMS Mobile WebCondition: Type 2 Diabetes Rx History: Rx = > 6months Medication: METFORMIN Diabetes Anxiety/Stress Scale: Med/High 8 9. Analytics + Data Results, ROI, Insights ENROLLASSESSINTERACTMEASUREHIPAA secure real time data collection and analytics67%Avg. participation ratesSelf-Report Data Valid and Real-time55%Upto Objective Data Validated / Correlated changes in MPR88 % retention ratesIntervention Data & Insights@memotext 10. Select ClientsSelect Programs Hypertension & Cholesterol End-Stage Renal Disease Type 2 Diabetes Contraception Multiple Sclerosis Glaucoma Idiopathic Pulmonary Fibrosis Actinic KeratosisPharma Mfg. Genzyme Canada Merck Canada + confidentialInsurance, Provider, PBM Accountable Health Connect Health Inc. Green Shield Canada Genzyme Canada PerformRx St. Michaels (Toronto)Academic Arizona State Univ. Univ. of TorontoImmunotherapy Medical Device Integration Asthma10 @memotext 11. How did we get here?Started as a reminder app, pivoted to SASS (algorithm) engineMEMOTEXT 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 whos paying? 11 @memotext 12. 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 dayAnalyzeStakeholder input (CATWOE) Meta-Analysis Study designMethodology addedDesignRequirements Data Integration SegmentationDeployMeasure Pivot?12 @memotext 13. 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. @memotext100% 14. You are Competing for mind-share: -Professional Marketing Overwhelmed and overloaded by apps, iTunes Natural resistanceNo 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 15. 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 Patients are hungry for tools and hungry to provide input but Patients are also very defensive Test persuasive language, recruitment tactics15 @memotext 16. Bad DesignAlthough Most technology needs to go to finishing school - David Rose 17. Lessons learned The biggest challenge is: Behavior Change Ground ZERORECRUITMENT/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! 18. RECRUITMENT/ADOPTION hierarchy Despite best efforts to enrol patients in mobile/text programs, patients get defensive when approached.Perceived as medical advice by the patient1:5 recruitment ratio byI think you should consider this support program - try it Physican/Clinician out 1:20 recruitment ratio by PharmacistI think you should consider this support program try it out Perceived as what are you trying to sell me? 19. 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) Dont 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 Whos paying? 1/3rd19 @memotext 20. THANK YOU! Questions for me?@memotext [email protected] Office: 647-430-8233 #104@memotext