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Text messaging your way to better health

HealthLeaders Media
"Medicine on the Net"
By Cynthia Johnson
April 2008 Cover Strory

Text messaging- the same technology that American Idol fans use to cast votes for their favorite contestants- is making its way into the American healthcare industry. Several companies hoping to profit from the public's craving for quick information on the go have products on the market, and many more in development, that allow mobile phone users to receive medication and appointment reminders, manage chronic conditions such as diabetes and asthma, and receive healthy-living advice.

America's biggest drug problem
When physicians prescribe antibiotics, they tell patients to finish all of their medication to fully recover and avoid building up a drug resistance. But when symptoms subside and patients resume normal activities, they often forget their doctor's warning-and the few pills remaining in their medicine cabinet. One day goes by, then two, and soon it's no longer worth taking the rest of the medication. More often than not, patients remain healthy. However, the same cannot be said of patients who are prescribed medications for chronic conditions such as epilepsy or depression, which require that medication be taken according to strict guidelines. If these patients forget to take their medication, they undoubtedly will experience repercussions.

"Noncompliance, in my opinion, is America's biggest drug problem," says Kevin Aniskovich, CEO of Intelecare Compliance Solutions, Inc., of New Haven, CT. "From a public health perspective, we need to ensure that everybody understands the consequences of not being adherent."

Founded three years ago, Intelecare (www.intelecare.com) offers patients and businesses medical reminder and notification services via e-mail, voice mail, and text message. It has more than 3.2 million customers and sends out more than 5 million reminders every day, with e-mail being the most popular method, followed by text messaging and voice mail.

Intelecare is focusing its development efforts on the issue of increasing medication adherence- a lofty goal given that one out of every two patients is noncompliant. This noncompliance equates to $177 billion in lost or unrealized revenue. It also results in $47 billion in hospitalizations every year.

Victor Imbimbo, CEO of Caring Today (www.caringtoday.com), a Fairfield, CT-based magazine that focuses on providing resources and information to family caregivers, says that sometimes the more habitually we take medication, the easier it can be to forget to take it. If a patient doesn't take a medication at a certain time of day, by the time he or she leaves the house or office, the patient often forgets about it.

"Then what do you do? Do you double up [when you miss a dose]?" asks Imbimbo. "Well, some meds you aren't supposed to double up."

Many treatment plans require that patients take medication strictly as prescribed. If patients deviate from their treatment plan even the slightest bit, they can set back their progress to such a point that they may never be able to re-gain it.

Imbimbo predicts that the demand for medication reminder tools will grow.

"People aren't going to take fewer drugs over time; they're going to be taking more," he says. "Drugs are becoming so much more specific to the ailment an individual has. I believe over time, you have to deal with a lot more of the medication management issues."

Taking the burden off caregivers
According to Imbimbo, 25% of all households have a caregiver, and the number continues to grow-he says that it is projected to increase to another 10 million over the next 15 years. Caregiver needs also amount to an estimated $30 billion in lost productivity in the United States each year. Often, the average caregiver is a member of the "sandwich generation," someone who is attending to their health as well as that of their aging parents and their own children.

Caring Today introduced Intelecare's tool to help put control back into the hands of caregivers, who, on average, are 46 years of age and Web-familiar, but not Web-savvy, Imbimbo says. The feedback he has received indicates that the tool has been helpful and that users are having an easy time working with it.

"A caregiver has so many things to think about," Imbimbo says. "The time constraints and stress really take a toll."

Caring Today research has shown that caregivers' No. 1 concern is medication management, especially because the average person receiving care takes four and a half drugs. Caregivers must think beyond medication compliance and consider side effects and interactions. "A lot of other things they could learn by trial and error if they can't find resources, but with medication, they're out of their league," he says. "Many times, they can't think of everything, so knowing that they're going to get that message every day relieves them of having to worry about remembering things specific to a medication."

Of all the messages that Intelecare users create, Aniskovich says the company sends more reminders for cholesterol-lowering and blood-pressure-controlling medications than for any other drug. A high concentration of users also have reminders to take Allegra for allergies, Advair for asthma, and Actose for diabetes.

Imbimbo says chronic diseases such as Alzheimer's disease, depression, and epilepsy are important from both the patient and caregiver perspectives. He says that when a patient starts taking upwards of five drugs per day, it becomes easy to miss one of them. The service lets patients prioritize what they should be paying attention to the most, Imbimbo says. The product can also be used for short-term illnesses that aren't typically part of a patient's normal prescription routine, such as medications for blood disorders.

"They're not going to use it as much for colds, but they're going to use it when it's something that really affects their long-term well-being," he says.

Texting your way to disease management
It's not easy for people living with chronic conditions like asthma and diabetes to adhere to a regimen when it comes to their treatment plan. Perhaps for a few weeks after seeing their doctor, they will. But, as time passes, they stray, typically finding it too difficult to make behavioral changes.

To help these patients, BeWell Mobile Technology (www.bewellmobile.com) of San Francisco has created "patient engagement" software that uses mobile phones. Its product collects patient data so healthcare providers can track a patient's progress and determine whether personal intervention is required. The service also provides patients with information about their progress and makes suggestions about what they could be doing differently to improve their health status.

Rather than present physicians with peak-flow meter readings and glucose levels alone, BeWell provides them with a variety of information based on how their patients have responded to personalized questions posed to them via their mobile phone.

"It's not just one data point coming in and one static message going out," says Peter Boland, MD, BeWell's business development director.

For example, diabetic patients answer questions related to their insulin usage, meal intake, and level of activity, among others. Physicians can look at reports that will let them know which patients need their immediate attention based on their risk profiles.

"What we want to do is focus high-cost, high-expert clinic time on those folks [who] really need the time and attention," says Boland. "All this lays the groundwork [for] actual changes in behavior."

In 2007, 50 Kaiser Permanente diabetic patients who receive care at Riverside (CA) Medical Center participated in a 12-month project using BeWell. Before the project, HbA1c (a diabetic control index) levels ranged 9%-12%; anything over 7% is considered high risk.

"Everybody came down at least 2.22%, which is unheard of," says Boland. He describes the finding as very significant.

BeWell has also proven effective for severe and persistent asthma sufferers. San Mateo (CA) Medical Center conducted an asthma management project with BeWell involving 50 patients aged 12-19. Before the project, the patients averaged between three and five visits to the emergency room per year. After the project, none of the patients in the study made any emergency room visits.

"BeWell is trying to present a much fuller picture for clinicians to better manage the patient," says Boland. "We're trying to collect a whole series of data on what the patient's condition and symptoms are by the day, hour, and minute."

An appointment reminder for the 21st century
Branford (CT) Dental Care is a 40-year-old practice with approximately 3,200 active patients. Before using Intelecare, the practice relied on computer-generated phone calls and postcards to remind patients about upcoming appointments. It began actively using the service one year ago when it experienced an increase in missed appointments and last-minute cancellations, which hovered at 50%.

"That not only affects the practice's bottom line, but also places the patient's health in possible jeopardy because there is no guarantee when they will reschedule, increasing the risk for cavities, root canals, and more," says Ryan Finnegan, DMD.

The practice fully integrated the Intelecare service directly into its Web site (www.branforddentalcare.com), and it is seeing a steady adoption of patients using it.

Finnegan says it has consistently increased compliance by reducing missed appointments. The reminders have also cut back on administrative staff workload and costs, as the practice doesn't need to send reminder cards or buy postage.

"Everyone is different, and sometimes our postcards and phone calls did not have the impact which we had hoped," says Finnegan. "Their system allows our patients to decide when and how they want to be reminded for their upcoming appointment."

Customized convenience
Intelecare users sign up for the service after finding the company on the Internet or through the relationships that it cultivates with employers, insurers, pharmacies, and pharmaceutical companies. For the latter, Intelecare offers businesses the opportunity to rebrand their platform and integrate it on their own Web sites.

Intelecare's basic plan offers users free, unlimited e-mail reminders. Its plus plan offers an unlimited number of email, voice mail, and text-messaging reminders for $5 per month-with no commitments or contracts.

After users register with the site, they are given a user account and home page where they can list all their medications and edit, delete, and add new medications. From there, users specify which type of reminder they want to create. The service allows them to receive reminders about taking medication, refilling prescriptions, making doctors appointments, or monitoring health indicators, such as glucose levels. Imbimbo is impressed with how the service allows users to create personalized notifications specific to their medication. "You're getting your own message; you don't feel [as though] someone's intruding on you," he says.

Next, users answer several questions about how they'd like to be reminded, such as the time of day, frequency, and method-e-mail, text, or voice mail. Users can choose one, two, or all three platforms.

For voice mail reminders, the company uses a program that converts a user's typed message into speech. Imbimbo describes it as a great feature for caregivers who want to ensure that the people for whom they care take their medications.

"The hurdle to try the product is so minimal, and the benefits are so high," says Imbimbo of the service. "It's easy to like." Patients are allowed to print their information to share it Text messaging with healthcare professionals, but the product currently doesn't allow for two-way communication due to privacy concerns.

Privacy concerns
Text-message privacy concerns recently made national headlines when the Detroit Free Press examined more than 14,000 text messages between Detroit's Mayor Kwame Kilpatrick and his chief of staff, Christine Beatty. The messages, exchanged over a city-issued pager, confirmed the two were having an affair, which Kilpatrick had previously lied about under oath.

On many occasions, prosecutors have been able to receive the complete contents of a defendant's text messages. Judges in the Kobe Bryant case and a trial involving the attempted murder of rapper 50 Cent seized archived text messages.

It stands to reason that if you are ever on trial or are in the public eye, you may not want a text-message reminder to take, say, medication for bipolar disorder to be entered as evidence. It's worth investigating ahead of time to find out what is your provider's policy.

Standard text-messaging rates may not apply anymore
In Europe, Aniskovich says that text messaging is more popular than e-mail communication. His company is also closely watching trends in Asian countries where people are using their mobile phones to make purchases.

"We're a little bit behind the times, but we are seeing a rapid uptake in mobile technologies," he says.

Although the United States has not fully embraced mobile technology, especially when it comes to text messaging, that may soon change. Earlier this year, all four major wireless providers in the United States (AT&T, Verizon, T-Mobile, and Sprint) introduced new flat-rate plans for customers who used to buy by the minute or message.

"As we become more comfortable with our mobile devices and the [Short Message Service] features become more standard in our plans, there will be fewer barriers to utilization," says Finnegan. "More and more companies are developing ways to use mobile messaging, so it will at some point become second nature." According to CTIA - The Wireless Association (www.ctia.org), as of June 2007, 81% of the U.S. population had wireless phones. These figures are only expected to increase, making it very likely that there will be additional healthcare applications for mobile technology in the future.

"It's like having the doctor in your pocket," says Boland.

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About Intelecare
Intelecare Compliance Solutions provides best-in-class personalized reminder and notification services. Utilized primarily to address patient medication adherence, Intelecare enables patients and caregivers to create and manage their own personalized Email, SMS and Voice notifications. In addition to its patient-centric offerings, Intelecare provides scalable services for marketers, business and industry that range from target messaging to private label integration. Tackling a problem that affects 1 out of every 2 people and is linked to over $200 billion in lost revenue and hospitalizations annually, Intelecare focuses on providing programs that work the way patients and caregivers live in a practical, user-friendly manner.

www.intelecare.com

Contact Information
Alex Sicre
(203) 787-1500, extension 203
alex.sicre@intelecare.com

*Intelecare is a trademark of Intelecare Compliance Solutions, Inc. All other trademarks not owned by Intelecare are the property of their respective owners.

"...it [InteleApp] has consistently increased compliance by reducing missed appointments. The reminders have also cut back on administrative staff workload and costs, as the practice doesn't need to send reminder cards or buy postage."

Ryan Finnegan, DMD