Interview with Dr. Harry Wingate, MD, FACEP
Gary Barg: Today, it's my honor to be talking with Dr. Harry Tripp Wingate, MD, a fellow of the American College of Emergency Physicians, past Chair of the American College of Emergency Physicians Rural Emergency Medical Section, and medical entrepreneur.
One of the most important issues to pay attention to is getting a handle on the many different medications that our loved ones take throughout the day. First, can we talk about those terrifying statistics that affect way too many of us with regards to medical mis-adherence, from lives lost to the cost to our healthcare systems?
Dr. Harry Wingate: Healthcare is a very significant part of our economy, constituting trillions of dollars spent every year – about 75 percent of that is for the care of chronic conditions such as hypertension, diabetes, COPD, et cetera. And usually, a large number of patients have multiple conditions that require very complex medical regimens and it's that complexity that is at the heart of people struggling to try to take the right medicine, at the right dose, at the right time.
Failure to do so impacts in several ways, one of which is what you're talking about – adverse drug events. As an emergency room physician, one statistic that stands out is that about ten percent of the patients over age 65 present to the emergency room as a result of an adverse drug event, which costs an estimated $300 billion to the economy and more importantly, over 100,000 lives either injured or taken prematurely.
Gary Barg: You're in the best position, frankly, to see how medication mis-adherence affects us. Can you share some stories?
Dr. Harry Wingate: Certainly. We see people trying to manage five, ten, sometimes fifteen medications at a time, oftentimes with limited sight and support. One of challenges is also when patients don't have bottles properly labeled. It brings to mind one story of a gentleman in his 70s, who was preparing for his golf game and he normally would put all of his daily medicines in one bottle and just take that whole bottle. This particular morning, he grabbed the wrong bottle and it happened to be a bottle of Xanax and then took off to his golf game. When he got to the first hole and was about tee off, he just collapsed.
Of course, nobody knew what happened. They thought it was a stroke. They brought him in and we evaluated him – it just didn't seem right. There was no lateralization or signs of a stroke. It looked more like an overdose to me. He swore he only had taken his morning medications, but his wife came in and she was the one who figured it out. She was able to go back and see that he had grabbed the wrong bottle.
I've seen, over the years, many independent attempts to try to organize these complex regimens with school notebooks and writing down numbers on scrap pieces of paper. And of course, the plastic bag is probably the number one method of transporting medications yet it's just a jumbled mix of pill bottles. It's frustrating to the patient's caregivers, the nurses and the doctors trying to do what's called ‘medicine reconciliation’ where we try to make sure there are no redundant bottles and not taking the same medicines twice.
Those are sort of the challenges that got me thinking, several years ago, that there's got to be a better way to organize all of this. And that's where we came up with the ideas of the Med Manager.
Gary Barg: This is a great time to talk about your medical entrepreneurship. Can you tell me about the Case-It Medication Management System?
Dr. Harry Wingate: This really sprung into conception several years ago to come up with a way to carry medications, information, as a well as a calendar to track progress in reaching key metrics like weight, blood pressure, facilitate office visits and also to quickly bring records and medication to the emergency department.
Gary Barg: I shared the Case-It Med Management System with a loved one of mine who takes 20 medications a day on a variety of schedules. And I have to tell you, he thought that this was the most flexible solution he's ever seen. What does this system do and what are family caregivers are telling you once they've used it?
Dr. Harry Wingate: It looks like the school binders that students are very familiar with and it can take one month's worth of medication, small, medium and large, and secure them inside the binder. It also has a weekly pill planner and notepad, a file manager so you can carry all of your office notes, discharge summaries and x-ray reports along with your medication. It helps you to group your medications together, make sure there's no redundancy position on the label so they're easily read, so you don't have to fumble through a bag and try to individually sort through medicines. Providers, patients and caregivers can quickly glance and see what medications go with one condition.
Then we have the TKP calendars which is a 12-month calendar that allows you to be able track your weight, blood pressure and glucose reading. We partnered with the Society to Improve Diagnosis in Medicine and have their patient toolkit for diagnosis that helps you to prepare for office visits. This helps you think about the types of questions that you need to ask or to prepare information to help your primary care providers make the right diagnosis.
And as we all know, today those encounters last typically ten to fifteen minutes, so you have to be prepared if you want to get quality time, instead of spending nine out of ten minutes trying to make sure you're on the right medicine, and only one or two minutes actually talking about progress, goals, and treatment plans.
I'm very gratified with the testimonies that we're getting about how useful the product is. So, I appreciate you sharing that story with me. One of the great things is to see that you can come up with an idea to help people improve their quality of lives.
Gary Barg: One of the things I really like about this system is the flexibility, You really had a handle on what we go through as family caregivers. How did plan this system?
Dr. Harry Wingate: It was through seeing the frustration that we all encounter and thinking about how to make care simpler. I remember watching a nurse go through a plastic bag with fifteen to twenty medications. She was pulling out one at a time, lining them up, and writing them down. And I thought to myself, "What if we could create something where you could line the bottles up with labels facing out and secure them inside a notebook?
I went home and told my wife about this, and she said, "Well, you're talking about a zipper binder." It was back to school time and I have ten children. On the table, she had branded zipper binders for the kids, and I said, "This is great," and took the guts out of one, got some elastic cords and hot glue, and we made a prototype. It worked great, it looked great, and it was exactly what I was imagining.
Gary Barg: How do caregivers get the Case-It Medication Management System?
Dr. Harry Wingate: They can go on Amazon.com or on a search engine like Google.com and search for "Case-It Med Manager" or go onto the website, vivalife.care. We have the four versions of the med manager on that site, but we also have some additional products that we think are helpful.
Gary Barg: What would be the one most important piece of advice you'd have for family caregivers?
Dr. Harry Wingate: I would have to say the key word is "organization". We use "organization" in so many areas of our lives, our finances and our work. But when it comes to managing complex medical regimens, there was not an affordable organization system out there. And I think that's what we really provide; a product that's able to organize their health information and medication, help track their progress and facilitate the encounters with their providers. And it just makes a world of difference when you have got a plan and the tools to be able to execute. I think the main message, is that we're going to make the complex simple.