MedsManager

About half of everyone who is prescribed medications fail to adhere to their assigned regimen (1).  Medication regimen adherence is the likelihood that a patient will comply with healthcare recommendations -- put simply, the chances a patient will take their medications as directed. Poor adherence is shown to contribute to deteriorating health and increasing costs of care.

Of all medication-related hospital admissions in the United States [nearly 20 years ago], 33 to 69 percent are due to poor medication adherence, with a resultant cost of approximately $100 billion a year. (2)

Poor adherence is especially prevalent among the elderly in the United States, with polypharmacy and complicated drug regimens chiefly responsible for a formidable barrier to adherence. (3) 

Poor adherence is a significant problem among U.S. Latinos, in part because they are generally underserved and often have lower health literacy -- the ability to understand basic health information and make health decisions -- than non-Hispanic whites. Language barriers have contributed to these conditions; lower health literacy is more common among minority populations with lower English proficiency. Medical care is often perceived by Latinos to be of poorer quality and less trusted when healthcare providers neither identify as Latino nor speak Spanish. (4) 

It should come as no surprise that health literacy and adherence increase  among Latino populations with low English proficiency when health information is presented in Spanish.

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(1) Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares?. Mayo Clinic proceedings, 86(4), 304–314. https://doi.org/10.4065/mcp.20...

(2) Osterberg, L., & Blaschke, T. (2005). Adherence to Medication. The New England Journal of Medicine, 353, 487-497. https://www.nejm.org/doi/full/...

(3) Lee JK, Grace KA, Taylor AJ. Effect of a Pharmacy Care Program on Medication Adherence and Persistence, Blood Pressure, and Low-Density Lipoprotein Cholesterol: A Randomized Controlled Trial. JAMA. 2006;296(21):2563–2571. doi:10.1001/jama.296.21.joc60162

(4) Zagaar, M., Ndefo, U. (2017). Medication Nonadherence in the Latino Population: A Challenge and an Opportunity for Specialized Services. Pharmacy Times (online). Retrieved 3/21/2022 from https://www.pharmacytimes.com/...

MedsManager PE

MedsManager is a software solution designed to promote medication regimen adherence and health literacy by providing the patient or caregiver with bar graphs, calendar views, electronic calendar reminders of their current consumables supply, and access to public NIH data on their prescriptions, in either English or Spanish.

The personal edition (PE), currently in development and testing, can provide tracking for as many as three people. (The screenshots included here are from the current development version.) A small business edition is planned for the future, based in part on the success of the PE.

The Main Form

The main form features two tabs: Graph and Calendar.

The Graph Tab

On the graph tab, bars show green for supplies of 60 days or greater; yellow for 30 to 60 days; orange for 15 to 30 days and red for two weeks or fewer.

The data is summarized beneath the graph, which the user may email to a personal account on demand. Optionally, the email may include reminders in the form of electronic calendar events.

Counts of each item appear to the right of each bar (in the figures above, Fatima has 26 days of ALOGLIPTIN 25mg remaining), and appear in the tool strip status bar at bottom when the item's name is hovered over.

The Calendar Tab

On the calendar tab, items appear in an ordered list beside a month calendar. The items are ordered by remaining inventory, so those in shortest supply appear at top. The list items are color coded to match the bars on the graph tab. Marked dates on the calendar correspond to expected depletion dates for each item, and share the color coding described above.

As with the graph tab, the data is summarized in beneath the calendar and list displays, which the user may email to a personal account on demand. Optionally, the email may include reminders in the form of electronic calendar events.

The menu across the top of the main form provides access to patient and consumables configuration, and to the initial setup form which handles registration, language selection, and provides overviews of each feature. It also allows access to tips about safeguarding one's medications, and steps to consider if one is a victim of medication diversion.

Backup and Restore

The user has the capability to back up and to restore their consumables data in a custom .med format. Backups are encrypted upon creation, and can be decrypted if restored to the software.

Technology

MedsManager is developed by VICTORY Codeworks, LLC as Microsoft® Windows® software, programmed in Microsoft .NET, using a modern object oriented .NET programming language in Windows Forms. The application's executable is presently only 500KB; the entire payload is about  4 MB, which makes it suitable for delivery via download to a Windows® device.

Encryption

The settings and consumables data are HIPAA compliant files which are encrypted at rest using standard, modern, proven encryption methods and algorithms. Backups are encrypted upon creation, and can be decrypted if restored to the software.

The program will require an Internet connection for initial registration (via calls to a license generation service), and for use of the email capability (which, at this time, the user must configure if desired (5) (6)). 

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(5) Use of a HIPAA-compliant email service is being considered, which will negate the need for user configuration, but may add some complexity to message retrieval.  

(6) When generating email, the software partially obfuscates names of consumables the user has identified as a prescription medication; this is a common practice among online pharmacy services to get around the need for HIPAA-compliant electronic messaging.

MedsManager was designed with mature and senior adults in mind -- groups for whom regimen nonadherence is increasing or significant. It was designed for use by mature adults and caregivers (including mature children of seniors) with the goals of providing real-time projections of health consumables for themselves or the people they support, and for promoting health literacy by tying in public data from the NIH (the current prototype is intended for US consumers).

MedsManager was also designed for use in multiple languages -- presently, English and Spanish -- which is especially important and meant to remove the language barrier and offer tools non-English speakers can use to better understand and adhere to their prescribed medication therapies.

In the US context, the Spanish-language population is of primary concern, because the question of health care for Hispanics is a complex cocktail of bravado, fatalism, and culture; many distrust health advice dispensed from professionals who stand apart from their patients. MedsManager's support for the US Hispanic population could be extended as-is throughout Spanish- and English-speaking Latin America.
 

I am the right person to bring MedsManager to market because this software started as a personal tool for use with one particular pharmacy. Every month I get a call from them asking what I need. I needed a device that could report supply estimates I could quickly convey over the phone. If I don't get this right, I'll end up overlooking and eventually running out of some important medication, and that can have serious consequences.

It didn't take long to recognize the potential for this to help others like me... and not like me: I live in North Texas, with a large Latino population. My ancestry is Caucasian. My daughter's friends are almost all Latino, from families of varying English proficiency. I want to be sure I can help their families, too.

I've also found that staying on top of my inventory isn't enough. I take a series of medications for diabetes, cholesterol control, and hypertension. I know what my medications are, but I couldn't tell you which does what. So health literacy is a concern. The National Institutes of Health have some fantastic public resources that discuss such matters. It seemed like connecting MedsManager to this information was a "no-brainer."

My wife and I both have senior parents whose medication therapies include a wide and, to be honest, dizzying assortment of prescriptions. I think we're both thankful we're not responsible for sorting these out -- but there are plenty of caregivers and adults like us out there who are.  If I was suddenly responsible for my mother's medication, I absolutely would want to know what they are and what they do.

Americans spent nearly $1400 per person on prescription medication in 2020, making prescription medications worth nearly $350BB of a $539BB industry that year. (7) (8) (9) (10)  Currently, nearly half of Americans have taken at least one prescription medicine within the preceding month. (11) This data suggests I cannot be unique in recognizing the need for a product like this.

So it's a combination of research, consultation, location and situational awareness that drives me to build and promote MedsManager. I'm squarely in the target audience for the product (I originally built it for me). I've been consulting with peers about the product design and capabilities for this first iteration and beyond.

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(7) Statista. (2022, February 18). Pharmaceutical spending per capita in selected countries 2020. Retrieved March 20, 2022, from https://www.statista.com/stati...

(8)  Health resources - Pharmaceutical spending - OECD Data. (n.d.). theOECD. Retrieved March 21, 2022, from https://data.oecd.org/healthre...

(9) Statista. (2022, January 14). Prescription drug expenditure in the U.S. 1960–2020. Retrieved March 21, 2022, from https://www.statista.com/stati...

(10) Statista. (2021, September 20). U.S. total medicine spending 2002–2020. Retrieved March 21, 2022, from https://www.statista.com/stati...

(11) Statista. (2021, March 11). Total U.S. population with usage of prescription drugs within 30 days 1988–2018. Retrieved March 21, 2022, from https://www.statista.com/stati...

I am a "solopreneur." I've built MedsManager entirely on my own, and formed my LLC so that I could sell MedsManager as a product. I am applying to this challenge because I feel MedsManager can make a meaningful contribution in the care economy by allowing people to more easily manage their consumables to get and stay regimen adherent. 

Advertising is Challenge 1

My number one challenge is marketing. People in my target demographic aren't exactly millennials -- they weren't born with iPhones in their hands (like our kids seem to be).

I feel like my initial advertising success will lay in television and print. In the Dallas/Fort Worth television market, a single :30 advertisement on the local NBC affiliate during local evening news broadcasts run between $1800 and $2500. I've reached out to various publications and haven't heard anything back yet. I'm trying to get a feel for what's available and what the costs are, so I may approach a bank for a business loan.

Support is Challenge 2

Support will be another matter. I've done my best to set some expectations on the company and product websites, particularly where support topics and Spanish language support are concerned. My Spanish is good, but I can't keep up at the native pace. I want to be able to hire a team to support the products we produce.

I'm convinced I have a good product here with some great potential. I just really need to get the word out and get help supporting it.

If MedsManager PE is successful, I can move forward on developing the Small Business Edition (SBE), with support for more people and more consumables. SBE could make a greater impact on the adherence barrier, including lessons learned from PE.   

"It's Not Rocket Surgery"

At its core, MedsManager PE doesn't seem to me to be a novel and earth-shattering solution. It seems completely commonsense:

• People should have immediate access to their stock of medications, supplements, and testing supplies.
• People should know when they're running low, and when to pick up the phone to do something about it.
• People should have access to information about their medication therapies.
• This information should be presented in languages people understand.

The significant improvement here is that MedsManager could really be the "ah HA!" moment people need to understand and adhere to their chronic medication therapies.

My hope is the multilingual capabilities in MedsManager could offer especially Latinos an improved sense of control over their health by giving them access to data they can immediately use, and to Spanish language NIH information about their prescriptions.

MedsManager is conceptually simple software to encourage health for all.

Two objectives:

1. To improve adherence to prescription medication therapies
2. To increase health literacy among patients and their care providers

Collection of metadata and licensee participation in surveys may suggest how well these objectives are being met, because HIPAA regulations will not permit more direct methods of evaluation.

As a software company building software for the US market, measuring regimen adherence and health literacy in some direct manner (e.g., through examination of medical records and interviews with physicians) is simply not possible, but I could perhaps approach meaningful data through the collection of anonymous metadata and the use of customer surveys.

Data Collection

For example, MedsManager is capable of recording counts of the number of times it has been opened, the number of times any info link has been clicked, and the number of times any consumable item quantity increases. Data like this could be useful in tracking how often the product is used over a specific time period, whether the NIH data is being consulted, and whether refills are being tracked. Aggregated results like these, expressed as a ratio of licenses issued, would present overall rate of use (suggesting adherence) and the relative value of those public links (suggesting health literacy).

Survey Information

Probably the next best means I have is through customer surveys. Licensees who opt to participate could be asked questions pertaining to their perceptions of the benefit they receive from the software. Changes or enhancements to the software could be driven by respondents' appetites.

If the software was to be introduced outside of the US, expanded data collection to suit may be possible if it could be performed and/or persisted in accordance with applicable host nation laws.

MedsManager fortifies medication regimen adherence by helping to ensure personal health consumables remain on hand. The software removes the mystery of inventory information at a glance, anticipates depletion dates, offers summaries and electronic reminders to support inventory maintenance, and offers best practice information on safeguarding one's inventory.

MedsManager promotes health literacy by linking public information from the U.S. National Institutes of Health to prescription consumables, giving the user direct access to information about their prescriptions and their diagnoses and enhancing their ability to make health decisions.

Medication therapy adherence and health literacy are particularly important for the percentage of the U.S. Latino population with inexpertise of the English language. In the context of the US market, MedsManager offers Spanish language support for especially this group, though the software could readily be marketed throughout English- and Spanish- speaking Latin America.

MedsManager is developed by VICTORY Codeworks, LLC as Microsoft® Windows® software, programmed in Microsoft .NET, using a modern object oriented .NET programming language in Windows Forms. The application's executable is presently only 500KB; the entire payload is about 4 MB, which makes it suitable for delivery via download to a Windows® device.

The program uses specialized libraries supporting representational state transfer (REST) to exchange data with software licensing service endpoints, and cryptographic libraries for securing settings and consumables data (and backups) while not in use.

MedsManager collects certain data from its user through the user's interactions with the software. At present, this data is comprised solely of integers -- counts of events, like software startup or clicks on the links to NIH data on specific medicines, which infer software and feature utility. Descriptions and counts are directly available to the user through the main menu -- as a consumer, I appreciate transparency.

The incentive to collect this data is to measure progress toward the solution's impact goals -- improved medication regimen adherence and improved health literacy.

VICTORY Codeworks is a single-person LLC. But I anticipate a business need for support staff, especially Latinos who are fluent in Spanish.

I lived in Central America for a few years while I was in the service. Today my Spanish is somewhat limited from years of not having exercised it. My customers deserve to speak with people fluent in their supported language to assist them with whatever trouble they have.

KEY RESOURCES: Finance, testers, developers, computer hardware, computer software

KEY ACTIVITIES: Software development and testing, software support

COST STRUCTURE: Advertising will likely be my number one

SEGMENTS: Licensees (the people licensing the software), who may be individual patients, small families, or caregivers

TYPE OF INTERVENTION: The software product

CHANNELS: Advertising in print, television, and digital media

SURPLUS: Hiring contractors for testing, development, and support

VALUE PROPOSITION: Customers receive on-demand estimates of remaining health consumables levels as a function of inventory; anticipation of projected depletion dates; optional advance reminders for electronic calendars. Sustained use should illustrate medication regimen adherence and promote health literacy, measured through a combination of metadata collection and user surveys.

REVENUE: Sales

The business model for VICTORY Codeworks, LLC is entrepreneur support: selling products directly to customers, and seeking grants wherever it makes sense.

Most of the development investment in MedsManager PE has already been made; the plan now is to test and refine until I feel comfortable introducing the product to market.

I have none. I've developed the software by myself on my personal time,

and started the company using personal income. The same is true for the
company and product websites.