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Improving Medication Adherence: An Exploration

Medication adherence is a growing issue around the world. Among patients in developed countries with chronic illnesses, approximately 50% do not take medications as prescribed. Improving medication adherence would not only improve patient outcomes but also decrease healthcare costs. The World Health Organization reports that “increasing the effectiveness of adherence interventions might have a far greater impact on the health of the population than any improvement in specific medical treatment."  

There is no silver bullet solution to the complex issue of medication adherence. But interesting approaches and tools that can help tackle various aspects of this issue are being developed — from simplified medication management to smart pill bottles.

We were intrigued by the problem and wanted to explore new ways that technology could help patients adhere to their treatment programs. Our exploration led to the concept of Florence — a friendly chatbot that uses SMS to help patients understand and manage their medications. 

Here is a behind the scenes look at how we developed the concept:


This exploration began with research. Before we could start exploring solutions, we needed to gain a better understanding of the issue. We read reports and journal articles to learn more about the underlying reasons for non-adherence. We spoke with patients and healthcare professionals to understand the issue from various perspectives. We also looked at the different solutions that are evolving in this space, as well as in other verticals.


Our research led us to explore the use of SMS as one potential way to help patients adhere to their treatments by introducing awareness, guidance, and accountability into their routine. We were drawn to SMS in particular because it has the potential to reach a larger, more diverse audience and ultimately, help more people.

We compiled this background information and shared it with a broader group of folks at Viget so they could learn more about this issue before participating in a design studio. During the design studio, we worked through several prompts to explore this concept further. The design studio allowed us to further define how SMS could be used to improve medication adherence. 




We wanted to share our findings with others — and gain feedback — so we documented what we learned throughout the process and how Florence might work. You can learn more about Florence at  

Florence offers one potential technical solution to increase medication adherence. We hope that technology and design will continue to contribute to solutions that improve outcomes, decrease costs, and make patients' lives a bit easier. We recognize the complexity of this issue, however, and understand that in order to truly tackle this problem, solutions must also address socio-economic, education, healthcare access, and treatment model factors. 

Working With the Right CMS

Evaluating and working with content management systems (CMSs) is a large part of what we do at Viget. Our capabilities range from implementing of off-the-shelf (OTS) solutions to building customized applications with Ruby on Rails (check out what Lawson had to say about creating Colonel Kurtz). This means we're able to work with our clients to identify the most appropriate technological solution based on their particular needs, and not force anyone into a one-size-fits-all solution.

Oftentimes, we get to work with a client to determine the best option; but, occasionally, they've already done some homework and come to us with an idea of what they need. Even in those situations, we attempt to complement the client's ideas with our own research and experience to help make the best possible decision for the long term.

Dr. Jane Goodall on the Potential of Social Media

I recently attended the Wildlife Conservation Network Expo in San Francisco, where the legendary Dr. Jane Goodall gave the keynote address. Prior to the expo, she also participated in a small-group Q&A of which I was a part. During this conversation, Dr. Goodall touched on the power of social media, saying:

I find [social media] very inspiring … I was in last year's climate march and they expected 80,000 people and it was close to 400,000 people. And in major cities around the world everyone was tweeting and twittering and using Facebook and cell phones and telling their friends "come and join us". So it was the biggest gathering of people demonstrating in the streets … In the old days we might have been able to muster up, you know, about a couple thousand of our supports. But now it can go out virally. And it does.

… Now with social media we have a voice and we can use it. And we must use it.  

It’s inspiring to be reminded that our efforts in the digital space (e.g., the 96 Elephants campaign or the relaunch of do, in fact, reach real people. And these people (including ourselves) possess the potential for bringing about real change and impact.

Proprietary vs. Open Source Content Management Systems

The land of Content Management Systems has changed greatly over the years, from first only managing content in hard-coded HTML files, to Dreamweaver, to hundreds of full-blown systems created for the sole purpose of adding, editing, and removing content. We often help clients decide what system makes the most sense for their organizational and user needs, as the decision is nothing less than intimidating.

A question that often initiates this process is categorical comparison, between the Proprietary and Open Source routes. In this case, I’m defining Proprietary as a system built, owned, licensed, and supported by one company, normally requiring significant financial investment. Open Source, in this case, is the development or creation of a system using open source technologies and frameworks, like Ruby on Rails or Python. There is a third category that I’m leaving out, for the time being, including Off The Shelf options, that may technically be either Open Source or Proprietary, but muddles the lines between the categories (like Wordpress, ExpressionEngine, Craft, or Drupal).

There certainly is no clear “winner” for everyone, as the tool should enable organizations to fulfill business objectives, and the makeup of organizations, those objectives, and end users, vary greatly. But to start, here are the pros and cons of Proprietary and Open Source Content Management Systems that can aid in making those decisions:



  • Predictability - features are documented and can generally be demoed, pricing is consistent
  • Options - there are plenty of proprietary CMSes out there
  • Robust - generally come packed with a lot of features
  • Cost to implement - since the system is already built, there are often less upfront costs


  • Less current - proprietary CMSes are generally not using the newest or best technology, because there's a lot invested in a large legacy system
  • Licensing fees - you pay to use the software, you do not own it
  • Handcuffed to one or just a couple provider(s) - supported only by the company that sells it or limited implementation partners–if you're unhappy with service, support, flexibility, there are no other options
  • Lack of customization - "what you see is what you get"–the system is not created for your unique needs, but generalized to meet the needs of all their clients
  • Lack of flexibility - do you want to do something the system doesn’t do? It is often very difficult to get new features developed for a proprietary system, because of all the generalized dependencies across their clients

Open Source


  • Customizations - an open source system can be built and customized to your specific needs, both in initial setup and in the future; as those needs change, so can the system
  • Flexibility - built to easily integrate with other technologies and systems
  • Supported by a community, not a company - open source developers are able to pick up and learn a system to maintain and extend it, you would not be locked into one provider for support or further customization--could also be fully supported and maintained by an in-house team
  • Existing frameworks - while customization is at the core of open source, so is reusability of code assets, including features and systems that can easily be dropped in to create a complete system, so you’re not starting from scratch every time
  • New technology - often use the newest technologies, staying up to date on bugs, fixes, and new tech advances
  • You own it - when it is built for you, you own that instance of the software, thus you do not have to pay to use it, only to maintain it (in-house or by a provider)


  • Upfront cost - since they are highly customized, there is more upfront effort to get it off the ground
  • Less "out of the box" features - some features that come with proprietary systems might be expensive to create with open source
  • Less predictable support - support and maintenance only happens as needed, instead of regularly, and is generally less predictable

Beyond Content Management

Nobody is excited by content. The word itself implies a sterility and blandness that is antithetical to our clients' work. And when you build systems to create and manage content, the resultant experience feels like, well, content. So we don't.

Each of our clients has a unique and compelling story to tell. Battles to save vanishing species. Initiatives to preserve our history. Products to change people's lives. Our job isn't merely to build apps that hold these organizations' content. It's to help them tell their stories in the digital medium. We build systems to create and manage stories.

But what's the difference?

Content is a flat and singular notion, so content management experiences almost always fall into one of two categories:

Contrived (aka Too Rigid)

In systems designed to manage content, stories are treated as a series of data points. A title. A picture. Body text. That's it (deal with it).

Editors are forced to break down their stories into contrived pieces to fit them into a predefined set of fields. The editor loses control of the stories, and the stories lose their character.

Oftentimes, to make up for the constraints, the system will introduce an endless list of options to provide the illusion of flexibility. These efforts typically serve only to render the system bafflingly complex and unintuitive.

Unguided (aka Too Free)

In response to the shackles of contrived content management experiences, many instead favor what-you-see-is-what-you-get (WYSIWYG) tools for managing content. These tools give the editor more control, but they are complex, and difficult to use. Every possible decision is left to the editor. Layout. Colors. Font. Sizing. Everything.

So to a certain extent, the tool gets in the way of telling the story. And it's quite often difficult to achieve the consistency necessary to communicate a story in the context of a larger brand or initiative.