The digital therapeutic solution halving hospitalization rates

You might be trying to kick the habit of checking your phone when you wake up, but for the 985 patients on Medly, having their phone on hand has been instrumental in managing chronic heart failure. As a digital therapeutic solution, the Medly program (Medly) connects patients living with heart failure with a registered nurse. This includes those living in big cities to provide access to specialized care, to those in underserved communities where resources are not as readily available.

Smartphone-based healthcare app and program with an algorithm that triggers individualized self-care instructions from registered nurses remotely

Every morning, patients log on and record the following: their weight, blood pressure, heart rate and any symptoms they may feel that day. The expert-rules-based algorithm then analyzes their data and based on a personalized threshold, generates one of three responses.

Stop, slow, go

Go: Around 80 percent of the time, the recorded data shows no cause for concern, and users are free to go about their day after logging their vitals. This is an important statistic to Nadan Kapetanovic, Healthcare Affairs Manager Canada and project lead, given the country’s healthcare worker shortage. 

“While the team of nurses are still available for any clinical or technical concerns their patients have, they are able to direct their attention to the other 20 percent who require more pressing medical care,” he explains. One nurse can manage up to 250 patients at any given time through the app’s Medly program dashboard that provides them with a holistic overview.

Slow: Approximately  20 percent of cases, users receive a “caution alert” with further self-care instructions to follow. This could be to record their symptoms again later in the day should they feel unwell or to take an additional dose of a specific medication in response to symptoms. Their registered nurse also receives an alert on their dashboard to care for these users. Should further clinical expertise be needed, the nurses can escalate it directly to the user’s cardiologist.

Stop: The “critical alert” sends a trigger directly to the user’s cardiologist, allowing users to receive immediate attention remotely. While rare, accounting for 0.2 percent of all cases, Medly ensures that patients living in underserved communities can still receive urgent care to reduce the need for hospitalization.

The burden of hospitalization

Developed and tested by heart failure clinicians, researchers, and engineers at the UHN, one of the core objectives of Medly is to prevent patient hospitalization. There are an estimated 750,000 people living with heart failure in Canada. In 2023 alone, 100,000 people will receive a heart failure diagnosis. Of the patients who go to the hospital, one in five will return to the hospital within 30 days of their last visit.

“That places an enormous amount of pressure on a healthcare system that is already strained,” says Nadan. “When the app prompts a caution or critical alert, we are detecting potential situations that could lead to a major event for a patient. And crucially, we help prevent that from happening.”

Not only has Medly halved the number of heart failure-related hospitalizations, it has also reduced all-cause hospitalizations by 24 percent. Furthermore, clinicians have reported that the program enables better clinical decisions. The clinician dashboard provides the user’s care network and designated caregivers with a comprehensive data log that includes their personalized thresholds, lab data and historical trends. They are therefore able to better decide the next course of action necessary, if at all, for the patient.

“What if instead of being hospitalized, patients who come into the hospital are followed up on? The dashboard gives them insight that aids in that decision,” shares Nadan.

A win-win for patients and clinicians

Central to the program are the patients. Since Medly requires a high level of personal involvement, users are guided through the different ways they should care for themselves. A nurse remains their first line of contact for any potential issues, and that way, patients can be closely guided through any procedures they might be unfamiliar with. 

Users like Lionel Newton, are sure the technology has brought a significant improvement in maintaining and managing heart failure. “When you live with heart failure, you’re always wondering, ‘Am I okay?’” he says. “I think [Medly is] one of the best things that’s ever happened to me.”

More to come

Through our partnership with UHN, patients are currently enrolled in nine health organizations in Toronto. In March 2023, we completed an initiative in Weeneebayko Area Health Authority, a health-care network operating hospitals and supporting federal nursing stations in remote communities along the James Bay and Hudson Bay coasts in Northern Ontario, Canada. We share the aim of continuing to scale the use of Medly as a digital therapeutic to deliver equitable access to quality heart failure care in communities across Ontario and throughout Canada.