Compliance & The UFO: Ubiquitous Flashing Orb
The Flashing Orb & Medication Adherence
Pill Dispensers
We seem to be on a roll with pill dispensing devices so a press release (see above link) describing a mechanism in this category called a “Flashing Orb” proved irresistible.
The Smart Pillbox
Partners Healthcare Telemedicine Group (PHTG) is testing the Orb as an addition to its “Smart Pillbox” technology, which is currently based on sending text messages, if a medication dose is missed, to patients, and if there is still no response, then to family and clinical staff.
The goal of the trial is to determine if the Orb’s colored flashing light will effectively remind patients to take their medicine. The device, which will be connected to a central database of patient information via a mobile phone network, will flash a red light when a dose is overdue. The light turns green “when the medicine has been taken and the Smart Pillbox has sent a message to the server.” [One assumes that "when the medicine has been taken" actually means "when the medicine has been removed from the dispenser."]
A spokesperson for PHTG is quoted as saying
“The central application is alerted through the cellphone network when the pill’s bottle cap is opened and then closed. The patient only has to know how to plug the globe into a power outlet and how to open and close a regular safety pill bottle cap. The Orb is an unobtrusive visual reminder and can greatly increase medical compliance and the quality of patient treatment without requiring input from a healthcare provider.”
The Orb
The Ambient Orb itself, provided by Ambient Devices, becomes somewhat more interesting if one goes beyond the press release which focuses solely on its use as a signal of compliance or noncompliance. The Orb is, in fact, an infinitely versatile indicator of the status of almost any imaginable parameter. The Ambient web site notes that the Orb can “slowly transitions between thousands of colors to show changes in the weather, the health of your stock portfolio, or if your boss or kid is on instant messenger.”
David Rose (pictured at the top of this post, holding the Orb), the founder of Ambient and self-described ” technology visionary and serial entrepreneur,” predicts,
“This innovative use of real-time feedback can result in changed patient behavior, leading to improved adherence and health outcomes. With these partners we hope to offer the easiest way to help people remember to consistently take their important medications and avoid any unnecessary visits to the hospitals. … There are over 100 medications with over $1bn in revenues and compliance numbers below 50%. We believe that the combination of our Orb technology and the SIMpill technology will lead to this figure reaching the 95% mark, at least.”
In another presentation, Rose postulates that
Ambient awareness can motivate useful behavioral change
- Trade stocks more often
- Conserve natural resources
- Encourage public transportation
- Load-balance highways
- Motivate exercise
- Monitor trends in glucose, BP, diet, weight, stress
A comparative analysis of the strengths and weaknesses of the Ambient Orb vis-à-vis other indicators can be found, structured as an assignment in easy to read form at UC Berkeley School Of Information Management & Systems
An instructive discussion of the imminent success of the Ambient Orb, written in 2004, is available at Wired: This Ain’t Woody Allen’s Orb
The clinical testing is planned to monitor 70 patients for six months. At this point, no other information about the research is proffered.
Commentary
The use of the Ambient Orb as a information display is clever enough and has an intuitive appeal. Nonetheless, lights, sounds, and other signals have already been and continue to be used to enhance medication adherence so the Orb would seem a nuanced additional feature rather than a fundamental shift in compliance methodology.
Based on previous patient compliance research (See Noncompliance Myths and Patient Compliance: State Of The Art), Mr. Rose’s prediction that the Orb and SIMpill technologies will increase compliance from below 50% to “the 95% mark, at least” appears based on hope and speculation rather than evidence.
Of most concern, however, is the actual behavior being hypothetically reinforced by the Ambient Orb. As far as I can discern, the Orb would seem to be actually signaling whether or not the medicine has been removed from the dispenser rather than whether or not the patient takes the medication. Of course, the testing may address this point but without further details about the trials, this is unclear. Finally, A clinical trial of the concept with a total patient group of 70 also appears a less than rigorous scientific test.
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