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Summary:

While other meds-reminder apps require users to input data Nightingale is trying to solve the problem using the phone’s accelerometer and other sensors to learn users’ habits.

Remembering to take your medication — especially if you’re juggling a bunch of them — can be a huge headache. But a wave of new startups claim to help patients stick to their regimes with smartphone apps that provide reminder alerts, tracking tools, rewards and other incentives.

The latest of these is Nightingale, an iOS and Android app launched Tuesday by MIT dropout and Thiel fellow Delian Asparouhov. In addition to the $100,000 from the Thiel Foundation (which provides funding and resources to entrepreneurs under 20), Asparouhov has raised an undisclosed amount of funding from the General Catalyst-backed Rough Draft Ventures, which invests in student entrepreneurs in the Boston area.

To be honest, when I first learned that the company had launched yet another medication adherence app I couldn’t help but roll my eyes just a little bit. Medication adherence is definitely an important problem – it’s estimated that as many as half of Americans fail to take their medication as prescribed and that those oversights can cost the U.S. health care system about $290 billion in avoidable medical expenses every year.  It’s just that so many other startups, like AdhereTech, Mango Health and MediSafe, to name a few, are already tackling it.

But I have to admit that, at least in theory, I really like where Nightingale wants to go. While most other apps prompt users to input the times at which they want to receive reminders and then provide alerts at those specific times everyday, Nightingale uses the phone’s accelerometer and other sensors to learn users’ habits and then it sets reminder alarms accordingly. That means the reminders aren’t necessarily fixed to a specific time of day but to a user’s routine.

Phone sensors help the app personalize reminders

“There’s a reason why a lot of solutions don’t work: they’re one-size-fits-all. They’re not personalized,” said Asparouhov, adding that he came up with the idea for the company while helping to take care of his grandmother when she had breast cancer.

Nightingale appYou tell the app the medication you’re taking and, for the first few days, you indicate when you take it. And then, depending on how consistent your routines tend to be, it learns when to remind you. For example, Asparouhov said, if you tend to take your medication right after a morning run, it will monitor when your phone has left and returned to your house and then ping you with an alert. Or if you take your medication right after waking up in the morning, it will sense when you pick up the phone for the first time in the morning and provide an alarm soon after. When you travel, the app adjusts to the time change and your new routines.

Activity tracking apps that continue to run in the background using the phone’s sensors can take their toll on the phone’s battery. But Asparouhov said they had some back and forth with Apple on this issue and the new app doesn’t significantly degrade battery life.

I haven’t had a chance to play with the app (thanks to issues with Apple’s Developer Portal) and I can see some issues if people don’t keep regular routines or take their medication around routines that are harder for the phone to detect. But I back the idea of an app that tries to fit itself to patient behavior instead of the other way around.

Targeting doctors, caregivers with analytics dashboard

Another key feature of the app, which is also intended to be the source of Nightingale’s revenue, is its ability to let family members, caregivers and doctors monitor medication adherence through an analytics dashboard. While the app itself is free, Asparouhov said this feature will cost extra. He said he hasn’t yet set a definite price but estimates it could be about $20 per patient per year for doctors and professional caregivers who monitor several patients and less for individuals interested in keeping tabs on family members and friends.

Nightingale is starting with medication adherence because that’s where Asparouhov believes the company can gain early traction and learn the most about the market. But the company has bigger ambitions when it comes to encouraging patient engagement and doctor-patient communication.

“This is my first step in the door,” he said.

Image by ilzesgimene via Shutterstock.

  1. I’ve happily used Pillboxie for many months, it helps me keep a tab on when I’m due to take any of the 7 medications I’m currently on. The only problem with it is it doesn’t allow you take 1/2 tablet – just 1 or 2 or so on. That is the only complaint I have against it, it’s very good.

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  2. This is a great idea and on the right track, but I feel it’s missing something. PF Fogg says everyone has there own triggers that prompt you to into action. For a lot of people that is not going to be a phone notification. Can we really understand the habits in the home by your phone sensors? I personally put my phone down as soon as I get home. The first time I pick up my phone is in bed to read my email. I’m no where near my pills. I just don’t think this idea is personalized enough though on the right track. What they learn will help them build understand what else is needed before anyone else.

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  3. For many patients taking 5-10 pills a day, remembering to take meds isn’t the biggest problem; getting the correct pills in their mouth is the problem. The normal procedure is for patients to dispense a week’s worth of pills into a pillbox with slots for seven mornings and evenings. Getting 100+ pills into the right location from 5-10 different bottle is a challenging task for anyone, not to mention elder patients. The agencies that provide in-home caregivers usually refuse to allow them to be responsible for dispensing medicines. This must be correctly 52 weeks a year for years, despite changing prescriptions.

    I’d really like to be able to use a phone to take a picture of the pills a patient is about to take and confirm that the right number and type of pills are present. Manufacturers make every pill different from each other and photos can be found in the Physician’s Desk Reference. Immediately before taking pills, take a picture of them laying on a plate or napkin or perhaps a template with a sizing grid and standard colors. Software for a patient at home would need to distinguish between a few dozen pills at most, which should be a fairly trivial task. The software would tell the user what pills it identified and whether they agreed with the input list of meds the patient was supposed to take. Reliability would be an issue, but an app that could catch even half of the mistakes that are being made would be a god-send. Compliance could be automatically tracked by the software. Such an app would be worth several hundred dollars to anyone who stopped to think about the costs and consequences that might arise from a week’s worth of meds taken or missed by one mistake made while aliquoting out pills. This would be a killer-app, one that is worth buying the phone simply to use the app.

    Really big money should be available from a system that would work in a hospital or nursing home. The number of patients harmed in these locations is a dirty secret of the health care industry. Here software would need to be able to distinguish between hundreds of different pills and one would want to be able to identify the patient receiving the medicine (by a picture of his face or bar-coded wrist band). Reliability and liability would be bigger concerns.

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