The Medical Pal: A Smartphone App to Improve Healthcare Delivery to Palliative Patients

As the population of smartphone users grows, the role of the smartphone in healthcare has been transformed from a device used to call a physician to a tool that can be used for greater access to and more efficient delivery of healthcare. Specifically, mobile health in this realm can take the form of an application on the smart device, expanding a patient’s access to care. Palliative care is defined as ‘active total care’ of patients who are terminally ill. Assessment tools, such as the Edmonton Symptom Assessment Scale (ESAS), can assist the palliative care physician to determine the wellbeing of the patient and the severity of the symptoms. The ESAS measures, on a discrete numeric scale from 0 to 10, the patient’s levels of pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, wellbeing, and shortness of breath. In our experiment, the values that the patients enters into the smartphone-based ESAS are compiled with a continuous scale to produce a baseline value for each symptom for the patient. Current limitations keep the palliative physicians from continuously monitoring their patients. The proposed solution to augment the connection between patient and their palliative healthcare team was to create a smart device application that will facilitate a more “real-time” assessment and interaction environment. Moreover, as there is a statistical basis for detecting changes in any one parameter in the assessment tool by way of means testing, the program can recognize and alert providers to significant negative changes in symptoms.  A step-function is assigned to differentially respond to varying degrees of statistical variance.  Any statistical deviation from the baseline (mean) response values triggers a response that includes either an instructional text message or if the deviation is very alarming, a call from a palliative physician.  The app will continuously relay the collected information to a provider’s “dashboard” that contains all of the patients being managed by that palliate healthcare team. The data from these participants was collected and stored using Catalyze.io as the server. With the functions of this smart phone application, physicians will be able to securely access data concerning their patients and make more informed decisions regarding their plan of care. The anticipated future of this application will be its expansion to include patients from various hospitals, and eventually all Mayo Clinic palliative patients, such as those suffering from cardiac failure, kidney failure, Alzheimer’s, and many others.