Despite advances in cancer therapy and treatment, many cancer patients are more likely to die from cardiovascular disease, heart attack, or stroke than from their primary cancer. Why? Because providers and patients do not pay enough attention to common comorbidities during or soon after cancer therapy.
We have developed an automated approach for home blood pressure (BP) management using device-enabled patient-reported outcomes. Home blood pressure measurements taken on a QardioArm Bluetooth BP cuff are collected by the patient’s iPhone and shared with the Epic MyChart app using Apple HealthKit. These values are then imported from the MyChart app to a Maestro Care flowsheet. Each Monday, our newly developed algorithms evaluate the measurements from the prior week and score the patient on their BP control (with a goal of <140/30) as well as BP process (with a goal of 3-4 measures each week, with at least two morning measurements and one evening measurement).
Based on these scores, the patient is sent a MyChart message offering encouragement to keep up the good work, offering feedback to correct their BP process or notifying them that their primary care provider (PCP) has been alerted that they are above their BP goal. PCPs are informed of the workflow upon patient enrollment and are instructed on how to access this HealthKit flowsheet in Maestro Care. Each week in which a PCP’s patient is above his/her goal BP, the PCP receives a notification in Maestro Care recommending blood pressure management.
Site Principal Investigator: Kevin Oeffinger, MD
We developed, tested, and implemented a workflow to connect data from the QardioArm cuff to a Maestro Care flowsheet. We also designed, built, tested, and implemented a “semi-automated” package of Maestro Care tools to act upon home BP data in a bulk manner. A fully automated process is in development. Our study was interrupted when enrollment was temporarily halted due to the COVID-19 pandemic. At that time, we had enrolled four chronic lymphocytic leukemia (CLL) patients, all of whom have now completed the study.
We created provider-facing Maestro Care tip sheets for connecting Duke MyChart to iPhone HealthKit and accessing HealthKit data in Maestro Care. Since the pandemic has limited face-to-face configuration of an enrollee’s iPhone, we developed and are testing an iPhone configuration self-set-up workflow and tip sheet that we hope will allow us to enroll patients virtually once enrollment reopens.
The workflows developed here can have a wide range of applications across numerous patient populations. Researchers in the Duke Adult Blood and Marrow Transplant Program are using similar workflows to examine remote management of blood sugars in diabetics. Currently, data transfer to the Duke MyChart app is only possible via Apple HealthKit, but Android users will soon be able to use these workflows once Duke Health Technology Solutions (DHTS) opens that link. Once our workflow is fully automated, it can serve as a use case for low-touch, remote chronic disease management across large populations.