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Technologies are becoming ever more embedded in healthcare, now enabling people to participate as part of their own healthcare team following a heart attack, with deployment of a smartphone app called Corrie and additional devices. Seth Martin, a cardiologist at Johns Hopkins and one member of the Corrie development team, describes what was needed.

Martin: Provided them with an iPhone if they didn’t have one, we provided an Apple watch, which had the Corrie app on the watch as well so patients could track their physical activity, receive their reminders and so forth on the watch. There was also a companion blood pressure monitor that was part of the intervention. So patients would start using that in the hospital. Patients would then watch educational videos on their phone or stream it to an Apple TV in their hospital room.  :28

Martin predicts that use of an integrated range of devices will become standard of care for people who’ve had a first heart attack, as use of Corrie has been shown to reduce someone’s risk of rehospitalization by fifty percent. At Johns Hopkins, I’m Elizabeth Tracey.

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Corrie can help you avoid rehospitalization after you’ve had a heart attack, a study led by Seth Martin, a cardiologist at Johns Hopkins, and colleagues has shown. Corrie is the name of a smartphone app that integrates all aspects of a person’s care as well as providing educational tools so people can become informed participants in their own care.

Martin: The Corrie patients had a fifty percent lower risk of 30 day all cause readmissions compared to patients who were in the historical group that did not use Corrie. We really spanned large academic hospitals as well as more community based hospitals. We also published a cost-effectiveness analysis that really shows the associated of these outcomes with much lower costs of medical care, in fact can result in savings.  :31

Martin says additional studies on various aspects of Corrie’s impact are planned. At Johns Hopkins, I’m Elizabeth Tracey.

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Having to come back to the hospital shortly after you’ve been discharged is called rehospitalization, and for people who’ve had a heart attack that’s not an outcome anyone wants. Now an app developed by Seth Martin, a cardiologist at Johns Hopkins, and colleagues, has been shown to help inform and educate people so they can help manage their own care. 

Martin: It’s also about lifestyles, diet and exercise and knowing who to follow up with, knowing about the importance of enrolling in a cardiac rehab program. So as we brought all this together for patients and as they used the app and interacted with Corrie on a smart watch as well as using a connected blood pressure monitor, these high levels of patient activation were associated with improved outcomes, reduced 30 day all cause readmissions. Patients in the Corrie group were less likely to come back to the hospitals.  :31

Martin says using the app, called Corrie, in several types of hospitals has shown its practicality. At Johns Hopkins, I’m Elizabeth Tracey.

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Corrie is the name of an app developed by Johns Hopkins and Apple to enable people who’ve had a heart attack become informed, active participants in their own care, and that’s just what the most recent data show. Seth Martin, one of the app’s developers and a cardiologist at Hopkins, explains.

Martin: We’re testing the ability of the app to empower patients to follow everything that we know works. They’ve had a heart attack and the question is what’s next and that’s where Corrie came in. And so what we’ve found first of all that patients using the Corrie app had very high levels of patient activation and what means is a high level of confidence that our patients know what they need to do to be successful, so that’s your medications to lower cholesterol and control your blood pressure, and antiplatelet medicines to prevent stickiness of the blood.  :32

Martin anticipates wider availability of the app and additional positive results of ongoing studies on its use. At Johns Hopkins, I’m Elizabeth Tracey.

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Imagine how hard it is for some people to get to a physician’s office, especially those with disabilities such as movement disorders, or children. For them telemedicine has proven very helpful, but is poised to ramp down after special allowances during the pandemic. Brian Hasselfeld, director of telemedicine at Johns Hopkins, comments.

Hasselfeld: Not all care is perfect for telemedicine, but we should allow convenience and access and choice to be a main component of what we do in patient centered design. With many states after a seizure or a stroke you can’t drive for six months. Those patients aren’t getting to make the easy choice about go to the visit or not, they’re making the choice of how am I going to do that? How much easier would it be to do that virtually, I mean how much more patient centered would it be to do that virtually? Many patients are struggling not with oh of course it’s easy to go to that visit, I might not be able to go, period.  :32

Hasselfeld encourages everyone to reach out to lawmakers. At Johns Hopkins, I’m Elizabeth Tracey.

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Telemedicine proved its worth during the pandemic, providing medical visits to millions. Now barriers to continue to allow telemedicine services are curtailing them. Brian Hasselfeld, director of telemedicine at Johns Hopkins, says a big one is physician licensure.

Hasselfeld: The rule of the road is I must be licensed where you, the patient, are physically located at the time of the visit. In a world of expanded telemedicine care, you could be anywhere of course. That also means I need to be licensed anywhere potentially, or I can’t see you. And so now we’re stuck with this really difficult situation. You my patient. I know you, you know me, we have a trusted relationship. You happen to travel 45 minutes to the north and you’re in Pennsylvania. I’m not licensed there. I cannot care for you, legally.  :30

Hasselfeld says some states have limited agreements with one another, and these may be helpful in the short term. A longer term solution is needed however, since many specialty care visits simply aren’t practical in person for many people. At Johns Hopkins, I’m Elizabeth Tracey.

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During the pandemic, telemedicine has been a boon for many, perhaps most especially older people, who are often much more at risk for severe disease and death when they develop Covid-19 infection, and may be reluctant to visit a health care provider in person. Brian Hasselfeld, director of telemedicine at Johns Hopkins, says now this service may be largely eliminated.

Hasselfeld: Medicare beneficiaries, those insured by Medicare fee for service, when the federal public health emergency ends, Medicare beneficiaries will only have access to telemedicine in very specific circumstances. Mostly you won’t have access to it, so Congress will hopefully act to ensure that Medicare beneficiaries don’t get a new kind of Medicare donut. It used to be about pharmacy and prescription benefits, now it could be about telehealth benefits, not having telehealth benefits as a Medicare beneficiary.  :28

Hasselfeld says people should contact their legislators and express their desire to see telehealth services preserved under Medicare, and to urge Congress to act. At Johns Hopkins, I’m Elizabeth Tracey.