Miami Herald - Monday, March 5, 2001
Michele Chandler

"I was busy," said Nicholson, who then owned a financial services software firm. "I did not have a cold, headache or sore throat, so I had a hard time remembering to stop what I was doing and take my medication. Instead of 7:30, I'd remember it at 10."

Being late taking pills or forgetting them altogether spells trouble for people with chronic illnesses who need regular doses of medications to keep their conditions under control. For those with HIV, missing pills can permit the virus to develop a resistance to their drugs.

So Nicholson came up with a personal solution. He had his company's programmers devise software that dialed his pager with the message "1-2-3-4" to remind him to take his pills on a regular basis. "It was very discreet," Nicholson said. "I found it helped me improve my own adherence and it reduced stress because I was not constantly worried whether I had remembered or not."

Seeing wider potential for his innovation, Nicholson fine-tuned the idea and founded a company to assist others with similar needs.

In 1999, he formed Reminders On-Line Inc. That company's product is MediMOM, which uses the Internet and wireless devices including pagers, cell phones, Palm Pilots and other personal digital assistants to prod patients to take their medicines on time.

Users can also ask the system to deliver text message reminders to complete other health-related tasks, such as refilling prescriptions, ordering medical supplies, setting up doctors' appointments or even to have a snack because an upcoming pill must be taken with food.

Founders of Reminders On-Line include the former head programmer from Nicholson's financial services software firm, which he sold in 1997. The privately held Reminders On-Line has 25 investors and nine full-time employees. Although it's now based in New York, the company was started in Fort Lauderdale, where Nicholson still lives part-time.

Nicholson has spent the past year pitching the product to pharmaceutical companies, pharmacies, clinical research firms testing potential drugs and others that have a major financial stake in patients with chronic conditions taking medicines properly.

"We're marketing to healthcare professionals," rather than trying to get people to sign up on their own, Nicholson said. "Direct-to-consumer marketing for Internet products is very expensive. In health care, people tend to do what they are told by their health professional, nurse, pharmacist or doctor."

Some individuals have purchased the service directly through the company's website, www.medimom.com. Reminders On-Line provides the service; patients need to have a pager, cell phone or other device.

Much of the company's revenue has come from firms that have used the MediMOM system on a trial basis with a limited number of patients to assess how well the product works, and whether it does help people take their medications as directed.

One study, conducted recently at Fenway Community Health in Boston found that AIDS patients using the MediMOM system increased their compliance from 52 percent to 69 percent, said principal investigator Steven Safren.

While MediMOM's initial target is assisting people with HIV and AIDS, anyone needing to take medications regularly over a long period is a prime candidate for the service, Nicholson says. The program can also benefit people taking prescription drugs for asthma, diabetes, heart disease and birth control, he said.

By increasing adherence, Nicholson says, "Everybody wins. Pharmaceutical companies sell more of their medications and patients are healthier."

Reminders On-Line would also win. The company charges individuals $9.95 a month, while organizations that request services for multiple patients pay $4.95 a month per person. Nicholson hopes that companies serving people with chronic illnesses will pick up the cost.

So far, the company's losses have totaled about $3.5 million, with break-even expected next year after more customers sign on.

Nicholson's also searching for more investors. He hopes to raise between $7 million and $10 million in venture capital; last week, he talked to venture capital firms in several cities about putting money into the company.

Forgetting to take medicines on time is a widespread problem. Sticking with a medication schedule can be particularly challenging for people who must take prescription drugs several times a day over extended periods.

"There have been numerous studies that have shown that if you don't have a very high adherence rate, the risk of failure goes up," said Margaret Fischl, an AIDS expert and professor of medicine at the University of Miami School of Medicine.

Studies have shown that one third to one-half of patients with HIV or AIDS miss doses of their medicines, she said.

Fischl said prior efforts using devices to keep patients taking medications as they should have not always met success. Fischl said she has been involved in studies where sponsor-provided pagers were used, but people lost their pagers, forgot to carry them or sold the devices and spent the cash.

Privacy is also an issue. "People don't want to take a pager or cell phone to work and have it beep if that is the only thing that happens routinely," Fischl said. "If it beeps at 8 and 1 and 3 everyday, people begin to say, `what is going on there?' "

But Sheri Kaplan, executive director of The Center for Positive Connections, an AIDS resource and support center in North Miami, said if a reminder system is discrete, "I probably wouldn't mind that. Some people are really busy."

Retired Fort Lauderdale resident Robert Jones said he'd tried various tactics to remember to take his medication at mid-day, once even enlisting a friend to remind him. But his friend forgot, too.

After a representative from MediMOM contacted an AIDS service organization where Jones sits on the board, Jones signed on last year. "It's very effective. It's worked very well for me," he said.
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