Morisky surveys ask four questions that can determine, with fairly high accuracy, a patient's probability of adhering to a course of drug treatment. In other words, the survey can tell the doctor what the likely hood is that you'll finish your bottle of pills, take your shots, etc. The health impact to patients, and to the health care companies that provide his care, of NOT sticking to the plan can be critical. For instance, in people with diabetes, tight blood glucose control is correlated to reduced complications, and control is affected by medication adherence (Medication Adherence, Journal of Diabetes Nursing, Feb 2005). 26.9% of people with Type 2 diabetes have poor medication adherence. 20% of the elderly in the United States have this form of chronic illness. Both patients and health care companies have vested interests in reducing the complications from the disease, which can be reduced through compliance. Those patients that may not comply with the course of treatment can be identified using the four question Morisky survey.
In comes mashup telephony, which can use elements such as Voice XML platforms and services, database driven web sites and social networking features to identify which patients are likely to need extra help with their medication. Patients can be called with the survey to determine which ones need a visiting nurse, reducing costs for the HMO (which can be monetized) and increasing quality of life for the patient. This drives the financial model for the business case.
The fact that it's a mashup architecture makes it practical to implement on many fronts. First, the costs of demonstrations are amazingly low, with the only costs of demonstration being the engineering time to create the survey (a week, at most), the costs of hosting ($100.00 a month) and the incremental cost of making the calls (0.10 to 0.25 cents per minute). Secondly, since the demonstration architecture is identical to the deployment architecture, it scales very nicely. Since it uses a web services architecture, integration into the current enterprise back end is straightforward and achievable with internal staff or external consultants.
The Morisky Survey is only one of about ten such integrations that we at my company have found in the past three months, and that's only counting health care. Since the barriers to entry in terms of up-front investment and ongoing costs to implementing telephony solutions have fallen so far, these ideas are now practical, and I hope one day, wide spread.