Popular Blood Pressure App Misses the Mark

Study in 85 volunteers found highly inaccurate measurements and showcases weakness of unregulated mobile health applications, researchers say

Newswise, March 3, 2016 — A popular smartphone app purported to accurately measure blood pressure simply by placing a cellphone on the chest with a finger over the built-in camera lens misses high blood pressure in eight out of 10 patients, potentially putting users’ health at risk, according to research from Johns Hopkins.

Although the app, called Instant Blood Pressure, is no longer available for purchase, it was downloaded more than 100,000 times and is still functional on phones, the researchers say.

“We think there is definitely a role for smartphone technology in health care, but because of the significant risk of harm to users who get inaccurate information, the results of our study speak to the need for scientific validation and regulation of these apps before they reach consumers,” says Timothy B. Plante, M.D., a fellow in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine.

The study, described at the American Heart Association’s Epidemiology and Lifestyle meeting and concurrently online March 2 in JAMA Internal Medicine, was conducted by Plante and Seth Martin, M.D., M.H.S., an assistant professor in the Division of Cardiology at the Johns Hopkins University School of Medicine.

Blood pressure is best measured, the researchers say, using the well-established technique of inflating a cuff attached around the brachial artery in the arm to detect the force of blood flowing when the heart is beating and at rest. Either a trained medical professional or a machine “listens” to sounds from the brachial artery as blood flows under variable pressure from the cuff.

Plante and Martin undertook the study because “we were skeptical that even very talented people could design an app that could accurately measure blood pressure in such a different way,” Martin says. “Because of the absence of any rigorous scientific testing, there was no evidence that it worked or didn’t work.”

To conduct such testing, Martin, Plante and colleagues recruited 85 adult volunteers among patients and staff members in clinics associated with Johns Hopkins Medicine. The participants self-reported a range of body mass measurements, races and ethnicities, all factors known to influence blood pressure.

Each participant had his or her resting blood pressure measured twice using a reliable automated blood pressure monitor commonly used in research studies to avoid measurer variation or error. Participants also used the app to measure their own blood pressure twice on the same day.

Results showed that blood pressures measurements from the app were overwhelmingly inaccurate. Close to 80 percent of those with clinically high blood pressure, defined as 140/90 millimeters of mercury or above, measured by the automated blood pressure monitor showed normal blood pressure with the app.

The authors say that it is unclear how the app arrives at a blood pressure number. They suggest in the study that, rather than attempting to measure true blood pressure, the app gives a population-derived estimate based on the user’s age, sex, height, weight and heart rate, the latter of which could be detected by the phone’s microphone.

“Because this app does such a terrible job measuring blood pressure,” says Plante, “it could lead to irreparable harm by masking the true risk of heart attacks and strokes in people who rely on the accuracy of this information.”

Martin and Plante note that mobile health smartphone applications are becoming more commonplace, and many have the potential to greatly improve health by putting personalized medical resources and information literally in the hands of patients through cellphones.

Though the results of this study were discouraging, they say improvements in the technology could make blood pressure measurement apps accurate and useful. The app studied here, which cost $4.99 when it was sold, was removed from Apple’s App Store in late August 2015 for reasons that are unclear.

“The next big step in health care is to further engage folks in their own care and motivate them to reduce risks associated with diseases like high blood pressure,” Plante says. “But care must be taken to make sure they get the accurate ways to do that.”

Other researchers who participated in this study include Bruno Urrea, M.D.; Roger S. Blumenthal, M.D.; Edgar R. Miller III, M.D., Ph.D.; and Lawrence J. Appel, M.D., M.P.H., all of Johns Hopkins, and Zane T. MacFarlane, of Pomona College.

The work was funded by the PJ Schafer Cardiovascular Research Fund.

Doctors’ E-Mail Reminders Help Keep People More Engaged in Their Health Care

Newswise, February 13, 2016 — Research led by UCLA professor on ‘OpenNotes’ model finds that follow-up emails are critical to keeping patients in the know

A study led by Dr. John Mafi, a professor at the David Geffen School of Medicine at UCLA, has found that a simple note from a primary care doctor can be a critical way to keep patients involved in their own health care.

The research, published today in the peer-reviewed Journal of the American Medical Informatics Association, examined a growing national program that provides patients with easy online access to their doctors’ notes about their appointments.

The program, OpenNotes, began in 2010, when 105 primary care physicians invited nearly 14,000 of their patients to view their electronic notes about their clinic visits.

The initiative was intended to better engage patients in their own care and improve communication between patients and their doctors.

It turned out to be quite a success: Patients demonstrated better recall of their medical plans, felt more in control of their care and were more likely to take their medications.

Doctors found that sharing their notes with patients had little negative impact on their workflow. Five years later, more than 5 million patients are participating in the OpenNotes movement.

And recently, four nonprofits contributed a total of $10 million to expand the program to 50 million patients.

But even as the program began to grow, two major questions arose: Would patients continue to access the notes after the initial enthusiasm died down?

And, how important were the doctors’ reminders in prompting patients to remain active participants in their own care?

The study suggests that the reminders are indeed very important.

Led by Mafi, an assistant professor of medicine in the division of general internal medicine and health services research at the Geffen School, the researchers found that patients tended to view clinic notes substantially less once they stopped receiving the reminders, while patients who continued receiving them tended to continue accessing the notes.

Mafi said patients immediately forget between 40 percent and 80 percent of what their doctors tell them — and they get about half of what they do remember wrong.

“Poor patient–doctor communication represents one of the biggest problems in our health care system,” said Mafi, who conducted the research as a fellow in general internal medicine at Boston’s Beth Israel Deaconess Medical Center and Harvard Medical School.

“OpenNotes offers patients a way to remember their doctors’ instructions, rationale for their care plan and any other critical information about their health. OpenNotes has the potential to empower patients to take charge of their health.”

Another recent study about OpenNotes found that patients who read their notes are more likely to take the medicine they need to lower their cholesterol.

The team led by Mafi studied 14,000 patients at Beth Israel Deaconess and at Geisinger Health System in Danville, Pennsylvania, for two years. Doctors at Beth Israel Deaconess sent reminders throughout the study; those at Geisinger stopped after one year.

During the first 12 months, 53.7 percent of the patients at Beth Israel Deaconess and 60.9 percent of the patients at Geisinger checked their doctors’ notes within 30 days of their becoming available to them. Those percentages stayed consistent throughout the year.

During the second year, patients at Beth Israel Deaconess viewed their notes with the same frequency until a slight decline during the final three months.

At Geisinger, however, just 13.2 percent of patients continued viewing their notes once the email reminders ceased.

The study also found that compared to 55.1 percent of white patients viewed their notes, compared with 36.3 percent of black patients; these differences remained relatively consistent even after the researchers accounted for differences in demographics, the patients’ illnesses and other factors.

“While we predicted that reminders would influence patients’ viewing their doctors’ notes, we did not anticipate the large role that reminders seem to play in patients continuing to access viewing their notes,” Mafi said.

“The key lessons of our study are that sending reminders to patients to view their medical notes may be essential to promoting patient engagement and improving patient-doctor communication, and that new health technology implementation requires additional efforts to reduce potential disparities in health.”

Mafi said future studies should evaluate how to better engage non-white patients in order to help mitigate racial and ethnic health disparities.

Researchers should also evaluate the best way to invite patients to view their doctors’ notes and then gauge the impact on patient engagement, management of chronic diseases and health outcomes.

He also added that many patients already have access to their notes but might not realize it.

“We encourage people to ask their doctors or other healthcare professionals about whether they have access to their notes, and to make it a habit to view them,” he said.

The study’s co-authors are Roanne Mejilla, Henry Feldman, Long Ngo, Tom Delbanco, Christina Wee and Jan Walker of Beth Israel Deaconess Medical Center, and Jonathan Darer of Geisinger Health System.

The work was supported by a National Research Service Award training grant (T32HP12706) from the U.S. Health Services and Research Administration and the Ryoichi Sasakawa Fellowship Fund, the National Institutes of Health (K24DK087932); the Robert Wood Johnson Foundation (65921), the Drane Family Fund and the Richard and Florence Koplow Charitable Foundation

New Online Tool Allows Patients to Make Informed Cardiac Care Decisions

MedStar Heart & Vascular Institute Participates in Find Your Heart a Home in Partnership with American College of Cardiology

Newswise February 5, 2016– MedStar Heart & Vascular Institute at MedStar Washington Hospital Center is one of only two hospitals in the nation selected to partner with the American College of Cardiology (ACC) on the Find Your Heart a Home™ pilot program, a campaign aimed at empowering patients when making their heart care decisions. Through its participation,

MedStar Heart & Vascular Institute is further demonstrating its dedication to quality improvement, transparency, and patient and provider engagement.

In this era of health care transparency, patients and their families want access to credible information about quality of care to help them make informed decisions.

Consumers consult online search tools to make decisions on restaurants and hotels, and now they can do the same for their cardiovascular care.

Find Your Heart a Home is a first-of-its-kind hospital comparison database for cardiac care. It allows patients and caregivers, to search and compare hospitals based on the cardiac services they provide and important information on the quality of care they deliver.

“Transparency in health care is a growing expectation among patients and their caregivers,” said Allen J. Taylor, MD, FACC FAHA, chief of Cardiology at MedStar Heart & Vascular Institute.

“The Find Your Heart a Home tool can offer the transparency patients are seeking and help eliminate the information clutter by giving them reliable information they need to make informed choices. We are proud to be partnering with ACC on this important pilot project.”

Find Your Heart a Home is populated with data from the National Cardiovascular Data Registry, which tracks certain heart care procedures performed at hospitals nationwide.

 It rated MedStar Washington Hospital Center, the founding hospital of MedStar Heart & Vascular Institute, based on 1,810 cardiac catheterization and angioplasty procedures, and 520 implanted cardiac defibrillators. For each aspect of care evaluated, the Hospital Center’s performance earned the maximum four stars.

The tool is part of ACC’s CardioSmart initiative, a website full of educational information and tools to help guide patients on their heart health journey.

“MedStar Heart & Vascular Institute is a pioneer in this effort to give patients the tools they need to become an active participant when mapping out their cardiac care plan,” said ACC President Kim Allan Williams, MD, FACC. “They are showing a true commitment to transparency and quality and serving as an example to hospitals across the country.”

MedStar Washington Hospital Center’s heart data can be found here, or visit FindYourHeartaHome.org

When Loved Ones Battle Cancer, Families Head to Web for Information More Than Support

Newswise, February 1, 2016 – Loved ones of cancer patients are likely to search for further information about the disease online but less inclined to seek emotional support from social media forums, according to a University of Georgia study published recently in the journal Computers, Informatics, Nursing.

Individuals frequently suffer negative psychological and emotional effects when the people they care about are diagnosed with cancer. It is fairly common for loved ones of cancer patients to develop depression or anxiety disorders as a result of the diagnosis, but there aren’t many studies focusing specifically on cancer patients’ caregivers and family members, said the study’s author, Carolyn Lauckner.

“I think sometimes the loved ones and caregivers get forgotten about,” she said. “And that’s why I wanted to research this population to see if there are ways that we can better support these individuals.”

Lauckner, an assistant professor in the College of Public Health’s department of health promotion and behavior, surveyed 191 people whose loved ones were diagnosed with cancer in the past year or who were currently acting as caregivers to someone with cancer.

The motivation behind the research was personal for Lauckner.

“I went through a period of time where I had three loved ones diagnosed within a short amount of time,” she said. “I had these experiences where I heard about the diagnosis and I would go online to look it up, and then I would immediately become terrified and freak out about all the stuff I read online.”

More than three-quarters of participants searched online for information on a loved one’s disease. Most looked for treatment options, prevention strategies and risk factors, and prognosis information.

“I was pleasantly surprised by the amount of people who said that they were looking for prevention information online and detection information because that shows that not only are they concerned for their loved one but they’re also concerned about how they themselves can avoid cancer, which from a public health perspective is great,” Lauckner said.

Respondents were less inclined to view blogs or go online to hear about others’ cancer experiences. These kinds of sites were linked to negative emotions for participants, such as fear, sadness and anger.

“A lot of people, especially in the cancer realm, they will use blogs or discussion posts to vent and to talk about the harsh realities of living with an illness,” she said.

“And while I think that that is beneficial for both the person who is writing it and potentially for some people who want an idea of what to expect, when someone is dealing with the prospect of their loved one having to go through that experience, it can be extremely distressing.

“You’re only getting a snapshot of what that person’s cancer experience was like, and you may be seeing the snapshot of the worst day that they had” on blogs and discussion boards.

The most commonly visited websites were those of charitable organizations like the American Cancer Society, which were associated with positive emotions. Lauckner said she found this information encouraging because it shows that the participants were consulting reliable sources of information and not being swayed by personal accounts as much.

Lauckner ultimately wants to build on the information gleaned in this study to determine the most effective use of social media and technology to distribute cancer prevention and risk reduction messages to the public.

The study, “The Effects of Viewing and Preferences for Online Cancer Information Among Patients’ Loved Ones,” is available online at http://www.ncbi.nlm.nih.gov/pubmed/26636409

.

The study received funding from an internal research grant from Michigan State University’s College of Communication Arts and Sciences.

Why Daring to Compare Online Prices Pays Off Offline

Price comparison websites impact in-store behaviour, a Concordia study shows

Newswise, January 6, 2016 — The constant barrage of post-holiday sales touted by web-based retailers may make it seem like online shopping is killing real-world stores. But shoppers are actually engaging in “web-to-store” shopping — buying offline after comparing prices online.

A study from Concordia University’s John Molson School of Business shows this consumer behaviour has important implications for retailers.

When setting in-store prices or offering price-matching guarantees, offline retailers should focus more on online retailer ratings than on offering the lowest prices.

In a study published in the Journal of Retailing, one of the top journals in the retailing field, marketing professor Onur Bodur investigates how offline consumer behaviour is influenced by online price comparison sites (PCSs).

His results from three studies show that consumers pay careful attention to things like retailer ratings, how often a product is offered at the same price, and differing price levels.

“Price comparison sites like Shopzilla and PriceGrabber are solid online information sources that display numerous retailer prices for a product type or given brand,” says Bodur, who co-authored the paper with colleagues Noreen Klein from Virginia Tech, and Neeraj Arora from the University of Wisconsin-Madison.

For the study, the research team focused on how information from PCSs often acted as reference pricing for in-store shoppers.

“We asked: How PCS retailer ratings would impact in-store price evaluations? Do consumers really believe super-low online prices are obtainable?” Bodur says.

“The good news for brick-and-mortar retailers is that low online prices may not be used by consumers as comparison prices. We found that offline retailers should actually focus on prices that are associated with highly rated online retailers. That’s because their prices are perceived as more valid and therefore have greater impact on subsequent price evaluations,” he says.

“When there is little variation in PCS retailer ratings, offline retailers should also focus on prices that occur frequently in PCS searches and not just the low price.”

Related links:
Centre for Multidisciplinary Behavioural Business Research
Journal of Retailing
John Molson School of Business
Department of Marketing

Free Mobile App to Improve the World’s Cardiovascular Health

Top Cardiologist Dr. Valentin Fuster on a Mission to 

Promote a Full “Circle of Health” Around the Globe

Newswise, December 29, 2015— Leading cardiologist Valentin Fuster, MD, PhD, has developed a free mobile application called “Circle of Health” to empower individuals around the globe to take action to comprehensively assess and enhance their daily overall heart health. 

Cardiovascular diseases are the number one cause of mortality in the world. Dr. Fuster has created “Circle of Health” for the daily promotion of cardiovascular health worldwide and to reduce the epidemics of coronary artery disease, heart attack, and stroke.

The now internationally available mobile app was developed in English and Spanish by Fundación Pro CNIC in Spain, in collaboration with Dr. Fuster and Icahn School of Medicine at Mount Sinai in New York.

Overall, cardiovascular diseases are acquired and largely preventable. The vast majority arise due to one or more of six risk factors that can be prevented or reduced with daily lifestyle and behavior modifications. These six risk factors are: high cholesterol and diabetes (chemical), obesity and high blood pressure (physical), and smoking and lack of exercise (behavioral).

“These abnormal risk factors account for 90 percent of heart attacks and strokes,” says Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, General Director of the Centro Nacional de Investigaciones Cardiovasculares (CNIC), and past president of the American Heart Association and World Heart Federation. 

“Each person needs to pay close attention to these six risk factors and maintain them daily to remain heart healthy and reduce their chances of atherosclerosis, heart attack or stroke.”

“If you want to have good cardiovascular health, you must know what risk factors you have,” adds Dr. Fuster. 

“Simply downloading the new ‘Circle of Health’ mobile app right on your smartphone or tablet can help you.”

Using the mobile app, users learn directly from Dr. Fuster about the six variable risk factors, how to prevent or better manage them, and how to live a healthier and longer life. It assists adults on how to properly measure, prevent, fight, and reduce their risk factors.

The mobile app, developed Fundación Pro CNIC and Icahn School of Medicine at Mount Sinai in New York in collaboration with Wake App Health, has a unique, multimedia and interactive circular format which creatively incorporates video, audio, and educational graphics. 

It works by comprehensively evaluating your health with an initial questionnaire to assess and measure your baseline cardiovascular health, empowering you with health information and prevention heath tips you need to succeed, and weekly and monthly motivation to establish good habits, reduce bad habits, and providing you with challenges to get more physically activated to improve your health.

“This mobile app is for those people who want to improve their health and lifestyle habits including diet, exercise, and others—and it’s also a very useful tool for those that have or have had any heart attack, stroke, or artery disease to gain knowledge on how to reduce their chances of a future event,” says Dr. Fuster.

“Knowledge is power and you have to make a commitment to take care of your heart and yourself. It’s that simple,” says Dr. Fuster. 

“Cardiovascular disease can be prevented and you are capable of doing so. You now have the ability for no cost to have a tool in your hand that will help you to follow a healthy lifestyle and protect your heart from the ravages of heart disease.”

Currently, there are more than 6 billion people in the world with mobile phones, and nearly 2 billion with smartphones. Given the growing popularity of smartphones and tablets and the mutually growing global threat of cardiovascular diseases, Dr. Fuster believes there is no better way to reach people than via their mobile devices to prevent and reduce the risk factors of heart disease.

“Preventing and managing your heart disease should be as simple as reaching into your pocket or briefcase for a little motivation and support from your mobile device,” says Dr. Fuster. 

“Together you and your mobile device can work together to maintain your own daily ‘Circle of Health’. Don’t wait any longer and start your journey with the ‘Circle of Health’ today.”

The Icahn School of Medicine at Mount Sinai gratefully acknowledges Sesame Workshop for making available the Sesame Street characters and content from its Healthy Habits for Life programs for use in educating children and their families in connection with this Project.

To download Circle of Health, visit www.thecircleofhealth.org, the Apple iTunes Store www.itunes.apple.com/us/app/the-circle-of-health/id991821078 or Android www.play.google.com/store/apps/details?id=com.wakeapphealth.thecircleofhealth.

About Mount Sinai Health System


The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. 

Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community-based facilities to tertiary and quaternary care.

The System includes approximately 6,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. 

Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. 

The Mount Sinai Hospital is ranked as one of the nation’s top 10 hospitals in Geriatrics, Cardiology/Heart Surgery and Gastroenterology, and is in the top 25 in five other specialties in the 2015-2016 “Best Hospitals” issue of U.S. News & World Report. Mount Sinai’s Kravis Children’s Hospital also is ranked in seven out of ten pediatric specialties by U.S. News & World Report. 

The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmolgy, while Mount Sinai Beth Israel is ranked regionally.

For more information, visit www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.

Why Online Doctor Ratings are Good Medicine

Newswise, December 8, 2015— A growing number of health consumers are consulting online physician-rating sites when choosing doctors even if the value of those sites—whether they’re reliable sources for information, or capable of driving improvements in health care—is in dispute.

Some studies have shown how letting patients grade their doctors can lead to over-testing and over-treatment as doctors, hoping to improve their scores, bend to unreasonable patient demands.

But a new study in the December issue of Academic Medicine bolsters research linking good patient satisfaction scores with good patient outcomes. And it sheds light on another, unspoken benefit by showing how openly sharing patient satisfaction metrics created a culture of empathy, communication, trust and shared decision making between patients and providers at a health system in Utah: University of Utah Health Care (UUHC).

“Everyone, from payers and policy makers to patients, yearns for reliable, understandable information about the cost and quality of care, and it’s our duty as the region’s sole academic medical center to respond to that demand,” said UUHC’s CEO and the study’s lead author Vivian S. Lee, M.D., Ph.D., M.B.A. 

“What we underestimated was how being transparent with our scores would be such a force for cultural change within our organization—a catalyst for engaging physicians in patient-centered care and the glue to further cement the physician-patient relationship.”

The article was co-authored by UUHC’s Chief Medical Officer Thomas Miller, M.D.; Patient Experience Director Chrissy Daniels, M.S.; former Senior Director for Interactive Marketing and Web Brian Gresh, M.P.A; and Lee’s predecessor Lorris A. Betz, M.D., Ph.D.

Betz was the architect of the University’s “exceptional patient experience” initiative. Launched in 2008 with the mantra, “medical care can only be truly great if the patient thinks it is,” the effort culminated in 2012 when UUHC became the first academic medical center in the country to put its patient reviews online, complete with unedited comments and an accessible five-star ranking.

The University didn’t initially set out to go public with its scores. The goal was to improve service and patient care. In 2008, UUHC was saddled with patient complaints about delays in the scheduling of appointments, poor communication and lack of professionalism, among other things. 

Federal patient satisfaction scores placed the system in the 34th percentile nationally, and its quality metrics were average compared to other teaching hospitals.

Yet as the article states: “What began as a patient satisfaction initiative evolved into a model for physician engagement, values-based employment practices, enhanced professionalism and communication, reduced variability in performance, and improved alignment of the mission and vision across hospital and faculty group practice teams.”

Over the past seven years, patient satisfaction has markedly increased. Half of UUHC providers now rank in the top 10 percent when compared to their peers nationally, and 26 percent rank in the top 1 percent.

Neither the quality nor the cost of care has suffered. In fact, for six years running UUHC has placed in the top 10 of the University HealthSystem Consortium’s rankings, a comparison of the nation’s teaching hospitals based on quality and safety. What’s more, UUHC has managed to bend its cost curve even as costs nationally continue to rise.

Employee satisfaction also improved, revenue and patient volumes are up and malpractice litigation declined, resulting in a drop in premiums. 

“This has been truly transformative for our organization. Change didn’t happen overnight, and we faced plenty of challenges,” said UUHC’s Chief Medical Officer Tom Miller, M.D. “But we overcame the challenges, and the solutions we devised are adaptable to other institutions.”

"Creating the Exceptional Patient Experience in One Academic Health System" was published in Academic Medicine online on November 24, 2015