Friday, September 07, 2012

Adherence - Do We Really Need an App for That? Benefits Do Not Outweigh the Risks.

Adherence, as defined in the Pharma Marketing Network Glossary, is "Percent of doses of a drug taken as prescribed for entire period of study (compliance + persistence)." In short, "sticking to the proper self-administration of treatment." Lots of patients -- even patients taking life-saving medication -- are not as "adherent" as they should be, which means that the treatment does not work as advertised and drug companies lose money. This has been discussed ad nauseum (see the links to articles listed here).

There have been many attempts by the drug industry to improve medication adherence, but it has been a tough challenge. But the industry has not given up. The new battleground for combating non-adherence is the mobile smartphone and the smartphone app is the weapon of choice. An example is the Care4Today "secure mobile app and website" that was developed and recently released by Janssen Healthcare Innovation.

Jannsen claims that this app is more than just a new-fangled way to remind you to take your medicine -- Care4Today "serves as your self directed personal health assistant."

Here are the "key features:"
  • Customizable reminders and alerts on your mobile device:
  • Medications
  • Prescription
  • Refills
  • Appointments
You can also
  • Store key contact information
  • Store and password protect important medical contact information (Doctors, Pharmacies, and other important Care givers)
I downloaded this app on my iPad and was confronted by the screen shown on the left. It appears that I have to register on the care4today.com website before I can use the app, which I consider a stumbling block -- I hate registering on a pharmaceutical site. The terms are so long, tough to read and onerous that I just say "f**k it! I don't really no stinkin' app to remember to take my meds!"

But I soldiered on and registered. BTW, I could not click on the URL within the app to go directly to the website -- I had to quit the app, bring up my browser and enter the URL (or copy and paste from the app). BTW2, I hate running iPhone apps that are not specifically designed for my iPad as well. Just sayin'

Success! ...I think. I get a "Temporary Numeric Password" that is a 7-digit number. It says "Enter this Temporary Numeric Password into your mobile device." I do that and immediately get the message "The Numeric Password is a 4-digit number."

I guess it's time to call support! Whoops! Silly me - I didn't read carefully the new gray text that appeared in the boxes. It was asking me to "Enter a New Numeric Password," which should be 4 digits. This will prevent someone from gaining access to my data should I forget my iPad on the bus.

It took a couple minutes for the app to "synchronize" my data. In fact, it's still "synchronizing" while I am writing this. I'm guessing the app has crashed, but I will wait. Meanwhile, let me tell you more about this app.

The data you can enter on the care4today web site is very personal. It can be all you medications including dosages. It can include information about your doctor and pharmacist as well as all your appointments.

Whoops! Just got an error message: "Failed to establish network connection...For help go to care4today.com (code 08017203)." Whoa boy! If I were an 75-year old mensch, forgetaboutit! I'd quit this app in a heartbeat (ie, minute or two). But, I am your fearless pharma mobile app reviewer who will follow instructions.

Turns out I must call support again - that's what the website tells me to do. While I'm on the phone with "Donald," I try entering my numbers again and lo and behold, it syncs in a flash and I'm in!

I'm not going to get into all the features of this app such as how it helps you enter your prescriptions (i.e., it has a complete list of drugs that takes forever to scroll through -- it would be helpful if it found the drug as you begin spelling it out). My main concern is what Jannsen is doing with all this information.

I suspect that Jannsen may be using my information to do some market research and learn more about non-adherence. After reading the Privacy Policy, I see that Jannsen will "sometimes ... provide limited access to your personally identifiable information to our contractors and consultants, including vendors and suppliers that provide us with technology, services, or content for the operation and maintenance of our Application or data and analysis on Application use."

Jannsen will aslo use aggregated data: "We may combine user-inputted information, including personal health information and information regarding your use of the Application, with information from other users to create aggregated data that may be disclosed to and utilized by our affiliates and by third parties."

Jannsen will also use the app to send out ads about their products: "From time to time, we may ask for your consent for us to send other messages to you. For example, these messages may be directed to improving your understanding of the medications that you are taking as well as conditions for which those medications are typically taken. By providing your consent at those times, you will be specifically consenting to receive the types of messages described in the consent request."

Also ads from other companies: "From time to time, we may also ask whether you would like us to share your personal information with another company that may want to send you information about their products or services. If you consent to such transfer by us of your personal information to another company, please note that the information provided will be subject to such company's privacy practices and not within our control."

Which is all very good and fine with me -- except that it is too much possible sharing of personal information for me to trust the app. Or look at it this way: Do the benefits outweigh the risks? I think not.

P.S. I forgot this tidbit from the Terms: "We have no obligation to provide technical support or maintenance for the Application. At any time and for any reason, without notice or liability, we may modify or discontinue the Application or any part of it or impose limits on your use of or access to the Application."

5 comments:

  1. Clearly, pharmacy benefits managers (PBMs) see a need, but will consumers? No offense to their protecting their revenue streams, but I don't want to use up all the space on my smartphone with an app like this!

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  2. I have not spent any time with this app, but the key principle driving its use is the same principle driving mobile app use in general: what's in it for the patients? Does it make their day a little easier? Does it offer incentives for adherence? Does it entertain? If it doesn't bring value to the user it just won't be used very much. If the developer builds the app around the needs of the client - Janssen in this case - it is doomed to failure.

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    Replies
    1. As I was struggling through the loading and initiation of this app, I was thinking the same thing -- was this designed for me or for Jannsen? Of course, I read all the fine prints and realized how much benefit Jannsen would get from my data, whereas I would get hardly any benefit. Who needs an app to do this. I could set up a reminder on my iPhone's calendar. OK, so I wouldn't get personalized messages. But I also wouldn't get any ads.

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  3. I too tried this app and was unable to get it going. People have been developing bad technology for decades without taking user requirements, actual needs, incentives, human-user interface design into account. Then the system fails and the technology gets blamed. There is more and more evidence of technology actually making a difference in health but there are few examples of evidence based design that are making it to the commercial marketplace. Creating technology that fails because of reminder fatigue, generic design and poor usability should not detract from the integration of technology into health and the adherence/compliance equation.

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  4. While I haven't downloaded and interacted with this app, I'm surprised it would have made it through user testing with so many challenges. If there was no user testing, then hopefully this post serves as a call-to-action for testing in the future. The nice thing about publishing apps in the iTunes store is that you can issue updated versions with relative ease, and notify your users (if they can make it past the installation/set-up process) that a new version is available. Looking forward to future reviews!

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