Redesigning the Patient Medication Experience

Could a low-tech solution be more effective than a high tech one?


There’s a fantastic and innovative new healthcare invention, called Pillpack, which serves as a great example of elegant healthcare design. It’s not a new fangled mobile application or pill. It’s a simple solution devised for a complex problem: medication adherence for chronic disease management.

There’s a lot of focus on technology for improving adherence, like the superfancy Proteus pill. Proteus made a huge splash for embedding a computer chip inside a pill, which can measure medication adherence as it travels through the digestive tract. Grandma swallows the pill, and when it reaches her stomach, the acid in the stomach triggers it to send information to a mobile phone application through a patch worn on the body, notifying loved ones and providers about if and when she is taking her medications. Super high-tech, but definitely a pricey option:

“It passes naturally through the body in about 24 hours,” Ms. Carbonelli said, but since each pill costs $46, “some people choose to recover and recycle it.” -Nick Bilton of the New York Times

At that price, I am not sure that it’s really a feasible or affordable solution for individuals who might need to take anywhere from 15-20 pills a day, and besides, who really wants to retrieve the pills at the end of the day after they have passed? (Yuck! That’s worse than taking a regular pill!) Not to mention that you would now have to wear an arm patch for the pill to communicated with the cellphone, making adherence even more complex). Finally, a missed medication dose that is noticed after the fact doesn’t really address the core problem of how to help a patient take his/her medications. So we can choose notify patients and scold them in gentle ways for not taking their medications, or we can develop solutions that actually fix the problem.

Let’s examine the problem of medication adherence from a design thinking perspective. You can imagine the complexity of having to take numerous meds per day. Why might an individual miss his/her doses of medication? You might mix up the medications if all the bottles look alike; you might have trouble opening the bottles with child-proof caps if you have arthritis or other muscle/joint/coordination issues; and you might have difficulty keeping track of time intervals at which medications are supposed to be taken and how to avoid drug interactions. No wonder adherence isn’t better; it’s a total confusing mess!

Here’s where Pillpack innovated a creative solution. They are a pharmacy service that packages a patient’s medications into individual packs of all the pills that must be taken at a given time. Check out their video below.

http://www.youtube.com/watch?v=PtBNhNG59GU

The packs are labeled with the time at the very top in bold letters (makes sense, it’s probably the most important piece of information that the patient needs), the day of the week, followed by the date, along with the medications and their doses.

They have done a really good job of creating an experience for the pill taking journey. It’s delivered every 2 weeks to the patients home, there’s proactive refill management, and it costs just $20 extra over the cost of the medications themselves, which is refunded if the pills are late. But there are some cons, like the fact that the packs are not child safe (which could raise issues for people with small children in the household).

It’s a decidedly low-tech innovation, although they apparently have a sophisticated technical backend, which passes each packet through an image recognition system (which can assess pills by size, shape, color, and density), to check that the right pills are in the packet. They actually write:

You should never receive a packet with an error. We are so confident this won’t happen, that if it ever does you will receive a full refund of all the monthly fees you’ve paid to date, and free PillPack monthly fees for life, should you decide to stay with us.

That’s pretty good service; wonder if any other healthcare systems or pharmacies would be willing to make that guarantee? My guess is no one.

Pillpack’s founders are Elliot Cohen and TJ Parker, and the startup apparently worked with IDEO Boston as a start-up in residence. I actually don’t know how the idea came about, but IDEO is known for its “hands-on” prototyping with physical objects during design sessions. I can only imagine what the prototype was in that first design workshop: a ziploc bag that someone shoved pills into and labeled with the date and time using a sharpie! Now that’s the power of design thinking! A company that puts pills in plastic bags with instructions written on the side, just raised $4 million dollars to expand their mail-order pharmacy operations to more states. Look out CVS and Walgreens!

Design thinking is the wave of the healthcare future; now only if the rest of us lumbering healthcare institutions could use it to help our patients. Please share other “low tech” innovations you have witnessed that can improve health and safety and the customer experience? I would love to hear about them!

I have no financial or personal affiliations with Pillpack or any of its investors. I just love the power of design thinking! I post about healthcare and design on Medium (https://medium.com/@joyclee) and you can also find me tweeting about #design #mhealth and #dataviz on Twitter: @joyclee, as I continue on my #designthinking #adventure!

Update: I am told that Pillpack no longer charges the $20 fee.