In a year best described as ‘challenging’, innovation has become much more than a buzzword. In fact, it has become a critical factor in the successful delivery of services across all industries, particularly healthcare.
2020 has provided a distinctly unusual environment for the delivery of healthcare, particularly for people who have been reluctant, or unable, to access traditional clinical services in both metro and regional areas. Health care providers have been required to accelerate innovation and adopt delivery models reliant on digital technologies to ensure care continuity, and that the quality of care has been maintained and accessible for all.
Even before 2020, the availability of over 40,000 healthcare apps on Android and IOS demonstrated the global consumer demand for apps and other digital technologies to independently manage their health. However, very few of these are evidence-based or designed to be incorporated into the mainstream delivery of specialised health services.
It is also necessary to recognise that with an aging population and the rise of chronic conditions such as heart disease, the availability of clinically validated digital health programs and apps to help patients manage their health is critical in reducing the impact on already stretched health services across Australia.
The need for evidence-based digital health resources is not just being recognised by tech entrepreneurs, biotech and pharma companies. Front line practitioners have long been aware of the disconnect between the needs of patients and the availability and accessibility of evidence-based digital health solutions.
An article by Jen Hummelshoj (RN) published in 2019 on the Australian College of Nursing website notes, “As Nurses, we know the importance of evidence-based practice. The widespread adoption of mobile phones presents a significant opportunity to improve health behaviour, particularly in relation to prevention and management of chronic disease, but the evidence base for these interventions is currently lacking.”
The pandemic has been a strongly motivating factor for the government’s investment in digital health innovation, not just to address short term needs, but also, as stated by Health Minister Greg Hunt “to support our efforts to become a leading digital economy by 2030.”
There is no doubting the potential positive impact of evidence-based digital health innovations that bring together clinical oversight and the tech-enabled delivery of structured care plans via apps. At Cardihab, we strongly believe that as an industry we need to focus on the crucial interdependencies of telehealth infrastructure and validated virtual programs that deliver clinical outcomes. Removing barriers to uptake, clinical integration and improving funding pathways will enable better delivery of person-centered care and efficiencies in healthcare utilisation.
As an industry we also need to consider what additional standards digital health programs should incorporate as best practice. For example, the inclusion of data from technologies that are registered on the Australian Registry of Therapeutic Goods ( ARTG) to ensure governance, quality frameworks and demonstrable clinical outcomes.
We also believe that context is important – making sure that the technology we use and the data we collect is clinically relevant and/or validated. Quite simply, clinical evidence is critical in differentiating patient centred, clinically led digital health programs from the multitude of solely tech driven consumer apps that source data from the Internet of Things (IoT).
Last, but not least, we are staunch advocates for the unequivocal protection of the health data that is collected during the use of digital health programs, ensuring privacy for both patients and clinicians.
Bertalan Meskó (The Medical Futurist) notes that “Digital health is nothing else but the cultural transformation healthcare has been going through in the 21st century.”
Further on he opines that “The reason why (digital health) hasn’t been implemented yet is purely human. It’s the 3Rs of healthcare gatekeeping: Rejection by individual medical professionals, good Regulations that are lacking, and the Resistance within the existing healthcare system, which is rooted in the belief that change can be stopped. Well, 2020 made it obvious that it can’t.”
Constantly incorporating feedback from patients and clinicians about the usability of developing digital health platforms, and extracting the best possible data from them, results in clinicians consistently delivering high quality and effective care to their patients, irrespective of whether that care is delivered via a digital health platform or face-to-face.
At Cardihab, we have focussed on patient-centered outcomes from the beginning and acknowledge the benefits of having a pandemic forcing a shift in thinking right across the health industry to embrace digital health solutions. The future for us is exciting and filled with opportunity to establish clinically validated technologies as core components to how healthcare is delivered either in the clinic, at home or in blended models that meet the needs of the patient and the care providers.
What are some of the things you believe the health care industry should be prioritising within the digital health scope as we shift towards a future where patients access healthcare in ways that work for them?
One of the key benefits of the CardihabTM program of Digital Cardiac Rehabilitation (DCR) is the ability to improve participation in Cardiac Rehabilitation (CR) compared to traditional models of care. This was demonstrated in the Varnfield Randomised Control Trial that showed DCR significantly improved uptake, completion and adherence to DCR programs when compared to traditional models of care.
In a subsequent study led by cardiologist Dr John Rivers from the Queensland Cardiovascular Group, it was demonstrated that these significant improvements in participation are repeatable in the real world context. The study evaluated the impact on CR participation that was associated with the introduction of a smartphone enabled app (CardihabTM) for patients declining conventional CR. Information on barriers to CR participation were also collected.
The results of this study were shared in late October at the Virtual Canadian Cardiovascular Conference. The study showed that patients who initially declined traditional CR were able to be re-engaged and initiated into CR programs when offered Cardihab. Offering Cardihab to patients that declined traditional models of care significantly increased participation from 21% to 63%.
Cardihab would like to congratulate Associate Professor Melinda Carrington from Baker Heart and Diabetes Institute who was recently awarded the Heart Foundation Vanguard Grant for ‘Improving secondary prevention and survivorship after a coronary event through enhanced disease management in higher risk individuals’.
Coronary heart disease (CHD) remains the number one killer of Australians and places a burden on the healthcare system as it is the costliest disease group to treat due to hospital readmissions.
After a person has a CHD event, they are recommended to attend Disease Management Programs (DMP) such as Cardiac Rehabilitation programs. Attendance to Cardiac rehabilitation programs demonstrate benefit on patient mortality, re-hospitalisations, psychological wellbeing, quality of life and CVD risk factors Many are unable to attend due to work or family commitments and geographical locations. Innovative concepts such as incorporating e-health and telehealth can overcome barriers by providing more flexible options.
We are honoured that we will be collaborating in this two-year study to improve the access and quality of secondary prevention and prolong survivorship after a CHD event in patients deemed to be at highest risk of a recurrent ischaemic event. This will be assessed by comparing 90-day hospital readmissions (primary endpoint) in patients receiving an intensive Disease Management Programs (DMP) utilising e-Health (SmartCR app) and telehealth strategies (intervention group) versus patients receiving Usual Care (control group). Extended 12-month follow-up and usage of the SmartCR cardiac rehabilitation platform app will be comprehensively evaluated.
Below is detailed bio of Melinda from Baker website
Great news this week with Melinda Carrington - Head of our Preclinical Disease & Prevention lab awarded a @heartfoundation Vangaurd Grant for a her work to improve secondary prevention of coronary #heartdisease in high risk patients with better disease management. @WomenSciAUST pic.twitter.com/BPRdGTcj2g— Baker Institute (@BakerResearchAu) October 23, 2020
Associate Professor Melinda Carrington is a Health Services Researcher and a Future Leader Fellow of the National Heart Foundation. She received prior NHMRC Career Development and Early Career Training Fellowships in Health Services Research. After completing her PhD in sleep research at The University of Melbourne, she undertook post-doctoral training in cardiovascular clinical trials at the Baker Institute before leaving to establish the Mary MacKillop Institute for Health Research at ACU. Melinda returned to the Baker Institute in 2017 with her team to head the Preclinical Disease and Prevention Unit.
Associate Professor Carrington has over a decade of experience in conducting community intervention trials in cardiovascular and metabolic disease prevention and chronic disease management. Together with her team, Melinda specialises in comprehensive risk assessment and nurse-led interventions to prevent cardiovascular disease and diabetes, particularly in settings where there is disadvantage, such as regional communities, lower socio-economic groups and amongst Indigenous Australians. The group have been integral in discovering clear benefits for eHealth resources with the provision for optimal care of patients with chronic conditions in the community, primary care and hospital settings.
Melinda is an Honorary (Principal Fellow) within the newly established Baker Department of Cardiometabolic Health at The University of Melbourne, Adjunct Senior Research Fellow at Monash University and an Adjunct Professor at Torrens University.
- European Society of Cardiology Heart Failure, Late breaking science award (2017)
- European Society of Cardiology, Late breaking science award (2015)
- European Society of Cardiology Heart Failure, Late breaking science award (2014)
- American Heart Association, Late breaking trial (2014)
- American Heart Association, Best research paper (2013)
- European Society of Cardiology, Best abstract from ESC affiliated cardiac societies (2012)
- American Heart Association, Best abstract from Australia (2012)
- National Heart Foundation Future Leader Fellowship (2016–2020)
- NHMRC Career Development Fellowship (2012–2015)
- Cardiac Society of Australia & New Zealand, McCredie/Wilcken Travelling Fellowship (2012)
Helen Souris presented at the Innovate Health #innov8health Pitchfest 2020 event to showcase our platform and share our story of how we are helping clinicians and patients recover from cardiac events. We also shared our vision for a future where clinically validated digital health platforms assume a prominent role in standards of care. There were 5 other innovative start-up companies pitching at this event and we are incredibly proud to have won that pitch event.
This is a significant moment for us to all celebrate but one that could not be achieved without the support and collaboration of our customers both present and future. A very special and heartfelt thank you must also go to the amazing Cardihab team that work tirelessly on our platform and our strategic partners.
We are driven by helping as many clinicians and patients get access to Cardihab so that patients continue to have access to essential care despite geographical and/or COVID-19 related social distancing challenges, and look forward to celebrating more great outcomes with you. READ MORE
Helping patients stay motivated and engaged in their recovery programs is important in the early stages post-acute cardiac event or procedure, but also in the longer term. Completing the Cardihab program through Medibank Heart Health at Home service improved Neil's compliance to prescribed exercise after his heart valve replacement and bypass operation.
"Not only filling it in encouraged me to do the exercise, and do the check in. I might not have done it [the exercise] otherwise, I would have got a bit lazy."
The 84 year old accessed the program on his iPad to help track his blood pressure, medications and other risk factors as well as having a weekly phone call with a cardiac nurse to discuss his progress and any concerns.
Read the full story: Keep Healthy with a heart health App By Ilsa Cunningham - 14 August 2020
The recent article published in the Moorabool Star Weekly shared another encouraging example of how Cardihab in collaboration with Medibank is helping support patients recover from cardiac events while adhering to social distancing measures required during the COVID-19 pandemic. While as a community we have demonstrated our ability to respond responsibly and well to the containment measures imposed for COVID-19, it is clear that we have a road yet to travel before we are able to resume our usually way of life. The importance of embracing evidence based digital health solutions like Cardihab was captured so eloquently by Kevin McCarthy in his explanation of what the Cardihab/Medibank Heart Health At Home experience meant for him.
“Doing appointments with nurses over the phone was obviously a much better way of doing it, being able to keep social distancing while also letting the nurses track my progress was important for my recovery."
It is this patient experience that is echoed by many of our customers that inspires us to expand the use of Cardihab across Australia. Ensuring access to quality care and continuity of care during the pandemic and beyond is our focus and we look forward to hearing many more success stories.
The Australian recently highlighted how Medibank is using Cardihab's remote digital cardiac rehabilitation solution to enable more people to access cardiac rehab during the COVID-19 pandemic.
Medibank’s cardiac rehabilitation program is experiencing an increase in patient referrals during COVID-19. Cardihab allows them to provide personalised remotely delivered one to one support to help prevent a second serious cardiac event.
The Medibank Heart Health at Home program is one of the first personalised, fully telehealth-delivered cardiac rehabilitation services in Australia, making it more easily accessible to our customers.
Patients with a chronic health condition have a higher risk of suffering more severe symptoms if they contract COVID-19, so access to care in their home is crucial.
The Australian featured the story of 71-year-old Allen Parsons, who lives just outside the Queensland regional town of Toowoomba, had his second heart attack in March. He underwent surgery to have stents inserted in his arteries.
Mr Parsons was referred by his local hospital to the Heart Health at Home program to assist in his recovery.
“I didn’t fit the normal heart attack mould as I am active, not overweight and don’t drink much alcohol, but I wanted to ensure I gave myself the best chance to prevent a third heart attack,” he said.
“The program has been a helpful tool in my recovery, with my nurse providing me with advice and support on changes I need to make to my diet and exercise that will help to strengthen my heart muscles following the surgery.
“It has given me the flexibility to participate in the program because no matter whether I am working in Brisbane or a regional town, it is delivered remotely over the telephone at a time that suits me.”
Cardiovascular disease is currently the nation’s leading cause of death, with an estimated 1 in 6 Australians living with the disease.
The cardiac rehabilitation rate for Medibank’s rural customers is less than half that of those who live in metro areas.
Cardihab CEO Helen Souris said Cardihab was very proud to be able to support continuity of cardiac rehabilitation services during COVID restrictions and beyond.
"Cardiac rehabilitation has the potential to significantly reduce the occurrence future cardiac events. As many cardiac patients are currently not able to access traditional cardiac rehabilitation programs, and/or afraid to seek medical advice due to fear of COVID exposure, clinically proven remote programs like Cardihab can make a demonstrable difference to patients and deliver improved outcomes."
Cardihab will help researchers understand the risk of COVID-19 infection and isolation for people with reduced heart function as part of a project to be undertaken at an innovative new COVID-19 rapid response research centre.
The Wesley Medical Research virtual COVID-19 Rapid Response Research Centre aims to support the global community to fast-track answers to overcome COVID-19. The centre had its official opening last week.
Cardihab’s digital health platform will be used in one of the first research studies conducted by the Centre. This piece of research, led by Dr John Rivers, will examine the impact of COVID-19 infection and isolation on patients with reduced heart function.
At-risk cardiovascular patients are among the many vulnerable people who are isolating to reduce the risk of COVID-19 infection. These same people are inadvertently potentially exposing themselves to a new set of risks by the very process of isolation; reduced medical care, missing routine medical appointments, inactivity and weight gain as well as poor control of hypertension and other comorbidities.
Dr Rivers explained that while the COVID-19 risk is high, chronic heart conditions remain the major cause of death in Australia and globally. Looking after these patients therefore should remain a priority and this project hopes to improve their care during the pandemic.
“We need to balance the requirements of protecting those people from the virus with the risks of protection itself,” Dr Rivers said.
The study aims to assess whether a digitally-enabled management strategy provides improved outcomes when compared with conventional care in a cohort of Left Ventricular Dysfunction (LVD) patients who are infected with, or isolating to avoid, COVID-19 infection. It is likely those with LVD or heart failure who become infected with COVID-19 will see a deterioration of left ventricular function.
This study will use Cardihab’s clinically validated digital model of care to enable physicians to care for patients with impaired heart function remotely. Using the Cardihab app via smart phone devices and the secure clinician portal, physicians will be able to assess whether this model of care improves outcomes for those at-risk patients in terms of heart failure readmissions, deterioration of symptoms and their condition. Quality of life and mental health status will also be assessed in this study.
The transition from conventional care to models incorporating digital healthcare delivery has been accelerated as a result of COVID-19 and this change is likely to be sustained in the way chronic diseases are managed in the future.
“The impact of isolation and COVID-19 has given us the chance to reconsider how we deliver healthcare in the future, to a model which is more patient centred, user friendly for the consumer, and enables better outcomes,” Dr Rivers said.
The use of evidence-based digital health technologies is set to become the new standard in chronic disease management. Helen Souris, Cardihab CEO welcomes the technology transformation currently taking place in the healthcare sector and is an advocate for establishing evidence-based digital health technologies as a standard of care.
“We are proud to collaborate with Wesley Medical Research and Dr Rivers to enable a better understanding the benefits of technology in managing patients with chronic heart conditions affected by COVID-19 and isolation,” Ms Souris said.
One of the outcomes from the COVID pandemic is the fast-tracked adoption of technology to care for and triage patients through the healthcare system. But still, questions remain about the role of age in identifying patients who can benefit from these new ways of delivering patient care.
Telehealth and digital health platform usage surged as traditional models of care were either restricted or abruptly ceased to minimise the risk of exposure to COVID-19. Cardiac rehabilitation services across Australia were among those that were significantly disrupted, resulting in many clinics seeking to introduce remote models of care, frequently including digital solutions such as the Cardihab platform.
Cardiac rehabilitation is recommended for any patient who has an acute cardiac event, generally the result of cardiovascular disease (CVD). While not exclusively a condition for people over the age of 45, the vast majority of Australians with CVD fall into the age groups of 65-74 (30% of CVD patients) and 75+ (32.5%). Therefore, chronic CVD and cardiac rehabilitation patients might not be the first clinical population thought of as suitable users of digital health apps.
However, recent data from 200 patients enrolled in Cardihab's digital cardiac rehabilitation program suggests that age might not be as clear cut a factor when deciding who to prescribe digital health programs. Data from our real-world experience has shown that 59% of our patient users are aged over 60, with those aged between 70 and 80 representing the largest patient group (31% of users).
In the Cardihab context, a patient is referred and enrolled in a digital cardiac rehabilitation program by a Healthcare professional (HCP). Their prescribed program is delivered via the Cardihab app and supervised throughout the course of their program by a qualified HCP. While it is feasible that user age in our sample is influenced by the demographics of the HCP’s patient population, this is an important insight into the potential user age differences that might be observed between a prescribed and clinically guided digital health app like Cardihab vs a freely available consumer self-help app.
What is becoming clearer as the collective evidence grows, is that technology access and literacy are important pre-requisites for using digital health platforms. In particular, technology literacy is an important factor for determining which patients would be suitable for digital health apps. From our experience, these 3 simple questions provide adequate insight into a person's tech literacy to enable a decision as to whether to prescribe digital health app to a patient or not.
- Do they have a smart phone? Yes/No
- Do they currently use apps for general living? Yes/No
- If so how often?
Patients that use apps at least weekly are likely to have the aptitude to use digital health apps efficiently and effectively. We therefore encourage HCPs to consider asking these simple tech literacy questions before ruling someone out of a digital health app.
While there is still much to learn about the use of digital health apps in the management of chronic cardiovascular disease, we are encouraged by our observations on the age of patients enrolled in our digital program. We look forward to contributing further insight as our real-world experience grows and as digital health apps take their place as an important option for chronic disease management.
We recognise that many centre-based cardiac rehabilitation services have been disrupted in response to mechanisms deployed to manage and contain the spread of COVID-19.
As a clinically proven model of care that enables the remote provision of cardiac rehabilitation to patients in their home, we are keen to work with the network of providers to support the continuity of care for patients throughout this time.
The Cardihab model enables staff to work from home, as well as patients receiving care from home, thereby reducing the risk of contamination and spread.
Remote cardiac rehabilitation may be accessible under Medicare via the Federal Government’s COVID-19 health package.
If you have concerns around the continuity and access to cardiac rehabilitation that you think we could assist with, please contact us.