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.

1. Improving the bottom line for
healthcare by increasing
medication compliance.
Amos Adler M.Sc.
President, Co-founder
@memotext
amos@memotext.com
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-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

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, 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

5. 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

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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

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 day
Analyze
•Stakeholder input
(CATWOE)
•Meta-Analysis
•Study design
Methodology
added
Design
•Requirements
•Data Integration
•Segmentation
Deploy
•Measure
•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.
@memotext
100%

14. 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

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
•
•
•
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

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

17. 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!

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 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?”

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)
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

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