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HealthSteps: The Evolution of Patient Engagement

Five years ago, after a bizarre array of symptoms, my mother was diagnosed as having a glioblastoma — an aggressive brain tumor. She handled the surgery well, but as her treatments progressed from radiation to chemotherapy, her ability to manage her own care steadily declined. Thus, the burden of care shifted to my brothers and me. At that time, mobile apps existed for just about everything, so surely I thought, there must be an app for that! I was wrong. There were multitudes of apps to help you manage a specific disease or achieve some health outcome, but they all lacked one key feature — the ability to coordinate and manage care between people.

Coincidentally, about two years after her diagnosis, Apple released both ResearchKit and CareKit. Spurred by my motivation to find a better solution to coordinate my mother’s care, I realized I could use these frameworks to make this app a reality. With my engineering background and previous success launching a healthcare IT company, I created HealthSteps

HealthSteps is a mobile health platform designed to connect people around the concept of a digital care plan with sharing and syncing capabilities. Unlike traditional paper-based plans, CareKit’s digital care plan enhances care and compliance through real-time medication reminders, detailed instructions and links to multimedia resources like videos, personalized symptom tracking, the ability to embed surveys to track patient-reported outcomes and direct-to-provider text messaging.

The heart of the HealthSteps app is the share-n-sync feature, which connects a patient’s care plan with their network of family members, caregivers and healthcare providers in a safe, HIPAA compliant environment. Share-n-sync solved a recurring issue during my mother’s care: knowing whether she took her medication and if she took the accurate dosage. By using HealthSteps, we all knew exactly what medications and dosages she needed to take and if she took them. When passing the torch to the next caregiver, medication and symptoms were already documented, letting us focus on my mother rather than relaying an exhaustive list of what had been done.

HealthSteps’ share-n-sync benefits extend beyond our family’s situation. For example, varied schedules in the pediatric population can lead to miscommunication-related medication lapses, such as when they have babysitters, spend the night at a friend’s house, switch households or have school-time medication needs. HealthSteps replaces lengthy discussions between caregivers with a succinct and up-to-date care plan that includes any recent changes. Thus, medication changes are not overlooked and double-dosing is less likely to occur – critical issues that can lead to relapse or adverse events in this vulnerable population.

HealthSteps is currently conducting our first pilot project in collaboration with Dr. William Slayton, the Division Chief of Pediatric Hematology and Oncology at the University of Florida – UF Health. In this study, parents of children undergoing leukemia maintenance therapy use HealthSteps to manage care by receiving medication reminders, detailed instructions and text messages from the clinical coordinator. For the first time, clinical coordinators can visualize real-time patient engagement data. This enhances their ability to quickly manage medication noncompliance, address adverse symptoms and ultimately improve patient outcomes. Since these pediatric patients are enrolled in a clinical trial, it allows coordinators to address data gaps before the trial concludes, which reduces administrative backtracking. This in turn shortens study turn-around time and moves potentially life-saving treatments into patients faster.

The American Medical Association (AMA) recognized HealthSteps’ power to enact change in the healthcare environment by selecting HealthSteps as the 1st place winner of the AMA Healthcare Interoperability and Innovation Challenge this past June. The challenge invited health and technology sectors to present mobile solutions that use patient-generated health data to improve physician workflow, clinical outcomes or reduce health care system costs. HealthSteps placed first among 38 international competitors.

The clinical research industry is ripe for a technology upgrade and Apple has led that effort by creating the CareKit and ResearchKit frameworks. In turn, HealthSteps has capitalized on these frameworks to create the next evolutionary step in clinical research and patient engagement. To learn more about HealthSteps and how we are working to improve health outcomes and accelerate clinical research, visit us at https://healthsteps.io

- Benjamin King, CEO, HealthSteps

Nutrino and Medtronic use CareKit on iPhone to provide individual FoodPrint™ reports for people with Type 2 Diabetes

Each of our bodies is unique - not only in terms of appearance, but also in body mass index, metabolic rate and susceptibility to conditions like diabetes. Our dietary needs are just as unique as our bodies. While an apple is generally a healthier choice than a cheeseburger, it’s not the ideal choice for every body at every time.

That’s why FoodPrint™ provides sophisticated scientific analysis of how each person’s individual body chemistry interacts with specific foods and provides smart, tailored advice on how to choose the right foods at the right moments.

These insights are especially crucial for people living with chronic conditions like diabetes, which make food choices absolutely vital for managing their symptoms and remaining in peak health.

Recently Nutrino, one of the world's leading developers of nutrition-related data services, partnered with Medtronic, to give people living with Type 2 diabetes an individualized picture — or FoodPrint™ — of how daily food intake interacts with sleep and other daily activities to impact their glucose levels.

The app is designed for use in clinics and patients can receive access from their doctor. Once a patient living with diabetes receives a professional iPro2 continuous glucose monitoring (CGM) evaluation, Nutrino combines scientific nutritional insights with data generated from that evaluation to deliver detailed, personalized nutrition analysis that inspires people to make positive dietary and behavioral changes.

We’ve worked with a group of physicians to incorporate the FoodPrint™ report into their practice and we’ve already seen some exciting results. We provide patients with an iOS app built on the CareKit framework to capture and log food images and information throughout the CGM evaluation.


A patient logs an apple snack using a CareKit app on iPhone. Automatic collection of a patient’s steps and sleep data.

At the end of the test period, we generate a personalized FoodPrint™ report that scores meals based on each patient’s personal glycemic reactions. One person’s score of ‘A’ could be another person’s ‘D’.

FoodPrint™ reports make personalized science-based nutritional insights accessible to everyone--and gives them greater understanding of how their bodies respond to the choices they make.

Initial results showed that nutrition information, delivered in an easy-to-understand format, is vital to the treatment of diabetes. Based on the success here, we will be incorporating CareKit into Nutrino for all users living with diabetes in the coming months. “This one-of-a-kind tool fills an important gap in the treatment of Type 2 diabetes,” said Dr. Adriana Katz. “Because food and glucose reactions are unique to individuals, this personalized FoodPrint™ report made it easy for my patients to make better food choices.”

To learn more about how Nutrino helps people find foods that love them back, visit https://www.nutrinohealth.com

- Yael Glassman, CEO, Nutrino

Sharp HealthCare has its Eye on Improving Cataract Surgery

The Sharp Health Companion app (now available on the Apple App Store) was created for patients and care team members who simply did not want to continue with the status quo. By leveraging CareKit, our app makes it easy to create personalized care experiences from start to finish: pre-surgery care, intervention and post-care. Since cataract surgery is the most commonly performed procedure within our hospitals, we knew we could make an impact.

"We had zero surgery cancellations, zero post-surgery complications and zero readmissions… It’s the kind of care and guidance that all patients deserve for any surgery or procedure they may undertake."

Pre-Surgery:

Pre-surgery instructions are often overwhelming but if they are not followed, surgeries must be cancelled for safety reasons. This results in higher costs and inconveniences for everyone. The Sharp Health Companion App uses the Care Card, which gives patients reminders for required tasks such as as using eye drops, stopping blood thinners, adjusting diabetic medications and receiving medical clearance.

Day of Surgery:

For patients, surgery day is filled with anxiety and stress. To help alleviate some of this anxiety, the app gives reminders for avoiding breakfast for anesthesia safety, selecting comfortable clothing as well as providing directions to the hospital on Apple Maps. There are also educational videos so patients know what to expect on surgery day to ensure there are no surprises.

Post-Surgery:

Once surgery is finished, the app experience changes to help manage post-surgery care. This is important because patients often have too much on their mind to remember the counseling they receive after surgery. Medication compliance can be as low as 30% in routine recovery so the app offers reminders, tutorial videos and even a timer to help patients use their eye drops. After surgery, patients can monitor their pain and eyesight by taking an eye test and even send photos of their eye securely to their care team if they are experiencing extreme pain. Any health data generated is securely transferred to the Apple Health app and can be shared if authorized by the patient. Most importantly, patients can stay connected to their care teams through the Connect tab and learn about any changes to their treatment plan through notifications. Care teams can also trend adherence and eye health during recovery which results in improved outcomes, fewer complications and better eyesight!


Pre-Surgery Reminder

Day of Surgery Checklist

Post-Surgery Eye Test

Connect with Care Team

Pilot App Experience and Observations:

In our initial pilot, the 32 cataract surgery patients (median age 69 years, ranging from 25 to 85 years) achieved an average of 78.2% medication adherence during recovery. We had zero surgery cancellations, zero post-surgery complications, and zero readmissions.

Patient feedback has been tremendous.

  • 90% felt the app helped them to understand the post-surgery instructions better.
  • 93% believed the app improved their overall surgery experience and
  • 97% would use the app if available in other surgeries or medical procedures.

Patients love having assistance from the app and said it’s like having a nurse or doctor right in the palm of your hand to guide you from start to finish. Care team members love the app too because it reduces friction points. It’s the kind of care and guidance that all patients deserve for any surgery or procedure they may undertake.

For more information about the Sharp Health Companion app, please contact our team at oppeye@sharp.com.

- The Sharp Health Companion App Team at Sharp HealthCare

The statements and opinions expressed in the CareKit blog are solely those of the respective author, who may or may not have scientific or legal training. These statements and opinions are not endorsed by and do not represent the opinions of Apple.

CareKit and the CareKit logo are trademarks of Apple Inc.