Researchers describe efforts to make new digital connections with patients

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Physicians and patients have more online connections ever, but there’s still much to learn about the best ways to integrate personal technology into patient care.

Three researchers shared their findings about wearables, smart devices and apps in “Digital Healthcare Innovations to Engage and Empower Patients in Their Care,” an online webinar hosted Oct. 11 by the U.S. Agency for Healthcare Research and Quality (AHRQ).

The agency has a Division of Digital Healthcare Research in its Center for Evidence and Practice Improvement. The division funds research that yields actionable findings about digital health care technologies that improve care for patients, clinicians and health systems, said Sheena Patel, MPH, a health research scientist there and program host. The three presenters noted they worked with teams of people, medical and technical experts, to develop the respective programs.

Helping ADHD

Attention deficit hyperactivity disorder affects an estimated 7% to 10% of the population, causing difficulties with attention to detail, hyperactivity and impulsivity, said Kimberley D. Lakes, PhD, professor in the University of California Riverside School of Medicine. It also has a high financial cost – estimated at $20 billion a year among children and $14 billion a year for adolescents, she said.

There is progress happening in medication treatments and cognitive behavioral therapies, but a current challenge is coordination across points of care, including homes, schools, therapists, psychiatrists, and pediatricians, Lakes said. That happens because of limitations on sharing information, which delays treatment adjustments, and lack of adherence or consistency in treatment can be problematic for patients.

Working with adolescents, parents, other caregivers, educators and clinicians, researchers created a smart watch and smartphone program tested in two studies with 10 families each, Lakes said.

Parents, using phone apps, and children, using the watches, would create lists of daily responsibilities, such as sleep or physical activity, schoolwork, or household chores. They decided on reward systems to motivate the youths, and the watches had prompts to encourage patients to reflect on their feelings and moods to promote emotional regulation, Lakes said.

The young people liked that the watches were discrete, she said.

“The data that we collected through the wearables also was valuable and promoting the opportunity to reflect, discuss and learn from their experiences,” Lakes said. “And it was very amenable to then making adjustments through the technology based on what was learned on a regular basis. And then finally, using these digital technologies to support parent child communication can decrease parent child conflict.”

Keeping in touch

Researchers at the University of Wisconsin-Madison interviewed older adults to discover their health needs and assets, in rural, suburban, and urban settings. Those customers “were really struggling with isolation and loneliness, with lack of community opportunities, and with transportation problems that interfered with their ability to get to where they wanted to get,” said Dave Gustafson, PhD, director of the university’s Center for Health Enhancement Systems Studies.

The researchers developed Elder Tree, an online portal with different services, ranging from a thought for the day, to a health tracker, to a public messaging system. Over a year, patients who had at least three primary care visits showed improvements in mental health quality of life, depression and feelings of social support, Gustafson said.

The researchers found advantages and limitations of using laptop computers – with larger screens, but heavier and locked by a password – and Amazon’s Alexa smart devices – lighter, but with smaller screens and sometimes limited editing ability and voice recognition.

Research continues, but participants loved weekly moderated discussions, “the key glue that held everybody together, that kept people coming back,” Gustafson said.

The researchers ran into a major technological glitch when they selected Google Nest smart devices for the program, but the tech giant ended its support for the needed back-end programming, Gustafson said.

“It's a business. I sort of understand where they're coming from, but it certainly didn't make things easy for us,” he said. “So, we had to start all over.”

Breathing easier

There is an asthma epidemic in the Bronx, so researchers have spent years developing an app that engages patients for asthma information. Despite social and economic disadvantages, patients largely had internet access, and most under age 60 had smartphones, said Sunit P. Jariwala, MD, FAAAAI, professor at the Albert Einstein College of Medicine and Montefiore Medical Center.

ASTHMAXcel has tailored push notifications, goal setting, patient and provider portals, asthma education that’s guideline-based, patient-reported outcomes, “and by far the hardest journey, but the most rewarding,” integration with electronic health records, Jariwala said.

Since then, the researchers have developed nine more apps, he said. Among their lessons learned:

• Address a pain point. “As the saying goes, you need to have the problem or understand it very well,” Jariwala said.
• KISS – Keep it simple, silly.
• MVP – Minimum viable products with rapid iteration. “One of our main lessons learned was that we waited just wait too long, I think three or four years, to launch the first version, whereas our approach now is, build the prototype and implement it. And then just get feedback and keep iterating.”
• Team science – Building the apps integrates expertise of content experts, behavioral scientists, psychologists, graphic designers, software programmers, an administrative executive champion, and experts in user interface/user experience.

The researchers measured app usage on the back end and, for patients, gamified it with leaderboards, virtual trophies and incentives, Jariwala said.

“Just to summarize, asthma mobile apps must be guideline based, user centered and validated and represent wonderful opportunities for personalized medicine and again, teamwork makes the dream work,” he said.