How Medical Devices Work Cohesively with mHealth Apps

mHealth Apps and Medical Devices Create a Comprehensive Approach to Care

Smartphones can help providers deliver part of a health intervention to a patient. Additionally, an app can connect patients with doctors via secure video calls. This engagement can be taken a step further by connecting the app with medical devices that collect biometric data.

In 2015, a team of Johns Hopkins physicians, nurses, pharmacists, engineers and public health experts, along with patients and families, developed the Corrie app, which connects with both a smartwatch to track a patient’s heartbeat and daily activity and a wireless cuff to track blood pressure.

“One of the things we’ve recognized in digital health is that part of the solution, from a technology standpoint, is having a comprehensive approach. Particularly in cardiology, it’s critical to determine what each part of the technology platform brings to the health data to help better manage and care for our patients,” says Dr. Francoise Marvel, assistant professor at the Johns Hopkins Department of Medicine, co-director of the Johns Hopkins Digital Health Lab and CEO of Corrie Health.

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The app not only tracks biometric data but also acts as a management tool. Corrie can alert users to schedule a follow-up appointment or take medications, which is especially important for patients who have recently had a heart attack or have been diagnosed with cardiovascular disease and are now on new medications. It also contains patient education materials related to heart-healthy lifestyles and instructions on how to use the devices properly.

“Often, we forget who we’re supposed to see once we leave the hospital. It’s critical to connect patients with follow-up appointments or cardiac rehab, a program that helps patients get back on track while recovering from a cardiovascular event,” says Marvel. “The app’s connect feature creates a 360-degree connection with our patients, from the hospital to the home. If I’m taking care of a patient, they can add me into the app as a contact, so they know how to find me and follow up with me if they need to.”

Johns Hopkins University’s MiCORE study paired the Corrie Health digital platform with an Apple Watch and iHealth Bluetooth-enabled blood pressure monitor to target self-management of cardiac medications, self-tracking of vital signs, education about cardiovascular disease through articles and animated videos, and care coordination that includes cardiac rehabilitation and outpatient follow-up appointments.

Measuring Success with mHealth Apps and Medical Devices

Before creating an mHealth app and connected medical device program, it’s important to identify a particular problem among a healthcare organization’s patient population. According to Dr. Rebecca Cunningham, senior medical director of primary care at Mass General Brigham,  assistant professor of medicine at Harvard Medical School and a practicing primary care physician at Brigham and Women’s Hospital, it’s best to choose an area that is a major predictor of morbidity and where there are inequities in health outcomes.

Mass General Brigham has focused much of its work on the use of medical devices in primary care for hypertension management. The goal is to enable patients to monitor their blood pressure at home and then submit the readings online to inform clinical decision-making. The organization aims to do this in a way that’s integrated, secure and equitable.

“When practices closed because of the pandemic, there was a subset of people who were able to buy blood pressure cuffs online or from a pharmacy and send in their readings. However, there was a subset of people who couldn’t do that,” says Cunningham.

This led the organization to focus its hypertension monitoring efforts on practices with patients who are less likely to have their blood pressure controlled. This patient population may have lower health literacy, speak English as a second language, or face racism or poverty.

“We’re building out a care team to help support people in their digital engagement with devices that are integrated with the electronic health record,” says Cunningham.

This could include logging in to the patient portal to use the device. The care team members can go to the home to help patients with their digital engagement, and many speak other languages to help connect with patients who don’t speak English.

“If you throw technology at people, some will be able to figure it out, but a lot cannot,” she says.

Cunningham adds that it’s equally important that clinicians know what to do with the data that is collected from these devices, which means it should be provided to them in a consumable way.

Creating measurable goals is one way healthcare organizations can determine the success of their program and create a phased approach to implementation.

Best Practices for mHealth App Implementation and Integration

The Corrie team enhanced the work it’s doing with the app by implementing a clinical dashboard to monitor the data collected from the medical devices.

“To provide secure and reliable infrastructure for the front end, which includes Corrie and the connected devices, we have an incredibly sophisticated backend that is run by Matthias Lee, our CTO, who focuses on how we get data securely to the backend system and then visualize it in the clinical dashboard in a way that creates actionable insights for our patients,” she says.

The data goes through Google Cloud using Kubernetes, a container management architecture.

“Lee has been able to create a backend architecture that allows us to scale quickly,” says Marvel. “For example, if we want to take the program to multiple hospitals, the way we’ve built it in the Kubernetes clusters in the Google Cloud platform lets us control the security and privacy to protect patients’ health information. That way, the data is only seen by providers who should have access to it with two-factor authentication.

When creating an mHealth app, Marvel says it’s important to make the information accessible and appropriate for patients, regardless of their background, to promote equity and improve outreach.

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Interoperability is also key to enhancing the clinical experience. Healthcare organizations should consider working with their EHR vendor to bring the data collected from the remote patient monitoring devices into the medical record.

At Mass General Brigham, patients engage with their data through a patient portal, which is connected to the organization’s EHR, according to Dr. Lee Park, a physician at Brigham and Women’s Hospital and senior medical director of QPE Digital Health at Mass General Brigham.

It’s also critical to ensure that the app can be used on both Android and iOS devices. Medical devices should be FDA approved. Cunningham says some devices connect to Wi-Fi via Bluetooth while others use a cellular plan, so healthcare organizations should be mindful of that when selecting devices. Lee explains that Mass General Brigham has a loaner device pilot program to provide devices for patients who don’t have a smartphones or internet so they can access the patient portal.

“Patients are eager for opportunities to engage with healthcare in a virtual environment. We know the touchpoints we have with patients from a clinical visit or in-patient stay are not enough. We’re seeing a lot of success with patients using connected devices to stay mindful and on track with their cardiovascular goals,” says Marvel. “It’s time for healthcare organizations to think deeply about how this could impact the patient experience and patient outcomes. They need to be prepared for change in healthcare. Often there’s more we can do in the patient’s community and at home than in a brick-and-mortar setting. We should take this on as an initiative and acknowledge that we can reach more people who are underserved.”