Integrated Mobile Health Platform - MS101.Me: Daily Patient Record of Symptoms, Medication Adherence, Sleep, and Activity to Support Outcome Assessment and Shared Decisions

Background: MS is a chronic, heterogeneous disease, with a fluctuating clinical course. Disease modifying therapy, symptomatic treatments, and exacerbation management can benefit outcome, but have risks and adherence issues. Patient self-care can also improve outcomes. MS evaluations are often challenging given limited frequency/duration of clinic visits and patient difficulty with recall of symptom fluctuations/medication dosing between visits. A simple, plain language mobile app was needed to capture Patient Reported Outcomes (PRO).  In addition, there was an opportunity to integrate wearable device tracker data as well geo-location specific weather data to aid patient-clinician assessments and inform shared management decisions.

Objectives: To evaluate a simple, secure integrated mobile app and web portal for recording and reporting daily symptoms, therapeutic dosing and assessing outcomes for all forms of MS.

Methods: The “MS101.me” mobile health platform was developed and deployed to a small pilot group of patients (2014 Android, 2015 iPhone) enabling the daily reporting for 11 MS-associated symptoms.  The mobile app requires 2 minutes of patient time per day to report symptoms as well as stress factors, medication dosing, and self-care activities. A patient centered approach was used to develop a novel severity scale anchored to the impact on activities of daily living.  Physical activity (step count) and sleep data captured via a Fitbit wearable tracker were also incorporated.  Personalized weekly and monthly emails containing analyses of symptom trends promoted patient engagement and drove usage of the integrated web portal for presenting innovative data visualizations.  Customized mobile notifications and reminders were created to promote dosing adherence and achievement of planned self-care goals.

Results: For more than 14 consecutive months the pilot group engaged in reporting of symptoms, stress factors, and medication dosing using the mobile platform. At home, patients used the simple color-coded web browser-based dashboard to review the incidence, frequency, severity, and duration of their symptom episodes. During the clinical encounter, the patient often used the dashboard and email reports to organize, quantify, and prioritize the discussion of symptom trends. The shared discussed of physical activity, sleep, and weather was enabled via the MS101.me web portal.

Conclusions: The MS101.me mobile health platform provides a rapid, efficient way of collecting and analyzing PRO and wearable technology-derived data. The platform has the potential to support symptom assessment, therapeutic decisions, treatment compliance and patient self-care goals.  In the future, this methodology could allow comparison of individual profiles with pooled data stratified by cohort. The relationship between symptoms and relevant parameters could then be analyzed in the context of medication dosing compliance and outcomes.