Can a Smart Phone Save Lives?

Self-care apps to ease the burden for those with chronic illnesses

Researchers at the Centre for Global eHealth Innovation – funded jointly by the University Health Network (UHN) and the University of Toronto – are dialing in solutions to do just that.

The centre is developing intelligent smart phone health apps that are helping those suffering from chronic illnesses self-manage their diseases, so that fewer people end up in the hospital.

It’s a win-win situation, according to Joseph Cafazzo , Lead at the Centre for Global eHealth Innovation and Senior Director, Healthcare Human Factors, University Health Network. Cafazzo points out that hospitals are designed to deal with only the most acute care moments rather than long term diseases requiring constant monitoring.
In fact, says Cafazzo, who is also an Assistant Professor in the Faculty of Medicine and Cross-Appointed faculty at the Institute of Biomaterials and Biomedical Engineering (IBBME), as many as 20% of chronically-ill patients are readmitted to hospital within 30 days of discharge–putting an added pressure on an already overburdened system.

Meanwhile, on average, a family physician will spend just 11 minutes with his or her patients, meaning that even those requiring chronic care monitoring are receiving little time with this front-line resource to help manage their disease.

So Cafazzo and his team decided to solve this problem from an end-user perspective: why not put tools into the hands of those with chronic diseases and their primary care givers – tools that will help this population take greater control over their diseases? Why not design intelligent, receptive systems that will help patients self-manage their illnesses and keep them out of the hospital?

The answer came in a deceptively simple packaging: the smart phone.

Inspired by a pilot project instituted by Toronto General that allowed patients to self-administer kidney dialysis in their homes, Cafazzo and his team developed Bant, a smart phone application created to help adolescent youth manage their Type 1 Diabetes.

Many teens don’t check their insulin levels while at school, citing reasons such as embarrassment before their peers and the general inefficiency of trying to take, record and send blood sugar readings in school bathrooms or cafeterias.

“This is an important time for kids to learn to self-regulate their disease,” explains Cafazzo, who while developing the app discovered that many adolescents were “tired of simply being data collectors,” and instead wanted more decision-making power regarding the management of their disease.

Cell phones were an easy choice for Cafazzo to start with since many of the kids would both have and be familiar with the technology. But the team knew that an app to help youth monitor their health couldn’t simply be a logbook of reading times and levels, but needed to be dynamic, interactive, and rewarding.

The Bant app, which went into clinical trials at Toronto’s Sick Kids Hospital, was designed to address these challenges by making the transfer of information immediate and wireless. Voluntary blood sugar readings are sent through a wireless interface on a smart phone, doing away with any “plug-in” technologies that might dissuade busy and distracted youth.

The design also implemented features to motivate adolescent participants, in particular, a social media “microblogging” component dedicated to patients and their families allows teens to publish their readings and promotes a dialogue with other teens managing their illness.

And, while parents are better able to monitor their child’s daily health, records are also instantaneously transmitted to health care providers. The app also boasts a learning component that helps teens understand the trends of their readings and make diet and exercise choices that lead to better health outcomes.

A rewards program – much like customer loyalty programs such as Air Miles – was also incorporated into the design, giving teens the chance to earn and redeem points for self-care management.

The results of the trial was remarkable: those who participated boasted a 49.6% jump in daily testing frequency, while recording a very high satisfaction rate of 87.5%.

But the Bant team went further, in that while most apps for chronic disease management are available only in English, Bant was produced in several languages. The app has since been downloaded 55,000 times, and lists more than 8,000 active daily users.

Other apps the Global eHealth Innovation team has been working on include one aptly called Breathe – for the Ontario Lung Association, which helps those suffering from Asthma – and one developed in conjunction with the Netherlands to monitor ECG readings from portable heart sensors in real time.

Cafazzo’s team also worked on an app funded through the Heart and Stroke Foundation to help hypertension patients monitor their conditions in the privacy of their homes without clunky and expensive equipment.

Patients in a clinical trial were given a Blackberry smart phone, which helped collect daily stats on blood pressure. Patients were prompted three times a week to take their blood pressure using a Bluetooth-enable blood pressure monitor. If a participant forgot, the phone prompted them.

The cardiovascular mortality rate dropped by a stunning 20% during the trial.

Importantly, Cafazzo points out, the outcomes in these app trials have everything to do with the patients and very little to do with health care interventions.

“Physicans have very little to do with this. Doctors did not prescribe new meds or schedule more visits,” he argues.

Instead, participants in the trials were described as more self-aware, more accountable, and tended to take important readings more frequently.

Because they’re designed with the end user’s needs and habits, these chronic illness management apps tends to be very sensitive to the community they serve, and are built to overcome the many hurdles between patients and their health – by putting the tools right into their hands.

Read further on IBBME’s Clinical Engineering programs.