Children's Health uses ingestible sensor to improve adherence in adolescent transplant patients

By Jonah Comstock
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The Proteus Discover digital health system uses an ingestible sensor embedded in a pill to record data about – among other things – patients’ medication adherence. The sensor sends data to an adhesive patch, which in turn sends it to a mobile device. But what are the use cases that require that kind of precision and reliability?

For the Children’s Health, a system of pediatric hospitals in the Dallas, Texas area, they turned to an ingestible sensor when other kinds of remote monitoring weren’t quite getting the job done for a population of post-organ transplant teenagers.

“What happens when you’re 15 or 16?” Julie Hall-Barrow, the vice president of virtual health and innovation at Children’s Health said this week at the Digital and Personal Connected Health conference at HIMSS17. “You want to start driving, making decisions, you’re independent, your mother is not on your hip 24-7. But the problem with this population is their mother had to be on their hip 24-7. It’s an extreme disease that requires a lot of regimen, and for a lot of kids the transition from Mom or Dad doing these things to doing it themselves is the transition from child to adult. And they have to do it, but there’s got to be a better way.”

For younger transplant patients, it sufficed to ask the parents whether they had taken their medication. But adolescent patients were much more likely to forget and to say they had taken their pills just to get the alarm to stop.

“They were going on sleepovers and hanging out with friends and they didn’t want to take all their stuff,” Hall-Barrow said. “And when we set them up with BYOD and we put it on their phone they were saying ‘Yeah I took it, I took it.’ Not very good data.”

So far the hospital has used the technology with 32 patients, seven of whom are still using it. Hall-Barrow shared two case studies from that group. In one case, with a 16-year-old girl, the system alerted her care team that she hadn’t increased a dosage when she was supposed to. They called her, talked her through it, and she started on the new dosage.

The other case was harder — an 18-year-old boy who was only taking a medication once a day rather than twice as prescribed. In that case the care team had to call him several days in a row, but eventually he started taking the second pill without the reminder.

“What would have happened without this technology if he came in after eight weeks and his blood pressure was so high?” Hall-Barrow asked. “They would have said ‘Have you been taking these twice a week?’ and he would have said ‘Duh, yeah,’ knowing that he hadn’t. Because no one likes to admit that they didn’t do what they were supposed to do. So what would our physician have done? Would he have increased the dose again? Would he have maybe changed medications and introduced more side effects? But they didn’t have to because they had the data that said ‘Was the patient taking the medication?’”

The biggest challenge the hospital has had was around reimbursement. In Texas the rules for remote monitoring reimbursement are very specific, though Children’s Health has found ways to work within them.

“You can get paid for remote patient monitoring in Texas, but you either have to have hypertension or diabetes,” Hall-Barrow said. “Well I’m pretty slick, these kids have hypertension, it’s just not primary and sometimes not secondary, but they didn’t have that in the law. They just said you have to have it.”

Hall-Barrow is also hopeful that pending legislation will pave the way for more comprehensive reimbursement.

Moving forward, Children’s Health plans to expand the program to include pre-transplant patients on the waiting list and to move to a BYOD system so teens can access their data on their own device, rather than on a tablet provided by the hospital.

They are also working with Proteus to expand the number of medications that can be co-encapsulated with the sensor and to tweak the adhesive patch so it is more friendly to children’s skin.