An App for Patients

The patient version of the Patient is in app provides care continuity and care coordination services for chronic conditions. Through its integration with Apple’s HealthKit and the Health and ECG apps on the iPhone and Apple Watch, our patient app democratizes cardiac care for everyone in the world irrespective of location or timezone by enabling real-time cardiac telehealth services. More specifically, the patient app provides the following features:

  1. Care Continuity and Remote Patient Monitoring (RPM). Traditionally, remote patient monitoring requires you, the cardiac patient, to contract with a third party monitoring service and rent one or more heart monitoring device. Periodically, the remote monitoring company will create a high-level report and sell it to your doctor. Your doctor will then bill your insurance company for his time, the cost of the report, the cost of the remote monitoring service, and the rental devices. Due to this added cost, insurance companies will only authorize your doctor to review your cardiac data infrequently and never daily. To enable your cardiac team to continually review your health data, our apps empower you to securely transmit your heart data directly to your cardiac team in real-time and connect with them at any time of day or night. Specifically,
    • Patients can securely stream their live pulse and other heart data in real-time to their cardiac team.
    • Patients can securely send their historical heart data to their cardiac team so that your cardiac team may continually reviewing your condition with updated health data.
    • Patients can securely send their ECG to their cardiac team for immediate review. Whenever you determine that an ECG review is needed, the patient app can send both the ECG report and the last 24 hours of cardiac data to your cardiac team.
  2. Telehealth/Telemedicine Services. With the patient app, you may request a FaceTime conference call from your cardiac team. Rather than wait to contact the doctor’s office during regular hours, each cardiac team member using the doctor’s version of the Patient is in app will receive a critical alert containing your FaceTime request. The doctor app provides a “one-touch connect” button allowing any cardiac team member to place a FaceTime call to you. The cardiac team is able to use the Group FaceTime capabilities to include other cardiac experts and team members as needed. Likewise, you should be able to include any of your caregivers on the Group FaceTime call.
  3. Care Coordination. Even if your condition does not require home-based monitoring, you can securely send your recent cardiac data to your doctor prior to an appointment so that your doctor has adequate time to review your health data since your last appointment.
  4. Personal Health Data Analysis. You can export your cardiac data from the iOS Health app into a spreadsheet and perform your own analysis with tools such as Microsoft’s Excel, Apple’s Numbers app, and Google’s Sheets.

Download


Installation

The first step in the setup process is to configure the Patient is in app with the correct iOS permissions. When you launch the app, it will display updated status. In this case, the app informs you that a cardiac team has not yet been assigned to monitoring you through the app:

Next, tap the button in the center to expand the app menu. You will be presented with four options:

  1. Export to a file or securely send your historical heart data to your cardiac team
  2. Securely send to your cardiac team your current pulse and other cardiac data
  3. Request a FaceTime conference call with your cardiac team
  4. Configure the app

Tap on the configure the app menu item and you will be presented with details on the permissions required by the app:

In addition to sending your health data to your cardiac team and requesting a FaceTime conference call, you can also request an ECG analysis by sharing the ECG report from the iOS Health app with the patient app. We will discuss this in a later section. The important point is that when a cardiac team member confirms your request, a notification or critical alert will be sent to you. To receive these confirmations as well as other important messages, you must enable Notifications:

and Critical Alerts:

The Critical Alerts permission authorizes the patient app to play critical sounds that ignore the iOS “Do Not Disturb” feature and your iPhone’s mute switch. You will learn how to customize notifications and critical alerts in a later section.

When you set up the app with your cardiac team, you will need to authorize location services. This allows your cardiac team’s charge nurse iPad app to identify your iPhone. Some medical facilities provide a streamlined check-in process by recognizing that your iPhone is on-site. If you want a streamlined check-in process, authorize “Always Allow”. Alternatively, authorize “Only While Using the App”:

To enable the app to access your health data, you must authorize access to your heart data:

Next, while at your doctor’s office a member of your cardiac team will use the charge nurse version of the Patient is in app to add you to the list of patients who are remotely monitored. Add your preferred name and FaceTime contact information in the app’s Settings view:

Configuring Notifications and Critical Alerts

With iOS 12, Apple introduced Critical Alerts which are high priority notifications which ignore the iOS “Do Not Disturb” setting and your iPhone’s mute switch and will play a critical sound at a higher volume than regular notifications. To ensure that you hear your cardiac’s team confirmation to your ECG analysis and FaceTime requests, the app uses Critical Alerts. You may choose to use regular notifications instead, a default sound or a verbal announcement, or change the volume of a critical alert:

How to Securely Send your ECG

Rather than emailing or faxing your ECG report to your doctor’s office and not knowing if or when it will be forwarded to your cardiac team for analysis, you can use the patient app to immediately and securely send your ECG report directly to the cardiac team members and they can confirm receipt in real-time. The doctor’s version of the Patient is in app allows the correct cardiac team member to analyze your ECG and associated cardiac data and instantly contact you over FaceTime with a single touch of a button. And with Group FaceTime, your cardiac team can include all the needed medical experts on the call and you can include your family or caregivers if needed. Here’s how to securely send your ECG:

  • After setting up the app with your cardiac team and generating an ECG from your Apple Watch Series 4, select the ECG from the iOS Health app and then tap the share button:

Alternatively, you may tap the “Export a PDF for Your Doctor” button and then tap the share button which is also in the top right. You will then be presented with a share sheet (which is also known as an activity view) allowing you to share the ECG report with the patient app:

The patient app will then be automatically launched and in a few moments, the app will inform you that an ECG analysis request was sent to your cardiac team. With the request, the ECG report and the last 24 hours of cardiac data are encrypted and forwarded to the members of your cardiac team:

The appropriate cardiac team member can confirm receipt and thereby remove any uncertainty that your cardiac team has received your request and has your up to date health data:

How to Securely Send Your Live Pulse

For those times in which you and your cardiac team want to actively monitor your heart rate, you can live stream your pulse to your cardiac team. While a medical-grade dedicated heart monitor will capture your pulse every second, the Apple Watch passively transmits your pulse to the iOS Health app every few minutes.

Since the Apple Watch is not a medical device, there is no guarantee when your pulse is captured and transmitted to the iOS Health app. Furthermore, there is an indeterminate delay when the patient app is updated with the new pulse and your cardiac team receives the updated pulse value. Additionally, iOS will only update the patient app when the lock screen has not been activated. To alleviate this constraint, the patient app continuously runs. Other apps such as the built-in Music app and other media apps also continuously run. Along with your current heart rate, the app also securely sends the last 24 hours of heart data to ensure that your cardiac team always has your latest heart data.

Whether you use the Apple Watch or a HealthKit compatible medical-grade device, to stream your pulse to your cardiac team members, tap the heart icon menu item:

An appropriate cardiac team member can confirm that the team is receiving your live pulse and is reviewing your cardiac data:

To stop streaming your pulse, tap the heart icon menu item again:

How to Securely Send Your Historical Heart Data

You can securely send the last 24 hours of historical heart data to your cardiac team for review. Tap the file icon menu item:

and then select “Send 1 Day of Cardiac Data”:

The patient app will create a spreadsheet file of your heart data and securely send it to your cardiac team. You can do this everyday to ensure that your cardiac team has your latest heart data and 24 hours of data should not be an overwhelming amount of data to analyze. Additionally, prior to a doctor’s appointment, your cardiac team may request that you send the most recent heart data to them.

While most cardiac teams contract with third-party monitoring services and then purchase from the service company a high-level report of your heart data on a monthly or quarterly basis, the Patient is in app suite empowers your cardiac team to continually monitor your health and actively participate in your treatment rather than wait for your next appointment.

How to Analyze Your Own Heart Data

Augmenting the built-in visualization tools provided by the iOS Health app, you can export your historical cardiac data into a spreadsheet file for your own review. Tap the file icon menu item and choose the duration to export:

You will be presented with a share sheet (which is also known as an activity view) allowing you to use AirDrop to send the spreadsheet to your Mac, send to the iOS Numbers app for analysis, the Files app for storage in iCloud, or to other apps and services:

In the above example, the patient is about to use AirDrop to share with his cardiac team 2 years of heart data captured by his Apple Watch.

How to Request a FaceTime Conference Call

The patient app empowers you to request that your cardiac team contact you. Irrespective of the time, your timezone, or location… your cardiac team is notified in real-time of your FaceTime request. Tap the FaceTime icon menu item to make the request:

An appropriate cardiac team member can confirm receipt of your FaceTime request and that the team is reviewing your cardiac data and is preparing to contact you using FaceTime:

Privacy and Your Health Data

As stated in the Patient is in app privacy policy: the purpose of the patient app is to securely transmit your heart data to your cardiac team. Together with the doctor and charge nurse apps, a secure conduit is created between your device and the devices of your cardiac team members. Your cardiac data and files are automatically encrypted prior to leaving your iPhone or Apple Watch and are automatically decrypted on arriving at each cardiac team member’s iPhone or iPad. The app developer does not maintain an off-device copy of the encryption keys used to encrypt and decrypt your health data derived from HealthKit.

Please contact us if you have questions about your data privacy.