As a fellow in the Stanford Biodesign and Gastroenterology programs, Jasmine Zia, MD, knew she wanted to combine her two passions, medicine and engineering, to create a device that would improve the delivery of patient care. But it wasn’t until she was back in the hospital closely observing the daily challenges of patients and doctors that she and her teammate, Raymond Bonneau, got the idea for an iPhone app to help patients diagnosed with irritable bowel syndrome understand how eating patterns might improve or aggravate their symptoms.
Zia recently presented (.pdf) on the app at Stanford before graduating and accepting a faculty position in the Department of Gastroenterology at the University of Washington in Seattle. In light of the growing popularity of the self-tracking movement, I was interested to learn more about her project and how the app could be used in a clinical setting. Below she discusses designing the app, the role patients played in its development, and a pilot study completed at Stanford.
Can you briefly describe how your mobile app works?
Our app, called Gut Guru, asks patients to log their meals and bowel symptoms every day for two to four weeks. This entered data is presented in a concise and organized manner on a separate screen for both users and their providers to see. Once enough data is acquired from a patient’s diary, a machine learning and pattern recognition algorithm will be applied to this data. Over time, this data will build a predictive model of symptom severity to help identify individualized food triggers.
What motivated your group to develop a tool for identifying food triggers?
Time and time again in my clinics and during hospital rounds, I was struck by how many affected patients, especially those suffering from irritable bowel syndrome (IBS), endorsed having their gastrointestinal symptoms triggered from certain foods. Prior focus groups report up to 70 percent of IBS patients endorsing food triggers. As the medical literature of functional gastrointestinal disorders and food is building, we felt motivated to bridge the gap between what we are learning from research to its practical applications in everyday life for real patients. Instead of giving a huge list of potential foods patients should avoid, we are developing a mobile app to help identify personalized food triggers for patients with irritable bowel syndrome to reduce one’s gastrointestinal symptoms, thereby improving their quality of life.
In designing the app, what specific problems did the team address?
By designing the app, we hope to address [three things]: a more complete and reliable patient food and symptom diary, a more organized presentation of the accumulated data for easier interpretation by both patients and providers, and a more validated and objective methodology for determining personalized trigger foods from a patient’s food and symptom diary.
At present, paper diaries formatted by patients are incomplete due to both limited instructions provided by the busy clinician and low compliance rates associated with the design of freehand pen-and-paper diaries. Prior studies in other chronic disease have clearly demonstrated the superiority of electronic diaries over paper diaries in both completeness and compliance rates.
Patients currently present the data from their food and symptom diaries to their providers in whatever format they choose. Anecdotally, this means pages of disorganized scribbled notes. Providers do not have enough time to go through these paper diaries during a single 20-minute clinic visit.
Finally, clinicians do not receive formal training during their medical career on how to determine individualized trigger foods from a food and symptom diary. There are presently no accepted guidelines instructing providers on how to interpret the data provided from a food and symptom diary.
IBS patients and their medical providers need a more reliable way to individualize dietary modifications to reduce a patient’s bowel symptoms.
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