28 Hours of RxPact, a Social Reminders App for Medication Adherence

I showed up a couple days early for the Health 2.0 Code-a-thon last weekend and went to the code-a-thon, where we were supposed to go from idea to team formation to development to demo in 28 hours, competing for $13K in prize money.

My team, composed of people who previously knew each other little or not at all, made an app with social reminders and social rewards for remembering to take your medications on time. We won the $3K Novartis prize,  second in size only to the $4K main prize, which went to a team that prototyped a take-home rehab box using a Kinect and other off-the-shelf hardware.

More details on the app and the experience follow.

I circulated through the room, looking for who might be thinking about a social angle on health and wellness. Eventually, I sat down with Eric Park and Alex Khomenko (@akhomenko), who were thinking about making a medication reminder app and were intrigued by my idea of making it social. (I, of course, was inspired by the Telefonica MoviPill study I wrote about last week in this blog.) After about 15 minutes of discussion, we were ready to form a team. Given the time constraints of the contest, we decided to make a web app without Flash and with a screen structure that would simplify future port to mobile platforms. They were both python/django wizards. Though I teach intro programming once a year using python and Google App Engine (which uses a framework related to django), I warned them that I am a very rusty developer and that I probably wouldn’t be able to contribute much useful independent coding, which turned out to be true. Fortunately, they were very good it, and we were joined by Sean Ahrens for the evening and next morning, who was also excellent.

While they were coding, I enlisted my wife Caroline, a physician, to help me create a sample drug regimen for a hypothetical patient.

The basic design was to have the individual’s schedule of upcoming medication doses on the left side of the screen, and social information on the right side. (See screenshot).

In the end, there were three social elements:

• Reminders can come from friends or family who see that you’ve missed a dose (though they don’t necessarily know what meds you’re taking.) Reminders arrive by SMS, and Eric was able to make it work live, by using the Twilio cloud service.
• After you report taking a medication, there may be a message that was left for you, providing a social reward. In our demo, the hypothetical participant’s son had left a message saying,

Glad you took your meds, mom. Here’s a picture of JJ.  He says, “I can’t wait to see you on Friday, Grandma.” (The picture I inserted was of my son, Jacob. Always slip pictures of your kids into things…)

• There’s a group quest to collect as many pictures of cute cats as possible. Sean, Alex, and I went through a lot of iterations about alternatives for this part. In the end, we decided to make it purely a group quest (no tracking of individual performance) to have it be reward-only (cats don’t get sick, run away, or die; each day starts with only a few cats and a chance to collect more rather than a threat of losing some during the day.)

One interesting dynamic was that my teammates, who had some experience with code-a-thons, were very focused on what would make a good demo and could be done in time, while I kept trying to think about what would make a good app for long-term use. For example, I wanted to use a metaphor of completing a jigsaw puzzle, with each team member’s completed dose contributing a piece, so that each day there could be a new picture to complete. I was overruled, in part because it would be harder to implement in the available time, and in part because it wasn’t likely to have a high impact on the judges, not in the way a bunch of cute cats would.

The team worked amazingly well, with no designated leader telling anyone what to do. Everyone just pitched in in whatever way they could, for the time that they had available (Sean arrived Saturday evening and was unavailable Sunday afternoon; Eric was unavailable Saturday evening, but worked from about 11PM-8AM and then joined us again at noon!). The morning of the second day, I worked on scripting the demo while the others continued development. and also searched the Internet for sound effects of cats meowing and food pouring. (All the resources used in the project were free except the $5 I paid for two sound files online…) I did the formal presentation to the judges, since they figured my experience as a Prof would come in handy for that.

All in all, it was an exhilarating experience: intense work toward a deadline; the potential of a prize and glory; an idea that we were excited about (I was excited about the social elements; Sean loved the cute kittens); the joy of having the coordination with people we hadn’t worked with previously go so well. Right after giving the presentation, I logged my first 10 in the mood tracking I started doing last week. And an hour later, when the letdown after an intense experience settled in, I entered my lowest mood score of the week.

RxPact is up on gitHub. Link to the gitHub project can be found at RxPact.com. If we do anything more with the project, news will be posted there as well. Chances are we won’t– we all have other commitments.

Feel free to download the source code from gitHub. It seems to run correctly on Safari and sometimes on Chrome, but not in Firefox. To make the SMS work, you’ll need to provide a twilio_settings.py file.