%0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e56 %T Detecting Influenza Epidemics Using Self-reported Data Through Mobile App (FeverCoach) %A Kim,Myeongchan %A Yune,Sehyo %A Han,Hyun Wook %+ Department of Biomedical Informatics, School of Medicine, Ajou University, 206, World cup-ro, Suwon,, Republic Of Korea, 82 1062920812, james.hw.han@gmail.com %K children %K epidemics %K health care %K human influenza %K Mobile health (mHealth) %D 2017 %7 22.9.2017 %9 Abstract %J iproc %G English %X Background: Timely forecast of influenza activity is critical for a public health system to prepare for an influenza epidemic and mitigate its burden. Currently, influenza surveillance relies on traditional data sources such as reports from health care providers, which lag behind real-time by several days to weeks. In an effort to reduce the time lag, internet search information, voluntary web-based records, and electronic health records have been suggested as the alternative data sources for influenza surveillance. However, low specificity, low rate of report, or privacy concerns limits the use of such data. Objective: FeverCoach mobile application provides tailored information to help caregivers manage a febrile child. Using the self-reported diagnosis data submitted to the app, we developed a new algorithm that accurately predicted the influenza trend in South Korea. Methods: Users of FeverCoach agreed to the use of de-identified data for research purposes. The app shows information about use of antipyretics and adjuvant way to relieve fever when users enter the child’s age, sex, body temperature, and the duration of fever. Users can choose from the list of 21 candidate diseases including Influenza after a physician office visit. Additional information about the disease was provided following submission of the diagnosis. Public influenza-like illness (ILI) data was obtained from the Korea Centers for Disease Control and Prevention (KCDC) website. The data was collected from September 2016 to March 2017. Ordinary least squares linear regression was used to build a model using the data from the app to predict the influenza trend. To perform linear regression, we calculate logit(Pcdc) and logit(Papp) where logit(p) is natural log of p/(1-p), Pcdc is (ILI visit counts)/(total patient visit counts) and Papp is (Influenza report on FeverCoach)/(total diagnosis report on FeverCoach). Results: We collected 13,014 self-reported diagnoses. Of all users, 81% of the children were under 5 years of age. The animated visualization of spatiotemporal diagnosis report is available online at https://www.youtube.com/watch?v=-8kDXz43gO8. Ordinary least square regression showed significant association between logit(Pcdc) and logit(Papp) (R2=0.860, P<.001). Using this regression model, we could detect an influenza epidemic 5 days before the 2016-2017 season’s influenza epidemic alert by KCDC. Conclusions: We found that it is possible to predict influenza epidemics earlier than KCDC with a relatively small amoount data. Collection of specific and accurate data was made possible by targeting a well-defined population. %R 10.2196/iproc.8686 %U http://www.iproc.org/2017/1/e56/ %U https://doi.org/10.2196/iproc.8686 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e45 %T E-motivate: Development of an App To Improve African Americans’ Screening Colonoscopy Rates %A Miller,Sarah %A Atreja,Ashish %A Fasihuddin,Farah %A Ramireddy,Karthik %A Zlatopolsky,Rivelle %A Deorocki,Allyssa %A Hassanzadeh,Neda %A Farahani,Ariana %A Lodhi,Sameed %A Otobo,Emamuzo %A Rogers,Jason %A Jandorf,Lina %+ Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY,, United States, 12122415090, sarah.miller@mssm.edu %K Colorectal cancer %K Mobile application %K Patient engagement %K Prescribing %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: Colorectal cancer (CRC) is the third leading cause of death due to cancer in the United States. Compared to other racial/ethnic groups, African Americans have the highest CRC morbidity and mortality rates. Despite the proven efficacy of CRC screening, more than one-third of African Americans have not received a colonoscopy screening within the recommended time frame (one colonoscopy per ten years). It is critical to improve this group’s colonoscopy screening uptake to reduce the burden of CRC among African Americans. Objective: The primary goal was to develop a tablet app, e-motivate, which incorporates motivational interviewing principles to increase African Americans’ colonoscopy screening uptake. Two-step field testing was conducted to examine the app’s efficacy. Methods: Participants (N=40) were African American primary care patients over the age of 50 (recommended age to begin screening for CRC). Immediately after receiving a colonoscopy screening referral, patients field-tested e-motivate in the primary care office, which took approximately 20 minutes. For Field Test 1, 20 participants used the app and engaged in a think-aloud exercise to assess the intervention’s feasibility. The feedback from Field Test 1 was used to modify the app. Field test procedures were repeated on an additional 20 participants to confirm feasibility. The feedback from the Field Test 2 was used to further modify the app. Results: In Field Test 1, descriptive statistics were run to determine the usability and acceptability of the app. The mean overall score on the System Usability Scale of 86.62 (possible range from 0 to 100) indicates high usability. The mean score on the Acceptability E-Scale of 4.8 (possible range from 1 to 5) indicates high acceptability of the app. Qualitative thematic analysis revealed that participants found the e-motivate 1.0 app to be user-friendly and helpful. Some participants reported difficulty with certain app functions (e.g., using a slider icon). The participants’ suggestions were used to guide the development of the e-motivate app 2.0. Field Test 2 is ongoing and results will be reported in the final poster presentation. Iterations to follow will be based on patient feedback. Conclusions: The two-step field test approach focused on user-centered design and directly informed the development of a user-friendly, patient-driven app with optimal user satisfaction and engagement to help improve screening colonoscopy uptake in African Americans. The next critical step in the app’s development is to test the efficacy of e-motivate in a randomized clinical trial. If the app is successful in the RCT there is a strong case for integrating e-motivate into standard clinical practices with the ultimate goal of reducing the preventable and unequal burden of CRC among African Americans. In the future, the digital prescribing platform RxUniverse, an efficient program which enables physicians to “prescribe” evidence-based mobile health applications to a large population of patients, can be used to bulk prescribe e-motivate. Trial Registration: Improving Colonoscopy Screening Uptake to Reduce the Burden of CRC Among African Americans %R 10.2196/iproc.8462 %U http://www.iproc.org/2017/1/e45/ %U https://doi.org/10.2196/iproc.8462 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e44 %T Review of Alzheimer’s Disease Focused Mobile Applications %A Ezeanya,Victor %A Choi,Seul Ki %A Friedman,Daniela %A Kannaley,Kristie %+ Division of Mathematics and Natural Sciences, Allen University, 1530 Harden Street, Columbia, SC, 29204, United States, 1 376 5700, ezeanyavictor@gmail.com %K Alzheimers %K Caregivers %K Dementia %K Mobile health (mHealth) %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: As of 2017, an estimated 5.5 million Americans are living with Alzheimer’s disease and related dementias (ADRD). Information and support for individuals with ADRD and their caregivers are critically needed. Technological advancements have provided patients and caregivers with tools that can provide information and education in areas such as improving awareness about the disease, disease management, and caregiving skills training. Mobile applications (apps) are an example of these tools. Studies have been conducted to assess the content of mobile apps focused on other health issues such as diabetes, weight management, and cancer; however, little is known about ADRD-related mobile apps. To our knowledge, this is the first comprehensive review of apps focused on ADRD. Objective: The objective of this study was to review the content of ADRD-related mobile apps. Methods: ADRD-related mobile apps were searched using keywords such as “Alzheimer”, “Alzheimer’s Disease” and “Dementia” in the App store for iOS-supported apps and Google Play Store for Android-supported apps. Apps were included for final review based on description, and inclusion and exclusion criteria. Three reviewers coded characteristics of the app (e.g. developer, version, number of installations, user ratings), target users, purpose, content of information provided, and technical aspects. Descriptive statistics, including frequencies and percentages, were used to analyze the data. Results: A total of 38 apps were included in the review (16 were only available in iOS; 9 were only available in Android; 13 apps were available in both operating systems). IT companies developed 36.8% of the apps reviewed, followed by non-profit organizations (18.4%), and health-consulting organizations (10.5%). Very few apps were developed by government agencies (5.3%) or pharmaceutical companies (5.3%). Most apps were intended for caregivers of individuals with ADRD (63.2%), followed by the general population (44.7%). The main purpose of the apps was for disease management (55.3%), skills training (42.1%), disease and treatment information (34.2%), and to improve disease awareness (29.0%). Very few apps had a goal of providing peer support (2.6%). Most of the content was focused on caregiving (63.2%) and disease management (50.0%). Other information frequently presented included signs and symptoms of ADRD (34.2%), types of ADRD (31.6%), financial and legal issues (29.0%), resources for supporting patients (29.0%), and healthy lifestyle for ADRD prevention (29.0%). Few apps contained information about differences between typical aging and ADRD symptoms (13.2%), and health insurance option for ADRD patients (10.5%). Few apps had video (23.7%) or audio (2.6%) lectures or tutorials. Interactive features were limited; few apps had a function of sharing (18.4%), an app community (10.5%), or sending reminders (7.9%). Conclusions: ADRD mobile apps that provide caregiving information can potentially benefit individuals who are supporting ADRD patients. Most ADRD mobile apps reviewed did not cover certain aspects related to ADRD, such as how to differentiate ADRD symptoms from typical aging. In addition, information provided by the apps was mainly presented in the form of text with limited audio/video options. There are opportunities for further development of ADRD apps with respect to content and format. %R 10.2196/iproc.8460 %U http://www.iproc.org/2017/1/e44/ %U https://doi.org/10.2196/iproc.8460 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e43 %T A Web-Based Tool to Facilitate Shared Decision-Making Regarding Neoadjuvant Chemotherapy Use in Muscle-Invasive Bladder Cancer %A Galsky,Matthew %A Diefenbach,Michael %A Mohamed,Nihal %A Baker,Charles %A Pokhriya,Sumit %A Rogers,Jason %A Atreja,Ashish %A Ramireddy,Karthik %A Hu,Liangyuan %A Tsao,Che-Kai %A Sfakianos,John %A Mehrazin,Reza %A Hassanzadeh,Neda %A Waingankar,Nikhil %A Oh,William %A Kohli,Akshay %A Otobo,Emamuzo %A Mazumdar,Madhu %A Ferket,Bart %+ Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY,, United States, matthew.galsky@mssm.edu %K Muscle invasive bladder cancer %K Radical cystectomy %K Neoadjuvant chemotherapy %K Mortality %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: Urothelial bladder cancer kills over 16,000 people annually. Approximately 30% of affected patients have cancer cells invading the muscularis propria at the time of diagnosis. Standard management for muscle-invasive bladder cancer (MIBC) patients involves radical cystectomy and pelvic lymph node dissection. Approximately 50% of these patients will develop fatal metastatic recurrence. In an attempt to eradicate micrometastatic disease, neoadjuvant chemotherapy (NAC) was integrated into treatment. Even though studies show that this improves these patients’ prognosis, population-based studies have demonstrated that NAC is still underutilized. The difficulty of predicting an individual patient’s outcome with cystectomy alone and the potential added benefit with NAC was cited as a common reason for this. Objective: The aim of this study is to develop a web-based app for MIBC patients treated with cystectomy, with or without NAC, designed to improve prediction and enhance communication of these patients’ prognosis. Methods: This study included patients from the National Cancer Database (2003 through 2011) who were diagnosed with MIBC and were subsequently treated with cystectomy. Patient, tumor, and facility-level predictors were incorporated in the outcome prediction model and a state-transition model was synthesized to calculate the 5-year death risk with and without NAC. Internal and external cross-validations were performed to validate the predictions. Using U.S. Life Tables, bladder cancer-specific and other cause mortality were distinguished from all cause mortality rates. The effect of NAC was integrated using a literature-derived hazard ratio (HR). Finally, a web-based tool was developed using the state transition model and usability testing was performed. Results: A total of 9,824 patients who had MIBC and underwent cystectomy met the eligibility criteria and were included in the prediction model (Figure 1). Factors such as race, advanced age, higher clinical T stage, and higher comorbidity index were associated with shorter survival. On the other hand, factors like private insurance, higher income, and undergoing cystectomy at a higher volume facility were associated with longer survival. The prediction model was well-calibrated across geographical regions. Individualized survival estimates of each patient can be generated using the web-based app (BladderCancerRisk.org) by feeding in the predictor variables and a user-defined HR associated with the effect of NAC. The output of the tool is displayed using infographics (Figures 2 and 3). A cohort consisting of 13 clinicians field-tested the usability of the tool. Conclusions: A web-based user-friendly app was developed for patients with MIBC treated with cystectomy, with or without NAC, which individualizes outcome prediction and communication in these patients, and may also facilitate physician-patient shared decision-making. This app can be easily accessed or prescribed by the physicians using the Rx Universe platform (a digital platform that enables physicians to directly “prescribe” evidence-based mobile health applications to patients). %R 10.2196/iproc.8456 %U http://www.iproc.org/2017/1/e43/ %U https://doi.org/10.2196/iproc.8456 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e42 %T Competitive Usability Study: Ideal Checkout Experience for Prescriptions %A Jin,Ellie Shuo %A Pratt,Elizabeth %A Smith,Danielle %+ Department of Psychology, College of Liberal Arts, The University of Texas at Austin, 108 E. Dean Keeton Street, Austin, TX, 78751, United States, 1 3462560, ellieshuojin@utexas.edu %K online %K prescriptions %K user centered design %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: What makes for an ideal checkout experience for prescriptions? Due to a variety of factors, including access and convenience, greater percentage of Americans are choosing to complete prescription purchases online. Objective: In a nationally representative remote usability study, we compared the online checkout experience between Express Scripts, Amazon, Walgreens, and CVS among maintenance medication takers between ages 21 to 65+ in order to identify the ideal checkout experience for patients. Methods: The 24 participants recruited from across the United States completed online checkout of vitamins on Express Scripts, Amazon, Walgreens and CVS through remote screen share. Results: Results indicate that usability and appearance play important roles in patients’ judgement of trust and credibility, as well indices of loyalty (eg, likelihood of returning and referral to colleague/friend). Specifically, usability of a website was significant in terms of being positively associated with trust of the website (r=.659, P<.001), and loyalty to the company (r=.707, P<.001). Conclusions: Recommendations for improving online checkout highlight opportunities to increase patient satisfaction and overall company revenue. %R 10.2196/iproc.8749 %U http://www.iproc.org/2017/1/e42/ %U https://doi.org/10.2196/iproc.8749 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e38 %T Evaluating the Usability and Usefulness of a Mobile Application for Atrial Fibrillation Using Qualitative Methods: Exploratory Pilot Study %A Hirschey,Jaclyn %A Bane,Sunetra %A Mansour,Moussa %A Sperber,Jodi %A Agboola,Stephen %A Kvedar,Joseph %A Jethwani,Kamal %+ Partners Connected Health, Partners HealthCare, 25 New Chardon Street, Suite 300, Boston, MA,, United States, 1 7242361, jhirschey@mgh.harvard.edu %K medication adherence %K pilot study %K nonvalvular atrial fibrillation %K patient self-care %K mobile application %K exploratory research %K usability study %K acceptability study %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: Atrial fibrillation (AFib) is the most common form of heart arrhythmia and a potent risk factor for stroke. Non-vitamin K antagonist oral anticoagulants (NOACs) are routinely prescribed to manage AFib stroke risk, however non-adherence to treatment is a concern. Additional tools that support self-care and medication adherence may benefit patients with AFib. Objective: To evaluate the perceived usability and usefulness of a mobile application (app) designed to support self-care and treatment adherence for AFib patients who are prescribed NOACs. Methods: A mobile app to support AFib patients was previously developed based on early stage interview and usability test data from clinicians and patients. An exploratory pilot study consisting of naturalistic app use, surveys, and semi-structured interviews was then conducted to examine patients’ perceptions and everyday use of the app. Results: Twelve individuals with an average age of 59 years and a diagnosis of AFib completed the 4-week study. All participants somewhat or strongly agreed that the app was easy to use, and 92% (11/12) reported being satisfied or very satisfied with the app. Participant feedback identified changes that may improve app usability and usefulness for patients with AFib. Areas of usability improvement were organized by three themes: app navigation; clarity of app instructions and design intent; and software bugs. Perceptions of app usefulness were grouped by three key variables: core needs of the patient segment; patient workflow while managing AFib; and the app’s ability to support the patient’s evolving needs. Conclusions: The results of this exploratory study suggest that mobile tools that target self-care and treatment adherence can be helpful to AFib patients, particularly those who are newly diagnosed. Additionally, participant feedback provided rich insight into the varied needs and health experiences of AFib patients, which may improve the design and targeting of the intervention. The benefits of qualitative methods for gaining rich insight into the real-world use and acceptability of health applications are well documented, and the value of incorporating patient perspectives during the early stages of intervention design is supported by a growing body of research. Yet, it is still rare in medical research to use qualitative methods to examine patient perceptions of a treatment at an early stage, or at all, prior to implementation. This often leads to less than optimal, or even negative outcomes for patients who receive the intervention. The results from this study we hope will help clinicians and researchers in the field of AFib care learn from our qualitative research and design insights, and ultimately build better tools for patients with this burdensome condition. Additional studies evaluating the AFib Connect mobile app over a longer period, and including a larger, more diverse sample of AFib patients, will be helpful for understanding whether the app is more broadly useful and effective in supporting patient self-care and medication adherence. %R 10.2196/iproc.8591 %U http://www.iproc.org/2017/1/e38/ %U https://doi.org/10.2196/iproc.8591 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e37 %T Feasibility of an Automated System Counselor for Survivors of Sexual Assault %A Howe,Esther %A Pedrelli,Paola %A Morris,Robert %A Nyer,Maren %A Mischoulon,David %A Picard,Rosalind %+ Department of Psychiatry, Massachusetts General Hospital, 6th Floor, 1 Bowdoin Square, Boston, MA,, United States, 1 6176437690, ehowe3@mgh.harvard.edu %K CBT %K web chat %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: Sexual assault (SA) is common and costly to individuals and society, and increases risk of mental health disorders. Stigma and cost of care discourage survivors from seeking help. Norms profiling survivors as heterosexual, cisgendered women dissuade LGBTQIA+ individuals and men from accessing care. Because individuals prefer disclosing sensitive information online rather than in-person, online systems—like instant messaging and chatbots—for counseling may bypass concerns about stigma. These systems’ anonymity may increase disclosure and decrease impression management, the process by which individuals attempt to influence others’ perceptions. Their low cost may expand reach of care. There are no known evidence-based chat platforms for SA survivors. Objective: To examine feasibility of a chat platform with peer and automated system (chatbot) counseling interfaces to provide cognitive reappraisals (a cognitive behavioral therapy technique) to survivors. Methods: Participants are English-speaking, US-based survivors, 18+ years old. Participants are told they will be randomized to chat with a peer or automated system counselor 5 times over 2 weeks. In reality, all participants chat with a peer counselor. Chats employ a modified-for-context evidence-based cognitive reappraisal script developed by Koko, a company offering support services for emotional distress via social networks. At baseline, participants indicate counselor type preference and complete a basic demographic form, the Brief Fear of Negative Evaluation Scale, and self-disclosure items from the International Personality Item Pool. After 5 chats, participants complete questions from the Client Satisfaction Questionnaire (CSQ), Self-Reported Attitudes Toward Agent, and the Working Alliance Inventory. Hypotheses: 1) Online chatting and automated systems will be acceptable and feasible means of delivering cognitive reappraisals to survivors. 2) High impression management (IM≥25) and low self-disclosure (SD≤45) will be associated with preference for an automated system. 3) IM and SD will separately moderate the relationship between counselor assignment and participant satisfaction. Results: Ten participants have completed the study. Recruitment is ongoing. We will enroll 50+ participants by 10/2017 and outline findings at the Connected Health Conference. To date, 70% of participants completed all chats within 24 hours of enrollment, and 60% indicated a pre-chat preference for an automated system, suggesting acceptability of the concept. The post-chat CSQ mean total score of 3.98 on a 5-point Likert scale (1=Poor; 5=Excellent) suggests platform acceptability. Of the 50% reporting high IM, 60% indicated preference for an automated system. Of the 30% reporting low SD, 33% reported preference for an automated system. At recruitment completion, ANOVA analyses will elucidate relationships between IM, SD, and counselor assignment. Correlation and linear regression analyses will show any moderating effect of IM and SD on the relationship between counselor assignment and participant satisfaction. Conclusions: Preliminary results suggest acceptability and feasibility of cognitive reappraisals via chat for survivors, and of the automated system counselor concept. Final results will explore relationships between SD, IM, counselor type, and participant satisfaction to inform the development of new platforms for survivors. %R 10.2196/iproc.8585 %U http://www.iproc.org/2017/1/e37/ %U https://doi.org/10.2196/iproc.8585 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e36 %T Building Mobile Technologies to Improve Transitions of Care in Adolescents with Congenital Heart Disease %A Lopez,Keila %A O'Connor,Michael %A King,Jason %A Alexander,Douglas %A Challman,Melissa %A Lovick,Donna %A Goodly,Nicole %A Bonaduce De Nigris,Francesca %A Smith,Amelia %A Fawcett,Elliott %A Mulligan,Courtney %A Thompson,Deborah %A Fordis,Michael %+ Pediatrics, Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, Houston, TX,, United States, 1 8265915, knlopez@bcm.edu %K adolescent health %K chronic disease %K health disparities %K mobile health (mHealth) %K patient empowerment %K patient involvement %K self-efficacy %K smartphone %K user centered design %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: Congenital heart diseases (CHDs) are the most common type of birth defects. Improvements in CHD care have led to roughly 1.4 million survivors reaching adulthood. This emerging “survivor” population are often palliated but not cured. Thus successful transition from pediatric to adult care for CHD patients is crucial. Of adults with CHD, <30% are seen by adult CHD physicians. Transition and Transfer rates are even worse for minority and lower socioeconomic status (SES) populations. Few CHD transition programs exist, necessitating creation of a tool to assist in the transition to adult care for a diverse CHD population. Objective: The objective of this project was to first complete a stakeholder needs assessment to inform the educational content and design of our mobile application; second, we aimed to develop the design, functional, and educational components for a mobile application guided by an adolescent CHD expert panel. Methods: To inform our mobile application, we conducted a literature search regarding best practices in transition medicine, adolescent mobile applications, as well as expert CHD guidelines. We also conducted individual interviews in the cardiology clinic with CHD adolescents to understand possession of mobile phones, knowledge gaps, and missing transition readiness skills. We then partnered with 2 adolescent CHD expert panels, pediatric and adult cardiologists, and transition experts to further determine our educational content and mobile application design. Results: We completed 327 individual interviews with CHD adolescents ages 15-22 years. Of these, 78.2% had moderate or severe CHD complexity; 41.6% of CHD adolescents were female; 12.7% were African American; and 35.8% were Latino. Of these patients, 36.5% had public insurance. Most patients had minimal understanding of their CHD, but expressed an interest in learning (42.2% of aged 15-17 years and 47.9% aged 18-22 years). Average transition readiness scores reflected an average of 49.4% readiness for those aged 15-17 and 58.6% for those aged 18-22. Of the adolescents, 95.8% had access to a smartphone. The adolescent expert panel expressed the need for an application tailored to their specific CHD, for quick access to specific educational questions (eg, “can I exercise”), for a forum to tell their stories or hear from others with CHD, to have mentorship, and to have a checklist so they could know what needed to be done during their transition. They also desired to make CHD clinic appointments and have a way to ask questions on the application. We subsequently built a mobile application incorporating assessments of transition readiness and knowledge, a CHD diagram, a medical summary, as well as the recommended blog, checklist, and question/answer space. Conclusions: Based on our data of average CHD knowledge and transition readiness scores, CHD adolescents are largely not prepared for the transition and transfer to adult care. The vast majority of adolescents possess a smartphone, regardless of SES or race/ethnicity. Adolescents with CHD informed areas of focus for a mobile application to aid in the transition process that drove the creation of our mobile application. Next steps are to conduct usability testing, to further build CHD educational content, to perform alpha and beta testing, and use focus groups to refine our current mobile application. %R 10.2196/iproc.8583 %U http://www.iproc.org/2017/1/e36/ %U https://doi.org/10.2196/iproc.8583 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e24 %T Use of Electronic Patient Reported Outcomes and Automated Devices for Heart Failure Disease Management %A Pinney,Sean %A Otobo,Emamuzo %A Freeman,Robert %A Rogers,Jason %A Fasihuddin,Farah %A Ramireddy,Karthik %A Deorocki,Allyssa %A Hassanzadeh,Neda %A Goldstein,Marni %A Zlatopolsky,Rivelle %A Ullman,Jennifer %A Atreja,Ashish %+ Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY,, United States, 1 2416500, sean.pinney@mssm.edu %K congestive heart failure %K sensors %K quality of life %K electronic patient reported outcomes %K remote monitoring %K self-management %K hospital readmission %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: Congestive heart failure (CHF) is a major public health issue. Today, CHF affects 6.5 million people in the U.S. and the incidence rate is projected to rise by 46% to more than 8 million cases by 2030. Current reimbursement policies use readmission rates and length of hospital stays as indicators of quality of care, and incentivize providers to meet these quality measures as the cost of hospitalization alone significantly contributes to the overall burden of CHF on patients and health systems. Symptoms of CHF can be unpredictable and presently there are no reliable solutions to track disease control for discharged patients. Objective: This study aims to improve patients’ self-monitoring practices post-hospital discharge, quickly identify critical warning signs, decrease hospital readmissions and reduce healthcare costs for CHF patients by integrating remote monitoring ePRO into standard outpatient care practices. Methods: The pilot study seeks to enroll 60 patients who were admitted to The Mount Sinai Hospital for acute CHF exacerbation and have access to either an Android or iOS enabled smartphone. RxUniverse (a digital platform that enables physicians to directly “prescribe” evidence-based mobile health applications to patients) will be used to prescribe HealthPROMISE and iHealth mobile apps (Figure 1). Patients update and record their CHF-related symptoms and quality of life measures daily on HealthPROMISE. Vital sign data, including blood pressure, heart rate, and weight, is collected through an ambulatory remote monitoring system that includes a smartphone application and Bluetooth-connected smart devices. ePRO data is submitted electronically to a dashboard monitored daily by a practitioner, who determines whether to continue current care or to call the patient for further assessment of symptoms (Figure 2). Any critical red-flag values automatically alert the physician and prompt the patient to seek medical attention. Enrollment barriers included: onboarding time (30 minutes), identifying patients, competition with other Mount Sinai initiatives and research trials, language barriers, and low health literacy (Figure 3). Results: The study had 52 of the 60 patients enrolled. Thirty-eight patients (73%) continue to actively use the mobile apps and smart devices to track blood pressure and weight, 27 patients (52%) have completed one month of active use, while 5 patients have dropped out. There have been 4 hospital readmissions (7%) mainly due to non-compliance and complications from other chronic conditions (Figure 3). Conclusions: Given the increasing burden of CHF on patients and healthcare systems, there is a critical need for an effective, sustainable, and feasible remote monitoring system for CHF patients following hospital discharge. The ability for providers to access patient-reported outcomes and vital signs in real-time can significantly impact the quality of outpatient care, potentially reducing readmissions and costs. CHF patients are showing positive health outcomes; CHF patients had a 7% readmission rate compared to the national readmission rate of >25% within 30 days of discharge. Enrollment challenges were overcome by enrolling CHF patients 2-3 days before expected discharge and adding a patient coordinator to hospital rounds. These latest advances in remote monitoring show promise for the future of technology-connected healthcare. %R 10.2196/iproc.8459 %U http://www.iproc.org/2017/1/e24/ %U https://doi.org/10.2196/iproc.8459 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e21 %T Engaging Heart Failure Patients with Interactive Voice Response Calls and Multimedia Programs as They Transition from Hospital to Home %A Mulert,Mark %A Wolens,Elizabeth %A Clough,Joann %A Baumblatt,Geri %A Gottlieb,Jason %+ Emmi, 300 W Adams St, Suite 1200, Chicago, IL,, United States, geri@emmisolutions.com %K adherence %K congestive heart failure %K engagement %K heart failure %K heart failure, congestive %K interactive voice response %K Internet-informed patient %K multimedia %K online survey %K patient activation %K patient communication %K patient education %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: When people with heart failure (HF) are discharged from hospitals, they need to manage their condition. Patients are overwhelmed and feel poorly. To avoid complications and readmissions, it’s essential they quickly engage in new behaviors, such as weighing themselves each day. Patients often do not start or maintain these behaviors. Objective: Researchers sought to measure the impact of a user-centered, interactive voice-response (IVR) phone call and multimedia program series (EmmiTransition®) to educate, and motivate patients to take self-care actions post-discharge. Methods: Researchers analyzed call records and conducted aggregate analysis from patients who interacted with the series between August 2013 and May 2016 at UAB Medicine and other healthcare organizations. The 45-day IVR series explains key concepts and behaviors and asks patients to report information like their daily weight. Short multimedia programs provided additional information. Call records from 4,503 patients who completed the series were analyzed. There were 3,615 people who answered and interacted with the calls. Interactions were analyzed to identify the impact on driving people to report their weight daily post-discharge. The percentage of patients who reported weighing themselves daily increased steadily over the first two weeks. After viewing a multimedia program, patients could take an optional survey from Emmi Solutions. Responses and comments were tabulated. Results: On day one of the IVR calls, 66% of UAB Medicine patients who answered the call reported their weight. On day 14 of the calls, 89% of UAB Medicine patients who answered the call reported their weight, comprising a 36% increase in reporting in two weeks. The behaviors seen over the first two weeks were sustained. For the remaining 30 days of the series, 93% of patients who answered calls continued to report their weight. There were 936 patients who opted to take the post-multimedia program survey. The survey findings were as follows: 66% showed increased confidence to ask questions; 75% were prepared to manage their health condition; 75% were more motivated to take their medications; 89% were more aware of how their lifestyle impacts health; 87% were willing to take new action to manage their health; and 88% indicated that they were motivated to change their lifestyle. Examples of patient comments follow: “Read labels and try to decrease processed foods and transfer to whole fruits and vegetables utilizing herbs for seasoning”; “making sure I have a calendar over the bathroom scales to keep track of weight instead of going my memory”; “was not aware diet soda contained high salt count. I will not drink diet sodas as often maybe a glass once or twice a week”; “I will get a flu and pneumonia shot every year. This is not something I did in the past.” Conclusions: Most patients who engaged in this series started a new behavior, regularly reporting they weighed themselves. Most people continued this behavior throughout the 45-day series. Most patients who viewed a multimedia program and completed the survey expressed plans to take specific actions or behavior changes based on information offered by the program about how to weigh themselves, reduce sodium, or manage their fluids. %R 10.2196/iproc.8457 %U http://www.iproc.org/2017/1/e21/ %U https://doi.org/10.2196/iproc.8457 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e15 %T Towards Precision Stress Management: Design and Evaluation of a Practical Wearable Sensing System for Monitoring Everyday Stress %A Hao,Tian %A Rogers,Jeffrey %A Chang,Hung-Yang %A Ball,Marion %A Walter,Kimberly %A Sun,Si %A Chen,Ching-Hua %A Zhu,Xinxin %+ IBM Thomas J. Watson Research Center, 1101 Kitchawan Rd, Yorktown Heights, NY,, United States, 1 9453000, thao@us.ibm.com %K mobile health (mHealth) %K stress %K wearables %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: Overstress is becoming an epidemic issue in modern society, contributing to a broad range of health problems ranging from depression to cardiovascular diseases. According to a 2015 national survey by American Psychological Association, 75% of Americans reported experiencing at least one symptom of stress in the past month, such as anxiety and headaches. Despite the growing evidence of the negative impact of stress, there is still a lack of practical tools that can unobtrusively gauge and manage people’s day-to-day stress. Objective: Our study aims to design, develop, and evaluate a practical wearable sensing system that can continuously and reliably infer the wearer’s stress level through analyzing passively obtained bio-signals. Such a system can potentially offer individuals timely awareness of stress and personalized interventions for reducing stress. Methods: We investigated the feasibility of using biomarkers based on heart rate variability (HRV) to infer stress. To this end, we developed algorithms that process signals from photoplethysmography (PPG) sensors (Empatica E4 wristband1) to extract an HRV-based biomarker that is indicative of stress. We then investigated the correlation between each subject’s self-reported stress and the biomarker by conducting controlled, in-lab experiments designed to put subjects through structured periods of relaxation and stress. We also conducted in-field experiments to identify and deal with the practical challenges associated with measuring stress in real-life situations, such as unpredictable data quality due to motion artifacts. To evaluate the system’s in-field performance, we compared the system’s stress output and the self-reported stress associated with a particular daily event. Results: A total of 17 subjects were recruited for the initial data collection. We collected more than 300 hours of data that contains activities such as working, giving a presentation, driving, doing cognitive challenges, etc. Of the activities tracked, 146 were annotated by the subjects with associated stress information (eg, “8-8:30 am, driving to work, feeling stressed about being late” and “3-4pm, attending a seminar, not stressed”). We found that the subjects are more likely to report stressful activities (114 reported) than non-stressful activities (32 reported). Compared with the reported stress information, results from the system achieve a sensitivity of 92.1% (105/114) and a specificity of 50.0% (16/32). Conclusions: Our results suggest that the developed system can offer a reliable proxy of stress, and therefore has potential in serving as a convenient tool for gauging and understanding daily stress dynamics. The relatively high false positive rate results in a 50% specificity, which was mainly caused by interferences from subjects’ physical activities. The specificity can be further improved by mitigating the impact of such interferences—for example, by taking other biomarkers and contextual information into account. In future studies, we will also explore methods of leveraging the system’s continuous stress level output to generate timely notifications and personalized recommendations. %R 10.2196/iproc.8441 %U http://www.iproc.org/2017/1/e15/ %U https://doi.org/10.2196/iproc.8441 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e12 %T Intuitive Interactive Platform for Preoperative Communication Between Hospital and Patients/Caregivers: Towards Community Partnership for Peri-Operative Person-Based Healthcare Model %A Hee,Hwan Ing %A Chen,Jacob %A Lui,Simon %+ Information Systems Technology and Design Pillar, Singapore University of Technology and Design, 8 Somapah Road, 1.502-18, Singapore, 487372, Singapore, 65 90274092, simon_lui@sutd.edu.sg %K preoperative communication %K preoperative instructions %K telehealth %K customer relationship management %K optical character recognition %K information retrieval %K patient screening %K automated messaging %K automated interaction %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: Preoperative phone screening of patients’ recent health status and communication to patients about time of admission, surgery and fasting is the back bone of preoperative care in day surgery. Nursing staff are increasingly burdened by non-direct administrative duties, removing them from direct patient care. The amount of time nurses spend on direct patient care have been reported to be less than 40% of their working hours. This negatively impacts the quality of care, patient outcome and experience, results in job dissatisfaction and burnout among nurses. In our institution, day surgery constituted 50% of our surgical workload with an estimated 3000 cases per annum. Objective: The objective is to develop a novel application (APP), “Image and Go” (InG), an efficient and secured closed loop system of automated electronic preoperative communication for scheduling day surgery patients. The system frees the nurses from mundane jobs of telephone screening and delivery of routine preoperative instructions and the system is enabled to highlight patients who require a follow-up phone consult for counseling enhancement. InG has minimal intrusion to the current workflow of the nurses. It does not require complicated integration with the hospital’s IT system. InG provides real-time overview of the patient’s response to the nurses. Nurses can adjust the instructions in a few clicks, the InG backend system automatically reschedules the affected patients. InG is a secure and convenient platform, which taps on SMS/Telegram that millions of people use daily. Methods: We leveraged the widespread use of printed day surgery schedules in day surgery centers. We developed the InG app for iOS/Android smartphone/tablet. InG takes photo(s) of printed day surgery form(s), identifies the patients’ information and carries out interactive preoperative communication with patients via SMS/telegram automatically. 1. A survey was conducted on frontline nurses directly involved in nurse-led preoperative screening and instructions to identify problems and time expenditure during the work process. 2. We evaluated the performance of InG in a mock test with 20 university students as mock patients. In the test, 12 confirmed the appointment, 6 requested for time change, and 2 requested follow-up phone calls. Then we compared the result with the traditional approach. Results: 1. An average of 4 hours was spent in nurse-led phone calls per day. There was strong agreement among 87.5% nurses that direct patient care gave them job satisfaction, and 75% strongly agreed that it is more productive to channel time from nurse-led calling to direct patient care. Of those queried, 87.5% strongly agreed that automation with close loop increases the efficiency of the work process. 2. InG is 6.03 times faster than the traditional approach. InG took 32 minutes to complete the communication with 20 patients. The nurse could work on other duties while InG was processing the telegram communication. The traditional approach took 3 hours 13 min with 20 patients. Conclusions: The closed loop system of automated electronic preoperative communication provides a secure and efficient communication platform for the hospital-community partnership in healthcare with better utilization of nursing time for direct patient care and greater work satisfaction. %R 10.2196/iproc.8425 %U http://www.iproc.org/2017/1/e12/ %U https://doi.org/10.2196/iproc.8425 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e25 %T A Patient-Centered Approach to Tailoring a Mobile-Based Mindfulness and Social Support Intervention for Adolescents and Young Adults With Cancer %A Donovan,Elizabeth %A Zeltzer,Lonnie %A Federman,Noah %A Cousineau,Tara %A Payne,Laura %A Martin,Sarah %A Seidman,Laura %A Weiman,Marjorie %A Knoll,Marla %A Burton,Joseph %+ BodiMojo, Inc., 1631 Canton Avenue, Milton, MA,, United States, 1 333 0441, liz@bodimojo.com %K adolescent %K app %K cancer %K young adult %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: There is an emerging interest in identifying and meeting the unique needs of adolescents and young adults (AYA) with cancer. Roughly 700,000 AYA are diagnosed with cancer each year in the United States, and the incidence in this cohort has increased steadily over the past 30 years. Nevertheless, improvements in cancer outcomes for AYA lag far behind the advances that have been made for young children and older adults. Recent work has documented significant levels of unmet needs among AYA with cancer, particularly psychosocial challenges during the transition to adulthood—e.g., abrupt disruption to school and social life, fears for an uncertain future, and body image concerns. A mobile-based intervention for youth is an ideal way to complement treatment by delivering a psychosocial intervention which is developmentally appropriate and derived from evidence-based approaches to fostering resilience through mindfulness-based coping strategies and social support. Objective: To use a patient-centered approach to design, and evaluate the feasibility of a mobile-based psychosocial intervention for adolescent and young adult cancer patients. Methods: Formative research involved three steps: (1) In-depth interviews were conducted with ten AYA with sarcoma, with parents of the five adolescents, and six healthcare providers (N=21). Families were recruited from UCLA Pediatric Bone and Soft Tissue Sarcoma Program. Interview guides were based on the Resilience in Illness Model (RIM), which describes four health protective factors for resilience (social integration, family environment, courageous coping and derived meaning), and two risk factors (illness-related distress and defensive coping). Interview guides also included questions about preferences for a mobile intervention. Coding and analysis was inductive, also based on the RIM theory. (2) Adaptations were made to an existing mindfulness app (Whil Concepts, Inc.), which offers a program for youth called “Grow,” with over 500 audio relaxations. Modifications included creating a 4-week “Mindfulness for Resilience in Illness” program, with 28 relaxation exercises, and the addition of videos featuring two sarcoma survivors as program hosts. A patient advisory board was created to review drafts of content. (3) A one-month pilot study was conducted with 20 AYA cancer patients, which included using the app and engaging in a private Facebook usability group to (a) elicit beliefs about the mindfulness app and potential future enhancements, and (b) promote social support. Pre- and post-measures of mindfulness, social support, body image and quality of life were collected as well as post-intervention satisfaction data. Results: Themes derived from the in-depth interviews were incorporated into a demonstration version of the mobile app specifically for AYA cancer patients. Quantitative and qualitative evaluation data will be presented. Conclusions: A patient-centered approach may be a useful way to inform development of a mobile-based intervention for AYA with cancer. The intervention may be a feasible complement of medical and psychological treatment. %R 10.2196/iproc.8408 %U http://www.iproc.org/2017/1/e25/ %U https://doi.org/10.2196/iproc.8408 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e8 %T The Informal Caregiver Engagement Framework %A Milosevic,Mladen %A Singh,Portia %+ Philips Reserach, Acute Care Solutions, 2 Canal Park, Cambridge,, United States Minor Outlying Islands, 617 613 2258, mladen.milosevic@philips.com %K caregivers %K engagement %K informal caregivers %K needs %K journey %D 2017 %7 22.09.2017 %9 Abstract %J iproc %G English %X Background: In the United States, there were 42.6 million adults age 65+ in 2014 and that figure is expected to double by year 2060 to 98 million. According to the AARP, 90% of older adults would prefer to age in their homes, creating an ever growing need for informal caregiver (ICG) support. About 34 million Americans provided care to a person 50+ years old with an average of 24.2 hours of care per week in 2015. Caregiving comes in many forms and levels, from proving a ride to a grocery store to administering medications and help with bathing and dressing. High levels of caregiving can cause high strain on caregivers. Therefore it is important to understand informal caregiver (ICG) needs as caregivers engage in providing care at different levels. Objective: This work aims to map different ways informal caregivers engage in providing care to an elder care recipient (CR). We sought to define stages of an informal caregiver’s engagement journey to uncover their needs in a progressive fashion. Methods: Literature review, journey mapping and a commercial landscape of ICG solutions were conducted. Results: Five stages of engagement in caregiving process were identified including Noticing Changes, Making Adjustments, Shifting Responsibilities, Actively Helping and Running the Show. Categories of needs (e.g. communication and information), as well as tasks they may complete at each stage of engagement (e.g. share and gather information about care recipient condition in the communication need of Stage 3), were also mapped. The first two stages are the lowest level of engagement and are often hard to differentiate. The main distinction is that in Making Adjustments, caregivers have acknowledged that changes in the care recipient’s health and functional abilities require some level of engagement. The informal caregiver’s health and functional limitations start to limit their independence in Stage 3. Caregivers take over more responsibilities from the care recipient, mainly instrumental activities of daily living like shopping, transportation, and housework. The ICG is more deeply engaged with providing care in Stage 4. The care recipient is likely still living independently; however, doing so safely is becoming increasingly more difficult. Informal caregivers in this stage start to need deeper engagement in self-care as caregiver burden is a concern. In the final stage, the care recipient has lost their independence, relying on the ICG for most needs. The care recipient may collocate with the caregiver or alternative living arrangements like transfer to a skilled nursing facility are made. Caregivers are very familiar with the care recipient's disease and treatment options and are instead in need of emotional and decision-making support. Conclusions: As the number of people age 65 and older continues to grow, the need for informal caregiver support will increase. Consequently, informal caregivers themselves will also need support. This work focused on revealing different stages of engagement for informal caregivers and caregiver needs at each stage. This work shows the landscape of informal caregiver needs and engagement points for which solutions can be proposed. This will help academic, legislative, and commercial entities deliver the support informal caregivers need. %R 10.2196/iproc.8374 %U http://www.iproc.org/2017/1/e8/ %U https://doi.org/10.2196/iproc.8374