Tomo

Overview

About

Tomo is a digital and physical solution that addresses the nonadherence problem by providing patients with a simple way to collect records, set reminders, and connect with healthcare professionals and caregivers alike. Likewise, caregivers can connect to the app to help monitor patient adherence. By using the mobile pill organizer, users will always have their medication with them. Tomo is designed to simplify and assist patients in adhering to their regimens, so you will never be alone in your adherence journey.

My Role

This a group project, I worked with a teammate. The project is sponsored by Cognizant company.

My role focused on:

• Generative Research

• Primary Research (Survey, interview)

• Competitive Analysis

• Data Analysis

• Persona Creation

• User Journey

• User Stories

• Ideation

• Concept Generations

• User Flow

• Low and High-Fidelity Prototype

• Visual Design

• Branding

• User Testing

Duration

3.5 month project

The Problem

Non-adherence to medication regimens has led to increasing hospital readmissions and rising healthcare costs. However, the majority of people who are not adherent are not intentionally non-adherent: they can forget to take their medication because of a busy schedule or an irregular daily routine.

The Scope

This project addresses the medication nonadherence problem by providing an assistive solution to patients who are willing to adhere by giving them a physical device and/or digital application to keep up with their regimen more easily.

Research and Problem Definition

Why we care?

To understand about the current percentage of adults and older millennials in the United States with chronic medical, we conducted secondary research

Percentage of adults and older millennials in the United States with chronic medical conditions in 2021, by number of conditions

Region
United States
Survey time period
April 2021
Number of respondents
4,012 respondents
Age group
18 years and older

Percentage of adults and older millennials in the United States with select chronic medical conditions as of 2021

Release date
May 2021
Region
United States
Survey time period
April 2021
Number of respondents
4,012 respondents
Age group
18 years and older
Special properties
At least 831 respondents ages 33 to 44 years

Source from statista.com

Going further in depth, we wanted to investigate how chronic diseases affected an ageing-population.

April 23, 2021

Source on National council on aging

HIGHLIGHTS

These illnesses is projected to increase, with over 157 million Americans expected to be living with one or more chronic diseases by 2023

The cost burden of chronic illness in the United States was $1.3 trillion in 2009 and is projected to exceed $4.2 trillion by 2023

Patients with chronic illness utilize hospitals and emergency rooms at a higher rate than the general population, putting further strain on the healthcare system

THE PROBLEM OF MEDICATION NON-ADHERENCE

• Nonadherence may adversely affect the safety and efficacy of the treatment and may also lead to drug resistance.

• The importance of precisely defining and monitoring adherence behaviors could help one motivate themself to take medication at the right time.

PRIMARY AFFECTED POPULATIONS

There are a variety of reasons as to why a person would not adhere to their medication regimen, and none are universal. However, by using past data on how chronic illnesses and ecological factors affect populations and their adherence, a few specific groups can be identified.

ELDERLY

Many chronic illnesses manifest in old age. Many, such as dementia and Alzheimer’s, can cause memory issues. Many people also begin to retire in old age due to factors such as illness or injury, which can cause problems regarding cost.

Homelessness presents many challenges, medication adherence being one. Limited access to pharmacies, inability to travel, and economic instability can all contribute to medication nonadherence.

HOMELESS

Ecological factors can influence adherence. Some medications may carry a social stigma that the user desires to avoid. Personal and historical medical practices may also affect patient-physician trust among ethnic and racial groups.

CULTURE

CHRONICALLY AFFLICTED

Those affected by chronic illnesses can often have comorbid conditions that complicate regimens and make them difficult to follow. Additionally, patients may tire of “feeling like a sick person” and discontinue adherence.

Language barriers and inability to understand regimens can affect adherence. Unclear directions and small text on pill bottles are contributing components to the larger problem: lack of education regarding treatment.

ILLITERATE/ UNEDUCATED

To understand more about those who might be affected by medication nonadherence, we first needed to figure out who takes medication.

The article “Medication Adherence in the General Population” published by the Health Policy Institute at Georgetown University in 2012 cites a 1998 study whose results found that 66% of all US adults took prescription drugs - more than 131 million people.

The majority of adults afflicted by one of five common chronic conditions - diabetes, heart disease, hypertension, arthritis, and cancer - use prescription drugs. The proportion of the mentioned populations using prescription drugs can be as high as 89% for arthritic persons and 98% for diabetic persons.

MEDICATED POPULATION STATISTICS

Average Number of Prescriptions Filled Annually for Adults

The proportion of people using prescription drugs and the number of prescription drugs said people require varies by demographic group. One notable observation is that prescription drug use increases with age; this is not surprising as many chronic conditions begin to present as people get older.

Average Number of Prescriptions Filled Annually for Adults

According to the CDC, prescription drug use increased with age, from 18.0% of children under age 12 years to 85.0% of adults aged 60 and over between 2014 and 2016.

Prescription drug use was highest among non-Hispanic white persons, followed by non-Hispanic black persons, and lowest among non-Hispanic Asian and Hispanic persons.

Percentage of U.S Population that Used Prescription Drugs (2014-2016)

CAUSES FOR MEDICATION NONADHERENCE

Considerations for a user-centered approach for better clinical outcomes

• Ecological perspective

• Patient factors: literacy, cognitive function

• Provider factors: complex regimens

• Social/community factors: access to providers and pharmacy

• Healthcare factors: interaction with the healthcare system, trust, prior authorization

• Policy implications: coverage of medication

BELIEFS

A person’s beliefs and perceptions may conflict with the prescribed regimen, which can influence the user not to adhere to the regimen. Ecological influences such as the social stigma of the illness and medication or pressure from family and friends can influence a patient’s decision to adhere to the regimen.

Intentional Non-adherence

LEVEL OF COGNITION

Intentional nonadherence is heavily dependent on a person’s level of cognition, as in their ability to assess the situation and make a judgment about their behavior regarding the regimen based on rational decision-making. This means that trust in the physician, acceptance of the diagnosis, and belief that all health care providers involved have the patient’s well-being in mind are all possible factors in the patient’s decision not to adhere.

PROS AND CONS

A patient’s decision not to adhere to their prescribed medication regimen can be a judgment call made due to perceived and actual benefits and disadvantages. For example, a patient may feel that the side effects outweigh the benefits of the medication, or a patient may feel they do not need medication due to the current lack of severity of their illness.

MEMORY

Unintentional nonadherence could be due to something as simple as forgetting to take medication due to a busy morning before work. Conversely, it can be as complicated as a patient forgetting to take medication or forgetting whether they had already taken the medication due to injury- or disease-related impairment.

LACK OF KNOWLEDGE

Intentional nonadherence can sometimes be attributed to a person’s lack of knowledge regarding their diagnosis and prescribed regimen. Many medications are required to be taken under specific circumstances in order to be effective, such as swallowing with water or consuming on an empty stomach. Education is an effective solution to informing patients about their regimen and why it is necessary, therefore building trust with the physician and improving adherence.

COMPLEXITY OF REGIMEN

The complexity of the regimen can affect a patient’s ability to adhere, especially among chronically-affected patients with complicated medication schedules. Patients may forget to take medications on time, if at all, or may take them under incorrect circumstances. Taking multiple medications incorrectly may cause adverse reactions.

Problems Causes by Medication Nonadherence

“Medication Adherence in the General Population”
–Julia A. Glombiewski, Yvonne Nestoriuc, Winfried Rief, Heide Glaesmer, Elmar Braehler

The World Health Organisation (WHO) determined that medication nonadherence is one of the most prominent causes of morbidity, mortality, and the cost of health care. In their estimation, between 30% and 50% of prescribed medication is not taken as directed.

“Is it time to stop counseling patients to “finish the course of antibiotics”?”
–Bradley J. Langford, BScPhm, ACPR, PharmD, BCPS & Andrew M. Morris, MD, SM(Epi), FRCPC

In 2017, the article stated that 700,000 deaths occurred due to antimicrobial-resistant organisms, and that number was only increasing. The WHO and other agencies have identified antimicrobial resistance as a major problem. This resistance is often caused by medication nonadherence when taking antibiotics: not finishing an antibiotic regimen allows microbes to multiply and adapt to avoid current medication solutions.

Competitive Analysis

Current Solutions for Medication Nonadherence

We conducted a competitive analysis to see what solutions already exist for medication nonadherence and what resulting technologies are present in the market. This helps us assess which demographic groups are currently being targeted and how well those solutions current solutions apply themselves to the broad problem of nonadherence.

Karie

• One-time product cost + monthly subscription fee

• Device + companion app

• Manages and delivers medication

• Coordinates with personal & medication schedule

• Visual & auditory reminders

• The app can notify caregivers of nonadherence and provide reminders
  

Hero

• $299.88 annual subscription fee; $29.99 monthly subscription fee

• Device + companion app

• Remote caregiver monitoring

• Automatic refills & free delivery
  

Problem Statement

The medical industry has advanced leaps and bounds in the past century with concerns to diagnostic identification and medication development, allowing physicians to improve the lives of many. But physicians can only do so much within their limited interaction with a patient; it is up to the patient to take the medication and follow the advice the doctor prescribes. This leads to an issue of accountability: not following a prescribed medication regimen is a complicated problem because it can affect a broad spectrum of people for a variety of different reasons. It can be as simple as a busy person forgetting to take their medication because they were late or far more difficult to resolve when considering elderly patients, people affected by chronic mental disability or memory issues, among other barriers such as religious or cultural norms or inconvenience and complexity of treatment. Some solutions have been proposed but it remains difficult for physicians to ensure that patients are taking medication as prescribed.

HOW MIGHT WE…

…help users understand the importance of medication adherence so that they will follow the protocol?

…help caregivers and physicians manage and monitor patient regimens effectively?

…help people stay motivated and keep taking medication?

…help users track their adherence?

…help caregivers and physicians know if someone is taking their medication and following through on adherence?

…drive patients and motivate them to do the tasks?

Design Objective

Our goal is to develop and test possible physical, digital, or synergistic physical and digital solutions for the current lack of ability to monitor and ensure that a patient is following a prescribed medication regimen.

CONCERNS

Patient beliefs
Patient preferences
Barriers to medication-taking: cost, technological access and abilities, concerns about treatment and use
Patients have complex, difficult-to-follow regimens
Patients don't understand the reasons for treatment or believe side effects outweigh the benefits
Patients may take medication on time in the beginning but don’t think it is effective and stop taking it
Languages barriers
Disconnect between provider and patients; for example, getting generic medicines with different formulas instead of the prescribed medicine
Social pressure from friends
Religious pressure
Patients want to take medication on time but always forget

Opportunities

Education
The goal is to help patients understand how important of taking medication on time and be confident about medical treatments at home
“I know what each of my prescribed medications do”
“I am confident that I can follow through on medical treatment I may need to do at home”

Change patient behavior
This goal is to help patients who are not rule-followers and patients who stop taking medication because they think it doesn’t work

Motivation programs
Help patients to be motivated in manage and follow doctors’ instructions

Interactive reminder systems
This might help with patient who wants to follow instructions but have a hard time doing it

Surveys

We disseminated online surveys to learn more about user demographics, habits, and needs. There were 61 respondents from a variety of socio-economic backgrounds and a wide age range.

The following questions were used to discover why participants were not taking their medication and whether they used any kind of medication management system to assist in adhering to their regimen.

User Interviews

After analyzing the survey results, we conducted user interviews to gain a deeper understanding of pain points within maintaining a consistent regimen, medication management styles, if and how technology was used to manage medication regimens, and the participant’s knowledge of the importance of medication adherence in managing a chronic illness. We interviewed seven chronically ill prescription medication users; the insights from those interviews have been consolidated below and are color-coded by the interviewee.

INSIGHTS

THEMES

PAINT POINTS

OPPORTUNITIES

Reminders pads

Physical device linked with an app

Appointment reminders

Refill reminders

Cross-communication between physicians & pharmacists

Education

Two user personas were designed using the information we consolidated from user interviews and surveys. We aim to solve nonadherence among the two target profiles described below

Personas

PERSONA 1

Marcello is a long-time chronic illness sufferer. He believes he is adherent to his regimen but has forgotten some of the physician’s original directions because he was diagnosed so long ago. Due to the fact that he believes he is adherent and has been for a long time, he is stubborn in his ways and unlikely to take advice from most about his regimen.

PERSONA 2

Saba’s nonadherence stems from missing doses due to her busy schedule. Though she knows she is not adherent, she does not believe that it has a significant impact on her well-being. She is more perceptive to alternative solutions but hasn’t sought out many herself.

Value Proposition

Current State User Journey

Below is the current user journey beginning with a diagnosis and ending with regular medication management. We analyzed the journey map and consumer feelings within the journey using our research and personas to find critical points in each phase of the journey. This eventually helped us identify steps within the journey where improvement could be made. There are seven steps in the journey: receiving a diagnosis from a physician, receiving a prescription, dropping off and picking up prescriptions from the pharmacy, storing medications for access and ease of use, taking medication as closely as possible to the physician’s recommended regimen, accessing personal medical data, and refilling medication once it runs out.

Current State Storyboard

The current state storyboard provides a visual representation of how a consumer might experience the process, from picking up medication to using it at home. Consumer behavior was drawn directly from anecdotal examples from the interviewees in the research phase.

User Stories

We created user stories to further break down and simplify user perspectives. The purpose of the user stories is to articulate how a particular feature could provide value to the end user.

As a user, I want…

Ideation

Initial ideation consisted of quick brainstorming and preliminary ideas that would be dissected using an ideation matrix to identify key factors within each solution.

We used an ideation matrix to examine the goals and ideas within our initial brainstorming session and identify some key factors that would contribute to the final concept. Each color line is representative of the key factors within one of the primary concepts.

Initial Concepts

PHYSICAL PRODUCT

Sketches

This concept integrates a digital aspect with a physical product, such as a physical reminder system that alerts a user when it is time to take their medication. This system contains some gamification, and users can earn points within the system to earn rewards.

This concept focuses on creating a management system that connects the pharmacy, the physician, and the end user for ease and clarity of communication. This system would work with a physical model to remind users when to take their medication.

This concept aims to create an ecosystem that focuses on the pharmacy’s role within the ecosystem. The goal is to motivate and change user behavior. The concept consists of a mobile device application that can generate set reminders for users about appointments, refills, and medication dose times as well as provide educational resources so that users can use a consolidated resource to learn about their illnesses and medications.

Initial Concept Refinement

CONCEPT 01

The digital medicine cabinet works much like a regular medicine cabinet in that it stores medication but differs in its additional functionality. The medicine cabinet can be slotted with one’s personal tablet or digital device and connects to an app to track how often the cabinet has been opened, what medications are being stored, when the next refill will need to be called in.

CONCEPT 02

Initially, the concept for a portable or mobile pill carrier began as a wearable - specifically, a watch that could hold pills. However, after reflecting on prior research done in interviews and through surveys, it was apparent that the majority were not interested in replacing a current wearable or adopting a new one. Thus the mobile pill carrier became a keychain: it is portable, discreet, personalizable, and always with the user.

CONCEPT 03

This concept is about integrating pill dispensers with AR experience. Users can interact directly with the device to talk with doctors and pharmacists and learn about their medication. There is a camera on the device so it can monitor when users take medicine and can send notification to the users or caregivers.

Semi-Final Concepts

The concept for “Tomo” of medication management and adherence. The device was conceived as an uncomplicated solution for portability, discretion, and personalization. It has a range of functionality: there are education and community features within the paired app if desired, but Tomo also functions as a basic reminder system if no additional functionality is required.

This concept is similar to Tomo in that it is portable and personalizable. It is designed as a device that can help patients follow their adherence protocol by managing the medication and providing a digital helper to remind the user to take their dose.

Future State Storyboard

A future state storyboard was created as a visualization of how a
user might experience the journey of receiving medication and the following steps they might take to store, manage, and use the medication when using Tomo as opposed to not being assisted by Tomo, as was visualized in the current state storyboard.

User Flow

The user flow breaks down the process of functions that occurs when a new user accesses the mobile application to add a new medication reminder or a reminder for refilling a prescription.

Low-fidelity Prototype

Initial digital physical product interface

• Users can choose different pets, also known as “Tomos,” within the app

• The change will appear on the linked Tomo keychain

• Users can earn points that can count towards Tomo upgrades and customization

• Users can personalize their profiles to join the Tomo community through the app, share their progress with select users such as caregivers, or stay private

Pet selection screen

Choose pet

Mobile app interface

The screens below show low-fidelity prototyping for how the application will eventually look without regard to the product aesthetic. Included on this slide and the next are the splash screen, reminder setting screen, and home screen, which features a to-do list for the user, community interfaces within the app, a friends list, and visualization of progress in their adherence journey.

NEW USER ROUTE

COMMUNITY

Ecosystem Map

A map designed to visualize the main stakeholders in a patient’s medication adherence ecosystem and identify the kinds of value being exchanged between which entities. The main areas of this map cover the initial consultation and diagnosis, personal care, informal and family care, social and community care, and professional care, as well as the stakeholders within those areas. The value exchanged between these stakeholders includes time, trust, money, information, goodwill, and security.

Business Model Canvas

An outline of the advantages, targets, risks, costs, and opportunities for the proposed business idea. While our medication adherence solution can be sold as just a product, it would be far more beneficial to the ecosystem and patients in particular if we are able to partner with pharmacies and physicians to recommend and inform patients about the solution.

Task Flow

The task flow defines a user’s journey through specific tasks that can be completed by using the app. Several pathways are shown to the right in which a patient can add medication and set reminders for taking it, add friends and join community discussions, and set notifications for refills and appointments among other additional features that are unique to Tomo, such as medication discount programs and point redemption and resultant customization. The following three pages will show a low fidelity mock-up of the app screens displaying the capabilities listed in the task flow.

Developing Mobile App Prototype

Low-Fidelity Physical Device

This prototype altered some elements from the original sketch: instead of the entire bottom being the medication organizer, a removable piece was created for easier cleaning. However, this caused us to increase the size unnecessarily. Additionally, a rotating pin was used for the opening and closing mechanism, but it was too flimsy and broke easily on the prototype.

Pros: Round, friendly design.
Cons: Device requires more space than actual pill organizer. Suggestion: Make entire bottom shell the organizer.

Pros: Removable pill organizer section makes cleaning easy.
Cons: Requires a separate piece that is integrated into a design larger than the organizer itself.

Pros: Top lid connects to the bottom section through a rotating point. Allows for easy opening.
Cons: Easily broken, not very sturdy or secure.

Screen presented on the face of device to give reminders, suggestions, and so on as is set by the user on the companion app.

Physical Prototype-Refined

The final prototype was based on the second prototype and included many of the design features of the original concept. Painted red unlike the teal concept sketch to show variability and personalization, the Tomo device is small, able to be held in the hand, clipped to a bookbag, or attached to a keychain. It has the ability to carry up to 490 pills total, and the front face is black to indicate the screen that would display notifications and reminders.

Device Context Visualization

We wanted to exemplify how Tomo might be used in day-to-day life by using a realistic render. The context visualization image below shows how easy it is to carry Tomo with you and the subtlety and discretion of its design.

Visual Design

We aimed to convey friendliness, trustworthiness, and fun with our visual design. To achieve this, we created a moodboard that exemplified what we wanted Tomo to be. Our final visual design decisions included clean lines, rounded forms, soft textures, and bright colors.

Moodboard

This moodboard was the inspiration for the final design of the device. The device intends to be discreet and sleek while still being fun and friendly.

The color palette primarily directed our color decisions on the app interface. We wanted to connect the Tomo device and app through visual design so that they may be viewed as a unit.

Typography

Icons

Other elements

Branding

“Personable & Personalizable”

The name “Tomo” was derived from the Japanese word tomodachi, meaning “friend.” The word tomodachi can be shortened to just tomo or dachi, which places the word in a more casual light, meaning something like “buddy.” Tomo is designed to invoke an impression of helpfulness and friendliness to remove some of the seriousness of maintaining a long-term medication regimen.

Logo exploration | black color

Logo exploration | color

Final logo

White background

Black background