BackgroundDespite the advances in mobile health (mHealth) systems, little is known about patients’ and providers’ experiences using a new mHealth system design.ObjectiveThis study aimed to understand challenges and provide design considerations for a personalized mHealth system that could effectively support heart failure (HF) patients after they transition into the home environment.MethodsFollowing exploratory interviews with nurses and preventive care physicians, an mHealth system was developed. Patients were asked to measure their weight, blood pressure, and blood glucose (if they had diabetes). They were also instructed to enter symptoms, view notifications, and read messages on a mobile app that we developed. A Bluetooth-enabled weight scale, blood pressure monitor, glucometer, and mobile phone was provided after an introductory orientation and training session. HF nurses used a dashboard to view daily measurements for each patient and received text and email alerts when risk was indicated. Observations of usage, cases of deterioration, readmissions, and metrics related to system usability and quality of life outcomes were used to determine overall effectiveness of the system, whereas focus group sessions with patients were conducted to elicit participants’ feedback on the system’s design.ResultsA total of 8 patients with HF participated over a 6-month period. Overall, the mean users’ satisfaction with the system ranked 73%, which was above average. Quality of life improvement was 3.6. Patients and nurses used the system on a regular basis and were able to successfully identify and manage 8 health deteriorations, of which 5 were completely managed remotely. Focus groups revealed that, on one hand, the system was beneficial and helped patients with: recording and tracking readings; receiving encouragement and reassurance from nurses; spotting and solving problems; learning from past experiences; and communication. On the other hand, findings also highlighted design issues and recommendations for future systems such as the need to communicate via other media, personalize symptom questions and messages, integrate other health tracking technologies, and provide additional methods to analyze and visualize their data.ConclusionsUnderstanding users’ experiences provides important design considerations that could complement existing design recommendations from the literature, and, when combined with physician and nurse requirements, have the potential to yield a feasible telehealth system that is effective in supporting HF self-care. Future studies will include these guidelines and use a larger sample size to validate the outcomes.

In the US, approximately 5.8 million people suffer from Congestive Heart Failure (CHF). It is the most frequent cause for hospital readmissions such that 21.2% of Medicare patients diagnosed with CHF were readmitted to hospital within 30 days of discharge. Tele-monitoring daily self-management regimens may reduce hospital readmission. MyHeart is a telehealth system, which we have designed for CHF patients to bridge the current gap in the Congestive Heart Failure care continuum when the patient moves to the home environment. The system uses wireless health devices and a mobile application to collect patients' data; moreover, it sends messages to patients to encourage self-care as per Fogg's behavior model. On the clinician's end, we designed a rule-based expert system and a dashboard to process and display patients' vitals, symptoms, and health risk. MyHeart is currently being used at Loma Linda University (LLU) Medical Center and we report here our initial findings.

MyHeart is a telehealth system designed to bridge the current gap in the Congestive Heart Failure care continuum that occurs when the patient transitions from the hospital to the home environment. The system uses wireless health devices and a mobile application on the patient's end, a rule-based expert system, and a dashboard on the clinician's end to facilitate the exchange of information pertaining to vitals, symptoms, and health risk. The system also sends messages to patients that aim to encourage self-care as per Fogg's behavior model. An experiment to evaluate MyHeart is currently underway at Loma Linda University Medical Center and encouraging initial findings are reported.

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