Doctors Prescribe New Apps to Manage Medical Conditions

Your doctor may soon prescribe you a smartphone app in addition to drugs

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and physical therapy.

Hospitals are developing new mobile apps to help patients manage serious medical conditions and feed information back to their doctors between visits, often in real time.

The new apps aim to help with highly specific issues such as recovering from surgery and managing cancer-related pain. Because they are prescribed by physicians and used under medical supervision, researchers say, they stand a better chance of being integrated into patients’ daily routines, compared with health apps that consumers download and use without their doctors’ involvement.

Researchers are conducting clinical trials to test apps that help patients adhere to HIV medications, manage the symptoms of inflammatory bowel disease and asthma, and prevent repeat heart problems after a cardiovascular rehabilitation program. In addition to sending messages, reminders and instructions, the apps can alert providers to developing problems before they become a crisis. Researchers say their use could help reduce costly emergency room visits and hospitalizations.

“We want apps to be educational and inspirational, help people adhere to their therapy and enable them to share important information with their doctor,” says Joseph Kvedar,vice president, Connected Health, at Partners HealthCare in Boston and author of “The Internet of Healthy Things.” Partners, which includes Massachusetts General Hospital, is testing apps to help patients with atrial fibrillation manage blood-thinner medication, oral chemotherapy regimens and moderate to severe cancer pain.

A new app from the University of Michigan called Breast Cancer Ally is offered to patients to help them manage the onslaught of information and instructions they get throughout their diagnosis and treatment. It allows patients to look up and record their symptoms and provides guidance on when to consult the doctor about complications or concerns. PHOTO: UNIVERSITY OF MICHIGAN HEALTH SYSTEM


The cancer pain management app, known as ePal, coaches patients on taking their medication as scheduled and dealing with nausea and other concerns and side effects of narcotics. It offers brief educational videos and supportive messages, and allows patients to make medication refill requests and keep a diary about how they are feeling. If a patient indicates a fear of addiction to pain medication with an increasing dose, for example, an educational message pops up to explain the difference between increased tolerance and addiction.

“When our patients have severe pain we usually come up with a great plan and medication regimen when we see them in the clinic, but within four weeks the plan kind of falls apart for a variety of reasons,” says Mihir Kamdar, associate director of the division of palliative care and director of Mass General’s cancer pain clinic. “If we can have more points of contact in between visits, we can see who might be developing pain at a crisis level, control it better and keep them out of the hospital.”

The app prompts patients to assess their pain level over the past 24 hours three times a week, or any time when they experience an exacerbation of symptoms or breakthrough pain. It tracks their responses in real time, and if it is escalating, or severe, the app sends a notification to an on-call-clinician.

Adrien Negro, a 32-year-old patient with metastatic thymic cancer, a cancer of the thymus gland in the chest that was causing pain in his shoulder, says that when Dr. Kamdar asked him to participate in a study of the app, he was intrigued. “I’m on my phone constantly anyway and so I used it to track my pain.” Though he hasn’t had pain severe enough to be connected directly to the clinic for help, he says, “It was good knowing I always had access to the doctors.” He records observations and questions for future doctor visits, so when he goes in for an appointment with Dr. Kamdar, “I don’t have to worry about forgetting things, because I had jotted down notes so I could remember, ‘yeah, last Tuesday, this happened,’ ” he says.

The University of Michigan’s Breast Cancer Ally app gives patients information about how to manage after a surgery, including reminders and diagrams of how to exercise to regain strength.

The University of Michigan’s Breast Cancer Ally app gives patients information about how to manage after a surgery, including reminders and diagrams of how to exercise to regain strength. PHOTO: UNIVERSITY OF MICHIGAN HEALTH SYSTEM

The University of Michigan Health System in Ann Arbor, Mich., is developing several mobile apps, and already offers patients a skin cancer app to help them follow suspicious moles. “We want to provide apps that enhance physician-patient communication and help the patients do the things we recommend, but don’t always provide a lot of support for,” says Michael Sabel, an associate professor of surgery and chief of surgical oncology who is leading the effort.

Dr. Sabel’s team developed an app called Breast Cancer Ally for patients at its cancer center by asking specialists about their most important reminders and issues for patients. The team also asked patients what they most need once they left the office or hospital, identifying areas for each stage of treatment where mobile technology could potentially help improve outcomes. The app enables patients to track side effects, makes recommendations on how to manage them and provides guidance on when to call the health-care team.

Jacqueline Tonks, 78, had a mastectomy last summer and is undergoing chemotherapy. She had tubes inserted under her arms to drain excess fluid and used one of the features in the app to track and measure the volume of fluid. She was able to let her health team know when the level was low enough to have the tubes removed.

Ms. Tonks says she especially appreciates the daily reminders that pop up to remind her to perform a regimen of exercises that are recommended to help breast-cancer patients deal with shoulder movement difficulty and pain through the course of her treatment after lymph node removal, including which exercises to do and how many repetitions. “This keeps me on track, and it’s very convenient,” says Ms. Tonks.

At Women’s College Hospital in Toronto, a teaching affiliate of the University of Toronto, researchers are testing whether a mobile app for breast-reconstruction patients can reduce the need for them to see their doctor in person for the first 30 days after a procedure. That is when they are at highest risk for complications and readmission. A pilot study, published in Journal of Medical Internet Research last February, found that the app reduced in-person visits and was cost-effective, with high patient satisfaction scores. Based on the pilot, the researchers recently completed a randomized trial with 76 patients, comparing patients who used the app with those that had usual in-person follow up care.

John Semple, the hospital’s surgeon in chief and lead investigator on the project, says the early evidence shows the app helped reduce readmissions and has the potential for cost savings. Surgeons also found unexpected benefits. They were better able to look at the progress of incision healing by reviewing photos that patients took with their devices and uploaded daily compared with seeing patients in person at one and three weeks postsurgery. And the pictures enabled then to identify rashes and possible wound infections “before they became major problems.” At the same time they were also able to tell patients if the issues weren’t serious and they didn’t need to come in for a visit.

“This is a technology that is in everyone’s pocket and makes patients feel engaged in their own care,” Dr. Semple says.


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