Who invented medication adherence systems?

The search for who invented medication adherence systems reveals not a single lightbulb moment, but rather a long, evolving response to human fallibility and complex medical regimens. The need to ensure patients follow medical advice is ancient; as far back as the 5th century B.C., Hippocrates noted that patients often lied about taking unpleasant prescribed drinks, sometimes resulting in death. ^[5][6] Fast forward millennia, and this observation remains central: "Drugs don't work in patients who don't take them". ^[4]

The formal, scientific pursuit of tracking and improving adherence gained traction later. In modern medicine, Robert Koch in 1882 famously characterized noncompliant tuberculosis patients as "vicious consumptives, careless and/or irresponsible". ^[7] By the 1970s, the groundwork for what we now study took shape, particularly at McMaster University Medical Centre, leading to the seminal book Compliance with Therapeutic Regimens by Sackett & Haynes. ^[7] This established the early focus on "Patient compliance" as a measurable phenomenon, which became an official Medical Subject Heading (MeSH) term in the U.S. National Library of Medicine in 1975. ^[7]

# Conceptual Evolution

The very language used to describe patient behavior has been a system in itself, evolving over decades. Initially, compliance dominated, carrying a connotation of passive obedience from the patient to the clinician. ^[1][5][7] Many in the field found this term problematic, feeling it suggested excessive physician control over a complex personal behavior. ^[4][7]

This dissatisfaction spurred change. The term "adherence" gradually replaced "compliance" as the preferred nomenclature by organizations like the World Health Organization (WHO) and the U.S. National Institutes of Health Adherence Research Network. ^[1] Adherence suggests a more collaborative process and acknowledges the diverse, non-blaming reasons for deviation. ^[1][4] Building on this, the term "concordance" was introduced in 1995 by a joint working group of the Royal Pharmaceutical Society of Great Britain to specifically emphasize a mutually agreed treatment program between the patient and provider. ^[7] Thus, the "invention" of adherence systems is tied not just to technology, but to a fundamental philosophical shift in the patient-provider relationship. ^[7]

# Early Objective Tools

While behavioral science worked on terminology, researchers also sought objective ways to measure if a system was working. Early methods were crude—pill counts or pharmacy refill rates—which the WHO recognized were insufficient. ^[4][5] The move toward true technological systems targeted the flaws of patient self-reporting, which is often inaccurate due to forgetfulness or a desire to avoid perceived caregiver disapproval. ^[2][4]

One of the earliest and most significant technological systems for objective measurement was the Medication Event Monitoring System (MEMS). ^[5] Though the precise inventor is not named, MEMS technology, manufactured by the Aardex Corporation, ^[5] utilized an electronic cap on a standard pill bottle. ^[2] This system recorded the date and time a bottle was accessed, providing researchers and clinicians with an objective, time-stamped history of access, serving as a proxy for ingestion. ^[2] This move from subjective self-report to objective electronic monitoring marks a crucial phase in the development of adherence systems.

The effectiveness of electronic monitoring is clear, as studies show that patient self-report often grossly overestimates adherence compared to MEMS data. ^[2] The development of MEMS and similar devices established a pattern for future systems: using a container interaction (opening the cap, removing a pill) as an observable event that is automatically recorded and transmitted. ^[2]

Who invented IVR systems?

# The Digital System Proliferation

The 21st century saw adherence systems evolve from simple event monitors to complex, connected ecosystems driven by mobile health (mHealth) and the Internet of Things (IoT). ^[2][3] These modern systems aim to do two things simultaneously: accurately monitor behavior and intervene in real-time. ^[2]

This later generation of systems can be broadly categorized by their method of tracking:

• Electronic Pill Boxes/Bags: These improve on the basic pill bottle by offering compartments for multiple medications, which better suits patients on complex, multidrug regimens. ^[2] Some newer versions, like those linked to cellular networks or Bluetooth, transmit data wirelessly. ^[2]
• Blister Pack Technology: Attachable labels containing microchips can monitor the removal of individual doses, which helps avoid the "pocket dosing" problem inherent in pill bottles, though accidental breaking of adjacent circuits remains a potential inaccuracy. ^[2]
• Ingestible Sensors (Digital Pills): These represent the most direct objective measure of ingestion, where a sensor is co-encapsulated with the drug and transmits a signal upon contact with gastric fluids. ^[2] While offering high accuracy (95% to 99.1% detection rates), they raise significant ethical concerns regarding invasiveness and patient autonomy. ^[2]
• Electronic Medication Management Systems (EMMS): These systems integrate multiple technologies. For example, the RMAIS system uses RFID tags on pill bottles and a rotating platform, while the MBMS uses motion sensors, video, and scale weight detection to confirm a dose was dispensed. ^[2] A startup like Concordance Health Solutions Inc., founded around 2018, developed the Smart Med Reminder system which combined a connected vial cap, mobile apps, and a cloud service to remind patients and alert caregivers when doses were missed—addressing the need for timely intervention. ^[3]

If we must assign credit for inventing specific components of the modern adherence system, we look to the companies and research groups that developed these specific artifacts. For example, Aardex Corporation is tied to the early objective monitoring tool (MEMS), and Concordance Health Solutions Inc. represents the modern, interconnected, low-cost solution integrating mobile reminders and caregiver alerts. ^[2][3] However, the core idea—monitoring and prompting—is a layered evolution, not a single invention.

# Systemic Context Versus Technological Capability

It is insightful to note that even with highly accurate objective monitoring systems like ingestible sensors achieving up to 99.1% ingestion detection, their successful implementation in routine clinical practice remains rare. ^[2] This points to a gap between the invention of a measuring device and the adoption of a functional adherence system.

A system designed only for measurement, no matter how sophisticated, often falls short because it doesn't account for the Feasibility and Implementation category required for successful adoption. ^[2] Many devices are expensive, require specialized software integration, or create an unnecessary burden of data management for clinicians. ^[2][4] For instance, while electronic pill bottles were common in research, their limitation to a single medication type made them unsuitable for patients with the complex, multidrug regimens common in chronic care. ^[2][4] The history shows that for a system to be truly useful, it must be compatible with clinical workflow and affordable; otherwise, it remains a promising artifact rather than a ubiquitous solution. ^[2]

This leads to an editorial consideration: the most sophisticated tracking technology cannot substitute for addressing foundational patient needs. Experts suggest that if prescribers could simply design the right regimen—simplifying the schedule, reducing the pill burden, and confirming drug appropriateness—non-adherence could potentially drop to as low as 10-15%. ^[6] No amount of technological monitoring can fix a regimen that is inherently too difficult for a patient to maintain.

Here is a basic checklist patients and providers can use to match adherence needs with the system or intervention available, recognizing that technology is only one component:

Who invented outbreak detection systems?

# The Ongoing "Invention"

The work defining what counts as adherence—the taxonomy itself—is also an ongoing system development process. Researchers like Bernard Vrijens and colleagues proposed a standardized taxonomy that breaks adherence into three phases: Initiation, Implementation, and Discontinuation. ^[7] This provides a common language for comparing adherence systems and research findings. ^[7]

In sum, there is no single "inventor" of medication adherence systems. Instead, the history reveals a progression: from the ancient recognition of the problem, through the mid-20th-century conceptualization of compliance, the development of basic electronic monitors like MEMS (associated with Aardex), and finally, to today’s integrated, IoT-enabled digital health solutions pioneered by groups like Concordance Health Solutions Inc.. ^[2][3][7] The true system-wide invention is the recognition that adherence management requires a multi-component ecosystem—combining simple behavioral psychology, clear provider communication, simplified regimens, and only then, targeted technology—to truly impact patient outcomes. ^[2][4][6]