%0 Journal Article %@ 2369-6893 %I JMIR Publications %V 4 %N 2 %P e11778 %T Designing Connected Health Interventions for Emerging Mobile Users %A Ganju,Aakash %A Saharan,Sumiti %A Lin Fabiano,Alice %A Lee,Lily %+ Avegen Pte Ltd, 1103 Cliff Avenue, Glencroft, Hiranandani Gardens, Powai, Mumbai,, India, 91 821195149, aakash@avegenhealth.com %K emerging mobile users %K design %K user experience %K connected health %D 2018 %7 17.09.2018 %9 Abstract %J iproc %G English %X Background: While mobile technologies have unlocked opportunities to address health care access and affordability gaps, billions of emerging mobile users are yet to reap the benefits of connected health. Objective: We studied data enabled mobile phone ownership and behaviors amongst low income young Indian families. Our goal was to study the barriers to usage in this rapidly growing segment and how these barriers can be overcome to design meaningful health interventions. Methods: Starting with secondary research, our team conducted primary research interviews in a group of 250 young families (pregnancy or an infant in the family) within six diverse low income communities in Mumbai and Delhi. The surveyed population represents the global segment of the next billion emerging mobile users. The hypotheses generated from our research were used for rapid prototype development, testing and iteration over two rounds with similar users in Mumbai. Prototype development was informed by learnings from commercial apps used by emerging mobile users that address patchy connectivity, low data speeds and cost conscious consumers. The prototype testing included qualitative and quantitative methods. Results: Our primary research showed rapidly increasing and recent ownership of internet enabled phones (83%) in our surveyed population. 56% of users had acquired their smartphone in the last year and only 10% had owned a smartphone for more than 2 years. Phone ownership had a strong gender bias with only 39% women owned phones compared with 85% in men. Smartphone ownership was linked to monthly house income, rising from 35% ownership in households earning less than 20,000 INR to 90% in households earning 20,000-40,000 INR. Phone ownership across the same income segments increased dramatically in digitally ready neighborhoods that had a superior infrastructure and connectivity. The main reasons for not using the internet were lack of knowledge (80%), cost (57%), lack of local language content (39%) and lack of motivation (35%). Emerging mobile users were drawn to the internet primarily for entertainment (95%), social networking (82%), and online gaming (74%). Only 18% of the population was using internet to seek health care related information, and when they did, digital health information was reported as least reliable, with close to 90% of respondents ranking them lowest on the reliability scale. Our users were more likely to respond to the test mobile app when it was data light, transparent, and allowed for offline viewing and sharing. Behaviorally, reducing cognitive load significantly allowed users to make confident decisions. This meant creating linear user journeys, minimizing screen choices and nudging users towards specific messages using a combination of rewards and loss aversion techniques. Even though literate, our users responded overwhelmingly to visual and video content than to written text. Finally, activating the user journey on the app was much more powerful when done through a trusted community resource. Conclusions: Slimming down existing health apps won’t address the unique needs of emerging mobile users. Designing connected health interventions for the next billion mobile users requires multi-disciplinary teams to design content experiences and user journeys rooted in local ecosystems and tailored to the users’ unique sensibilities. %R 10.2196/11778 %U http://www.iproc.org/2018/2/e11778/ %U https://doi.org/10.2196/11778 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 4 %N 2 %P e11797 %T The Addition of Asynchronous Chat-Based Coaching to a Digital Behavioral Health Tool Promotes Support and Personalization %A Link,Alissa %A Lukowski,Amy %A Hirsch,Abigail %+ myStrength, Inc, 1875 Lawrence Street, Suite 550, Denver, CO,, United States, 593 8200, alink@mystrength.com %K behavioral health %K chat %K coaching %D 2018 %7 17.09.2018 %9 Abstract %J iproc %G English %X Background: Digital behavioral health (BH) tools can help improve or maintain BH conditions such as depression, anxiety, substance abuse, stress, chronic pain or insomnia; the efficacy of digital self-care tools can be enhanced via addition of human touch-points. Objective: The objective of this study was to evaluate the feasibility and acceptability of adding asynchronous chat-based coaching to the myStrength digital BH platform. Methods: Participants who were at least 18 years old, fluent in English and readily able to access the internet were recruited via Craigslist advertisements to participate in a pilot intervention. Participants were asked to use the digital tool at least 2 times per week and to communicate via online chat with a coach at least 2 times per week. Participants completed online surveys at 2 weeks, 4 weeks and 6 weeks, and completed a 30 minute telephone interview between 5 weeks and 6 weeks. Results: Of 226 who responded to the advertisement, 200 people were invited to participate, 134 engaged in coaching initially and 96 completed the final interview. Seventy-eight percent of participants were female, 62% were white, 23% were black, 8% were Hispanic and 6% were Asian. One-fifth were in treatment with a BH provider, one-fifth received BH care from a medical provider, and 22% were taking BH medications. In response to the question, “On a scale of 0-10, how helpful has your coach been over the past 2-weeks,” the mean score and standard deviation were 7.5±2.4 at 2 weeks, 8.2±1.9 at 4 weeks and 8.6±1.9 at 6 weeks. Satisfaction with coaching was 7.6±2.5 (out of 10) at 2 weeks and 8.3±1.9 at 4 weeks. Participants felt that coaching increased the value of the digital tool, with a mean rating of 8.4±1.9 (out of 10). Three-quarters of participants felt that the encouragement coaches provided was the most helpful aspect, followed by guidance to specific resources (53%), support (51%), connection to another person (42%), and assurance (40%). These findings were corroborated in the qualitative data; participants emphasized the value of having personalized suggestions amidst a large breadth of content, an outside perspective, and greatly appreciated the “human contact in a digital world.” The coach-patient relationship strengthened over time (2-weeks vs 6-weeks): 78% vs 93% felt that the coach discussed things that were important to the participant; 78% vs 90% felt that the coach liked and understood them; 85% vs 93% felt the interaction with their coach was helpful; 77% vs 88% had confidence in the working relationship with their coach (all P<0.05). Eighty-one percent of participants reported that they would prefer to work with the same coach over time whereas 19% would have preferred to talk with a coach in real time. Conclusions: The addition of asynchronous coaching to a digital BH platform was well received, perceived as helpful, and promoted a more personalized experience with the digital BH tool that improved over time; future studies will evaluate impact on clinical outcomes and engagement. The added human element helped participants feel supported in their struggles with BH issues and has the potential to help increase engagement to myStrength’s effective, evidence-based, well-being resources. %R 10.2196/11797 %U http://www.iproc.org/2018/2/e11797/ %U https://doi.org/10.2196/11797 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 4 %N 2 %P e11808 %T The Impact of Providing a Tool Kit for Innovators in an Academic Medical Center to Scale Digital Health Innovation %A Saxena,Ritika %A Elias,Josephine %A Cao,Chenzhe %A Zhang,Haipeng %A Landman,Adam %+ Brigham and Women's Hospital, Brigham Digital Innovation Hub, 60 Fenwood Road, Boston, MA,, United States, 599 9146, rsaxena@brandeis.edu %K implementation %K innovation %K innovation adoption process %K digital health %K startups %K scaling innovation %K pilot %D 2018 %7 17.09.2018 %9 Abstract %J iproc %G English %X Background: An internal iHub survey shows that 72% of innovators within Academic Medical Centers abandon their ideas due to a lack of direction for their visions. While internal innovators are frustrated without direction and support to launch their ideas, hospitals need to balance innovation while ensuring information security-HIPPA compliance. Brigham and Women's Hospital houses a digital innovation hub (iHub) that fosters innovation for Brigham clinicians, scientists, researchers, administrators, and staff. In 2014, BWH founded a program called Digital Health Innovation Guide (DHIG) to provide structure for innovators to pilot new and novel technology in a safe, efficient, and successful manner. As a continuous cycle of innovation, the iHub identified successes and ways to improve the DHIG process and quality of service. Objective: We gathered and analyzed data from participants of the DHIG and creators of the program to project the outcomes of the Digital Health Innovation Guide. With that information, we were able to quantify the impact of providing these resources and determine ways to improve the process of helping scale and structure digital health innovation. Methods: We conducted a case review of existing data on DHIG projects. This included gathering data on projects from 2014-current. We reached out to 40 participants that went through the DHIG program to fill out a survey of questions regarding logistics of their project, successes and failures they faced, their thoughts on DHIG process, and its impact on the piloting process. We interviewed 10 participants to discuss the impact of the DHIG process, and to quantify where more support is needed from the iHub to better aid innovators to utilize and innovate new technologies in health care. Results: From the responses collected, 50% of the innovators collaborated with external startups, while the other 50% were custom developments. 86% of teams had over 4 members, and of the remaining 14%, only 20% were still actively working to pilot completion. Conversely, 100% of stalled projects had less than 4 members. Participants listed that upholding deadlines and maintaining communication with internal stakeholders as well as external, such as developers and other hospitals, brought on successes for their project. Internal bottlenecks like indeterminate delays of IRB approval timelines and info sec reviews slowed down progress and, in some cases, led to withdrawal from sponsors. Conclusions: Based off team sizes and member engagement, we found that it is crucial to have a team of at least 4 members with an engaged clinical champion, administrative champion, and project manage to ensure pilot completion. The iHub and DHIG process can improve pilot completion by expanding external support resources such as developers and other hospitals. The DHIG, while successful in providing a clear and rigid structure for innovators in an AMC to further develop their innovations, must continue to breakdown internal barriers by acting as an expediter. %R 10.2196/11808 %U http://www.iproc.org/2018/2/e11808/ %U https://doi.org/10.2196/11808 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 4 %N 2 %P e11815 %T Reinventing Inflammatory Bowel Disease (IBD) Clinical Trial Recruitment Using Novel Digital Medicine Tools %A Otobo,Emamuzo %A Park,Christopher %A Rogers,Jason %A Fasihuddin,Farah %A Garg,Shashank %A Yang,Chloe %A Roja,Zahin %A Chandrasekhar,Vishu %A Singh,Kritika %A Kumar,Vinod %A Madisetty,Divya %A Dhillon,Harkirat %A Atreja,Ashish %+ Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY,, United States, 241 0124, emamuzo.otobo@mssm.edu %K clinical trials %K internet recruitment %K mobile health %K mHealth %K recruitment %K IBD %K Crohn's disease %K ulcerative colitis %D 2018 %7 17.09.2018 %9 Abstract %J iproc %G English %X Background: Issues with patient recruitment and enrollment are the primary barriers for missed clinical trial timelines; 8 out of 10 clinical trials are delayed or unable to be completed because of lack of timely patient recruitment. Current patient recruitment efforts are inefficient and time-consuming, since they are typically dependent on manually screening patients during face-to-face visits to the clinic or hospital. With the rapid development of digital communication platforms within health care and the broad consumer adoption of smartphones, there are increasing opportunities to overcome some of these barriers. These platforms have particularly great potential for research and clinical care of chronic conditions, such as inflammatory bowel disease (IBD), an often debilitating disease which currently affects over three million adults in the United States. Objective: To integrate and utilize a digital medicine platform to improve patient recruitment and enrollment processes in clinical trials. Methods: Patients enrolled in the Mount Sinai Crohn’s and Colitis Registry (MSCCR) were remotely approached about enrolling in a mindfulness study for IBD patients. A text-based clinical rules engine was used to inform registry patients about the trial and to allow patients to indicate interest in participating via text message. Eligible IBD patients were bulk “prescribed” a notification through RxHealth’s digital medicine platform, RxUniverse. Characteristics of the enrolled population, characteristics of patients who responded, and timeliness of responses were analyzed. Results: Of the 1364 patients in the MSCCR with available phone numbers, 270 patients affirmatively replied they wanted to participate in to the study. Patients who opted into receiving more information about the study were more likely to have inadequate control of their IBD (25.64% vs 18.97%; P<.05) and more likely to have a recent history of depression based on a validated patient health questionnaire (15.38% vs 8.4%; P<.05) than those who opted out. Furthermore, patients who opted in tended to be younger, were more likely to be female, and less likely to have ulcerative colitis, though these trends did not reach statistical significance. Patient race did not significantly differ between those who opted in and opted out. In terms of timeliness of response among those enrolled, the majority of patients responded within 2 hours of notification. Conclusions: Digital medicine software platforms can facilitate large-scale, lower-effort recruitment of eligible patients for clinical trials. Future research should be done to explore their expanded use for recruitment, patient education, and study data collection. Additional technologies such as patient-powered networks, social media, e-recruiting bots, and other remote engagement platforms can aid clinical trials by saving time and reducing costs of patient recruitment. %R 10.2196/11815 %U http://www.iproc.org/2018/2/e11815/ %U https://doi.org/10.2196/11815 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 4 %N 2 %P e11793 %T Humanizing the Chart: Becoming More Responsive to Patient Needs Through Implementation of PatientWisdom %A Crotty,Bradley %A Holt,Jeana %A Cusatis,Rachel %A Asan,Onur %A Williams,Joni %A Flynn,Kathryn %A Moore,Jennifer %A Makoul,Gregory %+ Collaborative for Healthcare Delivery Science, School of Medicine, Froedtert & Medical College of Wisconsin, 8701 Watertown Plank, Milwaukee, WI, 53226, United States, 1 532 3783, bcrotty@mcw.edu %K communication %K consumer health informatics %K electronic health record %K implementation %K sociotechnical %D 2018 %7 17.09.2018 %9 Abstract %J iproc %G English %X Background: Over the past several decades, health care has been shifting to a care model that more fully values patient engagement. Recently, there has been increased attention on the role of health information technology that enables patients to collaborate with clinicians through the sharing of patient-generated contextual data. We implemented the PatientWisdom tool using a sociotechnical model to improve patient experience and visit effectiveness. Objective: To understand the facilitators and barriers to the routine incorporation of patient contextual data into the record, and the subsequent initial impact on the experience of care within academic and community practices affiliated with an academic health system. Methods: Our health system co-developed the PatientWisdom tool, which elicits patient values, preferences, and other contextual data ahead of visits through an email invitation to a secure Web application. Results are summarized and viewable within the EHR. To assess the implementation, we performed workflow shadowing and semi-structured interviews of clinical staff from April through July 2018. The Consolidated Framework for Implementation Research (CFIR) guided the collection and analysis of qualitative data. Researchers used the PatientWisdom platform to elicit patient data ahead of visits and summarize insights in the EHR. The researchers conducted sampling and data analysis in tandem; sampling concluded when the researchers determined no new themes were surfacing; therefore reaching data saturation. To assess the impact of the program on health care operations, including patient experience, a random sample of clinicians and patients (both users and non-users) was performed. Results: In workflow assessment and clinician interviews, we learned that the data needed to be more visible within the chart, and we made improvements within our electronic health record to make link to the data more apparent and visible when data were available. Main themes from our interviews were: Patient contextual information fosters a holistic approach to care; PatientWisdom is an innovative tool used to sync clinician-patient goals; clinicians may have an incorrect perception of PatientWisdom adopters (expecting millennials); and clinicians who proactively integrate PatientWisdom into their workflow identified it as an asset to care. In our initial assessment of impact, 945 patients completed surveys following their visits. Of participating patients, 87% say it improves communication and 90% rate the visit as going “extremely well” (compared to 82% when not used P<.05). Clinicians were significantly more likely to ask patients about barriers to care using the tool (65% vs 48%). The tool surfaced information about patient needs for clinicians and leaders. For example, we identified that 47% of participants did not have a health care proxy, and 60% of these patients were ready to talk about it with their clinician. Conclusions: Consumer informatics tools that link with electronic health records may help “humanize” the record and improve patient centeredness. This session highlights the initial implementation of an effort to collect patient-contextual data through the PatientWisdom tool and highlights the use of the tool to drive clinical and operational improvement. %R 10.2196/11793 %U http://www.iproc.org/2018/2/e11793/ %U https://doi.org/10.2196/11793 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 4 %N 2 %P e11776 %T Cloud-Based Implementation of New Frontline Clinical Workflows: Standardizing Practice at Scale to Improve Patient Safety %A Yoo,Jennie %A Han,Mary %A Jamena,Gemma %A Pei,Phyllis %A Baldocchi,Hillary %A Menard,Emilie %A Diane,Shelley %A Oishi,Peter %A Nguyen,Tam %+ School of Medicine, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA,, United States, 476 2342, jennie.yoo@ucsf.edu %D 2018 %7 17.09.2018 %9 Abstract %J iproc %G English %X Background: Implementation of new practices in large health care settings is difficult. Staff are already overwhelmed, and practice deviation is common. With time-constrained visits, providers struggle to address complex problems. Three scenarios were identified where frontline practice standardization would improve patient outcomes: sedation and analgesia for intubated patients (inpatient), colorectal cancer screenings (outpatient), and safety measures for opioid prescriptions (outpatient). We implemented these practices through a cloud-based solution designed for frontline health care staff, fostering peer-accountability and transparency of processes. Objective: 1) Introduce a standard approach to sedation and analgesia for intubated patients. 2) Increase colorectal cancer screenings for the clinic population. 3) Improve opioid safety for patients with chronic opioid use. Methods: Practices were implemented through a cloud-based app (Elemeno Health, Oakland, CA) that allows frontline health care teams to access an organization’s best practices through interactive decision guides, smart checklists, and how-to videos from any device. In a pediatric ICU, we first delivered a Critical Care Comfort Algorithm (CALM) for titrating sedative and analgesia medications, a bottom-up self-assessment for frontline staff to evaluate their performance, and a top-down audit checklist for charge nurses to complete. For multiple community health centers, we created colorectal cancer screening practice decision guides for medical assistants (MA) and providers, and deployed the practices through a 3-week gamified contest between individual clinics conducted through the app. For the opioid safety initiative, we created a Provider Chronic Pain Management Workflow checklist, Provider Pain Evaluation Guide, and a MA checklist for medication reconciliation; implementation was paired with a 2-month inter-clinic competition. Results: Within 2 weeks of the formal roll-out of the Pediatric ICU charge nurse audit tool, 107 checklists were completed and 83% of intubated patients were on the sedation protocol. During the gamified 3 weeks for colorectal cancer screening, 2107 checklists were completed with engagement from 74% of MAs and 80% of providers. MAs appeared to habituate to the practice with ongoing practice post-competition; there was a 70% increase in colorectal cancer screenings 1 year post-intervention. During the contest period for increased opioid safety, naloxone prescription increased from <10/month to 27/month for new prescriptions and 21/month for renewals. Opioid contracts with historically negligible adherence increased to 45/month for new contracts and 53/month for renewed contracts. There was also a 70% increase in referrals to the Behavioral Health Pain Management Program. Conclusions: Our clinical improvement initiative using cloud-based real-time actionable and trackable decision guides facilitated staff engagement with standardized protocols for pediatric analgesia and sedation, led to a significant increase in colorectal cancer screenings with high levels of provider and staff participation, and improved opioid safety and utilization of behavioral support resources for patients with chronic opioid use. The cloud-based application empowers staff with just-in-time access to microlearning tools and resources to manage patient care, simplifying management’s ability to train staff at scale. Standardizing practice and streamlining workflows liberalizes valuable face-to-face time with patients and improves patient safety. %R 10.2196/11776 %U http://www.iproc.org/2018/2/e11776/ %U https://doi.org/10.2196/11776