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Big data, BigDataMed15, Cardiovascular Medicine, Medical Apps, Stanford News, Videos

A look at the MyHeart Counts app and the potential of mobile technologies to improve human health

A look at the MyHeart Counts app and the potential of mobile technologies to improve human health

Keynote talks and presentations from the 2015 Big Data in Biomedicine conference at Stanford are now available on the Stanford YouTube channel. To continue the discussion of how big data can be harnessed to improve the practice of medicine and enhance human health, we’re featuring a selection of the videos on Scope.

At last count, the number of iPhone owners who have downloaded the MyHeart Counts app and consented to participate in a large-scale, human heart study had reached 40,000. The first-of-its-kind mobile app was designed by Stanford Medicine cardiologists as a way for users to learn about their heart health while simultaneously helping advance the field of cardiovascular medicine.

Built on Apple’s ResearchKit framework, the app leverages the iPhone’s built-in motion sensors to collect data on physical activity and other cardiac risk factors for a research study. The MyHeart Counts study also draws on the strength of Stanford Medicine’s Biomedical Data Science Initiative.

At the 2015 Big Data in Biomedicine conference, Euan Ashley, MD, a cardiologist at Stanford and co-investigator for the MyHeart Counts study, shared some preliminary findings with the audience. Check out the full talk to learn more about how the app is helping researchers better understand Americans’ health habits and what states have the happiest, most physically active and well-rested residents.

Previously: On the move: Big Data in Biomedicine goes mobile with discussion on mHealth, MyHeart Counts shows that smartphones are catching on as new research tool, Lights, camera, action: Stanford cardiologist discusses MyHeart Counts on ABC’s Nightline, MyHeart Counts app debuts with a splash and Stanford launches iPhone app to study heart health.

Cardiovascular Medicine, Medical Apps, Precision health, Research, Stanford News, Technology

MyHeart Counts shows that smartphones are catching on as new research tool

MyHeart Counts shows that smartphones are catching on as new research tool

using iPhone - 560

In the three months since Stanford researcher and cardiologist Michael McConnell, MD, told ABC’s Nightline that the new MyHeart Counts iPhone app would give scientists “a whole new way to do research,” the number of users has continued to steadily climb.

“Traditionally reaching many people to participate in research studies is quite challenging,” McConnell told business correspondent Rebecca Jarvis in March. “The ability to reach people through their phone is one major advance.”

The number of iPhone owners who have downloaded the app and consented to participate in a large-scale study of the human heart has now reached 40,000. In an effort to keep updated on how the app is progressing as a new research method, I reached out to McConnell, the lead investigator of the study, with a few questions. The MyHeart Counts study continues to break ground as a new method for reaching large numbers of research participants in a short amount of time, McConnell told me. Comparing it to traditional research trials, he said:

There have been larger research studies, particularly national efforts to study their populations, but we believe enrolling this many participants in such a short time frame is unprecedented.

The app, which was launched in early March, collects data about users’ physical activity using the smartphone’s built-in motion sensors. Participants also answer surveys concerning their cardiac-risk factors. In return, they get coaching tips and feedback on their chances of developing heart disease.

McConnell says that the next phase of the project, which will use behavior-modification methods to encourage healthy behaviors, is about to be launched. App users will be given more personalized feedback about their individual behaviors and risk, based on the American Heart Association’s Life’s Simple 7 guidance. Future tips will include messages on everything from how to manage blood pressure, eat better, lose weight and control blood sugar. Part of the study is to determine whether these type of “pings” used through apps are actually successful at changing human behavior, McConnell told me:

Healthy behaviors are critical to preventing heart disease and stroke, so the MyHeart Counts app will study which motivational tools are most helpful. This will follow the second activity and fitness assessment… The initial approach will be empowering participants with more personalized feedback about their individual behaviors and risk.

To sign up for the MyHeart Counts study, visit the iTunes store.

Previously: Lights, camera, action — Stanford cardiologist discusses MyHeart counts on ABC’s Nightline, Build it (an easy way to join research studies) and the volunteers will comeMyHeart Counts app debuts with a splash and Stanford launches iPhone app to study heart health
Photo by Japanexperterna (CC BY-SA)

Chronic Disease, Global Health, Medical Apps, Stanford News

Reporting and treating cholera: Soon, there could be an app for that

Reporting and treating cholera: Soon, there could be an app for that

8424972981_35858721c7_zIn the aftermath of the 7.0 magnitude earthquake that shook Haiti in January 2010, clean water for drinking and hygiene was scarce. This set the stage for the largest cholera outbreak in recent history, killing an estimated 6,631 people. Now that a devastating 7.8 magnitude earthquake has hit Nepal, a similar situation may be in the works. Eric Jorge Nelson, MD, PhD, a pediatrician and cholera expert, is working to change this scenario with a smartphone app that he and his team are developing for use in places at high-risk for cholera outbreaks.

Although disasters and cholera often go hand in hand, the disease is also a perennial problem in places like Bangladesh and Nepal, where monsoons routinely overflow sewers and contaminate water supplies, Nelson explained. In areas such as these, about 2.8 million cases of cholera occur each year.

Time is of the essence when reporting and treating cholera. “The time it takes from when a person ingests the bacterium [Vibrio cholerae], becomes sick with diarrhea, and dies can be less than 24 hours,” Nelson told me during a recent conversation. If untreated, as many as half of the people with cholera can die, but the mortality rate drops to less than one percent if treated in time.

Therein lies the rub, Nelson explained. Many cholera-stricken areas have limited access to electricity and the tools that disease experts and doctors need to rapidly report and respond to a cholera outbreak. “The reporting mechanisms are often six-weeks delayed,” Nelson said. “We need a way to help hospitals; they need an ongoing system to provide real-time data.”

To address this problem, Nelson and his colleagues are creating a smartphone app with the aid of a $1.25-million Early Independence Award from the National Institutes of Health. Their first goal is to develop and deliver the app to doctors working in hospitals in Bangladesh, where cholera is common.

The app is a series of four pages that prompt the doctor to collect data that helps them report, diagnose and treat patients with cholera. It also contains a checklist of “danger signs” that doctors may fail to notice; this list reminds him or her to look for other illnesses that could mask or mimic cholera.

Perhaps the best feature of the app is that it’s fast. “If English is your first language, you can get through the app in roughly 60 seconds. If English is your second language, it takes about two minutes,” Nelson told me.

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Cardiovascular Medicine, In the News, Medical Apps, Research, Stanford News, Technology

MyHeart Counts app debuts with a splash

MyHeart Counts app debuts with a splash

At Stanford Medicine, we’ve been anticipating the debut of MyHeart Counts, an iPhone app and cardiovascular research study, for some time. The researchers told us it had the potential to be the largest study of measured physical activity and heart health, and we were pretty darn excited. And we were also pleased to see the buzz surrounding Apple’s Monday morning announcement of ResearchKit, the app’s open source software host. Both MyHeart Counts and ResearchKit have been warmly received by both the tech and medical community and, just days after its release, the number of MyHeart Counts users is already in the tens of thousands.

We’re talking about data in medical research that’s never been encountered before

“Following the news, many researchers who spoke to The Huffington Post could barely contain how thrilled they were about the new iPhone feature, calling it ‘revolutionary,’ ‘groundbreaking’ and a ‘new dawn’ when it comes to scientific research,”  wrote on Tuesday. She went on to outline seven ways ResearchKit could change research for the better, and she quoted Stanford’s Alan Yeung, MD, an app architect and medical director of the Stanford Cardiovascular Health:

In most medical studies, 10,000 is a large number, but if we can really hit our mark and have a million people download it, you can do much larger population studies than anything that has been done in the past. So even though we might be slightly restricted in the beginning, we have plans to reach everybody in the world if possible.

This amount of data has never been available before, and if we multiply it by a million, let’s say, we’re talking about data in medical research that’s never been encountered before.

Enrolling 10,000 people in a medical study would normally take a year and the collaboration of at least 50 medical centers, Yeung told Bloomberg. “That’s the power of the phone.”

He said he also believes the app will make it less likely for participants to enter false reports because the device itself will keep track of their exercise. Researchers also plan to test how best to help people modify their behavior.

And the app isn’t just for avid techies or exercise enthusiasts. Physician-blogger Mike Sevilla, MD, wrote earlier this week that ResearchKit has the potential to improve medical care. “Imagine the synergy that will be created with the right app technology, engaged patients and interactive medical teams. Just mind blowing… The potential here is limitless.”

Strong words for a strong app. Check it out for yourself (there’s more info in the video above), because, yes, your heart counts.

Previously: Stanford launches iPhone app to study heart health, Even moderate exercise appears to provide heart-health benefits to middle-aged women and What needs to happen for wearable devices to improve people’s health?
Image by Ken

In the News, Medical Apps, Technology

Tips for women-entrepreneurs entering the medical technology field

Tips for women-entrepreneurs entering the medical technology field

In an article recently published in MedCity News, Kathryn Stecco, MD, a medical device entrepreneur who completed her residency in general surgery at Stanford, offers tips for women spearheading entrepreneurial endeavors in the medical technology industry. The piece is timely, as some have dubbed 2015 the “year of the technologically engaged patient.”

As Stecco writes, women with a medical background and an interest in technology have lots of opportunities, from working at small start-ups or large corporations to becoming a chief medical officer or finding a niche in law or finance. And, of course, they can start their own company. Unfortunately, though, few choose the latter option: Stecco notes in the piece that only three percent of technology companies are started by women.

To encourage more women to take the entrepreneurial leap, Stecco’s fundamental advice is to start with a big idea that fills a real unmet need. Beyond that, she suggests:

  1. Pursue a practical solution:  Focus on products that are safe, effective and easy to use for both physician and patient. If the product doesn’t make physicians’ lives easier, they won’t use it. The product must produce meaningful clinical data that speaks for itself.
  2. Build relationships – early – with clinicians: Medical entrepreneurs must be out in the field developing ties with physicians and getting their input early in the design process. No matter how well designed your product or how impressive your patents, physicians will have the last word on the usefulness of your product. They are vital to your success.
  3. Be prepared to shift gears:  Don’t fall into the trap of becoming so enamored of an idea or a product that you lose sight of its real likelihood of succeeding in the marketplace. You must have the flexibility to move on to something else when changes in the environment cause the ground to shift under your feet and your plans to be upended.
  4. Enjoy the ride!  Successful entrepreneurs make adversity the energy that fuels their creativity. They don’t learn their most valuable lessons in the classroom but in the trenches. They thrive on the long hours, the unpredictability, the rush that comes from building something important and valuable.

Previously: An online film festival for medtech inventors, Stanford alumni aim to redesign the breast pump and Medical technology entrepreneurs discuss challenges facing start-ups at Stanford event
Photo by jfcherry

Behavioral Science, Health and Fitness, Medical Apps, Public Health, Technology

What needs to happen for wearable devices to improve people’s health?

What needs to happen for wearable devices to improve people's health?

15353072639_f3a79557df_z“Wearable devices” are pieces of technology that are worn in clothes or accessories, and they often have biometric functionality – they can measure and record heart rates, steps taken, temperature, or sleep habits. Numerous tech companies have begun manufacturing and marketing such devices, which are part of a larger movement often referred to as the “quantified self” – where data about one’s life is meticulously gathered and recorded. Only 1% to 2% of Americans have used a wearable device, but annual sales are projected to increase to more than $50 billion by 2018.

Health and fitness apps are also proliferating, from software that maps where you run or provides a digital workout community, to programs that count calories or suggest how to improve your sleep. But what’s the real impact for people’s health?

Earlier this month, a report from the Journal of the American Medical Association called into question the idea that wearable devices will effect population-scale changes in health. There is a big gap, the authors claim, between recording health information and changing health behavior, and little evidence suggests that this gap is being bridged. Wearable devices might be seen as facilitating change, but not driving it. Mitesh Patel, MD, MBA, from University of Pennsylvania, and colleagues wrote:

Ultimately, it is the engagement strategies—the combinations of individual encouragement, social competition and collaboration, and effective feedback loops—that connect with human behavior.

The difficulty of population health is that changes have to be sustained to have meaningful effects, and that is quite difficult. The authors identify four steps that must be taken to bridge this gap towards sustained change.

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Cancer, Medical Apps, Stanford News, Technology

Using a smartphone and the Folding@home app to advance disease research

Using a smartphone and the Folding@home app to advance disease research

protein

Smartphones now have the power that personal computers had a few years ago, and more and more people have them. So researchers are developing ways to harness that computing power to solve pressing biomedical problems.

As described in a Stanford News piece, Stanford’s Vijay Pande, PhD, in partnership with Sony, recently developed a smartphone app that “folds” proteins while the phone’s owner sleeps. “There are a ton of people with really powerful phones, and if we can use them efficiently, it sets the stage for something really great,” said Pande, a Stanford chemistry professor.

This particular mobile app, called Folding@home, investigates the biology of diseases, including cancer, Alzheimer’s, and Parkinson’s disease. It’s an extension of the Folding@home distributed computing project started in 2007, and it’s now available on GooglePlay.

Disease biology is dependent on proteins, which are complex linear chains of molecules that become “folded up”, like snarled balls of yarn. The chain needs to be absolutely correct; any mutation that shifts a few molecules out of place will cause the protein to not work optimally, not work at all, or, worse, work in a way that does damage to the organism.

Understanding protein configurations is key to developing cures for disease. While real proteins take milliseconds to curl up, simulating this process with computers takes thousands of hours. But if 10,000 people download and use the Folding@home app, and it runs 8 hours a day while the phone is not otherwise in use, the team’s first research question could be solved in three months.

The app’s first focus is a kinase protein found in breast cancer. It seems that different people’s tumors respond differently to the several drugs available; currently, doctors use a guess-and-check method to choose a drug, but information derived from the proteins could enable doctors to choose correctly on the first try. In something as time-sensitive as cancer, this could save lives.

Next up for the app is a project related to Alzheimer’s disease. Eventually, if enough people enroll, the researchers could launch several projects simultaneously, allowing people to choose to take part in one that is personally meaningful.

Image of a protein Argonne National Laboratory

Events, Medical Apps, Medicine X, Stanford News, Technology

Countdown to Medicine X: Specially designed apps to enhance attendees’ conference experience

Countdown to Medicine X: Specially designed apps to enhance attendees’ conference experience

Figure 3 - BlanketLast year’s Stanford Medicine X conference explored ways in which technology could be used to augment the attendees’ experiences. During breaks between sessions, organizers used specially developed software to transform television screens set up in the lobby outside the main auditorium into interactive spaces where participants could exchange ideas. On one screen, attendees used their mobile phones to text their reflections on previous sessions or respond to prompts such as: “What’s your dream for health care?” The texts appeared as yellow sticky notes on a virtual corkboard. Another screen served as a digital journal where participants could text comments about what they learned and have them displayed to a wider audience. As people walked up to the screen to read the contextually relevant content, they naturally started conversations. In an effort to bridge the divide between the people who were physically present at the conference and those who were watching the live-stream from other locations, an additional screen broadcast tweets from around the world in real time.

This year, conference organizers have developed three iPhone apps for Medicine X based on Apple iBeacon, a Bluetooth-powered location system. “When we heard about the iBeacon technology, it was clear that it would fit really well into a conference setting as well as being useful for allowing people to interact with the large-screen displays,” said Michael Fischer, a PhD student in computer science in the MobiSocial Lab at Stanford, who helped develop the app. “We brainstormed all the possible ways that the iBeacon technology could help people participate in the conference and came up with some ideas that we are excited to test out at the upcoming conference.”

In anticipation of this year’s conference, I reached out to Fischer to learn more about how the apps will further enhance attendees’ experience at Medicine X. Below he explains how they will facilitate networking among participants, allow them to provide feedback or rate speakers and serve as a sort of “flight-attendant call button.”

Can you briefly explain how the apps work?

One app allows us to extend the Wellness Room, so that people can request items without having to go to the room and miss part of a session. The Wellness Room provides special amenities, such as warm blankets or a place to rest, to assist patients in managing their conditions during the conference. The room was designed to help patients physically attend the conference who might have otherwise not been able to. For example, a previous ePatient attendee had a medical condition called cryoglobulinemia, which causes proteins known as cryoglobulins to thicken if the ambient temperature drops too low. If this were to occur, it could lead to kidney failure and would be life threatening. So it’s crucial for this patient to keep warm. Using the iBeacon technology we were able to develop a system that allows people to use an iPhone to request a blanket or other item be delivered to their seat. There will be iBeacons on all the tables in the room so that the phone will automatically know where you are sitting. All the requests will be forwarded to a volunteer who will bring the item directly to the table.

Another app will be used during the breaks to help people get to know each other. The application works by displaying short bios on a nearby TV screen. In this way, the screen acts as a type of watering hole that people can gather around. When new people approach, their bios will be added to the screen. When a person leaves the proximity of the screen, the bio will be removed. We’ll have multiple screens set up around the conference. Our hope is that people can find a group that they might not yet be familiar with. The service is opt-in and people can switch to and from stealth mode at any time. Conference-goers will also have the option to forgo this app altogether.

Lastly, we have developed a feature that will be used at check-in. We want to create an experience that will surprise and delight people from the moment they step into the conference. There is a tradition at Stanford during freshman year that when you first come to your dorm, the dorm staff yells out your name. It is pretty big surprise and makes you feel part of the community instantly. We wanted to replicate that experience as best we could for the conference.

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Medical Apps, Stanford News, Technology

A Stanford physician shares his experiences creating evidence-based medical apps

iPad_080814A piece published earlier this week on iMedicalApps spotlights the work of Steven Lin, MD, a clinical instructor in family medicine at Stanford who is the co-creator of two evidence-based medical apps. The first app he helped develop was Ilithyia, a point-of-care clinic prenatal app, and the second is L’Allegro, which helps physicians select the appropriate antidepressant for patients. From the piece:

Dr. Lin first thought about creating an app as an intern when he noted the large gap between what he had learned in medical school and what was happening in practice. He had knowledge but it was often difficult translating that knowledge into point of care practice. He first concentrated on prenatal visits as he wanted to find the evidence base for current practice and make that available to himself as well as his fellow interns.

He started with researching guidelines, community standard of care, and even insurance allowances for visits and labs. He then took this information and made a framework of sorts. Each visit had allotted information- labs, guidance, findings, etc, and this framework became the basis for how he organized his app.

Lin and partner, a programmer who was finishing his final year of high school when they started working together, plan to “work with the Society for Teachers in Family Medicine and plans to create a mobile version of their study cases” for third app.

Previously: Heart bypass or angioplasty? There’s an app for that, A conversation about smart-device use among resident physicians and Stanford AIM Lab launches patient exam iPad app
Photo by Stanford EdTech

Medical Apps, Sleep, Technology

Can sleep trackers help you get a better night's rest?

Can sleep trackers help you get a better night's rest?

As the number of self-tracking gadgets grows, many people are beginning to experiment with monitoring lifestyle habits in an effort to improve their health. In fact, seven in ten American adults say they track at least one health indicator, according to data from the Pew Research Center’s Internet & American Life Project. But there has been some concern about the accuracy of such technology.

A recent CBS News segment took a closer look at the effectiveness of sleep trackers and outlined the differences in information collected by the devices and data collected by sleep specialists in a clinical setting. Stanford sleep expert Michelle Primeau, MD, also commented, “The reason why these devices are so good is [using them] puts greater emphasis on sleep.”

Previously: Why sleeping in on the weekends may not be beneficial to your health, The high price of interrupted sleep on your health, Exploring the benefit of sleep apps and Designing the next generation of sleep devices

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