High blood pressure? There’s an app for that

Twine Health co-founders, John Moore (right) and Frank Moss, at the MIT Media Lab.
Twine Health co-founders, John Moore (right) and Frank Moss, at the MIT Media Lab.

Among the ills of the American health care system is the disconnect between patients and their doctors. John Moore has an app for that.

Moore is cofounder of Twine Health, which is making a mobile app to improve communication between doctors and patients and nudge the sick to more closely follow their treatment plans.

The app creates a personalized health plan in the form of an electronic checklist: a pill in the morning, a walk in the evening, more vegetables with dinner. Patients check off each as they go along, while doctors get more frequent updates on their progress.

“It’s a motivational strategy,” Moore said of the Twine checklist. “We try to make [the plan] very concrete and actionable. It doesn’t feel like it’s made for someone else.”

Moore is nothing if not ambitious: Twine’s first target illness is hypertension, a chronic condition that affects about a third of adults in America. His company has gotten six medical practices in the United States, including clinics at Massachusetts General Hospital and Brigham and Women’s, to enroll a total of 159 patients in a test of Twine Health.

With Twine, Moore offers clinics a quicker path to healthier patients. But part of Moore’s pitch is that by streamlining the interaction between providers and patients, Twine will save hospitals big bucks.

For doctors, the Twine Health app is a dynamic but compact dashboard that charts the progress of patients as they log daily activities. Patients who have skipped a few pills or a blood pressure reading are automatically flagged. Twine has a private messaging app that physicians can use to remind patients to take their medicines, stick to the treatment plan, or suggest changes to make it easier for the patient to follow the plan.

“It’s pretty powerful. Patients have very broadly enjoyed the experience. They love the fact that they don’t have to come in as often,” said Benjamin Crocker, who is leading the Twine pilot at MGH as director of the Ambulatory Practice of the Future, a primary care clinic that encourages patients to be proactive with their medical treatment.

“Any time I can get a patient as fired up about managing their condition as I am, that’s a win-win,” he said.

The MGH practice is part of a broader movement within medical circles to encourage patients, and not just doctors, to make choices that determine their medical treatment.

“What we’ve found [is] that when patients really get to see their medical record, see that data, they really get invested in that,” said David Judge, chief medical officer at Iora Health, a Cambridge medical practice that is also testing Twine with its patients.

Twine Health also has some prominent backers that give the company serious heft in technology circles. Another cofounder is Frank Moss, a former head of the MIT Media Lab who is among the region’s most successful software entrepreneurs. One former Moss company, the social media analytics startup Bluefin Labs, was sold to Twitter for a reported $100 million in 2013. And in 1996 IBM paid $743 million for Tivoli Systems Inc., which Moss took public and led as chief executive.

“I’ve done a lot of startups in my time. This one for me is most exciting,” Moss said of Twine. “It’s the one I feel most passionate about.”

Moss is Twine’s chairman, Moore its chief executive; the third cofounder, Scott Gilroy, is chief technology officer.

Backers include Andy Palmer, another veteran Boston entrepreneur who serves on the boards of several other local tech companies.

For now, Twine is offering physician practices a limited-time free trial so they can track whether the medical conditions of their patients improve with use of the app.

If a practice signs on, Twine bills per patient.

Hypertension is a condition the medical community knows a lot about and knows how to fix. Still, many patients are not very good about following their doctors’ instructions to lower their blood pressure. Only half of American adults with high blood pressure are still taking their medication one year after diagnosis. And even though exercise and healthy eating are widely acknowledged as key to improving health, just 20 percent of people with hypertension stick to lifestyle changes.

Twine’s goal is to get 90 percent of the hypertension patients at a medical group practice to their target blood pressure in three months; currently only about half such patients, on average, are at their target blood pressure, according to the Centers for Disease Control and Prevention.

In a study in the Journal of Clinical Outcomes Management published in March, Moore showed that a version of the Twine Health app brought down the annual cost of treating hypertension from an average of $250 per patient to $70. Nearly all of the 44 patients enrolled in a randomized control trial continued to use the Twine app through the three-month study, and everyone hit their target blood pressure.

“What we try to set up is a total no-brainer,” Moore said. “A lot of people see our results and say I don’t believe that. It’s too good.”

In mid-October, the startup launched another electronic feature: a website that serves as a real-time monitor of Twine’s pilots. The website displays how many patients are enrolled, how many are actively entering and tracking data on the app, and how many are close to reaching their target blood pressure.

Though hypertension is the first condition in play, Twine said it can customize for any chronic condition.

Dennis Dimitri, president-elect of the Massachusetts Medical Society and a professor at the University of Massachusetts Medical School, said technology alone cannot solve some of the chronic health care issues facing Americans. Some patients still do not have reliable access to physicians or affordable health care; others may be uncomfortable using a smartphone to track their health or simply cannot afford one.

Katherine Rose, a primary care physician at Brigham and Women’s, said she hit such obstacles while trying to enroll patients in the hospital’s Twine pilot.

“A few people are like, ‘I barely know how to use this phone, I don’t think it’s right for me,’ ” she said. She also pointed out that the English-only app immediately rules out her Spanish-speaking patients.

Twine Health has 11 employees, including eight full-time staffers, most of them located in their shared office space at Koa Labs, one floor above Otto pizzeria in Harvard Square.

A sign taped on the wall reminds the team of its target: 1,000 patients by Jan. 1.

That goal is a stretch, Moore acknowledged, but said the lofty target is “to motivate us to shoot for the fences.”

Nidhi Subbaraman writes about science and research. Email her at nidhi.subbaraman@globe.com.
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