This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

The Pregnancy Checkup app.In 2017, Wayne State University (WSU) brought iPads loaded with an app that screens pregnant people for mental health and substance use-related risks to two rural prenatal clinics in Grayling and Alpena. Parents-to-be visiting the clinics could voluntarily use the app, Pregnancy Checkup, to provide answers to questions about depression, substance use, and other important concerns that they might not feel comfortable voicing to their providers. After their checkups, providers can opt to send text messages that address needs that the screenings revealed. Patients can download a new app to their own phones and devices.
 
"Rural areas are particularly open to and interested in technology. They know that it's a critical way for them to get access to services that they might not otherwise have," says Dr. Steven Ondersma, C.S. Mott Professor of Public Health at Michigan State University College of Human Medicine. Ondersma helped develop WSU's High Touch High Tech initiative, which led the effort.
Dr. Steven Ondersma.
High Touch High Tech, funded by the Michigan Health Endowment Fund, has succeeded in increasing behavioral health service use among patients who were previously hesitant to seek help. And it's just one of numerous innovative new health care technologies improving Michigan patients' lives. 

As a result of High Touch High Tech, healthier babies were welcomed to the world by parents who were better equipped to care for them.
 
The Pregnancy Checkup app."Another project … involves using text messaging to try to prevent perinatal depression, both prenatal and postpartum depression," Ondersma says. "We're excited about text messaging as an extremely low-bar, easy-access kind of an approach that many participants will welcome and sign up for."
 
Parents who sign up will receive informational messages that contain links to helpful additional content.
 
"One of the many advantages of text messaging is that texts can be tailored to the person," Ondersma says. "We can send a different message to each participant as a function of how concerned we are with their level of risk, their goals, their motivations, their access to services, their preferences, their age. The second major advantage is that the texts come without the patient having to reach out and ask. Once they give consent, we can continue to send messages that arrive proactively."
 
Ondersma considers this an extremely important strategy for the huge proportion of folks who screen positive for various risks and could benefit from services, but aren't interested in those services even when they're available.
 
Today, Munson Healthcare uses Pregnancy Checkup in each of its prenatal clinics. Because of the initiative’s success, the Michigan Health Endowment Fund is also funding its expansion to prenatal clinics throughout the Upper Peninsula and counties in Michigan’s Thumb.
 
U-M Collaboratory helps cities design walkable environments
 
Another innovative health technology is in development at the Urban Collaboratory at University of Michigan, which utilizes technology to make cities more walkable for people with disabilities and older adults. The "Enabling Independent Mobility in People with Physical Disabilities by Advancing Human-Centered Social and Technological Research" project evaluates the difficulties people using wheelchairs face while trying to accomplish simple errands like going to the grocery store or a doctor’s appointment. The project team has outfitted wheelchair users in Ann Arbor and Ypsilanti with wearable devices that register their stress responses as they make their way along sidewalks and across streets en route to their destinations.
 
"It's a lot like wearing an Apple Watch where it can pick up and collect certain data, such as your heart rate, temperature, and various pieces of information that can be fed into a computer somewhere that can interpret it," says Curt Wolf, managing director of the Urban Collaboratory. "For instance, if you're waiting for a bus that doesn't show up, your heart rate goes up."
 
The project determined that 50% of adults aged 65 or older who rent their homes in Washtenaw County do not have a vehicle; 70% of these older adults have to travel more than a mile to get groceries. By measuring these physical indications of emotional stress and correlating them to the routes that participants followed, the project team can pinpoint what barriers are most likely to impede mobility — and a person’s ability to venture out of their home.
 
"If you're a person with a disability, maybe using a wheelchair, there are many elements to your trip," Wolf says. "If you have to go from your house to the doctor or your house to the grocery store, public transportation might be a piece of that. But first you have to get out of your house, you have to get down a ramp, [and] you have to navigate all these different challenges to complete your trip."
 
Lack of transportation can prevent people from accessing healthy foods, medical care, employment, and social activities. And those factors can ultimately lead to poor physical and mental health as well as loss of independence. This project can give city planners the information they need to develop walkable infrastructures that truly work for all people.
 
Older adults keep PACE with technology
 
Care Resources PACE in Kent County employs many technologies to serve its participants. PACE, which stands for Program of All-Inclusive Care for the Elderly, provides comprehensive medical and social services at low or no cost to older adults who live at home throughout Michigan’s Lower Peninsula. PACE offers adult day health centers and provides care in participants’ homes. 
 
"I think COVID brought everyone to their knees in relation to finding new ways to communicate and to interact with our participants," says Care Resources Recreational Therapy Manager Garth Falkins. "We really did some research trying to find better ways to utilize technology to help our participants age in place at their homes for a much longer period of time."
 
For higher-functioning Care Resources participants, Health Recovery Systems links a tablet to participants’ blood pressure cuffs, pulsometers, and other devices that monitor vitals and relays the information back to the Care Resources nursing staff. WalkWise attaches to a walker or a cane to track activity and alert Care Resources if a person falls.
 
"With WalkWise, we can see increases and decreases in activity," Falkins says. "Sometimes we're noticing that people are up all night when they're supposed to be sleeping. If they're not registering any movement, we find out why they are not moving."
A man uses the care.coach tool, currently being deployed by Grand Rapids-based Care Resources PACE.
Another tech tool, care.coach, also makes use of a tablet but is interactive. An on-screen dog or cat avatar wakes up, rubs its eyes, and then gently reminds participants to take their meds and measure their vitals while providing social engagement and emotional support through music and games.
 
"Every couple of hours, depending on what parameters are set, that little dog or little cat will wake up and interact with participants to see how they're doing that day," Falkins says. "They just pet the dog's or cat's head to wake it up and then they can engage in whatever activity they want."
 A man uses the care.coach tool, currently being deployed by Grand Rapids-based Care Resources PACE.
care.coach provides 24/7 monitoring. A live person monitors participants’ activities on the tablet and alerts Care Resources if the participant requires urgent or emergency services. 
 
"If there's an increase in pain, or they're having trouble breathing, care.coach actually calls our nursing staff," Falkins says.
 
Care Resources is also using another new technology at its day center. It’s Never 2 Late (iN2L) makes use of a portable 75-inch touchscreen that offers more than 4,000 options, from word games and therapeutic exercise to educational videos describing medical procedures.
 
"It has videos of an endoscope going down the throat that you can actually look at," Falkins says. "Therapy uses the different games that are on it to encourage participants to stand or do movements and have fun while they're doing it. It’s like going to the gym and getting on the elliptical equipment."
 
While these technologies are up and running, more are materializing on the horizon. Ondersma is excited about integrating health care technologies with artificial intelligence as well as utilizing digital phenotyping that, with a patient’s consent, will collect and analyze smartphone social media activity, communication, activity, movement, and location data to help providers identify when a patient needs help — and then send targeted messages to assist them. And with new National Institutes of Health funding, an open-source platform for developing digital health care interventions will allow researchers around the world to develop more high-tech tools. A project led by Dr. Jordan Braciszewski at Henry Ford Health uses software developed through the platform to screen pediatric patients for substance use and mental health challenges. 

"Not only does all the energy we put into that platform allow me to do more good things more easily, it also lets other researchers do the same," Ondersma says. "It lets anybody, regardless of technical expertise, make very powerful interventions relatively quickly at no or almost no cost."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Steve Ondersma photo by Nick Hagen. care.coach photos courtesy of Care Resources PACE. Pregnancy Checkup photos courtesy of Steve Ondersma.