Talking Pill Bottles

In 2004, I ran across an news article which described the concept of a talking pill bottle, and it's utility for the visually impaired, handicapped, illiterate, and people with cataracts. Several firms were mentioned, and I thought I'd visit each firms website for a product overview. Each firm used a small electronic chip attached to the pill container, or a receptacle around it. But they had drawbacks, such as requiring a pharmacist or caregiver to read information into a recording device, needing patients to buy a $325 "reader" device, or using $10 disposable pill bottles. I did check with my local Walgreen's pharmacist, and he claimed they had no experience with such devices, though he agreed they'd be useful.

First, we have En-Vision America's Script Talk. The system acts in this fashion. When a patient using a ScripTalk reader submits a prescription, the pharmacy software prints and programs an auxiliary smart label using a dedicated, small-footprint printer. The smart label, which stores prescription information is placed onto the prescription container by the pharmacist. In the home, the patient uses a hand-held ScripTalk Reader that speaks out the label information using speech synthesis technology. By simply moving the prescription within an inch of the ScripTalk reader, pertinent information such as, the name of the patient; the name of the drug; the dosage; general instructions; warnings; prescription (Rx) Number; along with the doctor’s name and phone number are converted into speech.

The second vendor is MedivoxRx Technologies' Rex-The talking Prescription Bottle. Rex is fully automated through text-to-speech technology, allowing pharmacists to electronically record the label information to the pill bottle in a natural sounding computer generated voice using the pharmacy’s current software and data. As the pharmacist sends the label information to the printer, the label information is recorded into the base of the bottle. Features and benefits include ease of use (one push button), no special reader required, no usage training required, disposability, and low cost for patients.

The third vendor cited was Talking Rx. Talking Rx® is a simple, yet effective solution that provides audible guidance in taking medications. The device attaches to common-sized prescription bottles and contains a memo recorder that allows a physician, pharmacist, caregiver, family member or patient to record necessary information about the medication. Samples of the information that can be recorded include: name of the medication and the name of the person for whom it is prescribed, instructions for proper use, any special instructions or possible side effects, name and telephone numbers of physician and pharmacy, and expiration date and refill information, including the prescription reorder number.

Google's Health Council

I see both Google and Quicken as emerging players in the digital health arena (Please refer to my January 7, 2007 posting.). Today, Google announced the formation of it's Health Advisory Council. According to an article in the Health IT Strategist, the mission of the Council is to enable Google to better understand the problems consumers and providers face every day and offer feedback on product ideas and development. The Council is comprised of IT "movers and shakers" in the USA, including AARP's John Rother. It shall be interesting to follow their deliberations.

According to the news release, the panel will be chaired by Dean Ornish, the founder and president of the Preventive Medicine Research Institute and a clinical professor of medicine at the University of California at San Francisco. Other members of the panel are: RAND Health research scientist Douglas Bell; Cleveland Clinic Chief Executive Officer Toby Cosgrove; Health Technology Center CEO Molly Coye; Former Congressional Budget Office Director Dan Crippen; Wal-Mart Executive Vice President of Risk Management, Benefits and Sustainability Linda Dillman; Beth Israel Deaconess Medical Center and Harvard Medical School Chief Information Officer and Healthcare Information Technology Standards Panel Chairman John Halamka; U.S. News & World Report Health Editor and Columnist and a former head of the National Institutes of Health Bernadine Healy; American Medical Association Chief Operating Officer Bernie Hengesbaugh; AAFP Executive Vice President Douglas Henley; University of California at San Francisco Vice Chancellor of Medical Affairs and School of Medicine Dean and former Food and Drug Administration Commissioner David Kessler; Robert Wood Johnson Foundation Senior Vice President and Director of Health Care Group John Lumpkin; AARP Group Executive Officer of Policy and Strategy John Rother; Kaiser Permanente Vice President of Online Services Anna-Lisa Silvestre; FasterCures President Greg Simon; California HealthCare Foundation President and CEO Mark Smith; Palo Alto Medical Foundation Vice President and Chief Medical Information Officer and American Medical Informatics Association Board of Directors Chairman Paul Tang; Genetic Alliance President and CEO Sharon Terry; American College of Physicians Executive Vice President and CEO John Tooker; Lance Armstrong Foundation President Doug Ulman; UCSF Department of Medicine Associate Chairman and UCSF Medical Center Chief of Medical Service Robert Wachter; and I'm Too Young for This! Cancer Foundation for Young Adults Founder and Executive Director Matthew Zachary.

Andy Grove's Open Letter

Check out the June 11th issue of Fortune, where Andy Grove makes a pitch for using technology to keep parents at home as part of his "modest" proposal to fix the health care system. His comments follow.

"The cost of caring for the elderly is huge and will only grow as our population ages. Of the $440,000 the average American spends on health care in his lifetime, $280,000 will be spent after age 65.

Probably 50% of that post-65 outlay goes to assisted-living facilities and nursing homes. So it stands to reason that if there were a way to keep elderly patients in their own homes longer - without degrading quality of care - we'd have a cheaper and better system.

And we can do just that using technology. I'm talking everyday, low-cost technology - the sensors, microchips, small radios you'd find in today's PCs, in cellphones, and in Bluetooth earpieces. It's not too difficult to use this stuff as monitoring tools. Not to spy, but to detect trouble. For example, did the patient go outside to get the newspaper or did she wander away? Has the patient taken his meds? The same technology that brings us HBO can watch over the patient and trigger human intervention when needed.

A critical step to make this happen is to have it blessed - and reimbursed - by the dominant health-care supplier to the aged, Medicare. Candidates, I hope to see a phrase in your inauguration speech that starts like this: "I will have Medicare define specifications for electronic equipment that allows the average aging citizen to stay home two years longer than today."

As for affordability, Grove claims "As for the elder-care plan, the savings achieved by keeping just 10% of the aging population in their homes can amount to $30 billion a year."

Consumers' Guide to Aging Services Technologies

Enhanced use of information technology in health is believed to lower costs, enhance
quality, and improve access to care for all Americans. Information technology
designed for the aging has similar promise, and we are only in the formative stages
in the design and installation of such products. Emerging technologies for the aging
include smart homes, monitoring robots, talking pill bottles, virtual communities, and on line medicine cabinets. Will consumers embrace these products? Will they be cost effective? Will they ensure personal privacy? Ultimately, will they lower costs and improve care quality? For answers to these and other issues, come join us and learn how to be a wise consumer of aging technologies.

Uncommon Common Sense

Recently, I ran across a podcast sponsored by Deloitte called "Sharing the Health: The Promise of Health Information Exchanges." John Halamka and John Glaser (HIT household names, to be sure) were the featured panelists. I commend this podcast to you without reservation, because their views are devoid of hype, and grounded in the hard realities of HIT transformation in this country. Here is my take-away list.
a. HIT may be able to reduce the 15% redundancy rate in medical practice, but the 15% cost savings for payers equates to 15% income loss for practioners, who won't suffer that kind of income reduction lightly.
b. Two winning business propositions for HIE's are e-prescribing and sending discharge summaries to referring MD's.
c. The information exchanges are a social good, and therefore, governments need to play a major role in their funding--certainly well beyond the current support levels.
d. President Bush's goal of most Americans having access to EHR's by 2014 is unrealistic (I've often referred to it as a "mirage," not a vision). This vision will take decades to be realized. We'd better set in for the long haul.
e. Leadership will come from the States, and not the Federal government. The States can serve as funders, convenors, standard setters, and trust builders.
f. Payer sponsored personal health records are intended to capture market share. The payers are powerful, well funded, uncoordinated, and present real problems for the RHIO's community coordinating function.
g. BEWARE of the grant funding model, unless the grant covers 100% of the work to be done.
h. A shakeout in the RHIO world is forthcoming, akin to the dot com bust of the past. We're in an era of "irrational expectations." They anticipate that about a dozen HIE's will achieve financial sustainability (Out of 160 HIE's currently in existence).
i. There are much more pressing system needs than HIT (i.e., the uninsured). Sobering, but true, I believe.
j. RHIO's may have a better chance to thrive in regions with few payers, local ownership, and non profit structures.

2nd Annual HIMSS Blogger Meetup

Be sure to check out the 2nd Annual HIMSS Blogger Meetup in New Orleans, outlined at the Healthcare IT Guy. It should be an interesting session!

Early Adopters

For some time, I have been interested in the characteristics of the early adopters in HIT. The annual 100 "Most Wired Hospitals" list for 2006 seemed like a good place to start an examination. There were 13 new members in the 2006 listing, and if memory serves me correctly, the annual turnover on the list is about 15%. So, who are the institutions who have maintained the rating for all 8 years of the survey? Turns out there are 7 - Avera Health from Sioux Falls, MeritCare from Fargo, Partners from Boston, Sharp from San Diego, Hackensack University Hospital, the University of Pittsburgh Medical Center, and Valley Health System in Winchester, VA. On the surface, we can find no symmetry relative to geography, hospital type, or size. The answers lie within, apparently.
Turning to Wikipedia, we find the following:
Diffusion of innovations theory was formalized by Everett Rogers in a 1962 book called Diffusion of Innovations. Rogers stated that adopters of any new innovation or idea could be categorized as innovators (2.5%), early adopters (13.5%), early majority (34%), late majority (34%) and laggards (16%), based on a bell curve. Each adopter's willingness and ability to adopt an innovation would depend on their awareness, interest, evaluation, trial, and adoption. Some of the characteristics of each category of adopter include:
Innovators - venturesome, educated, multiple info sources, greater propensity to take risk
Early adopters - social leaders, popular, educated
Early majority - deliberate, many informal social contacts
Late majority - skeptical, traditional, lower socio-economic status
Laggards - neighbours and friends are main info sources, fear of debt
The 8 institutions are "Innovators,"to be sure, and have sustained their edge, when the diffusion rate of HIT was growing rapidly.
From my vantage point, I would think the internal reasons why the 8 have maintained their rating are: continuity of leadership, a culture which values innovation, sustained financial success, and thoughtful implementation of HIT initiatives.