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Boston Children’s Hospital and Duke Health Leverage CareKit to Help Patients Navigate Their Health with Caremap

Families of children with complex medical conditions navigate large health systems, visit many clinical providers and are tasked with tracking multiple aspects of their care, including symptoms, medications, nutritional intake and other physiologic and psychological factors related to their health. Boston Children’s Hospital recognized that this can be challenging for families to manage and collaborated with Duke Health to create the Caremap app (available for free on the Apple App Store) for families to organize and track their child’s healthcare. Adult patients can also use Caremap as their own personal health tool.

The Innovation and Digital Health Accelerator team at Boston Children’s leveraged Apple’s CareKit and ResearchKit frameworks to create an iOS app that families can use to securely record a snapshot of their child’s health record, identify care items they want to monitor, and share relevant details with their care providers and care givers.

The MyHealth feature in the app enables patients to capture details about their health conditions such as allergies, details about medical equipment they may be using, store emergency care instructions, and record major medical history events including procedures and hospitalizations. Data generated by patients and families is stored securely on the device. Future updates will leverage the open FHIR interoperability standard to enable patients of Boston Children’s and Duke Health to connect to their patient portal with Cerner and Epic, respectively. This readily accessible snapshot of a person’s health can be shared in emergencies by a patient with new doctors or caregivers.

Caremap leverages most of the core modules from CareKit. Using the Symptom Tracker and Care Card modules, the app provides a pre-configured set of care items that patients track including sleep, mood, pain, nutrition, and bathroom activities. Additionally, patients can create custom care items to monitor like school attendance or temper tantrums, allowing for individualized data and insights to be gleaned. HealthKit is integrated to capture data from connected health devices like weighing scales. The activities and assessments tracked are then available via Insights charts and graphs. These insights can be shared with the clinical team to provide clinical decision support and ultimately better care for patients.

Utilizing CareKit’s Connect module, Caremap users can simply add their most relevant clinical and personal contacts reducing the need to hold on to business cards and scraps of paper with physician names and phone numbers. Through Connect, they can easily share the information within the app as a PDF via text message, email, or printed copy to carry into appointments. Caremap also leverages Apple’s ResearchKit for some of the assessments, authentication, and graphing components.

The goal of Caremap is to organize the immense amount of information stored by families of children with complex medical needs, and provide additional resources and insights into their health for productive conversations with clinicians. At Boston Children’s and Duke Health, we believe that tools like Caremap will provide a medium for the patient to capture information about their health outside of the hospital or clinic and enable better coordination and conversation between patients, families and clinical teams.

For more information about Caremap please visit http://caremap.health

- Nitin Gujral, Innovation and Digital Health Accelerator, Boston Children’s Hospital

- Katie D. McMillan, Innovation Portfolio Manager, Duke Health

CareKit 1.2: Creating Fully Integrated Care Apps

We’re all about connectedness with CareKit 1.2! Today’s release includes updates to all four care modules, introduces new header views for more beautiful and intuitive ways to track health goals, and increases connectivity between consumers and care teams through our new Cloud Bridge APIs. We’ve even released a prototyping tool for anyone, even without coding experience, to use and play with these new features.

This release introduces a new tab called Care Contents that allows you to combine activities from both the Care Card and Symptom Tracker all in one place. We’ve also made some updates that let you create optional or ready only activities. The optional activities do not contribute to a user’s daily completion goals and the new read only activities are great for displaying information that doesn’t require any action from the user.

CareKit headers now display a daily ring view with customizable glyphs to reflect daily completion of care activities. The Apple team has designed 28 icons that can be displayed not only within the ring view but also as complications on the Apple Watch. Once a user reaches 100%, the ring will fill in and a star badge will appear to easily identify days of full compliance.

The Insights and Connect tabs have some great updates as well. You can now set thresholds on activities, and display alert UI and colors in the Insights tab if thresholds have been invoked. The Connect tab includes a new inbox feature with UI for messaging between consumers and care teams, friends, and family members directly within your apps.

We have also made data sharing between CareKit patient apps and care teams even easier with the new addition of our Cloud Bridge API. The Bridge API provides all of the necessary hooks through delegate functions for cloud bridge’s to seamlessly integrate with the CareKit framework, allowing developers and current cloud providers to easily create backend solutions that fit directly into the framework architecture.

You can play with all these amazing new features and upgrades without needing any development experience through our new prototyping tool! Simply download Xcode and the CareKit framework, fill in the details of your care app in the OCKPrototyper Plist, and show off your new app to colleagues, developers and loved ones!

We look forward to seeing how your CareKit apps can help further connect consumers to their health insights and care teams.

- The CareKit Team

Glow facilitates easy sharing of health information with CareKit

Women in the United States make approximately 80% of health care decisions for their families. These decisions aren’t made lightly—they often involve hours of research, and enlisting the help of family, friends, and medical professionals. Keeping this information organized and keeping everyone in the loop is crucial.

At Glow, we make mobile apps that empower women with health information. Our support begins when a woman gets her period and extends through parenting, when she becomes a central caretaker and starts to assume responsibility for the health of her loved ones.

Being a central hub of the family’s health information often requires sharing information between various parties. Knowing how much our users want to transfer their data to family members, doctors, or other caregivers, we were thrilled when Apple told us about the idea of CareKit.

CareKit’s Connect module enables fast, easy sharing of health information among family members, medical professionals, and caregivers of all kinds. For our Glow users, this means an ability to not just collect information in the app, but share that information with relevant parties and develop a solution faster.

Our apps anticipate the kind of data entries that should be shared between parties, and we leverage smart notifications to prompt users to visit the Care Team page, where they can transfer data right away. For example, a mom who uses the Glow Baby app to note that her baby has a fever will receive a notification directing her to share the information with the pediatrician, babysitter, or wider family on the Care Team page. In our Glow Nurture pregnancy app, Care Team notifications surface when a user indicates that she feels sick and when important prenatal appointments draw near.

Providing tools to make health management easier for women and families is core to our mission, and CareKit enables us to serve our users better in this regard. Better and easier sharing of information with all caretakers—doctors, nurses, partners, parents, babysitters—is another important dimension for taking control of one’s health.

- The Glow Team

CareKit + ZeroKit: Protect patient data in the cloud

Technology can improve patient lives in ways not seen before. Yet risks to data security interfere with innovation. Massive data breaches are all too common turning stolen patient passwords, personal identity, and medical records into articles of trade. To realize the true potential of mobile technology for patient empowerment, security concerns must be tackled.

Apple designed the iOS platform and CareKit with security at its core. When building apps where data is shared across devices and with other services, developers want to extend this security to the cloud. This is exactly what ZeroKit does.

Starting today, CareKit developers can use ZeroKit in their apps. ZeroKit complements CareKit: it’s a "Zero Knowledge" User Authentication service and Encryption SDK that enables developers to protect PHI (Protected Health Information) with the best available methods in the cloud. Using ZeroKit, CareKit developers can reach HIPAA compliance easier which attracts patients and healthcare providers who are looking for the most secure solutions.

ZeroKit offers the following:

1. Authentication of Patients/Healthcare Workers: ZeroKit takes care of user registration and login for your app. The service uses PAKE (Password-authenticated key agreement) technology which does not store password hashes, making it immune to "pass the hash" and safer against brute force and dictionary attacks. The SDK supports Touch ID authentication and also allows developers to never see their users' passwords.

2. End-to-End Encryption of Health Data: using the SDK, you can encrypt health data of authenticated patients. Before data moves to the cloud, PHI gets encrypted on the patient's device and remains encrypted throughout its life (over the wire, on servers and at rest). The encryption keys never leave the device in an unencrypted form. The next time data gets decrypted is when it's displayed on the doctor's device. Even in case of a breach to the servers, records are only visible in encrypted, unreadable form.

3. "Zero Knowledge" Sharing of Health Data: The "Zero Knowledge" key management technology enables secure sharing of encrypted patient data without exposing the data or keys to anybody or any service. Combined with ZeroKit's User Authentication service and CareKit's default file system encryption, this architecture protects PHI from breaches, while providing a seamless experience to your end-users.

The SDK is available for iOS (Swift), Android (Java) and web browsers (JavaScript). Despite the complex technologies used (PAKE-powered user authentication, End-to-End encryption, "zero knowledge" key management), the SDK doesn't require any previous knowledge of security:

ZeroKit is used by healthcare apps such as The Diary in the US & Asia to coordinate community care and hospital monitoring of discharged patients, Dr.near.me in Europe that enables patients sharing their health and personal health data with their doctors in the cloud and by consumer apps such as Caret, the living address book that personalizes presence info with context & interactive services.

For more information and to download the ZeroKit-integrated CareKit sample app, sign up at https://tresorit.com/zerokit/carekit

- The ZeroKit team

Beth Israel Deaconess Medical Center empowers patients with new iOS App

Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School, has developed BIDMC@home, a new app for engaging patients using Apple’s CareKit and ResearchKit frameworks and the HealthKit API. The app provides a flexible framework to help patients manage their health from home, as directed by their physicians. The app will be piloted in several specific patient populations and will eventually be offered to BIDMC’s entire network of over 250,000 patients.

BIDMC@home provides personalized home monitoring in many different conditions. HealthKit allows the app to collect data from various sensors and 3rd party apps to gain a holistic picture of health and help prevent hospital readmissions. Together with HealthKit-enabled wireless devices such as scales and blood pressure cuffs, patients with congestive heart failure can use BIDMC@Home to monitor vital signs and symptoms. Daily fluid, sodium intake and important predictors of fluid retention, can also be imported via HealthKit. Connected thermometers allow patients with autoimmune diseases such as lupus and rheumatoid arthritis to better predict infections and monitor inflammation. Outpatient chemotherapy is associated with varied symptoms and side effects. The app allows these patients to better monitor their health during treatment.

BIDMC@Home simplifies complicated post-operative instructions given to patients after orthopedic surgery by utilizing the dynamic care card and allowing them to track their recovery. Major bowel surgery can place patients at risk of severe dehydration. Connected scales and electronic patient reported outcomes will help prevent complications in these patients in between visits to the doctor’s office.

The app contains several key functions:

Care Card:

Every patient has a customized care plan that is seamlessly synced from the electronic medical record via FHIR interfaces. All outpatient medications are listed and updated in real time when a provider makes a change. Patients are encouraged to adhere to their prescribed medication regimen and can also track their intake of “as needed” medications. Providers can also define a care plan for non-medication activities, such as: diet, exercise, sleep or other instructions tailored to their individual care.

An essential part of staying healthy is the plan and thought process laid out in the health care providers’ notes. All too often these are hidden in the silos of individual electronic health record systems. BIDMC@home harnesses the capabilities of the Health app in iOS 10 to serve as a secure, patient controlled, shareable database of medical records. Under the umbrella of the Open Notes initiative pioneered at BIDMC, patients will be able to view and download their physician’s notes from BIDMC, transforming their phones into true personalized health records.

Assessments:

As part of each patient’s individualized care plan, he/she is prompted to provide subjective and objective data to monitor health. These data include values that are synced via HealthKit from connected sensors or other apps (e.g. weight, blood pressure, heart rate, temperature, daily sodium intake) and subjective assessments. Using the ResearchKit framework, the app collects meaningful patient reported outcomes using simple questions (e.g. shortness of breath on a 0-10 scale) or more elaborate validated survey instruments.

Insights:

To empower patients to take control of their own care, the app provides a dynamic graphing engine so that patients can see the relationship between measurements, medication adherence, or amount of “as needed” medications taken and the direct results. By reinforcing the relationship between treatment and outcome, we hope to reinforce positive behaviors and improve treatment compliance.

Connect:

The app syncs with our secure messaging system and allows patients to quickly contact their care team members.

For more information about BIDMC@home, please contact Seth Berkowitz, MD at sberkowi@bidmc.harvard.edu

- Seth Berkowitz, MD
   Beth Israel Deaconess Medical Center

Johns Hopkins Medicine Leverages CareKit to Empower Patients in Heart Attack Recovery

Patients who survive a heart attack have a long road to recovery which can be daunting and overwhelming for both them and their families. There are many unknowns after this major life event and patients may get limited answers to their questions, while in the hospital and head home with only a piece of paper to rely on for recovery instructions after discharge.

A perfect example is Mr. Sami Badra, a 30-year old heart-attack survivor. Sami recalls, “I was not using my time in the hospital properly…lying around and watching a lot of TV.  In the last two hours before leaving I was given instructions, but never fully understood them. I left the hospital feeling alone.”

Johns Hopkins medical and cardiology physicians, Francoise Marvel, M.D. and Seth Martin, M.D., and colleagues Matthias Lee, Gavi Rawson, Jal Irani, and Ali Afshar, recognized a need for a resource that heart attack survivors could use from day one in the hospital through discharge and recovery to aid in a successful recuperation and ultimately a heart healthy life. The multidisciplinary team established synergistic collaborations across the Johns Hopkins University including the Whiting School of Engineering, The Johns Hopkins School of Medicine, The Johns Hopkins School of Nursing, Carey School of Business, Arts as Applied to Medicine, Center for Innovative Medicine, Technology Innovation Center, Patient Safety Advisory Board, Patient Family Advisory Council, and community partnerships with YMCA and the American Heart Association to create the first cardiology CareKit App, called Corrie (Cor is Latin for heart).

The Corrie app, paired with the Apple Watch, offers the following:
Watch the video

1. Welcome Page: preview of the Corrie App features and sign-in.

2. My Activities: track progress taking medications and completing other care tasks like engaging in physical activity. Reminders are included to help patients stay on track.

3. My Vitals: stay in tune with indicators of recovery like heart rate, blood pressure, physical activity, and mood.

4. My ABCs: empower with heart health understanding through engaging state-of-the art videos and easy-to-read summaries addressing life-saving cardiology topics including understanding why heart attacks happen and tips on how to prevent them in the future (ex. medications, diet, exercise, and smoking cessation). Patients, families, and caregivers can easily share in the learning experience by engaging with these videos on their mobile device and via Apple TV in cardiac unit hospital rooms during their stay.

5. My Follow-Up: schedule and track follow up appointments with doctors and cardiac rehabilitation.

6. My Connect: keep critical health information a click away, including medical cards (e.g., stent cards, insurance cards) and care team contact information.

7. Apple Watch Combined with Corrie App: monitors cardiac recovery (steps, heart rate, activity goals) and keeps patients on track with medication reminders and doctor’s appointments that are critical for successful heart attack recovery.

Starting this fall at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center in Baltimore, the MiCORE (Myocardial infarction, COmbined device, Recovery Enhancement) clinical study will enable heart attack survivors to use the Corrie app on their iPhone and Apple Watch. The study will investigate how this app can help empower patients, such as Sami, and help answer the elusive question of “now, what?”

For more information about Corrie, please contact Francoise Marvel, MD at fmarvel1@jhmi.edu

- The Johns Hopkins Corrie and Apple CareKit Teams

HomeHero: Leveraging CareKit to Collect Patient Data in the Home

At HomeHero, our vision is to extend the care continuum into the home. Our registered and trained caregivers (“Heroes”) work daily with patients, collecting critical patient health information. Via the Hero iOS app, our Heroes manage patient care, assist with activities of daily living (ADLs), coordinate transitional care for discharged hospital patients and help monitor and record patient health. We use the patient data we collect to prevent negative adverse events — ultimately reducing readmissions and improving patient outcomes. But how do we organize and display this health data in a way that is compelling and easy to digest for caregivers, family members and case managers in the hospital? Enter CareKit.

The Care Card module condenses multiple layers of daily tasks into a simple indicator for each day of the week. Meanwhile, the Symptom Tracker provides a template to power both our Home Safety Assessment and Patient Health Survey to document environmental and behavioral health risks with easy “Yes/No” responses. CareKit’s open-source nature also allows us to maintain our own brand and style for the custom toolbars while giving us the ability to protect patient privacy — patient health data stays safely stored on our HIPAA-compliant servers.


On June 23rd, we officially launched the new HomeHero app as part of our Safe Transition Home program with Cedars-Sinai Medical Center, the largest nonprofit academic medical center in the Western United States. The program offers patients a safe transition from the hospital to their home, as well as rides back to the hospital for scheduled check-ups and appointments. Through this partnership and new program, Cedars-Sinai became the nation’s first hospital system to integrate with CareKit’s platform. This is the first of many steps as HomeHero, in partnership with CareKit, continues to extend the healthcare system into the home.

- HomeHero Team

CareKit 1.1: Care Card comes to the Apple Watch

You heard right. We released CareKit 1.1 today which includes two major updates to the Care Card: Apple Watch integration and 3D Touch.

With CareKit 1.1, the Care Card is now available on the Apple Watch. Extending the Care Card to the wrist just made adhering to care plans and marking completed care items on-the-go significantly easier. A new Care Plan complication on the Watch also lets users gauge their Care Plan completion throughout the day.


Care Card

Care Plan Complication

3D Touch is also now functional with the Care Card and Connect. Let users peek, pop and perform actions straight from the master screen. With Connect, you can even initiate FaceTime calls or other custom methods of communication. This added 3D touch enhancement seamlessly integrates with any iPhone that already uses 3D touch and will begin working automatically without any changes required from the development team.

For developers, adding the Care Card to Apple Watch could not be simpler. Drag and drop a folder for watch into your existing app build and a single line of code will immediately produce the companion watch app. Voila! It does not require a separate build, but rather is a “build one, get one” model. Build one iPhone app, get one watch app for free.

We are excited to see how you bring these features to life with the inspiring work you are doing. Download the new release and get started today.

- The CareKit Team

Patient Centered Care Management with The Diary & CareKit

At The Diary ™ we know that improving patient health is only achieved when patients, family members and providers can successfully collaborate in the delivery of effective treatment—using comprehensive, real-time, patient-generated data.

The Diary App successfully implemented CareKit for iPhone, iPad, iPod Touch, and Apple Watch to help users interact with their providers outside of the office, while effortlessly collecting valuable health and lifestyle information throughout the day.

The Diary helps people achieve daily and long-term health goals using the Symptom Tracker and Care Card modules of CareKit. Each module’s interface makes it easy to track daily Care Completion. Care teams utilizing the provider-facing counterpart The Diary CarePro™, view responsive heart-shaped progress indicator to quickly determine if their patients have completed their daily health goals. Care items and tasks are created and adjusted by the patient or provider based on needs—giving providers the opportunity to modify treatment plans to best suite their patient’s progress. CareKit’s intuitive interface helps us to solve two major problems facing medical professionals: engaging patients and successfully delivering ongoing care.

We are currently partnering with healthcare organizations to pilot care planning, the Insights module, as well as customizable alerts and reports which indicate when a patient’s data falls outside of typical thresholds. These threshold violations have the ability to improve health outcomes and decrease costs.

The Diary Corp. is dedicated to improving health globally and currently offers The Diary in 11 languages. When used together, The Diary and Diary CarePro provides a comprehensive care management platform and personalized health solution.

- The Diary Team

MDacne uses CareKit to help people struggling with Acne

At MDAlgorithms we believe that the journey to solve our health problems should start with a good, clear and personal road plan.

The mission of our MDacne app is to help the 500 million people struggling with Acne worldwide. MDacne is the world’s first mobile app to use real-time computer vision for immediate skin analysis of Acne. Built for iOS, the App analyses the user’s skin, provides a personal Acne control plan, educates on proper prevention/treatment and monitors improvement.

Using a Dermatologist’s validated algorithm to process the captured skin images, the app builds for the user a customized daily Acne routine. Once the plan is provided, the app uses image analysis to track skin improvement and a gamification system to increase treatment commitment.

The Implementation of CareKit framework allowed us to take MDacne to the next level. With the framework’s Document Exporter, our users can now email themselves a PDF report of their treatment status. Through the Connect Module they are able to share it easily with their Dermatologist and friends/family members.

We are all part of the revolution in mobile health. The recent improvement in smartphone image capture technology, data processing and “always on” cloud connectivity has enabled a quantum leap in the use of our smartphones to improve health.

MDacne, using CareKit, is an example of a new breed of mobile health apps, which can collect, process and share real world health data and images. These apps are the perfect candidates to educate, increase treatment engagement and monitor improvement.

- MDacne Team

One Drop + CareKit: Unlocking the Power of Data-Driven Self Care

At One Drop, we want everyone with diabetes to feel empowered by their everyday experience. We are transforming diabetes care by removing barriers to health data and providing support on-demand.

With CareKit, One Drop took data-driven self care to the next level. CareKit enhanced our platform by allowing users to set daily diabetes management goals and track their progress over time. CareKit also provided a way for users to instantly share data with their Care Team (e.g. family, friends, health care providers, One Drop Experts, etc.) for personalized feedback.

After just one month, CareKit showed its transformational potential. Specifically, CareKit demonstrated the power of self-motivation. Here's some data on users who set at least one daily diabetes management goal:

  • They became more engaged in their diabetes management.
    • 56% logged more data than they did before
  • Their blood glucose levels improved.
    • 40% spent more days with in-range average blood glucose values
    • 42% logged a greater number of in-range blood glucose values
  • They exercised more.
    • 35% increased the total number of minutes spent doing physical activity

All the data collected so far reinforces that we're headed in the right direction. This is the beginning of a major transformation in healthcare: data-driven self care. This is not just about diabetes; this is about all of us. We are building tools to empower everyone to take their health into their own hands.

We're in this together.

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.