By Sonia K. González, DrPH, MPH
Dr. Sunit Jariwala is the Director of Clinical and Research Innovation for the Department of Medicine at Einstein/Montefiore. He is also Director of Allergy/Immunology Research and created ASTHMAXcel, an app that delivers personalized asthma education to both children and adults. He has been the Principal Investigator for 12 grants, and his app has been awarded over $2 million in grant funding. He is currently extending the tool to other conditions such as type 2 diabetes, COPD, and congestive heart failure. To train the next generation of physician innovators, he is creating an Innovation Biodesign Training Program, which will launch in July 2020. Dr. Jariwala also completed the Entrepreneurship Lab Bio and Healthtech NYC (ELabNYC) accelerator program. He is the Vice-Chair and Chair-Elect of the American Academy of Allergy, Asthma & Immunology’s Health Informatics, Technology & Education Committee.
In 2011, our team of asthma physicians and health educators at Einstein/Montefiore formed the Montefiore Asthma Center to address the worsening asthma epidemic in the Bronx. Our Asthma Center’s health educator delivered on-site education that would keep asthma patients out of the emergency room. To replicate this approach for clinical sites without health educators, our team created the ASTHMAXcel mobile application in 2014. While our initial app focused on delivering asthma education for patients, we were fortunate to receive grant funding that enabled us to expand upon the app’s functionality (e.g. gamification, integration with the electronic health record system). To encourage the development and implementation of patient-facing mobile tools across specialties, I was promoted as the Director of Clinical and Research Innovation at Einstein/Montefiore. Throughout the past year, our team has been extending our mobile platform to other chronic conditions (diabetes, congestive heart failure, emphysema, and rheumatoid arthritis). We are currently creating an Innovation Biodesign Training Program (set to launch in July 2020) to train the next generation of faculty innovators. Finally, we are leveraging health technology to improve patient engagement and clinical workflows, and reduce provider burnout.
ASTHMAXcel is a patient-facing mobile platform that delivers guideline-based education and adherence support for adults and patients with asthma. This tool promotes sustained user engagement through features such as tailored push notifications, interactive games, the self-tracking of patient-reported outcomes, and animated videos.
We developed our first prototype by 2015 and launched the first version of ASTHMAXcel on the iOS and Android app stores in 2017. We developed our enhanced version in 2018. This app has impacted healthcare, as demonstrated by our recently published studies through which ASTHMAXcel has been linked to improvements in asthma control and quality of life, and decreases in asthma-related emergency department visits, hospitalizations, and oral steroid courses.
In retrospect, I wish that I had a better background in finance and marketing. The ELabNYC accelerator was a life-changing experience that connected me with mentors in these fields. I also learned so much from the other ELabNYC participants.
NYC has incredible diversity, and as an extension, a wide variety of potential user experiences. There are so many idealistic and accomplished individuals, and leading health care organizations that are working together to make the world a better place.
I think the greatest challenges are sustained user engagement, adoption, and inconsistent clinical validation of mainstream health technologies. The greatest opportunities are in leveraging predictive analytics and digital phenotyping for risk stratification and delivering targeted therapies. Health technologies can offer personalizable and user-centered interventions at scale.
Effective health tech is user-centered and can help underserved patients to access guideline-based medical care. One of my proudest moments was when an uninsured patient told me that she had learned how to better manage her asthma by downloading and using ASTHMAXcel. Our current version of ASTHMAXcel has incorporated content regarding social determinants of health, and deploys push notifications to inform patients about community resources that can help. I am envisioning stronger collaborations (e.g. GIS-enabled approaches) between the health tech and public health sectors to increase access and prevent morbidity among underserved populations.
To always think about one’s short-term and long-term objectives, and try to keep improving. In the words of Jack Ma, “If you want to be successful tomorrow it’s impossible. If you want to be successful a year later it’s impossible. If you want to win 10 years later you have a chance.”