MyHealthPal

Averting surgical site infections (SSIs) is a major concern in global healthcare. These infections arise after surgery, specifically where the surgical procedure occurred in the body. According to the Agency for Healthcare Research and Quality, SSIs are a leading cause for postoperative morbidity and mortality, and the most common reason for hospital readmissions after surgery.

Approximately, 0.5% to 3% of individuals undergoing surgical procedures are susceptible to developing an infection at the surgical incision site or in its proximity, and approximately 3% of individuals contracting an SSI die due to this infection. In comparison to surgical patients without an SSI, those affected by SSIs tend to have an extended hospitalization period, typically 7-11 days longer.

The issue of SSIs extends beyond individual health concerns to impose a substantial economic burden. According to data from 2019, there are 230 million surgeries performed annually around the world, and 5 in every 100 surgeries results in an SSI. In the US alone, these infections contribute to patients enduring over 400,000 additional days in hospitals, incurring an extra cost of approximately $900 million per year. Furthermore, studies such as those by Leaper et al. and Monahan et al., highlight the variable and underreported rates of SSIs, with economic costs ranging from 1.47 to 19.1 billion Eurodollars.1, 2 As to low-income countries, the lack of infrastructure and norms for safe practices contribute to higher overall expenses.3

Current postoperative wound monitoring methods often result in heightened patient anxiety, poor recovery outcomes, and unnecessary healthcare costs due to emergency room visits and worsened health conditions. Typically, patients are discharged with instructions to monitor their wounds for signs of infection and to schedule a follow-up visit within 7-10 days. However, this approach places a significant burden on patients and caregivers who may lack the necessary knowledge to effectively assess symptoms. This gap in care and knowledge can lead to missed follow-up visits, significantly increasing the risk of developing SSIs.

MyHealthPal is particularly relevant among vulnerable populations affected by social determinants of health. The American College of Surgeons highlights how these groups often encounter barriers to accessing quality surgical care, which can adversely impact surgical outcomes. Social determinants of health, such as health literacy level, language proficiency, income inequality, marginalization, challenges in taking time off from work, difficulties in finding childcare arrangements, and proximity to healthcare facilities, can significantly influence postoperative recovery.

Patients with low health literacy face heightened risk for poor postoperative outcomes due to difficulties in understanding and following medical advice and wound care instructions. MyHealthPal's intuitive design and multilingual support address these challenges, ensuring all patients, regardless of literacy or language proficiency, can effectively monitor postoperative recovery.

Other social determinants of health such as income inequality and poverty are also key drivers of health status, where individuals in lower income brackets have less access to healthcare services globally. MyHealthPal's remote monitoring capability is valuable for low-income individuals who may face difficulties in securing transportation for follow-up visits, thus ensuring continuous care without additional financial burdens.

References

Predictive Healthcare, a Boston-based company founded in 2021, has developed MyHealthPal, an innovative technology transforming postoperative patient care. By leveraging Artificial Intelligence (AI) and Machine Learning (ML), MyHealthPal enhances recovery outcomes by enabling timely intervention and reducing the risk of serious infections and chronic wounds.

MyHealthPal facilitates remote monitoring and communication between patients (or caregivers) and surgeons, allowing for the assessment of wound health status and prediction of SSI risk based on patient inputs and vital signs. Using a smart device, patients and/or caregivers can provide real-time updates on patients' wound healing progress including photos, vital signs, and symptoms. MyHealthPal not only delivers key data directly to physicians but also alerts them to symptoms, potential infections, or poor healing. Its accessibility, direct physician-patient communication, predictive capabilities for wound-healing outcomes, and early complication detection are poised to revolutionize postoperative care.

MyHealthPal is designed to be universally accessible, serving anyone who has undergone surgery and has access to a smart device. While it offers substantial benefits across the socioeconomic spectrum, it is especially impactful for those facing significant health disparities and resource constraints. This application can improve surgical recovery outcomes, reduce the incidence of surgical site infections (SSIs), and alleviate the stress associated with wound monitoring.

Globally, the challenge of health literacy is profound, impacting surgical recovery and overall health outcomes. As documented in The Economist's Health Literacy Around the World report, there are significant disparities in health literacy levels across countries, influenced by social determinants such as education, language proficiency, and access to healthcare.1 For example, in countries with low health literacy rates, people often struggle to understand medical advice and follow care instructions, which can lead to poor health outcomes. 

In areas with limited healthcare infrastructure, such as certain regions in low- and middle-income countries, MyHealthPal can bridge critical gaps by offering intuitive, multilingual support that transcends language and literacy barriers. It allows patients to monitor their recovery effectively, reducing the dependency on direct medical supervision and frequent hospital visits. This is particularly crucial in rural or underserved areas where healthcare facilities may be sparse. 

Furthermore, the application’s remote monitoring capabilities are invaluable for individuals in lower income brackets who might face transportation challenges for follow-up visits, ensuring continuous and equitable care. By leveraging technology to enhance convenience, access, and cost-effectiveness in healthcare delivery, MyHealthPal not only improves health outcomes but also contributes significantly to reducing global health disparities. This aligns with the global movement towards improving health literacy as a critical component of enhancing public health and healthcare delivery systems, as emphasized in international health literacy discussions and policies. 

By leveraging technology to enhance convenience, access, and cost-effectiveness in healthcare delivery, MyHealthPal can contribute to improved health outcomes and overall well-being for all residents. Funding for MyHealthPal represents not only an investment in healthcare innovation but also a commitment to equity, accessibility, and improved health outcomes for a wide range of global communities, serving as a model for using technology to address pressing public health challenges. 

1. The Economist Intelligence Unit. (2021). Health literacy around the world: Policy approaches to wellbeing through knowledge and empowerment. Retrieved from https://impact.economist.com/p... 
   

Talal Ali Ahmad, President and Co-Founder of Predictive Healthcare, found inspiration for MyHealthPal during a 2020 outreach medical program in Ecuador with Global Smile Foundation. Observing how often patients missed important follow-up appointments after surgery, he noticed a concerning trend of subsequent wound infections leading to emergency room visits. Conversations with surgeons shed light on how surgical site infections are a widespread issue overall, and particularly in resource-constrained areas where access to healthcare is inadequate. 

Motivated by this firsthand experience, Ahmad decided to develop a pioneering medical technology platform that would seamlessly connect patients and clinicians. His vision was to address the critical need for effective healthcare connectivity, especially in underserved communities. 

Global Smile Foundation (GSF) is a Norwood, Massachusetts-based nonprofit that operates humanitarian cleft care outreach programs in Ecuador, El Salvador, Peru, and Lebanon. GSF founding members have 37 years of experience in global surgery outreach and the NGO is known for the quality of their patient outcomes and long history of patient relationships.

Medical advisors for Predictive Healthcare are: 

Robert Jason Yong, MD, MBA 
Medical Director, Pain Management Center, Brigham and Women’s Hospital 

Adam Johnson, MD, PhD 
Associate Professor of Pediatric Otolaryngology, Arkansas Children’s Hospital 
Program Director University of Arkansas for Medical Sciences Dept. of Otolaryngology and Head/Neck Surgery 

R. Justin Mistovich, MD, MBA 
Associate Professor, Pediatric Orthopedic Surgery, Case Western Reserve University 
Attending Surgeon, Metro Health Medical Center, Rainbow Babies and Children’s Hospital

MyHealthPal is in the pilot phase of development and has tested the application on outreach medical programs with Global Smile Foundation in Ecuador (2022, 2023) and Lebanon (2022). MyHealthPal Clinical Study with Global Smile Foundation was used following Cleft Lip and Cleft Palate surgery. 

Ecuador 2022

Number of Procedures: 40 

Number of Patients: 30 

Patient Age Range: 3 months to 4 years old 

MyHealthPal Language: Spanish  

Monitoring Period: 30 days

Patient Compliance: 64%

Prediction Accuracy: 100% (no false positives or false negatives) 

Lebanon 2022

Number of Procedures: 53 

Number of Patients: 31 (28 patients with compatible devices)  

Patient Age Range: 3 months to 4 years old

MyHealthPal Language: Arabic

Monitoring Period: 30 days 

Patient Compliance: 85%

Prediction Accuracy: Only 1 false positive 

Ecuador 2023

Number of Procedures: 35 

Number of Patients: 20 

Patient Age Range: 9 months to 17 years old 

MyHealthPal Language: Spanish

Monitoring Period: 60 days 

Patient Compliance: 90%

Prediction Accuracy: 86%

Global Smile Foundation is partnering with Predictive Healthcare in the development of MyHealthPal. Funding will support the further development of the application’s analytics module, which includes testing the ability of our technology to detect wound image characteristics and identify any potential wound healing complications. We will continue to build a database of wound images and medical data from our clinical collaborators to teach the AI to detect key wound characteristics and develop a correlation of multiple data points and images to provide predictive outcomes.

MyHealthPal is revolutionizing patient care by leveraging AI and machine learning (ML) to predict the likelihood of surgical site incision infections and alert the clinician for early intervention. This technology is transforming the way healthcare providers can address surgical incision infections at an early stage and improve patient outcomes. The use of AI combined with remote wound monitoring and patient/physician communication has not been done this way before. 

MyHealthPal is designed to meet the needs of patients and physicians, connecting them in an efficient way that is enhanced by the use of AI to predict urgent situations and call for action at the early stage of the infection. 

Comments from surgeons: 

“Despite all the surgical site infection prevention programs that most hospitals have in place today, SSIs do happen and often result in readmissions for those patients. MyHealthPal holds great promise in catching these infections early and alerting physicians so that we can address complications as early as possible. But I am most excited about the platform’s potential for eliminating routine surgery follow-up office visits that can easily take place through the app and save patients multiple trips.” 

Raj M. Vyas, MD, FACS 
Professor and Vice-Chair, UC Irvine Department of Plastic Surgery 
Chief of Pediatric Plastic Surgery, CHOC Children’s Hospital Director of Clinical Research 

“When surgical site infection prevention strategies fall short, it’s very helpful to have a tool like MyHealthPal that can monitor patients and alert me if there is an elevated infection risk. Patients feel safer, I can monitor my patients remotely on a regular basis and have them come in if any issues come up. I see a lot of value with using MyHealthPal to monitor surgical site infections and look forward to using the platform with my patients.” 

Charanya Vijayakumar, MD 
Clinical and Research Fellow, Department of Plastic and Reconstructive Surgery, Cleft and Craniofacial Centre, Sri Ramachandra University 

For the next phase of development, our clinical partners will be Dr. Christopher Homsy, a Plastic Surgeon affiliated with Tufts Medical Center, and Dr. Kyle Eberlin, a Plastic Surgeon affiliated with Massachusetts General Hospital. We are in discussion with other Massachusetts-based teaching hospitals to collaborate on the project. 

In the next phase of development, our goals are: 

1. Generate evidence-based insight into the key factors that affect postoperative wound healing to develop the Analytical Module. This work will be done with 3-5 surgeons based in Massachusetts and at least 400 surgical patients. There are two steps: 
   1. During the first 6 months, upload images from surgical patients to train and develop AI. 
   2. During the next 6 months, evaluate and assess AI analysis against the standard of care delivery.  
2. Show that the platform can achieve 80% or more patient compliance and reach 85% or greater prediction accuracy for detecting wound healing/infection in General and Plastic Surgeries, including cleft lip repair. 

MyHealthPal has three modules: 

The Patient Module enables patients and caregivers to track the postoperative healing process in real time and direct communication with the physician. Patients take pictures of the surgical area(s) and report medical information. It features: 

• Active participant in surgical wound management 

• Can use a personal smart device 

• At home use 

• Intuitive and easy to use app 

• Ongoing surgical site infection monitoring 

• Surgical site infection alerts sent to physician 

• Tracking postoperative healing progress 

The Analytical Module is the core of the platform. The innovation will include the development of data pre-processing for extracting the exact surgical surface from the submitted pictures and an AI learning process that will use a database of wound images from our clinical collaborators to learn to detect key wound characteristics. 

The Physician Module will present patient information and predictive outcomes to the physician in a clear and concise format. The physician will be able to review and accept the predictive analysis provided by the platform or re-analyze the information. It features: 

• Surgical site infection monitoring 

• Elevated infection risk automated alerts 

• Direct access to all patient data and inputs 

• Patient and surgery specific setup flexibility 

• For any surface surgical incision 

• Smart device and desktop based 

• EMR integration 

• Secure and HIPAA compliant

This is a novel way to remotely monitor surgical site incisions and predict surgical site infections. Predictive Healthcare has verified the technology by training and testing the algorithm using thousands of actual surgical wounds we obtained from different hospitals for patients from different ethnic backgrounds.