IT takes on world's deadliest disease

Massive mHealth initiative promises big change for heart disease numbers
By Erin McCann
10:20 AM
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Ida Sim

The U.S. spends 86 percent of its healthcare dollars on chronic disease. Health IT is just beginning to loosen the tight hold these conditions have on the healthcare system. We take a closer look at the effect technology is having on the top three: heart disease, cancer and diabetes. In Part I of a three-part cover story series from our February 2015 issue, we highlight how health IT is taking on heart disease. Part 2, on cancer will run on Wednesday, and Part 3 on diabetes will run on Thursday.

Think about how long four seconds is. It's almost instantaneous. One. Two. Three. Four. Done. It's no time at all, really – for anyone. But for ischemic heart disease, the leading cause of death worldwide, it's more than enough time to do serious damage. The disease is so widespread, so fatal that it claims a life nearly every four seconds. For those doing the math, that's some 7.4 million lives gone in a single year.

And if the cost of human life wasn't sobering enough, there’s also the financial toll – a nearly $109 billion price tag for the U.S. annually.

It's a pandemic that has the world's best researchers, top innovators and leading physicians joining forces to help curb the effects of one of the world's deadliest diseases.

One of the ways healthcare researchers are doing this is by employing cutting-edge mobile health technology, data analytics and making patient engagement a priority to ensure those numbers don't go anywhere but down.

A mobile health initiative spearheaded by folks at the University of California at San Francisco is working on exactly that.

[See also: mHealth takes on Ebola in Nigeria.]

The Health eHeart study, led by three UCSF professors from backgrounds in epidemiology, cardiology and clinical research, relies on mobile health devices, biometrics and patient engagement to collect vast amounts of data researchers say will be integral to identifying patterns, which can then ultimately be used for intervention, prevention and treatment.

The study, which kicked off in spring 2013, is one of the first of its kind and, thanks to partnerships forged with industry heavyweights like the American Heart Association and Practice Fusion, has already enrolled some 15,000 patients.

Ultimately, officials hope to have one million participants enrolled in the program by the end, a goal officials say is far from out of reach. The fact that a whopping 90 percent, or 284 million, Americans currently have a cellphone, according to Pew Research Center data, and nearly 60 percent own a smartphone represents a huge opportunity for this type of study.

The end game? Developing "very robust and accurate models to predict the occurrence of heart disease in people who don't yet have the disease or slow the progression in people that already have heart disease," explained Jeffrey Olgin, MD, chief, UCSF Cardiology and principal investigator of the Health eHeart project, in a 2013 press statement announcing the study's launch.

What makes this project so unique as Ida Sim, MD, co-director of biomedical informatics at UCSF's Clinical & Translational Science Institute, and the study's co-investigator, explained is that they are asking what questions patients themselves are interested in collecting and how they wish to use that data either to manage or prevent their heart disease. "I think that's a very different perspective than what we've traditionally done in research," said Sim. "Scientists and doctors think of questions we want to answer."

What's different about Health eHeart, as Sim described, is that it's a "patient powered research network" aiming to promote a "joint culture of data collection."

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"Not only is (the study) bringing in the patient voice, but it's using technology to answer questions that traditionally we have not been able to ask."

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Sim also serves as co-founder of nonprofit Open mHealth, a group of clinicians, software developers and data scientists that have joined forces to build mobile health tools and architecture.

So how does the study actually work for those 15,000 patients enrolled? Patients can use their mobile devices to connect to the data collection system, which currently supports activity tracker FitBit; Withings, which provides the wireless blood pressure cuff and weight scale sensors; and Qardio, the EKG monitor sensor, among others.

One pulse application where a participant places their finger over the smartphone camera, and under 40 seconds, they will have their heart rate.

The data system also supports Ginger.io, a platform developed by MIT scientists that tracks a user's social activity on their phones. The application logs, for instance, what kind of mobile apps an individual is running, how many calls they make or receive and GPS locations to ascertain whether the patient is active and out and about frequently or instead if they more frequently stay home.

In addition to using the sensors and applications to generate data, as part of the project, patients also participate in health and behavior surveys every six months and have the option to send pertinent medical records via a secure mHealth application.

It's beyond the biophysical data collection, said Sim, as there are "other pieces of data as well that help us understand the context of peoples' lives."

And as Sim sees it, the project is working. "The heart disease community is very activated around this," she said. "I have been really impressed with the zeal of patients to get at their data and how they really relish the chance to be an investigator themselves, to ask questions."

Though the results as of now are mostly anecdotal, UCSF researchers expect this study will lead to more effective diagnosis and treatment of heart disease patients down the road due to the large patient population enrolled. And, as Olgin added, "because these patients are connected to us electronically and through their smartphones, we can deploy the study very quickly."

Added Sim, "Not only is (the study) bringing in the patient voice, but it's using technology to answer questions that traditionally we have not been able to ask."

It's not just mobile health technology that holds promise for heart disease. Recent research also points to telemonitoring as a successful solution for heart disease patients that can have some big time effects on readmissions and total cost of care.

A 2014 Geisinger Health Plan-led study, for instance, showed that telemonitoring heart failure patients – most of whom had coronary heart disease – yielded 44 percent lower odds of 30-day readmissions when compared to patients who were not enrolled in a telemonitoring program.

The study, which enrolled some 541 heart failure patients in the telemedicine program, also yielded overall costs savings of 11 percent – that's $216 per patient, per month.

Patients enrolled in the study sent weight measurements – a common metric used to determine if the patient has fluid buildup – through a Bluetooth-enabled scale back to the case manager or primary care physician. Worsening conditions of the patients were more easily identified, as the data was transmitted in real time back to the care team. 

Interactive voice response calls, which included specific questions aimed at identifying changes in physical condition – shortness of breath, for instance – were also a hallmark of the study.

"It is our hope," said Doreen Salek, Geisinger's director of population health business intelligence, in an Oct. 2 statement announcing study findings, "that supplementing a strong case management program with telehealth solutions, as demonstrated in this study, can improve on those odds and ensure better outcomes for our aging population."