Advances in mobile technology are enabling a leap forward in the ability for healthcare providers to collect, share and analyze patients’ health information, yet to leverage the value of mHealth, the technologies must be meaningfully integrated into clinicians’ workflow. Ricky Bloomfield, M.D., director, mobile technology strategy at Durham, N.C.-based Duke Medicine, shared how Duke is working to address this issue with a number of leading edge connected health initiatives during an opening keynote for the Connected Health Symposium at the 2016 HIMSS Conference and Exhibition at the Sands Expo Center in Las Vegas.
The Connected Health Symposium, titled “Care Anytime, Anywhere – Impact of Telehealth, Mobile and Wireless Technologies,” focused on the current state of connected health and how new consumer oriented technology is impacting health and healthcare.
Bloomfield shared how Duke Medicine is moving forward with connected health initiatives using patient-centric tools as well as provider-centric technologies.
Ricky Bloomfield, M.D.
Bloomfield led the effort at Duke to integrate Apple’s HealthKit and is helping to facilitate its use among faculty for both clinical and research purposes. One pilot project aimed at patients with hypertension collects, via patients’ MyChart app, patient-generated health data from devices such as activity trackers and blood pressure devices. The MyChart app is connected to the MyChart patient portal so that patient-generated health data is transferred into Duke’s electronic health record (EHR). The goal of the project is to for providers to use the patient-generated health data to monitor patients and reduce patient readmissions.
“Why wearables, why are they relevant and why talking about them?,” he asked the audience. According to Bloomfield, wearables aren’t the last stop on the journey, as he noted there are now healthcare devices that can be swallowed and implanted to collect healthcare data.
“It will be exciting to see where it goes. And, one of the greatest opportunities is with wearable sensors that can measure several things at once,” he said, referencing a contact from Google Life Sciences (now Verily) and the Apple Watch, which continuously measures heart rate.
“A computer, a wearable, that has constant contact with our skin, to me, that’s the turning point, a computer that is touching our body, that opens up avenues that can only benefit healthcare and health in general,” he said.
And Bloomfield noted that there are efforts at the federal level to lower barriers to better facilitate the sharing of health data, such as the Office of the National Coordinator for Health IT’s (ONC) 10 Year Interoperability Roadmap.
To paint a clear picture of where healthcare technology currently stands, Bloomfield highlighted the evolution of the Microsoft Word software program from 1983 through today. When he asked the audience where EHRs are relative to the Microsoft Word timeline, most in the audience said in the 1983-1996 era.
“EHRs are internet-enabled and we have mobile apps to interact with EHRs, but what this speaks to is that we still feel that EHRs don’t give us what we need and that’s something that could be improved. There are vendors working on that as that dissatisfaction is palpable across the board,” he said.
While EHRs play an important role in workflow and standardizing processes, moving forward, health IT leaders need EHRs that provide platforms for innovation. “As we look to build clinician decisions support tools, wouldn’t be great to do it in one standardized way and not have to build a customized platform?”
According to Bloomfield, that capability will be available soon due to developments with open APIs such as SMART and FHIR. Fast Healthcare Interoperability Resources (FHIR) is an open source interface developed by the Health Level 7 (HL7) organization. And, SMART is a platform that incorporates FHIR to enable “plug-and-play apps” to run natively inside any compliant EHR.
Bloomfield that highlighted how Duke is moving forward on innovative provider-centric connected health initiatives. Geoffrey Ginsburg, M.D., director of the Duke Center for Applied Genomics and Precision Medicine, is leading a study funded by the National Human Genome Research that uses the Duke-developed MeTree software program to help providers obtain family health history information from patients.
“Family history is the most effective genomic test and it helps us predict risk for patients, understand that risk, intervene sooner and help them to be healthier by applying the right treatment to the right patient at the right time,” Bloomfield said.
MeTree is a web-based family and personal health history collection and clinical decision support program that gathers information directly from patients to improve the recording of patients’ detailed family health history.
According to Bloomfield, Ginsburg and his team are now working to integrate the MeTree platform into Duke’s Epic-based EHR using SMART on FHIR. Duke also is an implementer of the Argonaut Project and was the first health system with an Epic-based EHR to run unmodified SMART apps directly.
The MeTree platform collects personal history on medical conditions, diet, exercise, vital signs and laboratory data in addition to family health history to calculate various health-risk scores and assess risk for 20 cancers, 14 hereditary cancer and cardiovascular syndrome and 21 other conditions.
To advance in research about autism in young children, a team of researchers and software developers from Duke University and the Duke Medical Center developed the Autism & Beyond app, a free app powered by Apple’s ResearchKit. The study aims to test new video technology that can analyze a child’s emotion and behavior. The goal of the Autism & Beyond program is to test the reliability of smartphone questionnaires and video analysis of facial expressions as a possible screening tool for autism and other developmental disorders of children.
“Apple’s ResearchKit is an open source framework that allows us to create an entire research study in an app. And what that does is allow us to reach people that we couldn’t reach before and at a scale not previously possible. With the autism project, we want to hone these algorithms to help kids,” Bloomfield said. “With handheld healthcare, the promise of where it can take us is real.”
