Digital Biomarkers of Movement, Emotional State, and Social Connectedness: clinically integrated tools to improve health disparities in older patients with chronic pain

Functional status—a summary of a patient’s physical, emotional, and social wellbeing—is a key index of disease risk, treatment outcome, quality of life, and overall healthcare usage across a wide range of clinical settings and patient populations. Especially in older patients with chronic pain, accurate functional assessments are critical for detecting age-related treatment side effects, disability, and decline. In older patients, pain is a leading, difficult-to-treat cause of disability that interferes with function and independence; however, many older patients lack access to or are unable to participate in traditional models of care. The lack of frequent, remotely available assessments of functional status is a clear barrier to improved patient care.

Digital devices promise to remotely capture real-time, real-world patient function and to inform clinical decisions in objective ways that are not now possible. Our team has shown that ubiquitous smartphones capture facets of functional status, but it is not known how separate measures might combine to form a concerted digital biomarker profile. Similarly, although 80% of Americans in their fifties and sixties own and use smartphones, the existing clinical ecosystem only uses these devices to coordinate face-to-face visits by teleconference. To impact and expand access to clinical care, a digital biomarker profile must demonstrate clinical utility (through scientific study) and usefulness (through engineered service design).

We have created the Pain Intervention and Digital Research (Pain-IDR) program, a research clinic designed to foster digital integration with clinical care. Overall, we present a unique opportunity for transformative work, providing a real-world clinical setting to develop and test workflows that maximize the utility of digital devices in two parallel aims: first, we will use patients’ own smartphones to define High-frequency Ecological Recordings of Mobility, Emotion, and Sociability (the HERMES phenotype). Second, we will partner with industry experts to engineer a clinical service design that implements the HERMES platform into the Pain-IDR workflow and will pilot decision support models in real-time, real-world patients. To meet these research goals, I require formal training in longitudinal digital biomarker development, clinical program administration, and entrepreneurship.

The primary mentoring team (Drs. Silbersweig, Insel, and Onnela) has extensive expertise in biomarker development, program administration, and entrepreneurship. Other key collaborators provide specific expertise in digital phenotyping (Dr. Baker) and health policy (Dr.

Ahern), while consultants offer mentoring in program administration (Dr. Grossman), industry externships (Dr. Basu, Ms. Mazzone), and commercial digital health platform development (Mr.

Barber and Mr. Whelan). Five years from now, we expect to deliver the HERMES phenotype as a candidate digital biomarker of functional status and, in parallel, the HERMES platform as viable toolset that integrates digital measures to support clinical decisions, to be further developed in future SBIR-supported projects.

Grant Number: 5K01AG078127-04
NIH Institute/Center: NIH
Principal Investigator: Daniel Barron