Many health systems are recognizing the impact of consumerism on healthcare delivery, and the need to respond to consumer demand for personalized care. At the same time, hospital and health system leaders also are seeing an opportunity to leverage digital tools to help patients manage chronic conditions with the overall goals of improving care and reducing hospital readmissions.
At Nemours Children’s Health System, senior executive leaders developed a new digital health strategy with an eye toward meeting consumers where they are, while also helping the health system in its transition to value-based care and reimbursement. Nemours is a pediatric health system that operates Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware and Nemours Children’s Hospital in Orlando, Florida, along with major pediatric specialty clinics in Delaware, Florida, Pennsylvania and New Jersey. As part of a broad effort by the health system to put more digital tools in the hands of patients, particularly those with chronic conditions. Nemours Children’s Health System recently launched a new mobile app for pediatric asthma patients and their caregivers.
The asthma app is the first product to be released by the Nemours’ Center for Health Delivery Innovation, which opened in 2016, and will be the first of several disease-specific tools designed to help patients and families better manage their chronic conditions by integrating the patient and clinician experience into one platform. The asthma app is now being piloted and is scheduled to be released through the Apple store in early 2018. Next year, Nemours plans to roll out two more specialty apps for diabetes and cardiac care.
As part of Nemours’ digital health strategy, these disease-specific tools for chronic disease management integrate electronic health record (EHR) data, the health system’s homegrown CareConnect telehealth platform, data from an informational website run by the health system, called KidsHealth, and a suite of connected home monitoring tools. The asthma app is a first step in the health system’s efforts to centralize all of the health system’s digital programs in order to give patients a “one-stop shopping” experience, according to health system leaders.
“This app is a model for Nemours, demonstrating how digital health allows us to meet families wherever they are and fulfill our commitment to the medical home model,” Gina Altieri, senior vice president and chief of strategy integration at Nemours Children’s Health System, says. “Our goal is to better engage with families, understand what is happening between visits, help families manage chronic conditions, and improve outcomes of care” and reduce hospital readmissions.
Tackling Asthma through Digital Tools
Unlike average health apps that track fitness or eating habits, the Nemours’ digital asthma tool provides digital synchronization between self-care and the doctor’s office. The goal is to offer patients access to care, anytime or anywhere, and encourage them to participate in care whenever it is necessary, PJ Gorenc, operating officer at the Nemours Center for Health Delivery Innovation, says.
“The piece that makes this a little bit different than what we’ve seen in the marketplace, what we’re calling our special sauce, is that this digital experience is designed to sit in the space between the patient and the clinician and provide a two-way conduit. It’s not just putting tools into the pockets of patient families; it’s supporting that care plan and the relationship with the clinician, and getting that real-time data into the tool and sent back to the clinician, so the clinician has better insight into what is happening with their patient in between visits,” Gorenc says.
He adds, “The idea is that the clinician can modify the care plan appropriately based on objective data that’s real and reliable. We’re also providing patients with the tools that support that care plan, and helping them to adhere to it, and hopefully making it easy for them to do the things that are appropriate for their condition.”
The app is designed with a patient-facing, user-friendly interface in which patients or their caregivers can tap through a series of questions and quickly determine if they are in the green, yellow or red zone. “The whole thing is designed to take less than three seconds. That information is being fed back in to the clinician, on a daily basis,” Gorenc says. “We’re also correlating all that information with air quality indexes. We’re providing push notifications through the app, if air quality is at a level that someone with asthma should be worried about. We’re also storing that air quality information along with all that data so that the doctor knows what was going on in the atmosphere that day,” he says.
The asthma app supports the use of physician ordered home-monitoring tools, such as a breath-flow monitor and a digitally connected stethoscope, provides video instructions for inhaler use and allows families to keep a real-time digital journal of symptoms. In addition, the app enables better communication for telehealth visits with asthma specialists. This important feature, Gorenc says, is to enable telehealth to be a tap away for families and caregivers. “Just one tap to be able to see a Nemours clinician who can see and hear their child and help them understand whether this is serious and the child needs to go to the emergency room, or if they can just follow their asthma action plan at home,” he says.
At the same time, helping patients and families to better manage a chronic condition like asthma correlates to the health system’s population health initiatives. “We recognize that as we get ready to take on value [value-based care and payment models], reducing hospitalizations, reducing the number of school days missed, and the ED visits and readmissions, these are issues definitely worth looking at,” Altieri says.
An Integrated Digital Health Strategy
Nemours’ digital health strategy, and the development of disease-specific tools, ties into the health system’s 2020 vision, which consists of six strategic initiatives. “One of these strategic initiatives is addressing consumerism; the Millennial parent, and appealing to their wants and desires” Altieri says. “Another strategic initiative is to prepare for value-based reimbursement. And, our highest-level strategy is to help patients and their families receive the care they need and want, exactly when and how they need it and want it. We believe that by creating the Center for Health Delivery Innovation, and this specific app, we are addressing those three strategic needs,” Altieri says.
Prior to the launch of the innovation center, Nemours’ digital assets functioned separately, and the health system is now focused on pulling all of its digital health offerings onto a single patient-facing platform utilizing the expertise within its innovation center. The development of the asthma app paves the way for future digital tools, as technologists had to pull together data from the EHR, the KidsHealth patient education website, and the telehealth service. The coordination of technology requires that each component is interoperable within one system to enable the file-sharing, journaling, and use of clinical tools.
Clinicians and families were integral to the design and development of the tool, participating through advisory boards and testing, Gorenc says.
“We began by designing the experience that we thought asthma families needed to have, and that really revolved around addressing several of those clinical and transactional friction-type problems. We designed and framed out a user interface, tested that with some families for usability, and then basically started building,” he says. “With pulling information from the EHR, from KidsHealth.org, and from CareConnect [Nemours’ telehealth platform], we worked with each of those entities to either utilize existing APIs (application programming interfaces) that they had available to pull functionality automatically. But sometimes, we had to custom develop hooks ourselves to get the information that we felt was going to be useful for the families. So, it’s been a range from relatively straightforward to extremely difficult to pull that off.”
Gorenc notes there were a number of technical challenges around data architecture and design. “We already had these really good existing tools and the vision was to bring them all together. Getting an initial conception of that and using asthma as our focus for doing it, that was a challenge to figure out what pieces do we want to pull in from all of these tools. The information architecture and the basic design and conception of what that experience would be like was a challenge that took a lot of work and trial and error,” he says, adding, “The other big challenge is that while the industry pushes toward interoperability and making data easily transferable, it’s not quite there yet. Some of the data that we needed to pull from various locations was quite challenging to figure out.”
There were also cultural challenges with this work, Altieri says. “Definitely alignment, at all levels, was a challenge; alignment within the Center, strategic alignment, alignment with the board and the executive team. Getting everybody to understand that this important and this is something that we need do. This what the consumer is doing to healthcare; they are demanding frictionless access to healthcare, they are demanding immediate response on their mobile device. This is what the patient and the Millennial parent is telling us that they want. And, we can’t really wait; we have to change the culture so that it goes from a provider focus to a patient focus.”
Nemours has a strong foundation for digital health, with nearly 20 years of investing in its EHR capabilities. The health system earned the Health Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 7 designation back in 2012.
“We are using the EHR and the data that comes out of the EHR at a very elevated, sophisticated level. That doesn’t happen overnight just because you’ve installed an EHR,” Altieri says. “We’ve had our KidsHealth site up and running and we understand what the consumer struggles with based on feedback that we received from them. It’s not a plug and play. You really need to invest in the infrastructure and understand your patients’ and families’ needs before you actually build something.”