Columbia Nurses Develop Medical Apps to Address a Host of Health Needs
With the tap of a finger on a mobile app, people at risk of strokes and heart disease can use their phone as a remote ECG and transmit readings to medical providers miles away. Researchers seeking ways to reduce risky sexual behavior among young gay men have designed an app that sends reminders to take medication or make doctors’ appointments. Patients who seek care from multiple providers can have all their medical data in a single place—their phones. Just as Florence Nightingale brought professional nursing care to the Crimean War 160 years ago, today’s digitally savvy nurses are bringing health care and preventive medicine into the digital age with the most modern of devices: smartphones and tablets.
“Technology has the potential to empower nurses and improve care by assuring ready access to evidence-based clinical practice guidelines,” said Bobbie Berkowitz, dean of the nursing school. “It can also provide insights into patient interactions and make care more efficient and cost effective.”
Kenrick Cato (SoN ’08, ’12, PhD ’14) was a data programmer before attending nursing school, where he became interested in informatics, the science of information processing. In nursing it involves using data science in patient care as well as health promotion and prevention.
With funding from the National Institute of Nursing Research and National Cancer Institute, he worked with a research team led by nursing professor Suzanne Bakken on an app that gathered information about patients’ tobacco habits. According to the Centers for Disease Control and Prevention, patients get screened for tobacco use in less than two-thirds of office visits, and smokers are advised on how to quit less than 20 percent of the time.
Using mobile phones loaded with tobacco screening guidelines, nurses asked patients about their smoking habits in 84 percent of clinic visits when they were prompted by the app, and they offered cessation counseling to 99 percent of smokers who wanted to quit. The study, published earlier this year in Oncology Nursing Forum, “showed that mobile applications can play a significant role in curbing tobacco use,” Cato said.
Other researchers at the nursing school design apps reflecting their own health care interests. Assistant Professor Kathleen Hickey, a specialist in cardiology, uses an iPhone app that monitors atrial fibrillation (AF), a condition that can lead to stroke if not properly treated. Her project just received a five-year, $2 million grant from the National Institutes of Health that will look at how mobile technology can improve patient outcomes. AF has few obvious symptoms. Proper diagnosis often meant patients had to walk around with bulky monitors that recorded every heartbeat for 14 days, or visit a doctor at exactly the right time. With Hickey’s app, patients can now whip out their phones to measure their vital statistics if they feel poorly.
Hickey also is partnering with the American Heart Association in a project to send out texts about heart disease. “We want people to get messages on modifiable risk factors, such as obesity and lack of exercise,” Hickey said. “We’ll send links to the association’s website about healthy cooking or how many grams of sugar are in a can of soda.”
When she was getting her Ph.D. in nursing, Rebecca Schnall, now an assistant professor, became a project coordinator working on mobile apps, which spurred her interest in using mobile technology for preventive health. In one study, Schnall gave 60 teenagers smartphones with unlimited texting, preloaded with health information. The teenagers received regular texts asking if they had questions about their health and whether they used the phones to find answers. The results, published in the Journal of Medical Internet Research last year, showed a 90 percent response rate to the text messages, and that the Internet was one of the top sources of health information for the adolescent study participants.
Now Schnall has designed two mobile applications: one for those who are HIV-positive and at high risk—men having sex with men—and the other for people living with HIV. Working with the CDC and a Columbia team that includes nurses, psychologists, programmers and a case manager, her apps allow patients to track their appointments, send text reminders to take medication and store medical records so patients have everything they need when they go to different medical providers.
The design documents for the apps are being sent to the CDC, which will decide whether to develop them further. “There are thousands of apps developed for HIV-positive persons, but not many include patients in the design process,” said Schnall. “It’s a tool so that they can better self-manage their care.”