More and more, individuals are taking an active role in their health care and collaborating with their medical teams to improve their well-being and treatment responses. This is the first installment in MPH@GW’s new series on the quantified self movement, which will explore this exciting new health movement through in-depth reports on relevant topics and issues. This first post introduces the quantified self movement, examining its potential benefits as well as inherent challenges, and then explores medication trackers and how they can improve health care delivery, engage patients and empower doctors through individual understanding of health data and improvements in health literacy on the population level.
The quantified self was a major theme at Health Datapalooza 2014 and the subject of a keynote speech by Adriana Lukas, founder of the London Quantified Self group. Lukas noted, “Whenever literacy of any kind comes into play, we are talking about potentially profound changes in any system affected by that literacy. Just as widespread literacy has had a profound and unforeseen impact — not only on the evolution of knowledge and information but also on society in general — health and data literacy as inspired by the demand side QS (quantified self) movement has the potential to do the same in the context of health and health care.”
What Is the Quantified Self?
Think about how hard it is to remember every single aspect of your health day to day. How happy were you last Tuesday? Can you remember what you ate or drank? If you have a chronic disease, such as diabetes, did you track your relevant vitals? Did you remember to take your multivitamin? The idea of measuring and charting information and tracking it over time is commonplace in many parts of our society, but most people do not routinely record their moods, food intake, sleeping habits and activity level for the purpose of improving their health and wellness. But there is a group of people who are doing just that — they are using data from everyday activities to improve their health and overall well-being in an approach called “self quantifying.”
How happy were you last Tuesday? Can you remember what you ate or drank? If you have a chronic disease, such as diabetes, did you track your relevant vitals? Did you remember to take your multivitamin?
The quantified self is a movement that incorporates technology into the acquisition of data relating to inputs (such as food or air quality), states (such as mood or blood oxygen levels) and performance (such as mental or physical) for the purpose of tracking and improving one’s own health. The overriding hope of the movement, beyond just individual improvements, is that this data will help the health care system move away from a sickness-based model to a prevention model through real-time data collection. Proponents say it helps individuals become agents of their own health and takes some pressure off of physicians and other health care providers.
Why Should I Monitor My Health?
“The unexamined life is not worth living.” — Socrates
Health monitoring plays a huge role in maintaining health and wellness and managing disease. Involvement in self-management also can save employers, insurers and individuals millions of dollars a year in medical costs and decreased productivity. There are hundreds of ways to track and monitor your health. You may, in fact, already be part of the quantified self movement without knowing it! Pew Internet Research recently found that about 60 percent of adults track at least one health metric, and 21 percent of all adults use some sort of technology to assist them. People and applications that can track and improve sleep, diet, physical activity, body weight, stress, mood and vital signs help abstract concepts to become more concrete. Elucidating these vitals could lead to improvements in health status and decrease overall health care costs while increasing the quality and accessibility of health care.
Issues and Complications
There are several issues and major challenges inherent in this kind of data collection; specifically, once the data has been collected, how can it be put to good use and is it safe?
The first problem with the data collected through self-quantification applications (apps) is that it is not covered under the Health Insurance Portability and Accountability Act (HIPAA), which means the data collected does not fall under the same strict privacy laws as health information you give to your providers or disclose in scientific trials. Many app developers have clauses in their user agreements stating that they have the right to share the information collected with third parties, including advertisers. In addition, smartphones can be lost or stolen. Or you could be putting your own data at risk by letting a friend swipe through your information or borrow your phone.
There also is the concern that as more and more data is generated on a person, there may be a move toward using that data to evaluate one’s “worthiness” for products, services and opportunities. Insurance companies could use it to hone health risk profiling algorithms, and employers could use the information to decide which employees are going to cost the company more in health care spending — and then make hiring or firing decisions based on that data.
Finally, too much data could possibly obscure or distract from what is really significant. Correlation is not causation, and deciphering the true meaning of intricate data must be a collaboration between a health professional and the patient.
The solution to most of these problems is consumer education to ensure that the people who sign up for these types of services (1) truly understand the decision to share their data and the consequences and (2) understand how the tools can assist them in attaining their personal health goals and addressing their needs.
Medication Management and Compliance
The more medications a patient is on, the more difficult it is to remember to take them. According to the World Health Organization, only 50 percent of patients in developed countries adhere to treatment regimens. This is particularly true when patients are on complex regimens that involve taking multiple pills multiple times a day. For many doctors, getting their patients to reliably take their medication represents a major obstacle. Patients who adhere to medication schedules tend to be more comfortable, have fewer complications and generally recover better and faster than those who do not. Yet, adherence to prescribed medication directions has proven difficult time and time again. For some, the problem lies in remembering to take the medication. For others, the problem is more complicated and tied to socioeconomic issues related to cost or communication issues such as not understanding the directions fully.
Besides the health of the patient, there are many costs associated with poor medication adherence. For instance, poor compliance rates for drugs treating tuberculosis, malaria, HIV/AIDS and other diseases has led to drug resistance — meaning the pathogen has acquired the ability to “beat” a certain class of drugs. For certain diseases, such as HIV/AIDS, where adherence to a medication schedule can lead to undetectable levels of the virus in the blood, non-adherence can contribute to the continued spread of the disease. Finally, non-adherence raises health care costs in general. For example, a patient who has not taken their medication faithfully may end up with extra medical appointments, more complicated treatments and perhaps expensive trips to the emergency room.
Thankfully, there are plenty of ingenious solutions to help patients take their medications, from the simple daily multivitamin to complicated chronic disease management. What follows is a description of some of the best options.
Dosecast is a free mobile app created by Montuno Software that helps patients track their medications easily and effectively. To use the app, one simply enters the drug name, dosage and dose frequency, and the app automatically sets up push notifications and schedules.
“About 500,000 patients have used the app cumulatively since we launched five years ago,” says Jonathan Levene, the CEO and co-founder of Montuno Software. “Some use it for short-duration treatments (say, after surgery or during a short illness), but many use it to help them manage chronic illness.”
One notable feature of Dosecast is the ability to set reminders based on the time elapsed since the last dose, allowing the app to adjust to your changing day. For example, if you are supposed to take a medication every six hours, you will get a reminder six hours after your last dose — which can be helpful if you miss a dose or take a dose late.
There also are features that allow you to skip doses and learn about side effects. In addition, a smart feature allows you to suspend alerts during sleep or other times when you otherwise do not want to be disturbed.
“Motivated patients want to stay healthy and are always looking for tools to help themselves.” – Jonathan Levene, Dosecast
Another great feature of Dosecast is that it works with or without an Internet connection and tracks your time zone, making it useful for frequent travelers. Dosecast does not collect any personally identifiable information, and information in the app is encrypted.
Dosecast offers an upgrade for $3.99 that includes refill notifications, links between doctor and pharmacy records for each drug, the prescription number for each medication, in-app one-touch calling to the prescribing physician or pharmacy, a drug database and a drug photo database.
Levene says that personal experience helped inspire the medication management app: “I have some family members who take a variety of medication, and I noticed there were no great solutions five years ago that were simple, easy to use and patient centric.”
According to Levene, medication adherence is also “a big problem” in the United States. “All players in the health care ecosystem care about adherence,” Levene says. “Motivated patients want to stay healthy and are always looking for tools to help themselves; providers now have a financial incentive to care about adherence in order to reduce CMS penalties arising from 30-day preventable readmissions; payers want to improve adherence to cut health care costs arising from complications (particularly for the chronically ill), and pharmaceutical firms want to drive sales and improve treatment outcomes from taking their products as-directed.”
Kraken, a medication-monitoring system developed by iMPak Health — a subsidiary of Meridian Health, a not-for-profit health care organization — is designed to help people easily organize their medications. However, for Sandra Elliott, who is the director of the iMPak Health Board, the tool isn’t just about simplifying a daily process. “Medication adherence is a gigantic public health problem in terms of patient outcomes, hospital admissions and readmissions and cost of care,” she says.
“We felt that if we were able to create a non-threatening system, we could increase patient adoption, which would allow us to really empower patients in managing their health on their own.” – Janet Egan, Meridian Health
Kraken has many of the same features as other medication trackers, such as the ability to enter drug information and receive reminders, but it also has capabilities to create easy, user-friendly reports that can be shared with anyone, including family members. Kraken uses Bluetooth technology to upload data to its Microsoft-based application. Kraken is easy to use, completely portable and designed to fit into a user’s daily routine. The app even has the capability to integrate with other Web-based platforms such as HealthVault.
Janet Egan, a pilot coordinator at Meridian Health, says that the point of the Kraken is to make medication management easy and flexible to maximize the number of patients who can stick with the program “We felt that if we were able to create a non-threatening system, we could increase patient adoption, which would allow us to really empower patients in managing their health on their own,” she explains.
And the unorthodox name? It’s German for “octopus,” and it represents an important metaphor. “The name Kraken came to us after we started thinking about patients trying to coordinate multiple medications along with living their active lives,” says Kyle Cittadino, a consumer product development manager at Meridian Health. “We kept visualizing an octopus juggling so many different things, and we just went with it.”
Mango Health does its best to make medication management fun instead of a chore. Whereas most medication managers rely on the patient having internal motivation to adhere to a medication schedule, Mango Health uses games and rewards to change human behavior.
“Mobile gaming may seem like an unusual background for building patient-engagement apps like Mango Health, but we believe that the future of health care depends on building apps that are fun to use every day and that inspire people to stay with them for long periods of time — just like mobile games,” says Jason Oberfest, CEO and co-founder of Mango Health.
The app capitalizes on the growing trend of mobile games employing an earned currency system, in which a player accumulates points that unlock the chance to win gifts outside the app. Mango Health users can earn rewards, such as charity donations or gift cards worth up to $100, that can be used at companies like Target or Starbucks, just by taking their medication on time and tracking it through the app.
“We believe that the future of health care depends on building apps that are fun to use every day and that inspire people to stay with them for long periods of time — just like mobile games.” – Jason Oberfest, MangoHealth
Like other medication managers, the Mango Health app provides medication reminder notifications and reports. Users also can compare their rate of compliance with other Mango Health users and access information on drug and food interactions, including interactions with supplements and vitamins.
“We believe the first step for digital health has been to focus on building applications that patients really want to use every day and that inspire patients to think differently about managing their health,” Oberfest notes. “That sounds so simplistic, but it’s such a critical first step.”
“Our vision is to empower our customers to live the independent lives they love, to be connected, protected and in control of their lives,” says Aaron Amerling, who manages digital and mobile apps for Great Call, the company that created MedCoach.
From the makers of the Jitterbug cellphone for seniors, MedCoach is an easy, free medication-management application that packs a lot of punch. It features a personal medication schedule, alerts when it’s time to take your medications, an easy-to-read- and-share log of when you have taken your medications, and a direct connection to your preferred pharmacy to refill prescriptions. Additional features include a medication reference library from the First Databank national drug database to help you look up drug information and the ability to create a list of your medications and medication adherence for your medical provider or caretaker.
“Our vision is to empower our customers to live the independent lives they love, to be connected, protected and in control of their lives.” – Aaron Amerling, MedCoach
The MedCoach app is user friendly for seniors and younger adults alike. The most intriguing feature of the MedCoach app is “Shake for Help.” If something gets confusing, simply shake your phone and a bubble appears with specific information on screen.
“What we’re really trying to do is develop this idea of active aging,” Amerling explains. “It’s about empowering individuals through tools that both connect them to their doctors and the outside world. These tools also help the caregiver stay connected to the person that they’re caring for.”
MedHelper is a free, comprehensive medication-tracking app that was designed not just with patients in mind but caretakers as well. It seeks to help individuals and caretakers collaborate to overcome the challenges of complex medication schedules.
MedHelper is great for families or people managing the medication of more than one individual. The app allows for multiple profiles along with separate alarms, snooze buttons and logs of past dosage. It tracks individual and group medication inventory, making ordering timely refills easy. When it comes to sharing information from the app with medical professionals or other caretakers, there are several easily exportable reports to choose from. Other great features of MedHelper that you do not find in many other free apps are note taking and vital sign tracking options that include pulse, weight, HvA1c, glucose, oxygen levels and blood pressure among others — all of which are exportable in various reports. MedHelper is basically like having your own portable medical assistant.
Created by Community Health Network, Pillbox is a free application for Apple devices that helps you not only keep track of your own medication but also that of your family. The main “weekly” screen provides a quick look at how many medications your family is taking per day and notes the days all medication schedules were adhered to and ones where there were misses. You can simply tap on the day to see detailed information. With Pillbox, each family member has his or her own profile, with medication information and dosage. Tap on a medication and a screen showing all the interactions, precautions and indications appears. You can even set your own intervals for reminders. Finally, you can integrate information from your contacts into the app, making importing physician information a snap.
For under a mere 99 cents, Pillboxie is a fun, elegant and inviting medication-reminder application. Created by Jared Sinclair, a registered nurse, Pillboxie is especially useful for those who prefer a visual reminder rather than just a text-based one. The app uses virtual “pill bottles” that you can label with information about your medication, such as pill type, color, name, frequency and dosage. This information is integrated into the look of the virtual pill bottle. For multiple medications, there is even a “day of the week” pillbox that automatically populates with your medications for the day. When it is time to take your medication, you are reminded through your iPhone’s Notification Center banner. Another unique feature of Pillboxie is the ability to not only track when you have taken your medication but also how you felt when you took your medication — something very important in the quantified self movement. Pillboxie has many features that make it a user favorite in that it supports multiple users, has clear instructions and has a passcode for added security.
Vince Treur is the founder and owner of App Singularity, the company that created Pills on the Go. He says the inspiration for the app was personal and practical. “Back in 2010, I was told that I had to take medication for the rest of my life,” he explains. “At that moment, I instantly knew I needed help with taking those pills on time and to make sure I got my refill prescriptions on time.”
Since Treur already had a smartphone, he figured an app would solve the problem of forgetting both, but nothing on the market suited his needs. So he wrote his own. “I used it for months before other patients asked me to publish it,” he says. “The adherence issue made it a perfect fit for a mobile app and also for a watch app since these devices will be in your pocket or on your wrist anyway.”
“Back in 2010, I was told that I had to take medication for the rest of my life. At that moment, I instantly knew I needed help with taking those pills on time and to make sure I got my refill prescriptions on time.” – Vince Treur, Pills on the Go
Pills on the Go is a simple, yet effective, medication-reminder app with a user-friendly interface that is designed for Android smartphones and is available for $1.99. With Pills on the Go, you can set alarms for taking pills as well as snooze the alarms, receive notifications when you are running out of medication, and adjust your dose when taking medications. All users have to do is enter their medication information into the app and set up the appropriate reminders through the app’s intuitive user interface. Pills on the Go even makes your pill schedule easy to adjust.
An added bonus for users that can’t be found on other apps is sophisticated widget design for Android. Pills on the Go offers two different widget sizes (4×2 and 4×1) that keep your medications on your home screen — so all you need to do is glance at your phone quickly to know when your next dose is coming up.
These features, says Treur, help patients refrain from taking the wrong amount of medication, or taking that medication at the wrong intervals — which can deplete the effectiveness of a treatment course or put the patient in danger. “All of this can be prevented if you are reminded in time, every time,” Treur says.
PocketPharmacist is a unique app in that it is designed for use by both health care providers and patients and is integrated for automatic ordering from Walgreens pharmacies. For only 99 cents, PocketPharmacist provides a wide array of services that are not standard on other apps. The main source of information in this app is a compilation of drugs approved by the U.S. Food and Drug Administration (FDA), categorized by chemical class or therapeutic use. This search function works with both brand and generic names. As an added bonus, PocketPharmacist features Med Check, an automatic service that cross-references medications for interactions, side effects and precautions.
“My mission was to provide easy-to-understand drug information for both health care professionals and individuals without medical training,” says Michael Guren, the creator of PocketPharmacist. “To be honest, my family asked me so many questions over the years (as a pharmacist) that it just made sense to document my answers in a format that was easy to understand.”
As with all medication trackers, it is possible to set up reminders to take your medications. PocketPharmacist’s medication tracker is called Med Box. Med Box organizes your medications as well as reminders for multiple users on one device, in one place. It also keeps track of allergies.
“My mission was to provide easy-to-understand drug information for both health care professionals and individuals without medical training.” – Michael Guren, PocketPharmacist
One of the coolest features of PocketPharmacist is its integration with myDrugCosts. This feature allows users to make cost-informed decisions about their prescription drugs and offers mobile access to medication costs as well as alternative medications.
What’s next for PocketPharmacist? Guren wants to move the app to the Web and provide all of its current features as a Web app, which would be available from any Internet connected device with a browser.
Like PocketPharmacist, RXmindMe is part of the Walgreens family of Application Programming Interface apps. RxmindMe is a basic, but incredibly useful, medication-management app that can be downloaded for free. The interface is clean and intuitive, making the barrier to starting the program low. Users input their current medications, and if they include prescription numbers, pharmacy and doctor information, they can easily set up reorder alerts.
RxmindMe has a comprehensive registry of prescription medications, so set up and identification of medications is very simple. You also have the option of adding herbal supplements and over-the-counter medications manually. The prescription medication registry is complete with photos straight from the FDA drug database, so you can always be sure you are taking the correct medication.
Users set reminders that subscribe to one of the nine pre-built dosing schedules or customize their own regimen. You can combine alerts so that you only receive one alert for several medications taken at the same time. Simply touch the box next to the reminder when you take your medication and you never have to worry whether you took the last dose. There are even 15-minute, 30-minute, one-hour and two-hour snooze intervals available.
You can e-mail yourself or your physician with your prescription drug history right from the app as well as get historical records of all your reminders and prescriptions. The iOS platform for RxmindMe also has added security with a passcode lock screen.
Participating in the Quantified Self Movement
Now that you’ve been introduced to the quantified self movement and medication trackers, how can you see yourself using these tools to improve your own health? What about the health of large populations and health care systems? Keep checking the MPH@GW blog, the blog for the online Master of Public Health at the Milken Institute School of Public Health at the George Washington University, for further updates on this new and exciting topic, and share your thoughts in the comments.