For patients with moderate to severe asthma, it’s not uncommon to see a pulmonologist or allergist for routine follow-up appointments at three- to six-month intervals. But a lot can happen in between those visits, and patients don’t always call their provider when their symptoms worsen – sometimes misjudging a significant deterioration of breathing as allergies, a cold or simply not bad enough to merit the hassle of trying to book another appointment.
Because of this, patients may not seek treatment until their symptoms escalate into an asthma attack, which can potentially become a life-threatening emergency.
But this cycle doesn’t have to be inevitable, contends Christopher Fanta, MD, director of the Partners Asthma Center and a pulmonologist in BWH’s Division of Pulmonary and Critical Care Medicine. In fact, it is often preventable.
“Severe asthma attacks don’t happen at the snap of a finger. There’s an opportunity to intervene early – it doesn’t have to get that bad,” Fanta said. “There is often a gradual decline over several days, and we have highly effective therapies to intervene so that it doesn’t develop into a crisis.”
Two innovators are confident that window of opportunity could be pried open with digital health tools. David Bates, MD, chief of General Internal Medicine and Primary Care and medical director of the Partners HealthCare Center for Clinical and Quality Analysis, and Bob Rudin, information scientist at the RAND Corporation, have teamed up to create an app that can help patients track their symptoms between appointments.
Following a conversation about how to best overcome the challenges of integrating patient-reported outcomes into routine clinical care, Bates and Rudin began collaborating on what would become the BWH Asthma App, a mobile application for patients to regularly track and report their asthma symptoms.
“Far too many digital health apps are targeted at people who are generally healthy, and what we need are more apps focused on chronic diseases, such as asthma, to help them manage their care more directly,” Bates said.
Interested in conducting a six-month feasibility study with Partners Asthma Center patients, Bates and Rudin approached Fanta with the idea for the pilot. An enthusiastic proponent of digital health innovation, Fanta happily came on board to support the clinical side of the study, which enrolled 26 patients with moderate to severe asthma and concluded earlier this year.
“Asthma was an ideal use case because while the clinical guidelines recommend ongoing symptom monitoring between visits, the reality is no one does that,” Rudin said. “The reason for that is there aren’t any tools that are readily adoptable or any best practices for figuring out how to do that.”
Created by Rudin, the app was designed for simplicity and ease of use – an approach that was influenced largely by interviews the team conducted with providers and patients before building the software.
The research team also engaged the Brigham Digital Innovation Hub (iHub). Using iHub’s Brigham Mobile Research Platform, they were able to ensure the app met stringent security and Institutional Review Board requirements while integrating patient-generated data with electronic medical records in Partners eCare.
Each week, patients received a push notification prompting them to answer five brief questions about their asthma. If their symptoms were somewhat worse than the prior week, patients were given the option to notify their care provider and request a call. If their symptoms were significantly worse, the app automatically notified the patient’s care team at the Partners Asthma Center.
Additionally, patients could use the app to view a graph charting their week-to-week changes. The more data they entered, the more valuable the feature became to both providers and patients.
The study was designed to examine whether patients would use the app consistently – 24 out of 26 did – and assess its potential burden on providers (it proved not to be burdensome). It did not measure clinical outcomes or costs, but the team hopes to investigate those in future studies.
After incorporating feedback and lessons learned from the initial pilot, the next frontier for the BWH Asthma App will be primary care practices at the Brigham, according to the team.
“We’re actively trying now to expand the population because most patients with asthma are treated by their primary care provider. Only a minority are referred to asthma specialists,” Fanta said.
Bates said he sees great potential not only for the asthma app but also the many digital health innovations yet to be discovered.
“We think of treating a patient today by prescribing drugs,” he said. “I think we’ll soon be prescribing apps.”