Our Results
Learn about emocha’s scalable solution at work through our published research and case studies.


Pediatric Transplant – Florida State University & UF Health

Killian, MO, Clifford, S, Lustria, MLA, Skivington, GL, Gupta, D. Directly observed therapy to promote medication adherence in adolescent heart transplant recipients. Pediatr Transplant. 2022; 00:e14288. doi:10.1111/petr.14288

“Pediatric transplant recipients have non-adherence rates as high as 40% to 60% during adolescence… [in this pilot study] 8 patients completing the 12-week DOT submitted 1211 videos of a possible 1344 (90.1% adherence), assuming 84 days with 2 videos per day for morning and evening doses.”

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Peer Reviewed Journal Publications of emocha Implementations


McIntire K, Weis B, Litwin Ye L, Krugman SD. Feasibility of video observed therapy to support controller inhaler use among children in West Baltimore. Journal of Asthma. 2021. doi: 10.1080/02770903.2021.1984525.

Hepatitis C

Brooks KM, Castillo-Mancilla JR, Morrow M, MaWhinney S, Rowan SE, Wyles D, Blum J, Huntley R, Salah LM, Tehrani A, Bushman LR, Anderson PL, Kiser JJ. Adherence to Direct-Acting Antiviral Therapy in People Actively Using Drugs and Alcohol: The INCLUD Study. Open Forum Infect Dis. 2021 Jan; 8(1): ofaa564.

“Persons with HCV who use drugs achieved high SVR with high but variable adherence to DAA therapies. Participants assigned to vDOT had a median adherence of 98%, and were more than twice as likely (21% vs. 10%) to complete all 84 doses in 84 days.”

Litwin AH, Jost J, Wagner K, et al. Rationale and design of a randomized pragmatic trial of patient-centered models of hepatitis C treatment for people who inject drugs: The HERO study. Contemp Clin Trials. 2019;87:105859. doi:10.1016/j.cct.2019.105859 (Protocol paper)

“This study addresses an urgent need for timely and accurate information on optimal models of care to promote HCV treatment initiation, adherence, treatment completion and SVR among PWID, as well as rates and factors associated with reinfection and resistance after treatment.”

Opioid Use Disorder

Godersky ME, Klein JW, Merrill JO, Blalock KL, Saxon AJ, Samet JH, Tsui JI. Acceptability and Feasibility of a Mobile Health Application for Video Directly Observed Therapy of Buprenorphine for Opioid Use Disorders in an Office-based Setting. J Addict Med. 2020 Jul/Aug;14(4):319-325. doi: 10.1097/ADM.0000000000000608. PMID: 31972762; PMCID: PMC7358111.

Schramm ZA, Leroux BG, Radick AC, Ventura AS, Klein JW, Samet JH, Saxon AJ, Kim TW, Tsui JI. Video directly observed therapy intervention using a mobile health application among opioid use disorder patients receiving office-based buprenorphine treatment: protocol for a pilot randomized controlled trial. Addict Sci Clin Pract. 2020 Jul 31;15(1):30. doi: 10.1186/s13722-020-00203-9. PMID: 32736660; PMCID: PMC7393902. (Protocol paper)

Godersky ME, Saxon AJ, Merrill JO, Samet JH, Simoni JM and Tsui JI. Provider and patient perspectives on barriers to buprenorphine adherence and the acceptability of video directly observed therapy to enhance adherence. Addict Sci Clin Pract 2019; 14:11.


Holzman SB, Atre S, Sahasrabudhe T, Ambike S, Jagtap D, Sayyad Y, Kakrani AL, Gupta A, Mave V, Shah M. Use of Smartphone-Based Video Directly Observed Therapy (vDOT) in Tuberculosis Care: Single-Arm, Prospective Feasibility Study. JMIR Form Res 2019;3(3):e1341.

“Median adherence was 74% (IQR 62%-84%), and median verifiable fraction was 86% (IQR 74%-98%). More than 90% of patients reported recording and uploading videos without difficulty.”

Holzman SB, Zenilman A, Shah M. Advancing Patient-Centered Care in Tuberculosis Management: A Mixed-Methods Appraisal of Video Directly Observed Therapy. OFID 2018, Volume 5, Issue 4, ofy046.

“Medication adherence on vDOT was comparable to that of in-person DOT (94% vs 98%, P = .17), with a higher percentage of total treatment doses (inclusive of weekend/holiday self-administration) ultimately observed during the vDOT period (72% vs 66%, P = .03).”

Olano-Soler H, Thomas D, Joglar O, et al. Notes from the Field: Use of Asynchronous Video Directly Observed Therapy for Treatment of Tuberculosis and Latent Tuberculosis Infection in a Long-Term–Care Facility ― Puerto Rico, 2016–2017. MMWR Morb Mortal Wkly Rep 2017;66:1386–1387.

“Use of asynchronous VDOT saved PRDH approximately 240 hours in DOT-related activities, equivalent to 25% of the workload for a full-time epidemiology technician/case manager over 6 months of treatment… As of July 12, 2017, all 11 patients with active TB disease and all six with LTBI had completed treatment with recommended ≥80% compliance (percentage of scheduled doses actually taken) (Table) (6).”

Morris S, Miner M, Rodriguez T, Stancil R, Wiltz-Beckham D, Chorba T. Notes from the Field: Tuberculosis Control Activities After Hurricane Harvey — Texas, 2017. MMWR Morb Mortal Wkly Rep 2017; 66:1362–1363.

“Sixty-one patients had already been placed on video-enabled DOT, 30 had TB disease (cases), and 31 had latent TB infection and needed DOT. Fifty-nine (97%) were monitored successfully and did not miss any medication doses.”

Perry A, Chitnis A, Chin A, Hoffmann C, Chang L, Robinson M, Maltas G, Munk E, Shah M. Real-world implementation of video-observed therapy in an urban TB program in the United States. Int J Tuberc Lung Dis. 2021 Aug 1;25(8):655-661. doi: 10.5588/ijtld.21.0170. PMID: 34330351; PMCID: PMC8327629.


Killian MO, Clifford SA, Gupta D. Directly observed therapy to promote medication adherence in paediatric heart transplant recipients. Cardiology in the Young 2021; page 1 of 3. doi: 10.1017/S1047951121002109.

The current study represents an advancement in mHealth research and efforts to translate these resources into clinical care of paediatric organ transplant patients.

Case Studies & Research Publications

emocha has been proven to secure high rates of medication adherence, even in areas where connectivity was challenging. Review our latest customer case studies and peer-reviewed research.

Peer Reviewed Posters or Presentations of emocha Implementations


Krugman, Scott; Weis, Barbara; Ye, Lindsay; McIntire, Katherine (2021, May 3). Feasibility of using remote video observed therapy to support children with asthma in West Baltimore. Poster presentation at the Pediatric Academic Societies Virtual Meeting.

Hepatitis C

Kiser, Jennifer J.; Brooks, Kristina M.; Castillo-Mancill, Jose R.; Morrow, Mary; MaWhinney, Samantha; Rowan, Sarah E.,; Blum, Joshua; Wyles, David L.; Huntley, Ryan T.; Salah, Lana M.; Tehrani, Arya; Roon, Laura; Bushman, Lane R.; Anderson, Peter L. (2020, March). Adherence in Active Drug Users with HCV: The INCLUD Trial. Poster session presented at the Conference on Retroviruses and Opportunistic Infections (CROI).

Opioid Use Disorder

Tsui, Judith I.; Godersky, Margo E.; Merrill, Joseph O.; Samet, Jeffrey H. (2018, April). Perspectives on Buprenorphine Adherence and Use of mHealth Technology to Address Barriers. Poster session presented at the American Society of Addiction Medicine Annual Conference: Innovations in Addiction Medicine and Science, San Diego, CA.


Henderson, Macey; Saha, Amrita; Langlee, Julie; Lees, Laura; Helfer, David; Waldram, Madeleine; Love, Arthur; Rivera, Francisco; Massie, Allan; Segev, Dorry; Brennan, Daniel. Personalized Mobile Medication Adherence Monitoring: A Pilot Randomized Control Trial of mDOT for Transplantation. Poster session presented at the American Society for Transplantation: Transplant Summit 2019, Phoenix, Arizona.


Cotter, Alexander; Girma, Haimanot; Bravo, Angelito. (2021, July). An observational study on tuberculosis medication adherence using asynchronous video observed therapy in Orange County, California. Poster session presented at the meeting of the National Tuberculosis Controllers Association, Online.

Perry, Allison; Chitnis, Amit; Chin, Andrew; Hoffmann, Christopher; Chang, Larry; Maltas, Gina; Munk, Elizabeth; Shah, Maunank. (2021, Feb. 24) Evaluation of Video-Directly Observed Therapy Implementation under Routine Conditions in a Busy Urban TB Program. Poster presentation at the 25th Annual Conference of The Union – North America Region (Virtual Meeting).

O’Mallan, Josephine; Mbakwem, Chima; Florig, Jenette; Camacho, Larissa. (2019, April). Mobile Technology Innovation in the US Pacific Islands: Guam’s Use of Asynchronous Video Directly Observed Therapy for Tuberculosis. Poster session presented at the National Tuberculosis Conference, Atlanta, Ga.

Helfrich, Cherie; Freeman, Dorothy; Baruch, Nancy; Rios, Katrina. (2019, April). Utilizing Data to Establish an Evidence-based Statewide Asynchronous Video Directly Observed Therapy Program. Poster session presented at the National Tuberculosis Conference, Atlanta, Ga.

Perez, Hector; Cervantes, Joaquin; Barrera, G.; Campos, A.; Assael, R. (2018, May). Patient-Centered Monitoring for TB Treatment Adherence in a Large Mexican Health Jurisdiction. Poster session presented at the National Tuberculosis Conference, Palm Springs, Ca.

Browning, Carol A.; Bertrand, Thomas; Marak, Theodore, P.; Rybak, Natasha. (2018, May). An Evaluation of the Use of Live and Asynchronous Video Technology for Directly Observed Therapy (DOT) for the Treatment of Tuberculosis (TB) in Rhode Island. Poster session presented at the meeting of the National Tuberculosis Controllers Association, Palm Springs, CA.

Sanders, Genevieve; Scott, Mary; Rios-Benitez, Hevert; Fields, Kimberly; Cruz, Merci; Becker, Les; Shah, Umair. (2019, April). Initiation of Targeted Testing Using VDOT. Poster session presented at the National Tuberculosis Conference, Atlanta, Ga.

Medrano, Alexis; Sekhon, Vishaldeep; Wiltz-Beckham, Dana; Fields, Kimberly; LaRue, Jennifer; Carrera, Denise; Scott, Mary; Reed, Brian; Becker, Les; Shah, Umair A. (2018, May). Video Directly Observed Therapy (VDOT) — A Useful Approach to Tuberculosis (TB) Treatment in a Natural Disaster. Poster session presented at the meeting of the National Tuberculosis Controllers Association, Palm Springs, CA.

Prado, Joe. (2018, May). Use of Asynchronous Video Directly Observed Therapy to Improve the Patient Treatment Experience and Reduce Greenhouse Emissions. Poster session presented at the meeting of the National Tuberculosis Controllers Association, Palm Springs, CA.

Chapman, S; Holzman, S; Rios, KC; Shah, M. (2017, March). Implementing Mobile Health for Tuberculosis Care in Sydney: Experience with Video Directly Observed Therapy. Poster session presented at the Australasian Society for Infectious Diseases 2017 Annual Scientific Meeting, Leura, NSW, Australia.

Rubinstein, Rebecca; Siddiqui, Sarah; Wiltz-Beckham, Dana; FIelds, Kimberly; Sakhon, Vishaldeep; Reed, Brian C.; Pennel, Cara; Kaul, Sapna; Becker, Les; Shah, Umair A. (2018, May). Costs Saved Using Video Directly Observed Therapy on Tuberculosis Patients. Poster session presented at the meeting of the National Tuberculosis Controllers Association, Palm Springs, CA.

Efficacy of Video DOT, non-emocha Implementations


Shields MD, ALQahtani F, Rivey MP, McElnay JC. Mobile direct observation of therapy (MDOT) – A rapid systematic review and pilot study in children with asthma. PLoS One. 2018;13(2):e0190031. Published 2018 Feb 5. doi:10.1371/journal.pone.0190031

“The final aspect of the research was a pilot study using MDOT (6 weeks) in 22 children with difficult to treat asthma. Healthcare professionals evaluated inhaler technique using uploaded videos and provided telephone instruction on improving inhaler use. The main outcomes were assessed at week 12 post initiation of MDOT. By week 5, all children still engaging in MDOT (n = 18) were judged to have effective inhaler technique. Spirometry values did not vary to a significantly significant degree between baseline and 12 weeks (P>0.05), however, mean fraction of exhaled nitric oxide (FeNO) values normalised (mean 38.7 to 19.3ppm) and mean Asthma Control Test values improved (13.1 to mean 17.8).”


Garfein RS, Liu L, Cuevas-Mota J, et al. Evaluation of recorded video-observed therapy for anti-tuberculosis treatment. Int J Tuberc Lung Dis. 2020;24(5):520‐525. doi:10.5588/ijtld.19.0456

Story A, Aldridge RW, Smith CM, et al. Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial. Lancet. 2019;393(10177):1216–1224. doi:10.1016/S0140-6736(18)32993-3

“In the ITT analysis, 78 (70%) of 112 patients on VOT achieved ≥80% scheduled observations successfully completed during the first 2 months compared with 35 (31%) of 114 on DOT (adjusted odds ratio [OR] 5·48, 95% CI 3·10–9·68; p<0·0001). In the restricted analysis, 78 (77%) of 101 patients on VOT achieved the primary outcome compared with 35 (63%) of 56 on DOT (adjusted OR 2·52; 95% CI 1·17–5·54; p=0·017).”

Garfein RS, Liu L, Cuevas-Mota J, Collins K, Muñoz F, Catanzaro DG, et al. Tuberculosis Treatment Monitoring by Video Directly Observed Therapy in 5 Health Districts, California, USA. Emerg Infect Dis. 2018;24(10):1806-1815.

“Median fraction of expected doses observed (FEDO) among VDOT participants was higher (93.0% [interquartile range (IQR) 83.4%–97.1%]) than among patients receiving DOT (66.4% [IQR 55.1%–89.3%]). Most participants (96%) would recommend VDOT to others; 90% preferred VDOT over DOT.”

Chuck C, Robinson E, Macaraig M, Alexander M, Burzynski J. Enhancing management of tuberculosis treatment with video directly observed therapy in New York City. Int J Tuberc Lung Dis. 2016;20(5):588–593. doi:10.5588/ijtld.15.0738

“VDOT enabled a DOT worker to observe a maximum of 25 patients per day, similar to DOT workers who observed patients in clinic (n = 25), but twice that of DOT workers who observed patients in the community (n = 12). Treatment completion with VDOT was similar to that with in-person DOT (96% vs. 97%, P = 0.63).”

Garfein RS, Collins K, Muñoz F, et al. Feasibility of tuberculosis treatment monitoring by video directly observed therapy: a binational pilot study. Int J Tuberc Lung Dis. 2015;19(9):1057–1064. doi:10.5588/ijtld.14.0923

“Compared to time on in-person DOT, 92% preferred VDOT, 81% thought VDOT was more confidential, 89% never/rarely had problems recording videos, and 100% would recommend VDOT to others.” 

Lam CK, McGinnis Pilote K, Haque A, Burzynski J, Chuck C, Macaraig M. Using Video Technology to Increase Treatment Completion for Patients With Latent Tuberculosis Infection on 3-Month Isoniazid and Rifapentine: An Implementation Study. J Med Internet Res. 2018;20(11):e287. Published 2018 Nov 20. doi:10.2196/jmir.9825

“During the study period, 70% (50/71) of eligible patients were placed on V3HP. Treatment completion among V3HP patients was 88% (44/50) compared with 64.9% (196/302) among 3HP patients on clinic DOT (P<.001).”