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MUSC Annual Report 2011-2012

Making the Smartphone Smarter

Frank A. Treiber, Ph.D., is used to catching the latest wave, whether it's in the Atlantic Ocean or in the use of mobile technology that he sees as a game changer in shaping the delivery of health care.

Treiber, formerly vice president for research and development at the Medical College of Georgia, came to MUSC in 2010 as a SmartState endowed chair in technology applications to prevent and manage disease.

He leads the Technology Center to Enhance Healthful Lifestyles that is charged with developing and commercializing software and technological products to improve the delivery of health care.

The field of mobile technology sort of chose him rather than the other way around, he said. His research career previously had focused on 24-hour telemonitoring devices that tracked patients' vital signs, such as blood pressure and heart rate, in their natural environment.

"As I saw technology developing, we started morphing into smartphones and into the management of diseases and prevention work. MUSC had the foresight along with USC to develop a Center of Economic Excellence involving technology applications."

The options for mobile health care are limitless. This is telemedicine, but it also is about enabling patients to better monitor their health, he said. "We wanted to reach out to a lot of people and what we have found that one thing that a lot of people have irrespective of their socioeconomic status, their ethnic background is a smartphone or cellphone."

A recent proof of concept study featured the app Tension Tamer. Many chronic diseases are stress activated or worsened by stress, such as high blood pressure, cardiovascular disease and Type II diabetes. Treiber said the beauty of the Tension Tamer is that it takes breathing awareness meditation that is easy to learn and has been shown to be effective in lowering blood pressure and puts it into an app that patients can access easily anywhere.

Researchers figured out how to use the smartphone camera to do pulse readings while a person is doing the meditation app so they can get immediate physiologic feedback. Based on study results with school teachers, they found large reductions in resting and ambulatory blood pressures in prehypertensive adults, he said. Participants also reported a reduction in stress and anxiety and better ability to sleep.

The long-term goal is to have an app available on the android and Apple side. 

"It'll be one of the 16,000 apps that are out there for health care or wellness, but it will be one of the very few that has been empirically validated - that has been shown to be very feasible and very usable and acceptable to those who are using it. The most important thing is that they maintain it. They keep doing it. We had high, high adherence rates to this twice a day, 10 minute sessions for three months, in part, because of the feedback they're getting."

Another success story is the pilot study called S.M.A.S.H., Smartphone Medication Adherence Stops Hypertension, which involved Hispanic adults with uncontrolled high blood pressure.

One of the biggest problems that health care providers face is getting patients with chronic diseases to take medications properly. Thirty to 50 percent of patients do not take their medications as prescribed. "It's not just people who are elderly or on a large numbers of medications, either. It turns out this problem affects a wide range of ages and patients.

With the SMASH study, patients were given an electronic medication tray with individualized compartments for each day's dosages. The patient receives a series of alerts, including a bright flashing light at first followed by a loud chime and an automated phone call if the medication remains untaken.  The patients also received a blood pressure monitor to take their pressures every three days.  The readings are sent wirelessly to their smartphone and sent via internet to a secure computer to be reviewed by their doctor, who receives summary reports of their patients' pressures every two weeks and alerts if pressures are ever in a danger zone.

Initial results from the three-month trial are very promising, he said. Patients who received the devices exhibited a 95 to 100 percent adherence to their medication regimen. At the three-month evaluation, they showed a 17.9 mmHG reduction in their systolic blood pressure across 24 hours compared to a less than 1 drop among the control patients. They went from hypertensive, with a systolic resting pressure of 154 to being normotensive at three months with a reading of 127.5.

Additional patients are now participating. If the findings hold up, the technology center will apply for funding to test the SMASH program in a large sample of uncontrolled hypertensive adults, he said.

What the studies are showing is mobile technology's ability to help people form and adhere to healthy habits. It also allows health care providers to address the issue of clinical inertia - when there's too much time lag in doctors getting information they need to monitor a patient's progress, such as being able to adjust a medication to be set at the right dosage.

"These mobile health technologies allow a doctor and a patient to be interconnected with each other 24/7. The doctor can monitor very readily with the technology that we have multiple vital signals - heart rate, pulse oximetry, glucose, weight. They can have all that processed and delivered to them."

Another promising area to explore is the innovative ways to use teleconferencing on mobile devices to deliver health care. All these innovations mean the possibility of better health care and more cost-effective monitoring.

"The doctor will be able to take care of them in the home environment without them getting so bad that all of sudden they end up in the ER in a crisis.  In the long run, these kinds of devices will help in the delivery of more efficacious and cost effective health care because we'll keep people out of the ERs and the hospitals."

Trieber, who has about 10 ongoing projects, said he's excited about finding ways to bring together the intellectual capital on MUSC's campus with the innovations of mobile high-tech health care.

"I saw the opportunity to come here and help bring this along as a way to really help treat diseases that are ravaging the South and the nation."

For more information, link to: MedMinder Video and Tension Tamer Video

The Medical University wishes to express its deepest gratitude to The Duke Endowment, whose generous support of the S.M.A.S.H. Program is saving and changing lives throughout the entire state of South Carolina.

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