Digital Medicine Conference: Presentation Recap 

Digital Medicine Conference: Presentation Recap 

By: Katie D. McMillan, MPH

On December 5th I presented during the Bringing Together the Best in Innovation Panel at the Digital Medicine Conference in New York City. Each panelist had 10 minutes to present the highlights of their team from the last year and a few lessons learned. I was joined by colleagues from UC-SF, LifeBridge Health, Children’s Hospital of LA, Murdoch Children’s Research Institute, and Centura Health. There are a variety of approaches to innovation in healthcare and one thing I took away was that at Duke we have a hybrid model of championing internal ideas as well as partnering with outside tech companies to help us reach our goals of improving the patient and provider experience through the smart use of technology. 

I hope you enjoy this recap of the presentation!

The Mobile App Gateway was founded in October 2017 with the goal of enabling mobile technology innovation at Duke. Our leadership team brings expertise from building commercial apps, testing sensors, conducting clinical research, providing clinical care, and navigating Duke processes. Prior to the Mobile App Gateway, there was no formalized pathway for the creation of apps or use of digital health technologies. We are now the hub for the curious researcher, staff and clinician wanting to leverage digital health tools to answer their research questions or improve clinical care.  

In our first year the Mobile App Gateway: 

  • Hosted 16 events-- including Duke's first Digital Health week which covered topics from IOT, behavioral economics, 3D printed prosthetics to entrepreneurship.

  • Consulted on over 180 projects. Our cornerstone service is an open door for anyone interested in technology innovation. The demand and interest at Duke is reflected in the number of project consults we did in our first year. 

  • Established partnerships with a mix of custom development agencies and product companies across the US. 

  • Supported the development of multiple apps which are highlighted below. 

One of our goals is to educate and empower the Duke community. People are hungry for information, especially at an Academic Medical Center so we work hard to build a network of innovators and feed them valuable content. 

We publish monthly blog posts that are driven by trends we see in our consultations and the digital health community at large. We also use this space as an opportunity to highlight researchers or clinicians at Duke.  We answer questions about where to find funding, Fundamentals of FHIR and how to use it, when to use texting instead of a native app, and more!  

Our events are a mix of hands on workshops where we bring in design and development experts who focus on skill building. We also provide a platform for innovators to share their work with the community. All our events are free and open to Duke and often to the public. One of our big lessons learned-- provide food! 

Everyone who comes through our door is trying to solve a problem and over the last year we have found ways to address most of these. We impress upon people to start with the problem, not the technology. If technology is the right way to solve the problem, there are generally two approaches:

We work with Medable for DIY ResearchKit apps and currently have 3 studies under development. Our team uses Invision to wireframe screens to support grant applications, create clickable prototypes, and reduce app build costs. Duke is also a big fan of REDCap and we use their texting capability often for research studies to easily collect data at the fraction of the price of a native app. 

We are focused on translation from research into practice as well as building a digital health ecosystem that seamlessly fits within the hospital workflow. Duke has partnered with Xealth to enable prescribing digital therapeutics and collect data on how those tools are working for patients. 

If one of these tools isn’t a fit, then we help people build their dream product by connecting them with software developers, reviewing contracts and IRB applications, collaborating with DHTS to ensure that their product works within the Duke environment, discussing marketing strategies, and a million other small tasks necessary for successful product launch.

I’ve highlighted three projects we have worked on over the past year. 

Medical Guidelines App: In an agile experiment we created a mobile-friendly web app for clinicians to easily access medical guidelines, policies and procedures at the bedside. This was built over the course of 6 weeks with some borrowed (human technical) resources and is being piloted in a few departments at Duke Health. 

Bridge by Vivor: We also have worked with the Bridge app team to match cancer patients with financial assistance resources. The app pulls down data on the patient's diagnosis, insurance coverage, demographics, and current medications and is matched with programs in a large database to offset cancer costs. 

D-SCAN: Another project I’ve worked closely on is the developing of the D-Scan app which is currently being studied as part of a clinical trial with plans to roll into standard of care by the end of 2019. This app collects patient reported outcomes in a way that feels conversational, like a text message, and then based upon those responses can identify supportive care services that could be helpful to the patient or their family and shows patients how to schedule them. This is a fun example of a collaborative agreement between the Duke Cancer Institute and Aztra Zeneca where we co-developed the app content with the help of Publicis Health. 

My final takeaway during the presentation was three lessons learned: 

Number 1:  Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has. - Margaret Mead

Our team started off small with no budget other than our current salary coverage for 2 people and permission from our supervisors to spend time on this. We now have a budget and a dedicated larger team but we still operate as a start- up to stretch that money as far as possible. We chose free event space, built our own website, and have been known to buy our muffins and cases of water from Costco so we can feed people. We are driven by our hutzpah and passion. If your health system is interested in getting into this space, don’t wait for the perfect storm, just get in there and start. 

Number 2 – Be nice to people.

This sounds trite but we can’t accomplish everything within our team. We need a network of security experts, clinicians, Epic builders, data scientists, lawyers, and leadership to get projects off the ground. This is much easier to do if you have good working relationships. 

Number 3- Successful digital health projects are 20% technology and 80% cat herding.

The technology is never the hard part. I was speaking with an MD last week who wants to send vital signs taken in the clinic into the medical record with connected devices. There are multiple ways that we can accomplish this technically- it doesn’t scare me. What will take time is all of the reviews, the testing in clinical environments, the changes to work flows and the buy in. If you can make peace with this you’ll be less frustrated. 

If you are curious about the Mobile App Gateway or have an idea you want to pursue reach out to me or our team and we can help! 

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