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Aging, Medical Apps, Stanford News, Technology

Stanford Letter Project, which helps users have end-of-life discussions, now available for mobile devices

Stanford Letter Project, which helps users have end-of-life discussions, now available for mobile devices

Stanford_LetterFor many of us, the topic of how we want to spend our final days rarely comes up in discussions with our family members or doctors. And a big reason why is that we think of reflecting on how we want to die as highly emotional and unpleasant.

But there are some compelling reasons to take the time to clarify what matters to you most in your waning days of life: It can reduce stress on your loved ones and help your physician provide a better quality of care.

Earlier this year, VJ Periyakoil, MD, director of palliative care education and training at Stanford, launched the Stanford Letter Project, a campaign to empower all adults to take the initiative to talk to their doctor about what matters most to them at life’s end.

Recently, Periyakoil released mobile app versions of the Stanford Letter Project for both the iPhone and Android. The apps, which offer templates comprised of simple questions aimed at getting the end-of-life conversation rolling, are free and can be downloaded from the iTunes and Google Play stores. Templates are available in Spanish, English, Italian, Taglog, Russian and Hindi.

As Periyakoil explained in a recent 1:2:1 podcast, “2.6 million Americans die every year, and very few of them get to talk to their doctor about their end of life wishes.” She urges every adult to tell their doctors about how they want to spend their last days; she suggests engaging in end-of-life discussions each time you reach a milestone in your life such as getting married, having a baby or being diagnosed with a chronic illness.

Previously: How would you like to die? Tell your doctor in a letter, Stanford doctor on a mission to empower patients to talk about end-of-life issues, Medicare to pay for end-of-life conversations with patients and “Everybody dies – just discuss it and agree on what you want

Medical Apps, Medical Education, Medicine X, Patient Care, Technology

A look at using smartphone apps for patient-centered research

A look at using smartphone apps for patient-centered research

The usefulness and power of mobile apps in research was one of the last topics at Medicine X yesterday. One of the panelists in the late-afternoon “Clinical research in the palm of your hand” session was Stephen Friend, MD, PhD, who told attendees how willing most patients are to share their health data for science. “If you give someone a choice and ask them, ‘Do you want your data to be looked at by qualified researchers around the world?'” people usually say yes, reported Friend, president of the nonprofit biomedical research organization Sage Bionetworks.

Panelist Michael McConnell, MD, professor of cardiovascular medicine at Stanford, can certainly attest to this: He’s principle investigator of a study, MyHeart Counts, that has seen tens of thousands of users offer up their heart-related data for study.

Stanley Shaw, MD, assistant professor of medicine at Harvard, shared thoughts on how having an ongoing data connection with patients can feel for a physician-researcher: “I had a surprising sense of immediacy when I started looking at… data. We had people upload information such as their blood glucose levels. You can see people cranking the level down day by day over weeks or months. It really does remind you of that pact between an individual and their physician and that it’s a privilege to take care of patients. It’s very exciting.”

Also exciting is when apps are shown to have a direct impact on a patient’s care or quality of life. Friend gave the example of a program that reduced emergency room visits and hospitalizations by allowing providers to keep track of patients via an app. “If someone has been holed up in their house for four days, we can send someone to find out why,” he said. And if a patient stops taking a daily walk, that provides the medical team with clues as well.

Of course, not every patient— especially one with a chronic illness — is going to bother logging onto an app to share data every day, said Yvonne Chan, MD, PhD, assistant professor of emergency medicine at Mount Sinai Hospital. “We talk about access and engagement,” she said, but different types of users are going to engage with an app differently. For example, asthma patients with severe, poorly-controlled baseline disease are easy to engage and keep — especially if they happen to own a smart phone. Such patients are highly motivated to better control their disease and stay out of the emergency room.

“But people with minor disease that’s well controlled, maybe they have better things to do,” she said. Apps could be designed to engage different patient populations; maybe that asthma app could have a mode that included more entertainment for patients who are less sick and less motivated.

More news about the conference is available in the Medicine X category

Medical Apps, Medical Education, Medicine X, Patient Care

Engaging and empowering patients to strive for better health

Engaging and empowering patients to strive for better health
Nancy M-D on stageMedicine X yesterday featured a series of talks on a topic that is near and dear to the heart of many conference attendees: Empowering and engaging patients. Marty Tenenbaum, PhD, a former consulting professor of computer science at Stanford, began the session with a moving talk on how difficult and frustrating it was to find the right therapy after he was diagnosed with metastatic melanoma 17 years ago.

“I spent a lot of time in the stacks of Stanford reading medical journals. They all agreed on one thing, which was my dire prognosis. I thought, there’s gotta be something better than this,” he said. Tenenbaum’s ordeal prompted him to create a nonprofit, called Cancer Commons, which helps connect cancer patients to the therapies that have the best chance of curing them.

Howard Look, president and CEO of the app Tidepool, said it “was like crawling through broken glass” to get access to his daughter’s blood glucose data when she was diagnosed with type 1 diabetes in 2011. “We quickly discovered how hard it is to calculate the right dose of insulin,” Look said, driving the point home by showing a series of texts he once received from his daughter, Katie:

Katie: “Dad, I’m low. I’m 52 and dropping.”
Howard: “That’s okay, you have your juice boxes right?”
Katie: “I can’t find my juice boxes.”
Howard: “I’ll come get you.”
Katie: “I don’t know where I am.”

“This is a scary moment if you are a parent,” he said. “You might think that when the stakes are this high there must be a way to manage your diabetes with some sort of software or app. At the time, there wasn’t one.” This motivated Look to design an app that helps diabetic patients get and use to their blood glucose data effectively. “When you liberate the data, you empower the patient and enable them to engage however they want to engage,” Look said.

Next, Brian Loew, founder and CEO of Inspire, talked about the online community of patients and medical professionals in that social network. Many patients have reporting feeling more able to discuss certain issues with their doctors after first talking with their peers in Inspire, he said. “How do I travel with a wheelchair? How can tell my kids I have cancer?  These are questions that are often easier to ask of a person who has done or experienced it,” Loew explained.

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Cardiovascular Medicine, Medical Apps, Public Health, Research, Stanford News

Stanford’s MyHeart Counts app reaches overseas to Hong Kong and the UK

Stanford's MyHeart Counts app reaches overseas to Hong Kong and the UK

MyHeart Counts on phoneIn an effort to continue signing up new participants for their heart research study at groundbreaking speeds, researchers at Stanford launched their iPhone app MyHeart Counts overseas in Hong Kong and the United Kingdom today. The goal is to reach out far and wide — quickly.

To date, about 41,000 users have signed up for the free app launched in March, which allows users to learn about their own heart health while also participating in a large-scale heart study. That’s an unprecedented number of people in such a short amount of time, researchers say, adding that it’s only the beginning. From our press release on today’s launch overseas:

“The idea is to move into one country at a time until we go global,” said Euan Ashley MD, a professor of cardiovascular medicine at Stanford and co-investigator for the MyHeart Counts study. “We hope to add more countries every few months.

“We are ready to take the study as far as it will go. We would like to build a new Framingham heart study for the ages,” Ashley said, referring to the long-term cardiovascular study that has followed three generations of participants in Framingham, Massachusetts. “We would like millions of participants.”

MyHeart Counts is the first of the initial handful of apps designed using ResearchKit, Apple’s open-source software platform for creating medical-research apps, to expand overseas. Along with its reach into Hong Kong and the U.K., the app is also being upgraded today, providing more information to users about their own heart health and breaking heart health news. The press release gives a brief overview of what the app does:

The free app offers users a simple way to participate in the study, complete tasks and answer surveys from their iPhones. Once every three months, participants are asked to monitor one week’s worth of physical activity, complete a 6-minute walk fitness test if they are able, and enter their risk-factor information. The app now also delivers a comprehensive summary of each user’s heart health and areas for improvement.

Previously: Lights, camera action: Stanford cardiologist discusses MyHeart Counts on ABC’s NightlineBuild 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

Autism, Behavioral Science, Medical Apps, Nutrition, Stanford News, Technology

Stanford grad students design new tools for learning about nutrition, feelings

Stanford grad students design new tools for learning about nutrition, feelings

2789442655_1f5c33ac51_zMushrooms and tomatoes, veggies that are often reviled by preschoolers, star in a new app designed by a Stanford graduate student that aims to involve children in preparing, and eating, healthy meals.

“Children are more likely to try food that they’ve helped cook,” explained Ashley Moulton, a graduate student in the School of Education’s Learning, Design and Technology Program, in a recent Stanford News story.

Moulton’s iPad app, Nomster Chef, is one of several student projects featured in the article and accompanying video:

Before cooking, children receive an educational video about a food they’ll be working with – for example, a video on how mushrooms grow. The app also incorporates food information in the recipe steps, like the fact that tomatoes are actually a fruit.

After user-testing the app prototype, “I heard from parents that they noticed differences in how their kids are eating,” Moulton said. The app also kept kids engaged throughout the cooking process.

For her project, fellow student Karen Wang developed an iPad app called FeelingTalk that helps children with autism interpret facial expressions:

…[I]n the first level of FeelingTalk, kids choose the one face that’s different (a sad face) from the three happy faces on the screen. The app will then label the different face “sad.”

“My app will be utilizing learning mechanics that directly work with the autistic brain to help them work on something that they’re having difficulty with,” Wang said. “By leveraging something they’re good at, we’re going to teach them to get comfortable looking at people’s faces, examining the key features, and eventually understanding emotions.”

Moulton, Wang and other students will present their work this afternoon at the LDT Expo at the Stanford Graduate School of Education.

Previously: A look at the MyHeart Counts app and the potential of mobile technologies to improve human health and No bribery necessary: Children eat more vegetables when they understand how food affects their bodies
Photo by Peter Weemeeuw

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

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