Dr. Payal Agarwal
Dr. Payal Agarwal is a practicing family physician in Toronto. She holds an undergraduate degree in Systems Design Engineering from the University of Waterloo, where she refined her software design and development skills while working at several technology companies. During her medical studies at the University of Toronto, Payal’s research efforts focused on the development of novel technologies to improve health care delivery and education. As an Innovation Fellow at WIHV, Payal is currently focused on the creation of new models of care by adapting proven methodologies from the design, technology and entrepreneurship fields, with a specific focus on virtual care. She also consults for several healthcare startups around product design and usability and will be starting a Masters in Health Service Research at the University of Toronto in September 2016.
As many of us know, migraines are a significant concern in primary care with an estimated 8% of Canadians known to be suffering from migraines. However, that is likely an underestimate as many patients do not seek medical treatment for their symptoms Even for those who are diagnosed, migraines can often be a challenge to primary care providers to deliver adequate relief of symptoms, leading to significant impact on work, sleep and quality of life.
This review is the first of two that focus on apps designed in Canada for Canadians. The growth of mobile health apps provides an exciting opportunity to support healthy behaviour changes that take advantage of digital technology. The vast majority of health and wellness apps on the market, however, are made by large private companies, usually targeted to the U.S. or international market. Although these may still provide benefit to Canadians, there are often factors that don’t quite fit a Canadian context. This review and the next are all-Canadian efforts to promote healthy behaviours. Among those reviewed, Carrot Rewards is especially promising as it integrates with popular fitness trackers to offer Canadians tangible rewards for improving their health.
Dr. Jeff Ashley
Dr. Jeffrey Ashley is a practicing family physician in Etobicoke and the former Corporate Chief of Family Medicine at William Osler Health System. Dr. Ashley has been on staff at the Etobicoke General Hospital campus of William Osler Health System since 1989. Dr. Ashley is also an Assistant Clinical Professor at McMaster University. A graduate of the University of Western Ontario, Faculty of Medicine, Dr. Ashley works as the Lead Physician for the Rexdale Family Health Organization.
As Ontario’s population ages, the incidence of atrial fibrillation increases. We know that atrial fibrillation can be intermittent or asymptomatic. We also know that diagnosed or undiagnosed atrial fibrillation without proper stratification can lead to stroke. If physicians were able to identify these patients earlier and more efficiently, there could be a significant impact on the prevention of disability or death due to stroke. As smartphones are now ubiquitous and the use of mobile apps for health management is growing, it’s worth taking a look at whether apps can contribute to aFib management.
Dr. Andrew Chou
Dr. Andrew Chou is a practicing family physician in Toronto. He completed his medical degree and residency at the University of Toronto. During his training, he became interested in the use of technology in medicine. He currently works in a community-based family practice where technology is used to enhance patient care and improve clinic efficiency.
According to the World Health Organization (WHO), “Health promotion is the process of enabling people to increase control over, and to improve, their health.” Part of this process involves access to credible medical information, but determining what is or is not credible is not straightforward.
Bloating, cramping, gurgling, farting, diarrhea and constipation: these are some of the many symptoms we hear about from patients suffering from irritable bowel syndrome (IBS). It’s overwhelming when patients come in and dump – if you’ll pardon the term – all of their dietary permutations, probiotic choices and descriptions of their stools all at once. Many apps are available that offer to help patients document their IBS symptoms and, by extension, help the physician sort through them. These apps can help with the diagnosis of IBS as well as monitor treatment responses. Not all apps, however, are created equal.
Dr. Matthew Cruickshank
Dr. Matthew Cruickshank is a practicing family physician in Toronto. He holds an undergraduate degree in Computer Engineering from Queen’s University where he developed skills in the development and implementation of technology products and an understanding of how they can enhance traditional systems. He studied medicine at University of Western Ontario and completed his residency at University of Toronto. During his medical education he developed an interest in practice optimization with novel uses of technology. Matthew is currently practicing family medicine at a community-based family practice in Toronto that has a focus on technology integration in family practice to optimize the patient and physician experience.
Anxiety disorders are very common and often encountered by family physicians. And although they can be effectively treated, there are common barriers to treatment. One of the most common barriers is access to formal psychological treatment. Cognitive behavioural therapy (CBT) and mindfulness-based therapy can both be effective at treating anxiety. Apps offer a way of delivering these therapies to individuals who are not able to access formal therapy with a healthcare provider.
Smartphone apps have great potential to improve patient care for asthma, a dynamic disease that can require treatment modification between visits, sometimes urgently. Asthma education, self-monitoring and self-management are very important for effective treatment. Apps have the potential to help by providing asthma education between physician visits, by allowing patients to more easily self-monitor their condition and by helping patients self-manage medications in response to their symptoms.
Insomnia is a common problem encountered in family medicine that causes significant morbidity for patients. A survey of Canadian adults found that 40.2% met at least one symptom of insomnia,13.4% met all criteria and 13% had consulted a healthcare provider for sleep difficulties at least once in their lifetime. Patients with insomnia have daytime fatigue, increased physical discomfort and increased psychological distress.
Dr. Farahnaz Daya
Dr. Farahnaz Daya is a family physician practicing in Toronto. She brings a unique perspective with experience in multiple healthcare systems around the world. She holds a medical degree from the University of Leicester, U.K., where she gained firsthand experience designing and implementing community public health initiatives that leveraged mobile health to empower patients toward preventitive screening. During her family medicine residency at Dalhousie University, she recognized the gaps in care experienced in underserved areas and saw the value that health technologies could offer to bridge those gaps. This inspired her to pursue a Master’s Degree in Public Health at Harvard University with a focus in Global Health and special interests in mHealth technologies and maternal and child health.
As clinicians, we have all had the experience of walking into an exam room when the only note on the chart reads “women’s issue”. Menstrual histories are notoriously filled with inaccuracy and are challenging for the patient and physician to gather. Wouldn’t it be great if our patient could easily and accurately track her periods? And she happened to have this data with her? Enter the era of smartphone menstrual tracking apps.
Dr. Rajesh Girdhari
Raj is a staff physician in the St Michael’s Academic Family Health Team and Women’s College Hospital Substance Use Service. He completed an MD at McGill University and MBA at York University.
Alcohol is one of the most used and abused legal substances in the world. I’m sure that we all know friends or family members who have had problems with alcohol use at some point in their lives. Treatments for alcohol use have traditionally rested on abstinence-based modalities, such as “detox” centres and 12-step programs like Alcoholics Anonymous.
Dr. Kavita Patel
Kavita is a family physician with a longstanding interest in healthcare information technology. Her various experiences include co-founding a company to develop an electronic paramedic form, interning at the Centre for Global eHealth Innovation performing usability studies on electronic medical records and consulting at eHealth Ontario to develop the provincial electronic health record. She knows good data is essential to making healthcare decisions and empowering patients is essential to improving health outcomes. Healthcare applications have the potential to tie these two elements together.
Hypertension affects about one in four Canadian adults, and can cause complications such as cardiovascular disease, kidney disease and death. Research shows that self-monitoring blood pressure (BP), self-management and self-adjustments of medications and M-Health based support groups can achieve reductions in blood pressure.
Dr. Stephen Pomedli
Dr. Stephen Pomedli is a family physician and the co-founder of ConsultLoop, an online referral platform that helps connect family doctors with specialists and betters the referral process for patients. He studied medicine at Harvard Medical School and completed a Master’s in International Health Policy at the London School of Economics. After his residency at St. Michael’s Hospital, he undertook a Global Health fellowship at the University of Toronto, looking at best practices in family medicine in Canada, the United States and Brazil. As a previous Innovation Fellow at Women’s College Hospital, he worked with a group of clinicians, entrepreneurs, designers and policy-makers to find new approaches to designing healthcare services, especially for patients with complex health care needs.
Follow Dr. Pomedli on Twitter @pomedli
Quitting smoking is really tough. As physicians, we know that encouraging and supporting smoking cessation is one of the most important things we can do to impact the health of the ~18% of Canadians who smoke. But as with all addictions, the quitting process can be frustrating for patients and providers alike.
Chronic pain is a complex experience, with multiple causes, huge variations in symptoms and many factors and treatment modalities that may better, worsen or not affect the pain at all. This can make monitoring and reducing pain quite challenging [1, 2].
The apps reviewed excelled in different ways: Manage My Pain and Chronic Pain Tracker feature strong reporting functions that reflect the complexity of chronic pain and communicate to physicians in an effective way. Pain Coach provides information and techniques to support self-management, while CatchMyPain has a strong online support community. Thus, each might help different patients in different ways.
Breast cancer represents up to 25% of new cancers in Canadian women and is the second most common cause of cancer-related mortality. The umbrella term “breast cancer” includes a group of conditions with a number of distinct tumour types, genetic markers, and cancer stages. Treatments and approaches can vary widely based on patient preference, local reimbursement models, evolving protocols, and awareness and availability of palliative care services. This heterogeneity makes creating an overarching “breast cancer app” quite a challenge. Nonetheless, apps in this genre have the potential to 1) offer education, from prevention and screening, through to diagnosis, treatment, symptom management and follow-up, 2) help track the patient’s illness journey, and 3) provide important social support.
Dr. Niraj Mistry
Niraj is a practicing pediatrician in Toronto. He completed an MD at the University of Toronto and Pediatrics residency at the Hospital for Sick Children (SickKids). During his fellowship in Academic General Pediatrics he completed a Masters in eHealth (Health Informatics) at McMaster University. Niraj is currently a staff pediatrician at SickKids, St. Michael’s Hospital, Toronto Western Hospital and Scarborough Centenary. Niraj is currently focused on the user-centred design, development and implementation of novel technologies to improve the application of the best available evidence at the point of care, to enhance care delivery and optimize the patient and family experience
Asthma is the most common chronic condition affecting children and the most common reason children are hospitalized. It is estimated that more than 15% of Canadian children have been diagnosed with asthma, nearly double the number of adults with the disease. Treatment guidelines emphasize that the critical first step in asthma management is self-management education. Children are highly unlikely to be motivated to self-monitor and manage their symptoms unless the right incentives are involved.
Anxiety is the most common mental health issue among children and youth. While evidence supports the benefits of psychological therapies, access to these services is a major barrier. As such, empowering children, youth and their parents through technology may be a viable solution. We provide a review of two apps consistent with Cognitive Behavioural Therapy (CBT), a general stress management app and an app aiming to foster resilience in children through breathing, thinking and doing.