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Nemours Children’s Launches New Digital Health Platform to Tackle Chronic Disease

November 15, 2017
by Heather Landi
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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.


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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.

PJ Gorenc

“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.

Gina Altieri

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, 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.”


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Vanderbilt Transplant Center Launches Mobile App for Providers, Patients

January 22, 2019
by Rajiv Leventhal, Managing Editor
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The Vanderbilt Transplant Center is now giving patients and providers instant access to critical transplantation data—such as educational resources and donor information—on their smartphones and mobile devices.

According to the organization’s officials in a recent announcement, the app is designed to be a resource for transplant information at the Nashville-based Vanderbilt University Medical Center (VUMC) for both patients and providers.

“It helps patients find information about transplant programs as well as educational links about transplantation. Patients can customize what organ they are interested in learning more about, meet the transplant team and find provider locations. Living donor information is also available as well as a living donor referral form,” officials stated.

The Vanderbilt Transplant Center, Tennessee’s only full-service transplant center, provides chances for patients to participate in clinical trials and studies, as well as access to other specialists. Its transplant teams have performed more than 9,500 solid organ transplants since 1962, including all the major organs—heart, kidney, lung, liver and pancreas, according to its officials.

For providers, the app aims to offer improved access in the referring process for both adult and pediatric referrals through REDcap referral forms. The app gives referring physicians a secure process to contact the on-call VUMC transplant physicians to enable better communication, while also containing a direct link to call the VUMC Transfer Center for urgent transfers of patients to VUMC facilities. Providers also have access to outcome data, officials noted.

The Vanderbilt Transplant Center has debuted a new free app available for iOS and Android devices, available by searching “VUMC transplant” in the respective app store.

“Development of this app will allow patients unprecedented ability to connect with our system, schedule appointments and interact with our providers,” Seth Karp, M.D., H. William Scott Jr. professor and chair of the Department of Surgery and director of the Vanderbilt Transplant Center, said in a statement. “We have every expectation this service will increase our ability to reach patients and provide outstanding care.”

Edward Zavala, transplant center administrator, added, “The Vanderbilt Transplant app is a significant addition for our referring providers to access the transplant center. Additionally, the patient education component of the app provides patients ready access to transplant-specific education.”

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Report: At-Risk Medicare Seniors the Next Apple Watch Target?

January 18, 2019
by Rajiv Leventhal, Managing Editor
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Apple is engaging in discussions with multiple private Medicare insurers about subsidizing the cost of the Apple Watch for at-risk people over 65 years old, according to a CNBC report.

This week’s report, from health tech reporter Christina Farr, noted, “The insurers are exploring ways to subsidize the cost of the device for those who can't afford the $279 price tag, which is the starting cost of an older model.”

The latest version of the Apple Watch—the Series 4—was launched in September, and as officials of the tech giant stated at the time, brings “advanced activity and communications features, along with revolutionary health capabilities, including a new accelerometer and gyroscope, which are able to detect hard falls, and an electrical heart rate sensor that can take an electrocardiogram (ECG) using the new ECG app.” This version retails for at least $399.

According to the CNBC report, “Apple has paid a visit to several of the largest insurers in the market, as well as some smaller, venture-backed Medicare Advantage plans. The people declined to be named as the discussions are still private.”

The watch’s electrocardiogram function and fall detection capabilities particularly make it appealing and valuable for seniors; about 19 million seniors, and growing, are enrolled in a Medicare Advantage plan, which are private health plans that receive government payouts for providing services to seniors—about $10,000 per member, on average, Farr’s report noted.

According to Apple, the new Series 4 Apple Watch intermittently analyzes heart rhythms in the background and sends a notification if an irregular heart rhythm such as AFib is detected.  It can also alert the user if the heart rate exceeds or falls below a specified threshold.

And, the Apple Watch’s fall detection function utilizes a next-generation accelerometer and gyroscope, which measures up to 32 g-forces, along with custom algorithms to identify when hard falls occur, the company has stated.

To this end, data from health technology company HealthMine shows that 21 percent of Medicare Advantage beneficiaries use a fitness/activity/steps tracker; and 70 percent currently use digital tools, with a blood pressure monitor being used by 50 percent of beneficiaries.

In this realm, Apple is working with other major insurers as well. It was recently announced that UnitedHealthcare Motion, an employer-sponsored wellness program, is telling its participants they can get a free Apple Watch if they meet the insurer’s daily walking goals over a six-month period. For this initiative, program participants can use the Apple Watch to see how they are tracking against the program’s three daily goals—frequency, intensity, and tenacity—helping integrate physical activity and engagement with their health plan.

Industry observers have already begun to offer some reaction to CNBC’s story. In Farr’s report, Bob Sheehy, the CEO of Bright Health, an insurance start-up with a Medicare Advantage plan, and the former CEO of United Healthcare, spoke to the idea of seniors potentially avoiding expensive care visits by leveraging the device. “Avoiding one emergency room visit would more than pay for the device," said Sheehy.

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PerfectServe Acquisition of Telmediq Consolidates Secure Communication Platforms

January 17, 2019
by David Raths, Contributing Editor
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Combined companies have more than 500,000 clinical users across 250 hospitals, 27,000 physician practices and post-acute care organizations

PerfectServe, a provider of cloud-based clinical communication and collaboration solutions, has acquired competitor Telmediq, a secure communications platform provider for health settings.

Knoxville, Tenn.-based PerfectServe said it plans to support both solutions going forward, taking advantage of each platform’s cloud-based, service-oriented architecture to integrate complementary features.

Telmediq is deployed across 300 healthcare organizations and 80,000 users. It offers a call center solution, nurse mobility, advanced alert and alarm management capabilities, and mass notification functionality. Combined, PerfectServe and Telmediq have more than 500,000 clinical users across 250 hospital sites and 27,000 physician practices and post-acute care organizations. 

PerfectServe said the acquisition is an important step in its effort to build a care team collaboration platform that unifies the entire care team across the continuum, from inpatient, to outpatient, to patients at home. “Our vision is to build a platform that is separate from, transcends, and is fully integrated with the EHR and all other point-of-care technologies,” said Terry Edwards, president and CEO of PerfectServe, in a prepared statement. “The goal is to make it easy for clinicians to overcome persistent care coordination challenges that have existed in the industry for years.”

The Telmediq acquisition follows an investment last year in PerfectServe by private equity firm K1 Investment Management.



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