Making It Mobile: The HEART Pathway App


Physicians avoid taking unnecessary risks with patients who come to the ER with chest pain—and for good reason. Better to keep a patient for observation and testing than discharge someone who could later suffer a more serious cardiac event.

But an abundance of precaution comes at a cost.

Of the 8 to 10 million people every year who visit emergency rooms across the United States reporting chest pains, fewer than 10 percent actually suffer adverse cardiac events. That means many patients with chest pain are undergoing observation protocols and tests that may be unnecessary, resulting in longer hospital stays and increased cost of care.

But what if there was a way to assess, right at the point of care, whether chest pains are a heart attack waiting to happen or something less threatening? And what if being better at that assessment could lead to fewer tests and hospital admissions?

There’s an App for That

Simon Mahler, MD, and Iltifat Husain, MD, of Wake Forest Baptist Medical Center recently developed the HEART Pathway, a digital app that helps medical professionals assess which patients complaining of chest pains can be safely discharged—all by using a simple, quick, non-invasive screening.

Dr. Mahler conducted the extensive research that underpins the application. Wake Forest Innovations, the commercialization arm of Wake Forest Baptist, licensed the proprietary rights to a startup company called Decision Point Informatics—which is owned and operated by the clinicians—that translated the protocol into app form.

The HEART Pathway app embodies a major shift in the future of health care in America—mobile health. Increasingly, people are using mobile technology to monitor and diagnose health issues. From losing weight and monitoring vitals, to online consultations and managing health conditions, to diagnosing ear infections and treating mental health, mobile technology is becoming the go-to for patients—and medical professionals.

Mobile health is now a big deal. By 2017, mobile health is projected to be a $26 billion industry, with over half of smartphone users downloading a health app of some kind. And in addition to rapid adoption of mobile health apps by the general public, it is estimated that 25 percent of physicians are using mobile technologies as they provide patient care.   

Reducing Risk

The assessment behind the HEART Pathway app is a clinical protocol that determines a patient’s risk for adverse cardiac events.

In less than two minutes, the HEART Pathway guides doctors through a series of questions that, using a proprietary algorithm, calculates the level of risk and provides information that helps physicians determine whether a patient can be discharged, kept for observation or admitted to the hospital for more tests.

Mahler developed the HEART Pathway protocol after conducting research about the effectiveness of the HEART Score, a diagnostic tool developed in the Netherlands. Mahler created the HEART Pathway because he believed that physicians needed a clinical protocol with a lower risk threshold.

“Doctor’s simply won’t take a risk of discharging patients unless there’s a less than 1 percent chance that the patient will develop cardiac problems after leaving the hospital,” says Mahler.  “The HEART Pathway identifies that lower risk.”

Impact on Health Care

The HEART Pathway, which has been used with over 8,000 patients, did more than decrease the chance of discharging at-risk patients. Through several studies, Mahler determined that using the HEART Pathway doubled the number of patients discharged from the emergency department without stress testing, none of whom suffered any adverse events in the 30 days that followed their trips to the emergency room. Additionally, use of the app decreased the length of hospital stay for patients by an average of 12 hours.

When fewer patients are kept for observation or admitted to the hospital, fewer tests had to be administered, decreasing the discomfort of hospital stays for patients and saving resources for the hospital. When the current standard-of-care costs the national health care system between $10-13 billion a year, these savings could be substantial.

Making It Mobile

None of this research makes much difference if the tool is not in the hands of the physicians who need it.

It was important to Mahler that the HEART Pathway could be easily accessed by physicians, so he teamed up with Husain, who has experience with medical apps.

“You can do a study that’s fantastic and publish it, but how do you get it into the hands of emergency room physicians?” asks Husain. “Just because you develop something awesome, doesn’t mean that people are going to use it.”

Husain saw the potential of the HEART Pathway as an electronic application, so he and Mahler worked with Scott Gilmore, a medical student at Wake Forest School of Medicine who wrote the code needed to turn the tool into a medical application that could be easily accessed at point of care.

And if that wasn’t enough, they developed a method for integrating the patient data generated by the app into EPIC–the hospital’s electronic medical record system. This makes the app appealing not just to physicians, but to health systems across the country aiming to provide more efficient care and streamlined process.

Under their company, Decision Point Informatics, Mahler and Husain launched the HEART Pathway app for free on the Apple app store. Now, any medical professional with an iPhone can access the app anywhere in the world.

“We’re motivated to improve patient health, and we can do that by putting effective tools into the hands of the doctors who need it,” says Mahler.

Read the press release or download the app. Learn how Decision Point Informatics is developing the HEART Pathway as an enterprise solution that integrates directly with electronic medical record systems in medical centers across the world.

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