Cardiology nurse Lois Freeman calls the heart failure patients who are regulars at the Baltimore VA Medical Center "frequent fliers."
They cycle in and out of the hospital because they can't or won't follow the strict diet and exercise regime required to keep their medical conditions in check.
Intent on breaking this cycle of repeat readmissions, Freeman came up with the concept of a smartphone app to track the diet, weight and exercise of cardiology patients. Her idea recently received development funding estimated at $1 million from the Department of Veterans Affairs.
Freeman, a nurse practitioner, and 14 other VA employees won the funding through the VA's 2016 Employee Innovation Competition, a national contest that brings private-sector technology to VA hospitals to improve quality of life for injured and sick veterans through inventions that do such things as allow paralyzed veterans to control TVs and lights with eye blinks and sip-and-puff straws.
The contest was open to every employee of the VA, and more than 4,000 employees submitted entries this year.
"There's always a need to innovate and there's always a need for frontline employees to have an outlet," said Kristopher Teague, who manages grass-roots innovation for the VA. "These are the folks on the front lines that care for veterans every day. We should be asking them, 'What can we do to help you do your job better?'"
The VA is promoting Freeman's heart app as part of a larger effort to seek recognition and credit for the research it sponsors and products it develops.
The federal agency has a huge "research footprint," a VA spokesman said, and funds a lot of university research that people aren't aware of — and for which the universities, not the VA, usually get the credit.
The nicotine patch — now widely used for smoking cessation in the general population and taken for granted as a medical convenience — is one example. The VA's Office of Research & Development funded the breakthroughs that led to the patch's development in 1984.
And VA researchers worked with Brown University and the Massachusetts Institute of Technology to develop the first electric motor-powered foot prothesis, unveiled in 2007.
VA innovators also developed algorithms to calculate the veterans' suicide risk by simply scanning their medical records.
"We dabble in just about every element of health care," Teague said.
The VA Maryland Health Care System spent $27 million on research projects last fiscal year, said Sandra Marshall, chief of staff for the system. The money funded 340 research projects. Each year, the Maryland system submits 15 to 20 applications for new patents. Robust research remains a core part of the mission to care for veterans, Marshall said.
"This is probably one of the best, hidden, wonderful things that we do," she said.
The goal of the heart app is to help veterans improve their well-being, develop trust and partnerships with their clinicians, and to encourage them to become active in their own care.
Heart failure occurs when the heart can't pump enough blood and oxygen to support the body's organs. It leaves patients breathless and weak. They also may gain weight and their legs, feet and ankles may swell. Smoking, eating too much salty and fatty foods, being obese and having a sedentary lifestyle all increase the risks for heart failure.
The condition afflicts 5.7 million U.S. adults, according to the Centers for Disease Control and Prevention. Half a million people are diagnosed with the condition each year. About half of people with heart failure die within five years, according to the CDC.
Freeman's mother, Ethel Freeman, died of heart failure in 1987 at age 67.
"It makes it personal to me," said Freeman who lives in Forest Park in Northwest Baltimore. "In those days, we didn't know as much as we do now about heart failure."
With medication, and a healthful diet and lifestyle, her patients may survive 30 to 40 years with heart failure. But they must limit the amount fluids they drink because too much fluid increases their body weight and requires their heart to work harder, Freeman said. Ignoring her orders leads to repeat "frequent flier" visits to the hospital.
Heart failure costs the nation an estimated $30.7 billion a year, according to the CDC.
"Every hospital or clinic across the nation has a problem with patients who have congestive heart failure being readmitted within 30 days," Freeman said. "We need to come up with something to interrupt this cycle."
She runs a weekly class to encourage heart failure patients to live healthier lives. The condition is especially common in aging and sedentary veterans, but a 39-year-old man arrived with the diagnosis this year.
"I'm working on him," Freeman said. "It used to be over 65, but it's hitting younger and younger, mostly because of their diet and lifestyle. Most meals used to be cooked in the home. Now with latchkey kids and both parents working, kids are eating in McDonald's, and the kids are playing video games, and they're not as active."
The VA had supplied veterans who suffered congestive heart failure with monitors to track their blood pressure, fluids and exercise. These monitors submitted updates to doctors through landline telephones, but they weren't practical for busy people with day jobs.
"They can't be sitting at home attached to this machine," she said. "I needed a mechanism to be able to capture some of the younger patients."
Freeman's app is being designed by Devin Harrison, an innovation coordinator with the VA. He estimates it will take one to two years. He's also developing an app to help doctors treat patients with bedsores.
The heart app will be piloted at VA offices in Maryland then offered to veterans across the country. It will track diet, blood pressure, weight, exercise and medication, and send all the data to doctors for review. It also will empower patients to track their own habits.
"We need to make them active participants in their care," Freeman said. "We can't afford to be frustrated. We have to keep giving these patients information until we move them to a place where they buy in to what we're telling them."