The Mayo Clinic's recent iPad trial for cardiac surgery patients, which MobiHealthNews first wrote about in February, has received a good deal of attention for using Fitbit activity monitors in a clinical setting. But Dr. David J. Cook, who led the study, says the real innovation of the study is unprecedented levels of patient engagement -- in patients he repeatedly described as "70-year-olds on morphine."

"Patient participation is completely dependent on usability," Cook said at a session at the mHealth Summit near Washington, DC. "Healthcare technology and tools are not meaningful unless they're integrated with care plans and expectations, and that's dependent on delivering knowledge to patients. Once you have a usable tool, you can help self-assessment and reporting, data acquisition and aggregation is meaningful, and clinically meaningful algorithms can impact patient outcomes."

In the study, 149 cardiac patients were given iPads with a specially created app preloaded. The app, called My Care, interacted with patients bi-directionally, giving them a to-do list for the day and also assessing their mobility (both self-reported and via Fitbit data) and pain.

"We also delivered what are traditionally provider tools to patients," Cook said. "This is a visual analogue scale for pain. Patients are asked each day through the day what is their pain score. They touch the screen -- it comes up on the iPad so it's easily useable -- so patients can see their scores throughout the stay and, obviously, so can we. We built algorithms in that allow us to act if pain is trending in the wrong direction or alert levels are hit."

Cook stressed the ability of the system to alert the hospital to timely interventions for both pain and mobility. These interventions can be put into place without ever involving a physician.

"If the patient's not meeting recovery expectations, we can send a physical therapist in without a physician ever having been notified," he said. "So the model has empowered what we would call lower level providers to function at a higher level."

Mayo Clinic is publishing a study in May 2014 that will put more data out about patient engagement in the iPad study, but Cook shared some data at the Summit.

"Patients completed 98 percent of the 1418 self-assessments we threw at them," he said. "They completed 85 percent of their educational modules." But, perhaps most strikingly, although patients ranged in age from 52 to 85, there was no discernible link between age and engagement. The oldest patients were, on average, just as engaged with the iPad tools as the youngest.

Cook said there's two pieces that need to come into place before the app can be distributed more widely. Security needs to be improved to take it out of a pilot setting, and he'd like to add EHR integration. Once those steps are taken, My Care can begin to be used in other hospitals, and even in at-home settings.

"The hospital's a great place to build this, but I think the model we've created is equally applicable to chronic disease," Cook said.