MHEALTH RAG:WHERE WE HAVE BEEN AND WHERE WE ARE GOINGLisa Schwartz, PhD

Nadia Dowshen, MD

Linda Fleisher, PhD, MPH

1

TODAY

• Update• Current membership and mHealth RAG

activities

• Results from survey of CHOP investigators current and future digital health research

• Discussion about where we are going and what is needed

2

THE JOURNEY SO FAR…

•Explosion of mHealth tools and interventions

•Increased research funding/grants•Increased research at CHOP•Integration into health care –multi-disciplinary teams

Ecosystem

•Text messaging intervention•Exploration of text messaging platforms

•Survey of patients/families•Survey of CHOP investigators

Chair’s Initiative 2014-15 •Decision Making and Processes to

integrating mHealth into practice•Environmental scan of pediatric hospitals – policies and governance

•Internal scan – CHOP departments & parent survey

•Telederm Pilot• Survey of CHOP Investigators

Chair’s Initiative2016-17

Office of Digital Health

mHealth RAG

CHOP MHEALTH SURVEY

• Summer 2015• Targeted CHOP investigators and clinicians

conducting QI projects• Supported by Dept of Peds Chair’s Initiative• N = 173

EXPERIENCE WITH/INTEREST IN MHEALTH RESEARCH/PROJECTS

Experience/Interest with mHealth n

Interested in learning more about mHealth/eHealth/digital health 84

Currently conducting mHealth/eHealth/digital health research or QI projects

60

Did/are currently doing research 33

Did/ are currently doing QI projects 27

0 10 20 30 40

app development

texting

web-based

social-media

other

Type of Research/ QI project

N=65

Number of Responders

BARRIERS TO MHEALTHRESEARCH AT CHOP

Barrier % Endorsement

1) Lack of technical infrastructure2) Getting funding

>50%

3) Lack of expertise at CHOP 40-49%4) Identifying vendors or industry partners5) Legal/contractual issues

30-39%

6) IRB/regulatory7) Identifying potential academic collaborators

20-29%

MHEALTH RESEARCH AFFINITY GROUP

The mHealth Research Affinity Group’s goal is to provide a formal structure to coalesce local CHOP-based researchers interested in and/or conducting mHealth research and other stakeholders (e.g., IS, bioinformatics), as well as researchers from other local institutions.

SPECIFIC AIMS ARE: • Foster collaborative efforts to expand the capability

to develop, test and integrate mHealth tools and approaches for children, adolescents, and their families.

• Provide a forum for educational and networking opportunities to enhance knowledge of mHealth and develop potential collaborations both within and outside the RAG.

• Serve as a liaison to CHOP Research Institute and hospital administration on needs and prioritization of resources to enhance and facilitate mHealthresearch and its implementation in clinical practice.

MHEALTH RAG OVERVIEW

In your opinion, how could the mHealth RAG best support mhealth/ehealth projects? n %Create opportunities to identify other collaborations at CHOP/Penn

32 68.1

Provide seminars on various mHealth research topics30 63.8

Solicit feedback from CHOP researchers about the resources they need to develop and conduct mHealth research

25 53.2

Provide linkages to other departments and groups at CHOP involved in mHealth (app development, data exchange, EHR)

32 68.1

Identify priorities for CHOP/the Research Institute to facilitate mHealth

32 68.1

Other 2 4.3

• 240 people on the mHealth RAG listserv email addresses • Membership survey

• 8 meetings/events

10

Role n %

PI/ Project director or lead 13 27.7

Collaborator 3 6.4

Project support (manager or specialist)

13 27.7

Other 22 46.8

Completed member survey= 4777% are now, planning to, or have conducted or collaborated on mhealth research, QI, or other projects

2016-2017 EVENTS

Osayame Ekhaguere, MDChen Kenyon, MDJames Guevara, MDChristopher Cushing, PhDPatrick FitzgeraldGelvina StevensonZev SunleifAnne Teitleman, PhDTiffany Montgomery, PhD Mauricio NoveloNalaka Gooneratne, MD

Presenters welcomedBryan Wolf, MD Dennis DurbinRaina Merchant, MDDan O’ConnorCharlene Wong, MDDevon TaylorGregory Tasian, MDLinda Fleisher, PhDNadia Dowshen, MDJorge Galvez, MDJeff MillerLisa Schwartz, PhD

2016-2017 EVENTS

• Attendance• 153 people attended at least one event• Attendees from CHOP, Penn, Drexel, Einstein,

Temple, Villanova, ECRI• 45 people attended more than one mHealth

RAG event; 20 attended three• Top 3 attended events:

• mHealth Research showcase• Speaker series: Christopher Cushing, PhD• Speaker series: Raina Merchant, MD and

Daniel O’Connor

• Survey responses (n=81)• Learned something about mHealth research

• they didn’t know= 99%• that may benefit their research/work=

95%• Likely to come to another RAG event= 100%

WEBSITE FEATURES• Home: mHealth RAG

purpose

• People: Links to key individuals’ professional networking profiles

• News: Regular updates of opportunities, resources, and events at CHOP and beyond

• Events: Upcoming and archived; slides, photos available

• Publications: Searchable database of members’ mHealth related publications

• Featured: Highlight ongoing CHOP research

Website launched in January 2017!

MetricsMar 1-Jun 15, 2017

337 visits Total hours viewed= 16 hours

Average duration of visits over 10 secs= 5.8 minutes

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UNDERSTANDING CURRENT DIGITAL HEALTH RESEARCH AT CHOP

INTEGRATING APPS INTO PEDIATRIC PRACTICE (IAPP)• Chair’s Initiative 2015-2017 – Fleisher & Fiks• Environmental Scan

• External – other pediatric hosptials• Internal

• Parent Survey• Mapping Exercise• Portfolio Analysis• Investigator Survey (building off of previous survey in 2014

under first Chair’s Initiative (Schwartz) & mHealth Work Group

• Pilot Study/Evaluation – Telederm• Current scan of digital health research at CHOP• Linking and Supporting new Digital Health Office

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mHealth Portfolio Review

Searched eSPA grant database using mHealth related MESH

terms

Developed portfolio of

mHealthinvestigators and projects at CHOP

Analyzed overlap between grant

database & investigator survey reported projects

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Portfolio Review Results

66 mHealth related projects identified in eSPAsystem

30 CHOP investigators identified as conducting mHealth-related projects

4 investigators overlapping between eSPAdatabase & investigator survey reported projects

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Investigator Survey

Survey Development

• Survey based on previous mHealth investigator survey

• Collected feedback from mHealth RAG leaders

Survey Implementation

• Implemented via REDCap

• Distributed through mHealth email lists

Survey Data Analyzation

N=86

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Investigator Survey ResultsN=86

19

0 10 20 30 40 50 60 70 80 90

Other (n=1, 1.2%)

Penn (n=15, 18.1%)

CHOP (n=79, 95.2%)

What is your position/appointment? (select all that apply)N=83

20

0 5 10 15 20 25

Other (n=13, 15.7%)

Coordinator (n=22, 26.5%)

Nurse Practitioner (n=1, 1.2%)

Nurse (n=6, 7.2%)

Professor (n=9, 10.8%)

Associate Professor (n=6, 7.2%)

Assistant Professor (n=17, 20.5%)

Attending (n=16, 19.3%)

Instructor (n=4, 4.8%)

Fellow (n=3, 3.6%)

Are you currently designing, conducting or collaborating on mHealth/eHealth/digital health research or QI projects?

21

N=86

0 10 20 30 40 50 60 70

No (n=65, 75.6%)

Yes (n=21, 24.4%)

What is your role in this project?

22

N=21

0 1 2 3 4 5 6 7 8 9 10

Other (n=3, 14.3%)

Technology Developer (n=1,4.8%)

Coordinator (n=5, 23.8%)

Collaborator (n=6, 28.6%)

PI/Project team leader (n=9,42.9%)

What type of technology does your project focus on? (Check all that apply)

N= 21

23

0 2 4 6 8 10 12

Other (n=3, 14.3%)

Web-based (n=10, 47.6%)

Wearable (n=4, 19.0%)

Device (n=5, 23.8%)

Text messaging (n=10, 47.6%)

Android App (n=9, 42.9%)

IOS App (n=9, 42.9%)

What is the purpose of this technology?

N= 20

24

0 2 4 6 8 10 12

Other (n=4, 20.0%)

Goal setting (n=3, 15.0%)

Health assessment tool (n=2, 10.0%)

Patient self-monitoring (n=4, 20.0%)

Information resource (n=7, 35.0%)

Assessment (n=9, 45.0%)

Delivery of intervention (n=11, 55.0%)

What is the current stage of development of your project/technology?N=21

25

0 1 2 3 4 5 6 7 8 9 10

Ready to commercialize (n=1, 4.8%)

Ready for broader implementation (n=2,9.5%)

Implementing my project/study (n=9,42.9%)

Finalizing project development (n=1,4.8%)

Early project development (n=6, 28.6%)

Brainstorming/thinking about how todevelop my idea (n=2, 9.5%)

What type of project is it?

N= 18

26

0 2 4 6 8 10 12

Clinical Operations (n=1, 5.6%)

OEI sprint (n=0, 0.0%)

Research study (n=10, 55.6%)

Research pilot (n=7, 38.9%)

What is the funding source of this project?

N=20

27

0 1 2 3 4 5 6 7 8 9

Other (n=7, 35.0%)

Foundation (n=4, 20.0%)

Other federal agency (n=2, 10.0%)

NIH (n=5, 25.0%)

Internal (n=8, 40.0%)

Who is the target audience/market for your project? N=20

28

0 2 4 6 8 10 12 14 16

Consumers (n=3, 15.0%)

Patients (n=15, 75.0%)

Parents/Caregivers (n=13,65.0%)

Providers (n=8, 40.0%)

AWARENESS OF VARIOUS INTERNAL PROGRAMS

29

0 10 20 30 40 50 60 70

mHealth RAG

Digital Health Office

Department of Biomedical & Health Informatics

Office of Entrepreneurship & Innovation

Operations Information Systems

Research Information Systems

I have connected with this group I have heard of this group I am not aware of this group

USE OF VARIOUS TOOLS

30

0 5 10 15 20 25 30 35 40

Apple ResearchKit

Apple Health Kit

Apple Care Kit

EPIC Apps

EPIC Survey

REDCap

I am not interested in using this tool I am interested in using this tool in the future I am currently using this tool

If proven to be effective, are you interested in integrating it into practice at CHOP?

N=21

31

0 5 10 15 20

Yes (n=19, 90.5%)

No (n=2, 9.5%)

Is your mHealth/eHealth/digital health project integrated with electronic health records (e.g. EPIC)?

32

N=20

0 2 4 6 8 10 12 14

No (n=13, 65.0%)

Yes (n=7, 35.0%)

How could CHOP help to support mHealth/eHealth/digital health research and QI projects?

33

0 10 20 30 40 50 60

Other (n=3, 4.0%)

Specialized analytics and statistical analysis (n=27, 36.0%)

Specialized or expanded Information Systems (IS) support (n=29,38.7%)

Education to IRB, risk management, etc. to mHealth/eHealth,digital health research (n=41, 54.7%)

A "core" or "center" to assist with all mHealth/eHealth/digitalhealth activities (n=48, 64.0%)

Contracts with vendors in place to facilitatemHealth/eHealth/digital health (n=33, 44.0%)

In-house web developer accessible to researchers and projectleaders (n=43, 57.3%)

In-house app developer accessible to researchers and projectleaders (n=49, 65.3%)

Someone designated to help vet and evaluate potentialtechnology-related collaborators/partners (n=48, 64.0%)

Are you interested in consumer/patient facing research, or provider/clinical workflow research?

N=18

34

0 2 4 6 8 10 12 14 16 18

Other (n=0, 0.0%)

Provider/Clinical WorkflowResearch (n=10, 55.6%)

Consumer/patient facingresearch (n=17, 94.4%)

Are you willing to be contacted about your specific projects and mHealth/eHealth/digital health work at CHOP?

N=20

35

0 2 4 6 8 10 12 14 16 18 20

No (n=2, 10.0%)

Yes (n=18, 90.0%)

Would you be interested in being listed in an internal resource to be contacted for participation in a specific project?

N=75

36

0 10 20 30 40 50

No (n=47, 62.7%)

Yes (n=28, 37.3%)

PROGRAM OVERVIEWDIGITAL HEALTH

01. CARE ANYWHERE

Supporting Scale & Growth

Extending our scale through telemedicine and connected health platforms

• Chronic Care ManagementRemote diabetes counseling using an app that integrates glucometer readings through Apple CareKit

• PT/Family Education & CoachingVideo instruction and monitoring of rehab therapies for Sports Medicine patients

• TelemedicineTransition existing portfolio of telemedicine pilots to Digital Health

02. ENGAGE + CONNECT

Clinical + Operational Experience

Using digital tools to rethink patient engagement and care coordination

• My MedAction PlanPatient-friendly, multi-lingual medication lists and reminders

• NICU Web CamerasLive video feed of babies in the NICU that families can share with friends and loved ones

• MyCHOP BedsideInpatient electronic portal to enhance patient experience

• Online Scheduling

Web-based solution for self-

service ambulatory

scheduling

03. RESEARCH EXCELLENCEInnovative Research Programs

Accelerating research discovery through technology

• Apple ResearchKit

Mobile research data

capture is a priority for the

research enterprise. We

will evaluate ResearchKit

and other apps in this space

to determine which best

meets our needs

04. ENHANCED PARTNERSHIPSMission Sustainability

Fostering relationships with communities, donors, and innovators

• PHRASE Health for

External Decision

Support

Public health agencies and

guideline developers can

easily create alerts that get

pushed to Epic for

outbreaks, emergencies,

and reportable conditions

Bimal Desai, MD, MBIChief Health Informatics Officerdesai@email.chop.edu

Gayle Stidsen-SmithSenior Director for Digital Healthstidsen@email.chop.edu

Contact Us:

MOVING FORWARD

• Newly established Hospital-based Office of Digital Health – Research Pillar and Research Liaison

• Potential to link investigators and digital health pilots (ODH, OEI)

• mHealth RAG – bringing researchers together and advocating for digital health research

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OFFICE OF DIGITAL HEALTHRESEARCH PILLAR

Facilitating research through innovative IT tools and approaches

• Across the continuum of clinical and behavioral research, addressing digital health research and using digital tools to facilitate the broader research community

• Lead, in collaboration with Research and Operations IS, team to identify and select tools. ODH provide resources for initial launch/pilots. Research and Operations IS maintain tools.

• Consultant service for investigators – how to integrate into EMR and other Enterprise systems, list of vendors, IS insights for research projects

Integrate evaluation/research throughout the Office of Digital Health pilots

• Develop a set of evaluation tools to facilitate ongoing evaluation/research• Develop evaluations/early research plans and approaches for ODH pilots in

collaboration with the Research Institute’s Digital Health Scholars• Collaborate on Implementation Science Research across Digital Health

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RESEARCH INSTITUTEResearch IS

mHealth RAGDigital Health

Scholars Community

OFFICE OF DIGITAL HEALTH

Research Pillar –Portfolio Leader

Team including Research

Advisor/Director, Evaluation

Coordinator; Medical Advisor

OPERATIONS ISOFFICE OF

ENTREPRENEURSHIP & INNOVATION

DISCUSSION AND QUESTIONS

• Any findings surprising?• What should we emphasize in our reporting

to the research institute?• Now that at least 50-100 investigators are

conducting mHealth research what internal resources should be prioritized?

• Developers, platforms, vetting of outside vendors?

• Suggestions for events for next year?

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