Can Gamified Mobile Apps Increase Prescription Adherence?

Nearly a decade ago when I started gyming, more than the struggle to acclimatize myself to the strenuous workouts, I struggled with getting used to a regular exercising schedule.  I would religiously follow a plan for a few weeks only to return to being consistently irregular. Fast forward a couple of years, I was not only able to stick to an exercising regimen but also started enjoying my workouts immensely. One change that brought about this transformation – switching from solo workouts to group workouts.

In his book, The Power of Habit, Charles Duhigg discusses the psychology of habits and how they drive actions. With his cue, routine, rewards framework he describes how one can identify habits and also change them if need be. According to the framework what I did was tweaked my routine (workouts) to incorporate better rewards (group workouts rather than solo activities) to motivate myself. And that’s indeed true. While I often got bored with solo cardio activities such as running on treadmill or using a stepper, I realized that the group energy in activities such as zumba, aerobics made me look forward to every session. A single change in routine and rewards brought about a tremendous behavioural shift in me. Mobile apps increasingly are adopting this technique, also called gamification, to get users to alter their behaviour. The question is can gamified mobile apps bring about behavioural change in users?digital_health_apps_success

One of the biggest troubles plaguing healthcare is not medicine related but behaviour related. Nearly 50% of patients do not adhere to medical prescriptions. Prescription adherence, considered mainly as a patient behaviour issue, costs around $300 Billion annually. While there are scores of gamification apps claiming to improve patient behaviour to adhere to prescriptions, I am wary of those claims. Here is why I think gamification in mobile apps fail to get desired outcomes:

  1. No Long-Term Sustained Change: People seek novelty and a gamified app offers limited newness beyond a point. After a certain amount of time when I got bored with aerobics I explored other group activities such as zumba, spinning etc. which helped me sustain a regular regimen.  This is not the case in apps. Post a certain level, the newness wears off which results in users abandoning the app.
  2. Have To doesn’t become Want To: To get people to do something they need to feel in control and believe that their actions are governed by no one but themselves. Patient adherence apps recommended by doctors or insurance companies therefore will not yield the same results as when a patient voluntarily adopts the app. For eg. a prescription adherence app might be a great tool for someone who already manages a journal or has employed other methods to stick to a medication schedule. That is the patient is motivated and wants to change and doesn’t have to change. Unfortunately, a gamified mobile app doesn’t convert a Have To to a Want To.
  3. Monetary Rewards are Limited in Value: Gamification apps today are unable to improve stickiness by employing only social rewards. They are turning to monetary rewards (gift cards) to incentivize users. This is counterintuitive. Extrinsic rewards have been proved to be less effective than intrinsic ones, especially when it concerns issues such as healthcare. If monetary incentives would have worked, the scores of gyming memberships today wouldn’t be as underutilized as they are.

Gamification has worked really well in other healthcare areas such as education. But as far as prescription adherence is concerned, more creative ways need to be identified to make it successful.

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Mobile Healthcare Technology: A Crucial Lever for Patient Engagement

While there are many cases illustrating how an engaged patient is a great asset to the healthcare ecosystem, one of the most compelling is that of Eric Dishman’s. In his TED talk, Eric shares his personal experience with the inefficient healthcare system. Through his own example he demonstrates how mobile technological tools can help fill in the gaps of the current flawed system. More importantly, he champions the role of a more engaged patient as a way to improve healthcare outcomes.

Patient Engagement is a Focus Across all Stakeholders

Healthcare has long been a paternalistic, hierarchical, doctor-knows-it-all industry. With the advent of the internet, social networks and smartphones this is no longer so. Patients today are much more informed, connected and ready to take an active role in their fitness and well-being. Moreover, in the wake of Affordable Care Act, patients are paying higher deductibles and out-of-pocket payments that further require them to take stock of their own health and wellness. As healthcare transitions from pay-for-service to pay-for-outcomes, providers have to ensure their services are effective and efficient, which necessitates a highly engaged patient. For payers as well patient engagement is pivotal to achieve shared savings under new delivery structures such as the Affordable Care Organizations (ACO) and Patient Centred Medical Homes (PCMH). Given that poor adherence costs US healthcare nearly $290 billion a year, patient engagement has been rightly deemed as the ‘blockbuster drug of the century’.

mHealth to Drive Patient Engagement

Mobile Health (mHealth) has enormous potential (as highlighted in Eric’s example above) to revolutionize healthcare through patient engagement. And as the focus of the healthcare system moves to Meaningful Use Stage 3, the strategic importance of mHealth is all the more pronounced.

mobile-solutions-chillmark

Source: Chilmark Research

As highlighted in the figure above, mHealth started with simple data storing and sharing systems moving to sophisticated preventive engagement. The applications include SMS medication reminders, remote medical advice and remote monitoring. A few recent innovations in the patient  mHealth space are as follows:

Education and Wellness

  • Kurbo Health: Mobile subscription service focused on fighting childhood obesity
  • HealthTap: Access to doctors anytime, anywhere to get personalized answers
  • Prana: Wearable tracking breath and posture

Remote Monitoring

  • Medtep: Targeting disease prevention through monitoring life habits
  • Nephosity : Collaborative medical imaging services
  • Sano: API for bloodstream (not yet launched)
  • ViSi Mobile System: Platform for vital signs monitoring designed to keep clinicians connected to their patients

Diagnostic and Treatment Support

  • Cellscope: Smartphone enabled home otoscope
  • Lantern: Offers online and mobile coaching programs to support mental health
  • Helius: Clinicians, patients and families can use the real-time information about medication-taking, rest and activity to make informed treatment decisions

The use and popularity of above applications attests that mobile technology enables patients to be more informed, collaborative and committed. But integration of IT systems, complex healthcare environment, quantifying the benefits, measuring the ROI, patient stickiness and privacy concerns pose serious barriers to adoption. Given an opportunity to save $290 billion and a case as compelling as Eric’s, can we afford to ignore it?