The patient's own notes about their illness are really important for the doctor's choice of treatment. Professor Peter Christensen from the Department of Clinical Medicine is the initiator behind Journl, a new app which makes this reporting easier and more accurate.

2018.09.14 | Simon Byrial Fischel

When patients are asked to register their symptoms in a diary or assess their well-being in a questionnaire, their information is often an important part of the medical doctors’ decision for the choice of treatment. In some cases, it is even the case that the patient's own notes are the medical doctor’s only option for assessing the scope of a disorder or the effectiveness of a form of treatment.

"There are some diseases that we can measure very directly, for example. by taking the patient's blood pressure or testing how well their lungs function. In other cases, we’re far more dependent on knowing the patient's own experiences of their health and quality of life in order to determine whether a treatment works. This is what we call patient reported outcomes," explains Professor Peter Christensen from the Pelvic Floor Unit at Aarhus University Hospital. "The problem is that the reports we receive are, at best, inaccurate, and at worst, unreliable," he continues. 

Began with incontinence
Peter Christensen specialises in incontinence disorders – an area where patient-reported information is often the starting point for comprehensive and costly procedures. For example, selected incontinence patients have an experimental nerve stimulating pacemaker attached over their tailbone or coccyx, which controls their defecation impulses. The pacemaker is far from cheap, and neither is it a good solution for all patients. Whether a pacemaker should be permanently implanted therefore depends on the patient's own reporting from the trial period.

Peter Christensen was frustrated by the imprecise and incomplete records and enormous amount of manual work associated with entering information from the paper diaries and questionnaires. This led him to contact a friend of a friend who was an engineer back in 2012, who then helped develop the first 'garage version' of a smartphone app for patient registered information.

From the garage to the sandbox
The first version of the registration app got off to a fast start. It made it easy for patients to register when they e.g. felt the urge to go to the toilet, failed to reach the toilet in time and a wealth of other information that the clinic needed. The initial tests were positive and both patients and clinicians found the app useful. However, it was clear from the outset that more resources were required to develop a platform on a larger scale. The timing was therefore good when AUH shortly after announced a brand new initiative in collaboration with MTIC called APPlab, which had the objective of helping clinicians, students and companies to assess, test and develop prototypes of apps for hospitals and patients. A mobile platform for patient registered information was among the very first projects to appear in the newly established APPlab.

APPlab helped the progress of the project by, among other things. providing drafts and guidelines for a new and more professional patient-oriented user interface, and a clinician-oriented user interface which made it easy to create automatic extracts of the data that the clinician required.

With APPlab’s support, Peter Christensen approached the hospital management at AUH, who allocated funding to further develop the prototype version into a version which could be tested in a research context.

This marked the beginning of the research project RETURN (Realtime Urge Registration), which gave Peter Christensen the chance to methodically verify the idea’s usefulness in a clinical context.

"Here is where you could say we moved from the garage into the sandbox. The results were really promising, but the perspective had always been that we should get this to work in clinical operation, that we should have our partner institutions to use the same app and develop a generic platform that could, with only a few configurations, be scaled to all of the areas that use patient reported outcomes," explains Peter Christensen.

From research project to spin-out company
That goal was more than Peter Christensen could achieve alone. He therefore sought help to find investors through AU's Technology Transfer Office.

"You can have a good app idea, but if you want your app to really get anywhere in real life, then you must have a professional organisation that can support the development and operation, and to do that you have to invest money. I honestly didn't know how much money we needed to move forward, so you could say that I approached the task naively," says Peter Christensen. In the spring of 2016 the first financing to start a spin-out company was secured.

Michael Thabang Jensen, newly graduated MSc in Information Technology and a healthcare technology engineer, who had followed the RETURN project from the sideline in his former student job in APPlab, joined Peter Christensen’s new team.

"We set out to reconnoitre the market and find out where we could sell our product. What we had was actually medical equipment and not just an app that we could put on App Store and then just hope that everything suddenly took off," says Michael Thabang Jensen.

When the company was launched under the name Journl in Spring 2017, it was with two developers to rebuild the entire platform from scratch in a version that could be sold and was scalable.

The first task
In the spring of 2017, Journl landed its first project in the form of a public-private innovation partnership (OPI) with the Danish Health and Medicines Authority for tele-medicine treatment of patients with haemophilia. The project was carried out in close collaboration with the Danish Haemophilia Society, the Center for Tele-Medicine and the haemophilia centres at Aarhus University Hospital and Rigshospitalet, in the form of a user-inclusive experiment that identified the exact needs of the patient group, developed solutions for these and pilot tested them.

"It really matched the concept for which we had developed the business concept, so it was an obvious task for us and became our primary focus over the next year," says Michael Thabang Jensen.

The pilot project was completed in March 2018 with a report to the Danish Health and Medicines Authority, who showed a very high level of satisfaction with the new solution among both patients and clinicians.

"The Center for Haemophilia and the respective haemophilia centres in the Central Denmark Region and the Capital Region of Denmark are ready to begin using Journl," says Michael Thabang Jensen. "But things take time and there are many pieces that need to fall into place when selling a product to the healthcare system. The last of them is the ISO 13485 certification of our quality management system which we hope to secure in the middle of September this year."

Towards new horizons
Sales agreements take time, but the waiting time can be sensibly utilised. The Journl team are now developing the platform for completely new areas through collaborative projects with the Department of Gynaecology and Obstetrics and the Department of Urology. Here they have just started a qualification process that measures how the clinics function today, and how the new technology affects its operation.

"It's fantastic that we’ve succeeded in making an app that is applicable across such diverse fields. The adventure with Journl has only just begun, but it’s guaranteed that I would never have come so far with the project if not for the incredible support I’ve received from both management and colleagues at Aarhus University Hospital and the support I got from APPlab and the Technology Transfer Office, plus of course the very competent team that comprises Journl A/S today," concludes Peter Christensen.

 

Contact
Professor Peter Christensen
Aarhus University, Department of Clinical Medicine and
Aarhus University Hospital, Pelvic Floor Unit
Tel.: (+45) 2466 1393
Mail: petchris@rm.dk