When M.P.H. student Alex Rich learned about the Plimsoll line, a fundamental of maritime safety, he had an “aha” moment.
A circle that is bisected by a long line painted on the hull of commercial ships, the Plimsoll line shows the maximum depth to which a ship may safely be immersed when loaded. Developed in the 1870s and introduced following a lengthy political battle, the line makes it easy for anyone to see if a ship is overloaded and potentially unsafe.
Here was a simple solution to a complex problem that once cost the lives of an untold number of young sailors. It is the kind of solution Rich wants to apply to health care: simple ones that take complicated problems with misaligned incentives and distill them down to inexpensive human-centered solutions.
One such problem touched Rich personally. His grandfather, who was his hero and inspired him to become a pilot, died of complications from pneumonia while Rich was deployed. It turned out that the illness had begun with challenges he had taking his medication on time. Rich later learned that what happened to his grandfather isn’t unusual; every year, 125,000 people in the United States die from prescription adherence problems. So Rich started thinking about simple Plimsoll-line-like solutions to help patients take the correct medication on schedule.
What he came up with is pillTracker, a reminder system that alerts patients that it’s time to take their medication and signals the need for human intervention if it doesn’t happen. “It attracts attention when it’s needed and leaves the patient alone when it isn’t,” said Rich, a first-year candidate in the Health Care Management Program.
Rich’s device runs on a small circuit board with a processor and a GSM cellular chip, the most ubiquitous standard for cellular networks. His friends and family will soon be using prototype versions to see what they think. For example, Rich’s father takes a statin for cholesterol. His pills will be loaded in each pod of pillTracker, which sequentially lights up, sounds a buzzer and sends him a text message when it’s time for him to take his medication. If he doesn’t, pillTracker will text message a family member or healthcare provider, who will close the loop with a phone call to make sure everything is alright.
There’s a shift away from fee for service to an accountable care model with incentives aligned to keep patients out of the hospital, not in them. That opens the door for my product.
Alex Rich, MPH Candidate
Numerous problems confronted by Rich’s friends have influenced the design of pillTracker. Family friends have had difficulties with connecting devices to Wi-Fi and blue tooth, reading medication labels and even being able to open bottles with arthritic hands. Rich worked to keep pillTracker as simple as possible. It plugs into an outlet and powers up on its own and will never have to connect to Wi-Fi or Bluetooth.
If the dry run with Rich’s family and friends goes well, he will try to market pillTracker to an accountable care organization. Eventually, he would like to work at a Veterans Administration hospital, where he thinks his approach to problem solving, one built around the user experience, could be welcomed.
“There’s a shift away from fee for service to an accountable care model with incentives aligned to keep patients out of the hospital, not in them. That opens the door for my product,” said Rich, who spent 10 years flying, including protecting military SEALS and Rangers as they assaulted terrorist compounds. Still he sees pillTracker as “the most important mission of my life.”
Rich was one of five masters and doctoral students who spoke at the recent Association of Yale Alumni Assembly. The five student presentations were part of a daylong program that marked the Yale School of Public Health's centennial. The students shared their innovative ideas and experience with hundreds of Yale alumni in Harkness Auditorium.
“Alex is one among many extraordinary students that we have in our program. He is, however, relatively unique in that he had minimal health care background before coming to YSPH,” said Professor Howard Forman, director of the Health Care Management Program at YSPH. “In Alex’s case, he made a strong argument for why he needed this program and how he was going to use his education and experiences to improve health care services and health. Pilltracker is just one way in which he is fulfilling this promise!”