Connected Health Innovation Research Program (C.H.I.R.P.): A bridge for digital health and wellness in cardiology and oncology

Abstract

Study objective: Cancer and heart disease are leading causes of mortality, and cardio-oncology is emerging as a new field addressing the cardiovascular toxicities related to cancer and cancer therapy. Interdisciplinary research platforms that incorporate digital health to optimize cardiovascular health and wellness in cancer survivors are therefore needed as we advance in the digital era. Our goal was to develop the Connected Health Innovation Research Program (C.H.I.R.P.) to serve as a foundation for future integration and assessments of adoption and clinical efficacy of digital health tools for cardiovascular health and wellness in the general population and in oncology patients.

Design/setting/participants: Partner companies were identified through the American Medical Association innovation platform, as well as LinkedIn and direct contact by our team. Company leaders met with our team to discuss features of their technology or software. Non-disclosure agreements were signed and data were discussed and obtained for descriptive or statistical analysis.

Results: A suite of companies with technologies focused on wellness, biometrics tracking, audio companions, oxygen saturation, weight trends, sleep patterns, heart rate variability, electrocardiogram patterns, blood pressure patterns, real-time metabolism tracking, instructional video modules, or integration of these technologies into electronic health records was collated. We formed an interdisciplinary research team and established an academia-industry collaborative foundation for connecting patients with wellness digital health technologies.

Conclusions: A suite of software and device technologies accessible to the cardiology and oncology population has been established and will facilitate retrospective, prospective, and case research studies assessing adoption and clinical efficacy of digital health tools in cardiology/oncology.

Keywords: Cardio-oncology; Connected health; Digital health; Digital transformation; Innovation; Learning Health System.

Fig. 1

Connected Health Innovation Research Program (C.H.I.R.P.) Foundational Design. A suite of software and device technologies accessible to the cardio-oncology population has been established. We have formed an interdisciplinary research team and established an academia-industry collaborative foundation for retrospective, prospective, and case research studies in digital and connected health. Thus, we have successfully launched C.H.I.R.P.. In addition, a beta version of our website is currently available, and we are developing a mobile application to centralize digital health patient technologies. We plan to incorporate remote patient monitoring and wearable physiological pattern information into patient charts, through an existing cardiology focused virtual care platform in collaboration with C.H.I.R.P. We hope to incorporate innovative solutions for patients like “Genius Bars” to enhance orientation to these new digital health technologies. C.H.I.R.P. team members have benefited from real world experience interacting and forming relationships with digital health companies. The development of our connected health cadre of industry partners has been accomplished by first screening companies for technologies that fit with our goals and have the potential to improve outcomes in cardio-oncology patients. This has led to the screening of ~30 companies through the American Medical Association innovation network and LinkedIn, with subsequent recruitment of ~20, and collaboration with ~10 companies. We have especially been investigating the technologies of 3 companies that specifically cater their technology or software to cardio-oncology patients, and are conducting initial retrospective, prospective, and case studies with these companies. Additionally, we collaborate with seven companies that offer their technology or software to a general user population; we are currently conducting retrospective analyses on the general users of these technologies or software.

Fig. 2

Range of technologies associated with Connected Health Innovation Research Program (C.H.I.R.P.) studies. Companies offer different applications of digital health. These include wearables, mobile applications, biometrics, patient education, virtual care platforms, artificial intelligence, and ECG/BP monitors. These applications are not mutually exclusive to a certain company, several companies integrate various applications of digital health to create a more effective technology or software. Templates from Infograpia were used in the making of this graphic. BP: blood pressure and ECG: electrocardiogram.

Fig. 3

Technologies, Features, and Study Objectives of the Connected Health Innovation Research Program (C.H.I.R.P.). A, Examples of specific technologies and unique features; B, Components of C.H.I.R.P.; C, Study objectives of C.H.I.R.P. for various forms of clinical studies. Retrospective analyses on clinical outcomes and user/patient satisfaction and adoption of the technologies will be investigated. Future prospective studies will interrogate how these technologies promote health in patients with or at risk for cardiovascular disease, especially in cancer survivors. Case studies will specifically test how these technologies can be used in unique cardiology or cardio-oncology patient circumstances. Projects will assess trends and provide foundational insight on study participants' satisfaction and adoption of the technologies. We will also investigate changes in short-term clinical outcomes among users compared to their own baseline. Our goal is to use findings from these retrospective and prospective studies on the general population to provide insight that can guide case and prospective studies for patients in cardio-oncology. These studies will advance connected health research by forming alliances with companies providing innovative methods for monitoring and fostering cardiovascular health and wellness in the general population, with application to cancer survivors. The broad array of patient-facing and clinician-facing digital health technologies is paralleled by a mixed group of users. Templates from Infograpia were used in the making of this graphic. ECG: electrocardiogram, MCW: Medical College of Wisconsin.

Fig. 4

Roadmap to building Connected Health Innovation Research Program (C.H.I.R.P.) interdisciplinary research collaborations and initiating studies. C.H.I.R.P. developed a roadmap to partner with industry companies to realistically offer technologies/software to patients to improve accessing and monitoring of physiology to enhance their care. A partner company offered remote patient monitoring through company-provided LTE-enabled devices, bypassing the need for broadband internet at home required for uploading blood pressure readings to a shared cloud service. We also served as a hub for some companies to connect with one another to share these innovative ideas and increase the number of patients they can reach with their technologies/software. Templates from Infograpia were used in the making of this graphic. BAA: Business Associate Contract; DUA: Data Use Agreement; and NDA: Non-Disclosure Agreement.

Fig. 5

The knowledge pyramid: Organization and Responsibilities of Interdisciplinary and Multi-Level Research Team. This figure groups team members into the various categories that make up Connected Health Innovation Research Program (C.H.I.R.P.)’s interdisciplinary and multi-level research team, the pyramid structure of the team represents the level of responsibility, experience and education of team members (with those having the most at the top). It also gives the specific roles and responsibilities of each team category. With team members fitting into various levels of the knowledge pyramid, there is minimal mismatch between experience of the team member completing the task and complexity of the task, as various tasks call for differing levels of experience and knowledge. C.H.I.R.P. educates members through their research endeavors, working with senior lab members and through peer mentoring. Direct guidance from mentors who are highly connected within the research community yields greater mentee academic success [54]. Peer mentoring has been shown to be a compelling contributor to early career scholars, and is encompassed by C.H.I.R.P. through collaboration of medical students and graduate students during long term projects [55]. These experiences prepare students to be active members of the academic community and add to their educational foundation [56]. EHR: electronic health record; IRB: institutional review board.

Fig. 6

Connected Health Innovation Research Program (C.H.I.R.P.) Poster Presentations: A screenshot from the Building C.H.I.R.P. poster presented by a Brown Lab medical student at the Cardio-Oncology Innovation Network 2021 Summit trainee rapid abstract session, on December 11th 2021. The poster outlines the aims, results, and next steps of C.H.I.R.P. and includes Table 1. A similar poster was also presented at the Medical College of Wisconsin Medical Student Research Virtual Poster Session on September 20th 2020 by another Brown Lab medical student. Both poster presentations were valuable educational experiences for a trainee to receive feedback from experienced researchers on the program and prepare a poster, abstract and give the presentation. Opportunities for presenting their work and mentoring newer lab members have created an environment of education and collaboration. Programs like C.H.I.R.P. will be instrumental in training professionals to conduct digital health research while concurrently assessing current digital health capabilities. AI: artificial intelligence; BP: blood pressure; ECG/EKG: electrocardiogram; EHR: electronic health record; and HR: heart rate. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)