Modern medicine's biggest challenge

If you're feeling sick and go to the doctor, the chances are (overwhelmingly) that they know what's wrong with you and have a treatment for it. So why isn't everyone healthy? The final frontier of modern medicine isn't some groundbreaking research or lab work. It's medical adherence.

For every 100 prescriptions given out, only 20 are taken correctly. The other 80 are not taken at all, not taken as prescribed, not refilled, etc. This is a huge problem and, besides costing insurance companies and payors billions a year, is fundamentally detrimental to patient health.

How Medicos helps

Medicos is fighting this reality. It's a HIPAA-compliant, turnkey platform that integrates with doctor's EMRs (their digital systems) directly in order to provide patient reminders that just work. No configuration needed.

When a doctor prescribes a drug ("creating a treatment"), patients get an email with instructions on how to download the Medicos app. Once they set a password, every dose they have is pre-loaded into the app, including across different providers/care teams. They can easily log whether doses were taken or skipped with a single press (or through interactive notifications, without ever opening the app).

The best part is, doctors get realtime updates on patients' progress via the Medicos provider dashboard. Previously, they had to wait until the next follow-up, which could be days, weeks, months, or never.

Medicos makes it easy for patients to stay adherent by better understanding their treatments, and for providers to intervene if something's going wrong.

The Tech Stack

Medicos has 2 major components:

1. The provider dashboard

This is a multi-tenant Next.js application styled with Tailwind using tRPC and Postgres via Drizzle on the back end. Practices using Medicos get their own dedicated subdomain (or custom domain) for ease of access.

Administrators can add providers, staff, and organize care teams easily. And, if they aren't integrating with an EMR, providers can easily onboard new patients and prescribe treatment plans (email is handled through Resend).

We used a Speech to Text API from ElevenLabs to support realtime dictation of treatments in addition to native text input. Then, using Amazon Medical Comprehend, extract structured information on dosages, frequency, standardized drug name, etc. to finalize a treatment plan.

2. The patient app

This was written in React Native (managed by Expo) in order to be cross-platform on both Android an iOS. We rolled our own auth from scratch using JWTs and integrated everything into the same tRPC api we use on the provider dashboard to reuse logic and ensure end-to-end typesafety.

The app is simple and intuitive by design. We standardized dosage scheduling via cron expressions, and interactions within the app use haptics follow various accessability guidelines. We also leveraged interactive push notifications, so patients don't even have to open the app to log doses.

By not overcomplicating the UI we were able to keep it as approachable as possible for patients of any background while also letting our backend do the heavy lifting to provide realtime adherence analytics on the provider dashboard.

Biggest painpoints

1. Integrating with EMRs. The data formats are quasi-standardized, but their APIs are old and a pain to deal with.
2. Scheduling notifications. You need to send these via the mobile platform's API. We ended up using complicated cron parsing logic to schedule jobs on a Temporal instance.
3. Getting HIPAA certified. This wasn't even technically complex—just required a lot of random work like making sure our office had an appropriate evacuation route for fires. We ended up using Drata to help with this, since it was 100% required for a health product.

What's next

We launched a clinical trial in Summer 2024 in rural Georgia and saw preliminary adherence improvements of 30-40%. Then, we exited in October 2024. Insane timeline, but it was a ton of fun and I'm glad I got to build something that actually helped people.