Medical student Soaptarshi Paul says he “couldn’t be happier” about getting the opportunity to put his computer-science background to use at Einstein. This past fall he and several of his classmates were able to pursue innovation biodesign training in an elective offered to fourth-year students that aims to encourage the development of technologies such as mobile health apps. Mr. Paul and his peers, who were born in the mid to late 1990s, are members of the first generation of “digital natives.” The internet, mobile phones, and social media have been a part of their experience from their youngest years, shaping their interactions with the world and inspiring an intuitive understanding of the opportunities digital applications can play in healthcare.
We want to be able to think about new ways to make the healthcare system more efficient and improve patient outcomes. In the biodesign space you break out of the box and think more creatively.
— Medical Student Soaptarshi Paul
“Today’s medical students have access to technology that wasn’t available even 10 years ago,” Mr. Paul says. “We want to be able to think about new ways to make the healthcare system more efficient and improve patient outcomes. In the biodesign space you break out of the box and think more creatively.”
Einstein’s biodesign effort is led by Sunit Jariwala, M.D., professor of medicine and director of clinical and research innovation at Einstein, medical director of digital transformation at Montefiore, and co-director of the Montefiore Asthma Center.
As an allergist and immunologist, Dr. Jariwala knew that people in the Bronx suffer from one of the country’s highest rates of asthma. He also knew that fully half of all asthma patients don’t follow their doctors’ advice, putting themselves at risk for serious complications. So he and his team came up with a technological fix to help patients breathe easier: an interactive and personalized app that patients can use to access asthma education and medication reminders just by reaching for their mobile phones.
Called ASTHMAXcel, the app was modeled on a health educator–delivered training for patients at the Montefiore Asthma Center. “We needed to empower our patients when it came to their health,” he explains. “So we based the app on educational videos describing how to use asthma medications, how to recognize the warning signs of an asthma attack, and how to track symptoms. We also included push notifications to remind patients to take their medication.”
Following several years of testing, ASTHMAXcel was introduced in 2017 as Einstein and Montefiore’s first homegrown mobile app. After using the app for two months, patients reported better control over their asthma attacks, used steroids less often, and had fewer emergency department visits and hospitalizations. The results were published in November 2020 in the Annals of Allergy, Asthma & Immunology.
The success of the two asthma mobile platforms spurred Dr. Jariwala to create the Einstein/Montefiore Innovation Biodesign Training Program in 2020, one of only six such programs in the country and the first to focus on chronic conditions and health disparities. Since its inception, the one-year experience has trained 18 residents, fellows, and attendings working in a variety of areas, from neurosurgery and diabetes care to cardiology and anesthesiology. The program includes coursework, a clinical immersion experience, a scholarly project, and mentoring from Einstein and Montefiore faculty and external experts.
The training has led to the creation of mobile health tools for pediatric asthma patients as well as for other conditions, including COVID-19, type 2 diabetes, and chronic obstructive pulmonary disease. “We wanted to take these technologies on a larger scale across departments and across chronic conditions, and teach faculty, residents, fellows, and medical students how to identify and address pain points. Then we could build the prototypes, help validate them, and scale them up to get them in the hands of patients,” Dr. Jariwala says.
Supported by more than $2 million in grant funding from foundations, industry, and the federal Agency for Healthcare Research and Quality (part of the U.S. Department of Health and Human Services), the Einstein/Montefiore Innovation Biodesign Training Program has led to the creation of 12 apps as well as 10 peer-reviewed published manuscripts, 25 seminars, and nearly a dozen health-technology podcasts.
In 2020 Einstein medical students were surveyed about their interest in coursework on health innovation. Based on the enthusiastic response, the Health Technology/Innovation elective was opened to fourth-years in the fall of 2021. The coursework not only covers medical devices and digital health technologies but also includes a market assessment to find out if there’s a real need for a particular healthcare device in the first place.
“For example, if you want to find a way to develop a better diabetes medication–compliance tool, you want first to learn about competitors already in the market and how you could be different and provide value,” Mr. Paul says. “If your device is a Bluetooth sensor that connects to a glucose monitor, you’d want to see all the other Bluetooth sensors out there and determine how they work, how much they cost, and the types of people being targeted. You may find there is not an opportunity there, or you may uncover something you’ve never seen before.”
Besides building digital tools, healthcare innovation also involves the examination of large amounts of data to identify patterns and make predictions. Mr. Paul and his classmate Moshe Beiser have been doing just that. As part of a summer project for Dr. Jariwala, they sought to better understand the physician experience with telemedicine during the pandemic. Their research was published in August 2021 in Telemedicine and e-Health.
“Biotech innovation will change the way I practice medicine,” Mr. Beiser says. “It is a way we can help a broader swath of patients than just the ones we work with face-to-face. The way Dr. Jariwala approaches data will absolutely inform how I see clinical questions as they arise and how I think about the solutions.”
Starting with the Class of 2026, biodesign training at Einstein won’t be limited to a fourth-year elective: During their first 18 months at Einstein, students can take biodesign and entrepreneurship classes within the new four-year Impact course, which will also expose them to basic-science research, community engagement, and global health.
“We wanted to build in these opportunities early on,” says Jessica Rieder, M.D., M.S., inaugural director of the new Impact course, associate professor of pediatrics at Einstein, and a pediatrician at the Children’s Hospital at Montefiore. “We want to allow students to explore the different career paths available to them, open their horizons, develop their professional identity, and help them realize that they can be leaders in these areas.”
During the summer after their first year, students can participate in the Einstein-CUNY Design Challenge to work with a team of Einstein and CUNY students and a faculty mentor or a team of professionals to develop a project that might lead to the creation of their own healthcare apps. “A lot of students already have been involved in these activities on their own time,” Dr. Rieder says. “The Impact course is designed to give them curricular time to develop a meaningful project based on their interests while improving health in the Bronx.”
Second-year med student Jasper Sim is already working on a health-innovation project, analyzing data to improve health systems. “Dr. Jariwala has been a great mentor, allowing me the independence to work on this project on my own—from refining my questions to analyzing the results, all the way to submitting the research for publication,” he says. “I’ve had some computer-programming experience, but I had never applied it to clinical research. This has been a great opportunity to learn a new skill.”