Strategies for the Successful Implementation of a Novel iPhone Loaner System (iShare) in mHealth Interventions: Prospective Study

Abstract

Background: As smartphone ownership continues to rise, health care systems and technology companies are driven to develop mobile health (mHealth) interventions as both diagnostic and therapeutic tools. An important consideration during mHealth intervention development is how to achieve health equity despite demographic differences in smartphone ownership. One solution is through the recirculation of loaner smartphones; however, best practices for implementing such programs to optimize security, privacy, scalability, and convenience for participants are not well defined.

Objective: In this tutorial, we describe how we implemented our novel Corrie iShare program, a 30-day loaner iPhone and smartwatch recirculation program, as part of a multi-center mHealth intervention to improve recovery and access to guideline-directed therapy following acute myocardial infarction.

Methods: We conducted a prospective study utilizing a smartphone app and leveraged iOS enterprise features as well as cellular data service to automate recirculation.

Results: Our configuration protocol was shortened from 1 hour to 10 minutes. Of 200 participants, 92 (46.0%) did not own an iPhone and would have been excluded from the study without iShare. Among iShare participants, 72% (66/92) returned their loaned smartphones.

Conclusions: The Corrie iShare program demonstrates the potential for a sustainable and scalable mHealth loaner program, enabling broader population reach while optimizing user experience. Implementation may face institutional constraints and software limitations. Consideration should be given to optimizing loaner returns.

Keywords: digital health; health care disparities; innovation; loaner device; mHealth; mobile phone; myocardial infarction; smart technology; smartphone; telemedicine.

Conflict of interest statement

Conflicts of Interest: The Corrie app, as described in this work, was developed by FAM, SSM, and Matthias Lee, PhD. They are also founders of, and hold equity in, Corrie Health, which intends to further develop the digital platform. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. This study received material support from Apple and iHealth as well as funding from the Maryland Innovation Initiative, Wallace H Coulter Translational Research Partnership, Louis B Thalheimer Fund, Johns Hopkins Individualized Health Initiative, and the American Heart Association. SSM also reports research support from the Aetna Foundation, the American Heart Association, the David and June Trone Family Foundation, Google, NIH, Nokia, and the PJ Schafer Memorial Fund. SSM reports personal fees for serving on scientific advisory boards for Akcea Therapeutics, Amgen, Esperion, Novo Nordisk, Quest Diagnostics, Regeneron, and Sanofi. SSM is a coinventor on a pending patent filed by Johns Hopkins University for a system of low-density lipoprotein cholesterol estimation.

©William E Yang, Erin M Spaulding, David Lumelsky, George Hung, Pauline Phuong Huynh, Kellen Knowles, Francoise A Marvel, Valerie Vilarino, Jane Wang, Lochan M Shah, Helen Xun, Rongzi Shan, Shannon Wongvibulsin, Seth S Martin. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 16.12.2019.

Figures

Figure 1

Apple Device Enrollment Program (DEP), Volume Purchasing Program (VPP), and Mobile Device Management (MDM) facilitate automated setup of iShare phones through a series of handoffs. Steps A-D are completed manually the first time an iPhone is adopted into the Corrie iShare program. Steps 1-6 are automatic and require only minimal interaction with the phone. Returned phones are reset with one click through the MDM server (step R), which triggers a factory reset and wipes all data. Phones then automatically proceed through steps 1-6. Physical cleaning and handling steps are not shown in this figure.