As we do every quarter, MobiHealthNews has rounded up our Q1 2016 coverage into a handful of longform stories. This section is focused on provider-related digital health news. Skip ahead using these links to read Q1 digital health news roundups about M&A, payers, pharma, and funding.
Big movers in Q1: Apple, Harvard and Stanford
Apple once again made some big announcements this quarter that should be on healthcare providers' and medical researchers' radars. At a special event in March, Apple announced the launch of its new CareKit platform, as well as some new features of Apple ResearchKit.
CareKit is an open source toolkit for hospitals and health systems. It will launch with two applications: one for home monitoring of Parkinson's and one for post-surgical discharge. The University of Rochester Medical Center, UCSF, Parkinson's Disease Care New York, Stanford Medicine, Johns Hopkins Medicine, and Emory Healthcare will all begin using the CareKit Parkinson's app, while Texas Medical Center will pilot another app, a replacement for paper surgical discharge forms.
Apple also announced that ResearchKit would be updated to more easily make use of users' genetic data, via a module designed by consumer genetics company 23andMe. Apple added other modules for common medical tests to ResearchKit.
Apple announced three ResearchKit apps that will begin incorporating genetic data, one new app and two existing ones. PPD Act, led by the University of North Carolina School of Medicine, will use genetic data to explore the question of why postpartum depression affects some women and not others. Stanford's MyHeartCounts app will incorporate data from 23andMe users who are already using the app, to help them to study genetic predisposition toward heart conditions and how they interrelate to lifestyle and activity factors. Mount Sinai's Asthma Health app, co-developed by LifeMap Solutions, will "use genetic data from 23andMe customers to help researchers better understand ways to personalize asthma treatment," according to Apple.
One more ResearchKit app that was announced during the quarter was TeamStudy, a ResearchKit app launched by Harvard University and Sage Bionetworks that aims to gather data from former NFL players as well as the general public to study and better understand the impact playing football has on professional athletes.
Boston Children’s Hospital, which is also affiliated with Harvard, launched a second ResearchKit app this quarter called Feverprints. People all around the United States will be able to download Feverprints and contribute information about their temperature (both when sick and when well), their medication use, any symptoms they might have, and demographic data. From the de-identified, aggregate data, Hawkins hopes to learn three things: what the range of "normal" temperature is, whether different diseases have identifiable temperature profiles, and whether fever-reducing medications actually improve recovery times or just treat symptoms.
Two hospitals also announced patient-generated health data projects that used Apple HealthKit. In January, Beth Israel Deaconess shared news about BIDMC@Home, an initiative the hospital has been working on for the past six months or so. The initial cohort will most likely be 25 to 50 patients and half a dozen doctors. The focus will be on congestive heart failure and hypertension and the devices used will be connected weight scales, as a proxy for fluid balance, and blood pressure monitors. In addition, Stanford published a study intended to demonstrate how a Dexcom CGM, HealthKit, and Epic can be used together to improve glycemic control in teens and kids with Type 1 diabetes. We also learned that Epic is working on an Apple Watch app for providers.
Stanford had an impressive quarter. In addition to the ResearchKit app and the CGM study, Stanford launched an Android version of its Stanford Health Care MyHealth app, which allows patients to view their medical information, check test results, pay medical bills, manage prescriptions, schedule doctor appointments, and consult with a physician via secure messages or through the video visits feature.
The hospital also partnered with UK-based mental health provider Mersey Care NHS Trust has partnered with Stanford University to develop an app to prevent suicide. When a person opts to use it, the conceptualized app will monitor their communications, like social media accounts, emails, and phone calls, to help physicians track those at risk of committing suicide. If users show signs of visiting a location where people often commit suicide or if they miss an important appointment, the app would notify the clinicians who could then call the user.
Late in the quarter, Stanford published a study in the Journal of the American Medical Informatics Association detailing their experience setting up continuous glucose monitoring with a Dexcom G4 CGM, Apple HealthKit, and Epic. Despite some technical difficulties, the technology was largely effective and easy to use.
Boston Children’s also had a big quarter. In addition to the Feverprints study, BCH revamped its Innovation Accelerator program into a new accelerator called IDHA (Innovation and Digital Health Accelerator) which draws on the work of about 50 hospital employees and hinted at a partnership in the works with Amazon to “embed Children’s Hospital know-how” in the Amazon Echo, the company's Bluetooth speaker that doubles as a voice control hub for connected home devices and services.
Government moves in Health IT
At HIMSS, HHS Secretary Sylvia Burwell announced a new joint commitment from a number of healthcare providers and health IT companies to make patients’ data more accessible, which includes a move to implement new interoperability standards. In her announcement, Secretary Burwell outlined a three-part commitment.
The first part, consumer access, is a pledge “to help consumers easily and securely access their electronic health information, direct it to any desired location, learn how their information can be shared and used, and be assured that this information will be effectively and safely used to benefit their health and that of the community.” The second is an end to all forms of information blocking, and a requirement that physicians share health information with their patients and other providers when requested. The third is a promise to develop federally recognized national interoperability standards for EHR.
Additionally Accenture Federal Services announced a two-year consulting contract with the ONC to help the federal government create a framework for collecting and using patient generated health data in both research and clinical care. Accenture executives told MobiHealthNews that this framework is an important first step toward creating standards that would make patient generated health data more interoperable.
And over in the UK, Google subsidiary DeepMind is working with the NHS to pilot two health apps, Streams and Hark. Streams is designed to help doctors get information about their acute kidney failure patients, including blood tests, faster, which will enable faster diagnostics in situations where time is of the essence. Hark's function is to help doctors and nurses organize information that is currently managed with hand-written notes, fax machines, and pagers.
And though no longer a government actor, former President Bill Clinton moderated a panel this quarter about health innovation, arguing that even as medical technology enables some amazing things, the most important breakthroughs in public health could still come from simple technologies that can expand access to care and improve communications. Both the Clinton Foundation panel and a February report from the California HealthCare Foundation drew attention to the need to make sure low-income populations benefit from digital health innovation.
Fitbit and other patient-generated health data
Consumer health tracker Fitbit made a surprising amount of provider news this quarter. Or perhaps more accurately, a number of provider groups used Fitbits in studies. We rounded up 21 studies that used Fitbits in some capacity, and there were even more on ClinicalTrials.gov that used the many other clinical and consumer activity trackers out there.
In January, Cedars-Sinai Medical Center embarked on a small study to see if a Fitbit Charge HR can help oncologists assess whether their patients are active enough for chemotherapy. The study is seeking to enroll 30 patients in advanced stages of cancer who are ambulatory, over 18, and have access to an internet-connected smartphone. The trial will mainly be a feasibility study, seeing how effective the Fitbit — as well as questionnaires — are at monitoring this population.
At HIMSS in February, we heard even more talk about providers using Fitbits. Pamela Landis, vice president of information services at Carolinas HealthCare System, shared a number of digital health efforts underway at Carolinas, including its MyCarolinas Tracker app, which Landis said started onboarding care management program patients on February 8th. The app collects data from about 70 consumer health and fitness devices, including Fitbits, then puts it into clinical context with data visualizations that show whether they are on goal or not. It also connects to the patient portal.
While the quarter saw a lot of use of consumer health technology, at least one survey suggested that clinically-validated tracking technology would improve adoption. In a 1,011-person survey commissioned by The Society for Participatory Medicine and health technology company Biotricity, some 71 percent of US adults said they would use a health tracking device if it was clinically accurate.
Another patient-generated health data company that made news this quarter was Proteus Digital Health. In addition to some announcements in our pharma section, Proteus partnered on the provider side with Barton Health System in Lake Tahoe, California. The company says this is the first time its technology has been implemented outside of a clinical trial setting in the US. Barton will use the medication adherence platform, which includes Proteus’s FDA-cleared ingestible sensor, in populations with uncontrolled and co-morbid hypertension. Implementation for other chronic conditions will follow if the first use case goes well.
A couple of academic medical systems invested in a range of projects around health sensors and patient-generated health data. UPMC Enterprises, the venture arm of University of Pittsburgh Medical Center, announced it would invest more than $3 million into six projects over the next six months, as it assesses commercial potential of each of them. And Calit2, the University of San Diego’s California Institute for Telecommunications and Information Technology, shared some updates on the $200,000 it invested last year in five projects that aim to use aggregated personal health data to advance research.
Digital health efficacy data
The quarter was dominated by a lot of talk about digital health efficacy data after some high-profile trials yielded disappointing results. First off, in January, news broke that Scripps Translational Science Institute’s Wired For Health study showed the digital health monitoring used in the randomized control trial of 160 patients had no impact on outcomes or the cost of care during the first six months.
The results were met with a mix of reactions from people working in healthcare who shared their thoughts on Twitter, among other places. Some chalked it up to it still being the early days of digital health, others pointed to the duration of the study -- just six months -- as not being long enough to show the program's true impact. A few wondered if the trial should have been conducted a different way.
Then in February, a study called Better Effectiveness After Transition–Heart Failure (BEAT-HF), which was published in JAMA Internal Medicine, found that there was no significant difference in outcomes among patients with heart failure who used remote patient monitoring tools and those who didn’t. Researchers recruited 1,437 participants who were hospitalized for heart failure between October 2011 and September 2013 for the study.
Later on in the quarter, Dr. Joseph Kvedar, Vice President of Connected Health at Partners HealthCare, which was not involved in the study, offered some suggestions as to why the intervention showed little effect, citing adherence to treatment and integration into physician workflows as potential sticking points.
Not all the efficacy studies in the quarter were negative. For instance, a small Mayo Clinic study found that cardiac rehabilitation patients who used a health app lost more weight following a heart attack than those who went through cardiac rehabilitation without one.
Finally, at HIMSS16 in Las Vegas, Dr. Ashish Atreja, director of the AppLab at Mount Sinai hospital, announced the launch of a new data sharing initiative meant to improve the situation around digital health efficacy data. Atreja described it as a "clinicaltrials.gov for digital health pilots", where hospitals will share as much as they can about what they're working on in single site studies, in order to avoid duplication.
Another trend that continued into the quarter was hospitals launching more, and more involved, patient apps.
For instance, in January the New York-Presbyterian Hospital announced the launch of a new app, called NewYork-Presbyterian, that is designed to improve a patient’s access to the hospital as well as communication between the hospital and patients. The New York-Presbyterian app currently allows users to locate a physician, find contact information for appointment scheduling and questions, get directions to the hospital, pay bills, and connect with the hospital on Twitter. But over time, the hospital plans to add many more features.
Ochsner Health System in Louisiana introduced a new program called Optimal Hospital that encompasses a number of different apps and devices to “improve workflow efficiencies in managing patient care, initiating more frequent and dynamic patient interaction,” according to the health system. Several aspects of the program are Epic apps, like the Haiku app for iPhone and Apple Watch, the Canto app on iPad, Epic Rover on iPhone, and the MyChart Bedside app. They’re also using the Sotera Wireless ViSi Mobile System to monitor patients.
Some hospitals also announced pilots of apps for specific conditions. The NYU Langone Medical Center’s Rusk Rehabilitation facility is embarking on a new clinical trial testing the effect of a mobile app on cardiac rehabilitation beyond three months. The 100-patient trial will test the MOVN app from Marina Del Rey, California-based Moving Analytics. Massachusetts General Hospital and behavioral health startup Cogito have partnered on a National Institute of Mental Health-funded project aimed at addressing depression and bipolar disorder. And UCSF Diabetes Center has announced a partnership with mobile-enabled health coaching company Yes Health to use the company's app user data for research.
But even as more hospitals launched apps, some studies suggested those apps weren’t seeing widespread adoption. Although 66 percent of the largest 100 US hospitals have consumer-facing mobile apps, and 38 percent of those have developed proprietary apps for their patients, a mere 2 percent of patients at those 66 hospitals are using apps provided to them, according to an Accenture report that came out in January.
Another report, from the Commonwealth Fund, found that just 43 percent of iOS health apps and 27 percent of Android health apps were useful, based on an assessment of the iTunes descriptions of 945 iOS and Android health apps.
There was some talk about patient portals and personal health records this quarter, and how patients could best interact with their data. Drs. Isaac Kohane and Kenneth Mandl of the Harvard-affiliated Boston Children's Hospital, published an editorial in the New England Journal of Medicine suggesting that now might finally be the time for personal health records to gain traction. On the other hand, a group of researchers from Johns Hopkins, the Ohio State University, and the National Cancer Institute argued in favor of continued patient portal adoption, issuing a widely panned prediction that, based on projections from NCI survey data, 75 percent of US adults will use personal health records (PHRs) by 2020, even without additional interventions.