About This Blog

 

Sherri Dorfman, CEO, Stepping Stone Partners, Connected & Digital Health Innovation Specialist

My blog is designed to spotlight healthcare organizations with innovative uses of technology & data to drive Care Coordination, Collaboration & Patient Engagement.

These new approaches may influence your product & service roadmap, experiences, partnerships and marketing strategies.

MY EXPERTISE:

While consulting, I leverage my extensive experience, knowledge and professional network to help companies make the right strategic product and marketing decisions. Services include:

> Strategic Planning Market Review: Competitive Assessments, Partnership Evaluations. Workshop facilitation. Insight drives product, partnership and marketing strategies

> Product Roadmap & Consumer Experience Planning: Conceptualizes, defines and validates solutions/experiences through Marketing Research and journey mapping.  Utilizes new innovative online and mobile research tools to co-create with target buyers and users, gathering input while understanding context to guide the development of personalized solutions & experiences.

> Strategic Product Marketing: Differentiated value proposition story incorporated into marketing & sales assets

Find out how I can help you. Call me at 508-655-6585. Email me at SDorfman@Stepping-Stone.net to set up an exploratory discussion.

Follow me on Twitter @SherriDorfman

 

 

 

 

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    Entries in consumer generated health and wellness content (22)

    Novant Health Deploys Mobile App to Monitor Behavioral Health Patients and Proactively Provide Support

    According to The Agency of Healthcare Research and Quality (AHRQ), an estimated “44 million people 18 and over suffer from mental disorders.” Further, “major depressive disorder is the leading cause of disability among adults”. This is a major concern for healthcare providers throughout the United States. As more patients struggle to manage their mental health condition, they are showing up in emergency rooms, where they are finding staff and systems ill equipped to deliver the specialized care that they so desperately need. This missed opportunity not only creates a negative experience for patients but also drives up healthcare expenses for providers.

    Novant Health, one of the largest healthcare systems in the country (15 hospitals, 350+ physician practices in NC, SC, VA, & GA), is proactively helping behavioral health patients, reducing readmissions and preventing costly emergency room visits.

    In 2013, Novant Health partnered with behavioral analytics company Ginger.io on a successful depression program in a Novant perinatal clinic. In 2014, Novant Health expanded the partnership with Ginger.io to address the unique needs of adult patients with depression by developing a customized care solution for this historically underserved population. 

    Ginger.io Depression Patient Survey

    The Ginger.io Behavioral Health Program initially enrolled patients who were already engaged in a partial hospitalization program or an intensive outpatient program at the Forsyth Medical Center. In an effort to complement the standard support groups and therapy 3-5 days a week over a 12-month period, Novant Health offers patients the continuous sensing smartphone. Patients download the smart phone app solution from Ginger.io to “connect the dots” between their behavior and their health and “stay in touch with the care team between visits”, according to co-branded patient communications from Novant Health.

    The smartphone app actively collects information from the patient about symptoms and medication. Based on the patient’s specific behavioral health condition (e.g., depression), she receives personalized questions to gather a specific set of data. The mobile app also passively gathers data in the background on her mobility, social interaction and sleep patterns. The patient’s active and passive information is then combined and fed into Ginger.io’s analytics engine to identify which patients are in need of intervention and to share that information through an alert with care staff. After receiving a dashboard alert, a licensed mental health professional (e.g. nurse, social worker or case manager) contacts the patient to discuss what is going on in the patient’s life based on her responses and behavior—what Ginger.io refers to as a “behavioral signature”.

    Novant Health is already receiving positive feedback and insights from both clinicians and patients.

    “Most innovation in Behavioral Healthcare in the past 20 years has been primarily focused on pharmaceutical development,” explains Dr. Todd Clark, Director of Behavioral Health Sciences at Novant Health. “This was necessary for treating patients in the acute phase, but there has only been minor progress related to services detecting mental illness upstream. The Novant Health Innovation Team led by Matt Gymer has created a platform in our healthcare system to leverage the cutting-edge advantage of Ginger.io for our behavioral health population. Ginger.io has revolutionized our ability to connect with patients in real time, even remotely, and allows us to provide patients with the most appropriate and timely care. This not only puts the patient on the most optimal pathway for treatment and recovery, but it also increases the number of treatment options for the patient—rather than the overused default option of the local emergency department. Ginger.io has flexed to meet our system’s particular needs, and our patients have expressed a high degree of engagement with the service.”

    Patients appreciate the opportunity to reflect on their mental state and the proactive contact they receive when experiencing challenges in their day-to-day life.

    According to one Novant Health patient, “I look forward to the surveys. For the first time in my life I feel that someone truly cares if I live or not. Someone cares how I feel and helps me work through those feelings. I feel I have purpose in my life again.” This is a powerful endorsement from a community in need.

    Ginger.io Behavioral Health Program Expansion

    Novant Health expanded the program in June to an outpatient drop-in assessment center and mobile crisis unit and then again in September to psych inpatient and psych outpatient clinics. Although these patients come into care during a crisis moment, it is important that they leave with a new tool for ongoing support and empowerment.

    Based on qualitative feedback Novant Health from the clinicians and patients using the mobile monitoring solution, care teams have decided to share historical survey responses and behavior patterns with patients through a provider-facing dashboard displaying past data and care alerts. Doctors/Care Managers can share this information with the patient to discuss behavior patterns, life situations, triggers and treatment plans. 

    Novant Health recently rolled out the Ginger.io technology in their main Psychiatric Clinic in Winston-Salem. Psychiatrists are giving the smartphone app tool to their patients and viewing the dashboard to respond to patients in need. The doctors will also use the information gathered to enrich their conversation with the patient during their office visit. 

    Novant Health continuously evaluates the value of the program through key quantitative metrics including patient satisfaction and engagement, operational efficiencies and outcomes improvement based on clinically validated measurements such as PHQ-9.   

    In the future, Novant Health plans to extend the Ginger.io Behavioral Health Program to five other regional hospitals across their health system. The expansion is intended to deliver “a remarkable patient experience,” according to Matt Gymer, Corporate Director of Innovation at Novant Health.

    Clinicians are interested in expanding the use of the Ginger.io platform to help them identify patients earlier, understand triggers for their symptoms and proactively provide needed support. This important behavioral health initiative aligns closely with Novant Health’s ability to innovate solutions to deliver proactive care to patients and customize services. 

    Boston Children's Hospital Monitors Young Patients with Data from Caregivers; Parents, Teachers and Coaches

    Dr. Eugenia Chan sat patiently waiting for her fidgety first grade patient and her frustrated mother to answer her question. "How was the new medication working to help Janie with her ADHD"? Janie's mom hadn’t had a chance to fill out an ADHD behavior questionnaire in the chaotic waiting area, so she tried to summarize her impressions since their last doctor’s appointment a few months ago.  She hadn’t heard specific feedback from Janie’s teacher, and had also forgotten to give the ADHD questionnaire to her teacher so that they would understand how she was doing in school.

    In 2011, Dr. Chan, MD, MPH, a developmental-behavioral pediatrician and health services researcher in the Division of Developmental Medicine at Boston Children’s Hospital, felt that she needed a better way to monitor her patients and gather insight into how they were doing with their medications and treatment plans.  With a grant from the Croll Family Foundation, Dr. Chan collaborated with Dr. Eric Fleegler, MD, MPH, a pediatric emergency medicine physician and health services researcher in the Division of Emergency Medicine at Boston Children’s Hospital, on the development of a new software tool, eDMC (electronic Developmental Medicine Center).

    Their goal was to gather and interpret the information from parents and teachers more effectively and gain a more comprehensive view into patient behavior between visits. The doctor determines when the system will email the parents, typically a week or two before the appointment. When the parent receives the email with a link into the software platform, she logs in and answers a set of questions about symptoms, school performance, quality of life, global functioning and improvement since the beginning of the treatment. The parent gives the email addresses of the patient’s teachers and other important observers of the child (e.g., sports coaches, behavioral therapists, tutors) to the clinician to get them set up in the system so they can answer similar questions.

    Clinicial InterfaceWith this information, Dr. Chan is able to determine how her patient is doing throughout the day, week and over time. During the visit, she shares this information with her patient and family, points out trends and discusses what has transpired. On the graphs, each line shows data from a different caregiver; parent, teacher and coach. The clinician can also drill down to see specific symptoms and their ratings that are incorporated into a score. With the treatment plan in mind, the clinician evaluates the data and focuses in on any discrepancies to determine what is really happening. This exchange supports her clinical decisions and enables her to participate in shared decision making with her patient and his family.

    “I’ve already started using the system to work with my adolescent patients who want to go off their medications. When I agree to let them try coming off meds, I suggest that we use the questionnaires to monitor results. At the next appointment, patients are often surprised to view parent and teacher ratings and comments, that she was ‘disruptive’ or was ‘unable to pay attention’”, describes Dr. Chan.

    Another feature of the platform is the ability to notify the clinician when there is a “red flag” patient problem that may require action (i.e. severe depression). Even though parents are made aware that this is not a real time monitoring system, there is someone responsible for ensuring that clinicians have seen the red flag alert.

    Parent InterfaceSince the program started, over 3,000 pediatric patients have participated.  One parent comments on the value that she sees with the system, “it is very easy to use and I like that we save the time at the doctor’s appointment and all of the information is there”. Dr. Fleeger adds that the system “transforms how patients are interacting with their clinicians. At the appointment, the clinician can show them the graphs and tables on the computer to understand where they are and have a fruitful conversation”.   Dr. Leonard Rappaport, Chief of the Division of Developmental Medicine at Boston Children’s, says that the platform “is the first major improvement we have made in individualized care for developmental disorders in the past two decades.”

    Currently the clinician can copy patient level summary information from the system into the EMR. Although the platform is web- based, Dr. Chan mentioned they were creating a mobile interface for access through smartphones and tablets.

    Expanding ICISS Health; More Patients & Populations

    In 2012, Dr. Chan and Dr. Fleeger renamed the platform the Integrated Clinical Information Sharing System (ICISS Health) to be more generalized for expansion into other pediatric patient populations.

     “We have extended the ICISS Health platform to additional clinics at Boston Children’s that treat patients with ADHD, as well as private practices affiliated with Boston Children’s, and we are expanding into new conditions such as autism, asthma, depression and epilepsy”.

    For each new condition, they have convened a cross disciplinary team to define the data that need to be collected to support decisions. “For example, we are working closely with clinicians from the Boston Children’s Autism Center to devise a questionnaire for patients, since there is no standardized set of questions for this patient population” explains Dr. Chan. “For asthma, we would like to invite the school nurse to participate and provide insight into frequency of nurse office visits and rescue medication use by the patient, and whether they used the patient’s asthma action plan.”

    The team at Boston Children’s is in the process of collecting information to evaluate the ICISS Health platform impact on patient health outcomes and healthcare utilization and costs. Dr. Chan also mentioned their interest in calculating potential cost savings from the platform by identifying problems early and intervening in time to prevent emergency department visits and hospitalizations.

    “As we think about the future of the platform, we are interested in going beyond the electronic questionnaires to capturing and integrating information from devices and mobile applications”, Dr. Chan concludes.

    Geisinger Takes Mobile Patient Engagement to the Next Level

    Geisinger has been investing in mobile technologies to engage patients and their families in their care since 2011. In my blog post last year, I shared Geisinger’s texting programs, mobile data capture and experiences with their first mobile app to support Cardiac Rehab.

    Geisinger continues to explore new technologies to involve patients and to improve the patient and physician interaction.  “Mobile apps are just another way to drive patient engagement. We think we will have better adoption by patients if we use technology that they have already adopted in their lives”, explains Chanin Wendling, Director, eHealth, Geisinger Health System. “Our goals are to improve patient outcomes and reduce costs.  We pursue patient engagement because of studies from folks like Hibbard & Greene 2013 and Veroff & Wennberg 2013 that show that engaged patients have better outcomes at lower costs.  We want to provide patients with tools that help them understand their condition and follow their care plans so they can stay as healthy as possible.”

    Piloting Mobile App Supporting Bariatric Surgery 

    Geisinger Get 2 Goal Mobile AppGeisinger began piloting their second mobile app Get~2~Goal in September, 2012 to help manage patients’ surgical weight loss expectation and provide a journal for tracking weight loss after the surgery. The Get~2~Goal app presents the patient with personalized weight management goals using her own entered data (e.g. age, weight, height). She can monitor her weight loss towards that goal and see how she is doing compared with other patients like her. 

    The app was developed by Geisinger’s Obesity Institute in collaboration with Bucknell University’s computer science staff and students. 

    Patients have shared positive comments including:

       “Great App! Surgery on Tuesday, so this will be a great motivator”

       “I like it. It's very helpful and lets you know whether you're on the right track or not weight wise. So far I'm doing above average. Woo hoo to us!”

    The clinical sponsor for the Get~2~Goal project was Dr. Christopher Still, Director of Geisinger Obesity Institute and Medical Director for the Center for Nutrition & Weight Management. He uses the app when discussing bariatric surgery with his patients and, recommends that they download it to their mobile devices. Dr. Still has observed an improved patient/physician interaction when a patient sets realistic weight loss expectations with the guidance of the clinician. “This app allows patients and their physicians to discuss patient specific outcomes regarding gastric bypass surgery. It is important for both the patient and their physician to have real expectations and assess the risk/ benefit of the procedure.”

    Building Mobile Apps Ourselves

    In addition to experimenting with Cardiac Rehab and Get~2~Goal apps, Geisinger wants to expand into apps for different chronic conditions and set out to research the market. “We were disappointed with what we found. Most vendors had apps focused only on one chronic condition. Although vendors had plans to expand into other chronic conditions, we had a hard time picking a reasonable partner based on their stated direction”, Wendling explains.

    Wendling feels the mobile health app market is still in the early stages. She explains that vendors are approaching her organization with a business model that just doesn’t scale. “If a vendor charges us a rate of $10+ per member per month, how do we make that work for patients with multiple conditions? We have over 75,000 patients with hypertension and 30,000+ with asthma. Although the app will not be appropriate for all of these patients, the costs add up rather quickly.”

    After evaluating many mobile apps, Wendling points out that the patient experience is not thought through. She has asked vendors about how patients can personalize their app.  “I may be a patient who works night hours so why shouldn’t I be able to set the time of the reminders to fit my schedule? Also, why can’t I select the method of receiving the reminders, through email or text messages”, adds Wendling.

    The final reason that Geisinger has decided to build mobile apps internally is because integration is important. “We’ve found that many solutions do not integrate with our EMR which is essential since we need to incorporate the patient information into our clinical workflow” Wendling explains. “Although it is not unusual that the early innovated apps do not integrate with the EMR, vendors do recognize that they need to get there.  So any app we purchase, we would most likely have to do the integration ourselves anyway.  We haven’t made any decisions that we will always develop our own apps.  If we see something out in the marketplace that works and we have the budget, we will go for it.  We just may need to wait a little longer until the marketplace matures.”

    Mobile App Development Journey

    As their first venture into internal mobile app development, Geisinger selected a simple procedure and defined key capabilities which are replicable across more complex procedures. With the new Colonoscopy mobile app scheduled to be launched next month, patients can prepare for their procedure through: 

    • Education: explains what will happen during the procedure
    • Shopping: lists can be created and transferred as a note to the mobile phone
    • Reminders: for days before the procedure directing the patients to steps that need to be done
    • Pictures: visual guides of their bowel movement during the preparation process

     “Geisinger’s colonoscopy mobile app is unique among health care related apps in that it provides a personalized experience for the patient.  From prep instructions based on scheduled appointment time, interactive ’am I ready for my procedure’ section to the ability to easily set reminders/alerts; this app takes advantage of a lot that mobile technology has to offer.  As a gastroenterologist, my hope is that this app will allow patients to feel more empowered and in control of their bowel preparation; typically the most difficult part of the colonoscopy experience. We know that with improved prep comes better outcomes and thereby, over time, lives saved. I feel that modern health care needs to embrace mobile technology as a rapidly growing and exciting tool to improve patient care”, explains Dr. Amitpal S Johal, Director of Endoscopy, Geisinger Medical Center.

    “We are looking into other surgical procedures which can use this same set of capabilities. One area that we are considering is Vascular surgeries since we work closely with our Vascular department at Geisinger”, shares Wendling. 

    Future Mobile Health Roadmap

    As they look to the future, Geisinger is working on enhancing current mobile apps and is exploring the use of mobile to support patient care before, during and after a hospital visit.

    The next version of the Get~2~Goal app is under development. Geisinger is improving the patient experience through a better user navigation, the capability for patients to enter their own weight loss goals, and the addition of recently developed calculations for other bariatric surgery outcomes (i.e. likelihood for remission of diabetes).

    Geisinger is also looking into ways that mobile devices and apps can help patients pre, during and post hospital stay. They are starting with their Janet Weis Children’s Hospital which treats kids with complex conditions such as cancer, heart or neurological issues. Geisinger understands that being in the hospital is scary for the child and their family. “With mobile apps, children and their parents will be able to prepare for the surgery, use an iPad during their hospital visit to capture pain levels and then track their recovery at home”, describes Wendling.

    In the future, Geisinger is planning for a personalized patient experience. “Our dream is to be tailored in our patient care.  Given the patient’s profile, s/he will have technology options and tools to gather preferences and schedules to guide the care plan. We want to use this information to also match the appropriate intervention”, Wendling concludes.

    Aetna Successfully Uses Social & Personalization to Engage Consumers Managing Metabolic Syndrome

    Aetna's Lifestyle Social Community on CaféWell

    According to CDC research, over 30% of U.S. adults have Metabolic Syndrome, a set of five risk factors including high blood pressure, high blood sugar, large waist size, high triglycerides and low (good) cholesterol.

    Aetna has developed several new initiatives to empower and engage members with Metabolic Syndrome. Aetna has designed each program to support members at their stage of readiness. 

    1. Alex, a Virtual Health Assistant, interacts with each member in a friendly, conversational way. Alex asks the member questions to personalize the interaction using content from Aetna Medical Directors, Nurses, health coaches & dieticians. Alex informs the member about the benefits of screenings and how to interpret test results.

    Alex helps the member to relate their results to what’s happening in their own bodies through entertaining and informative animated videos. Then Alex directs the member to where they can find resources andsupport to start making lifestyle changes to help reduce their risk.

    “We created Alex for members as a starting place since Virtual  Health Assistants are less threatening”, explains Paul Coppola, Head of Wellness Program Strategy & Development at Aetna. “Alex enables members to guide the conversation and explains this health issue to you personally based on your combination of risk factors”.

    Alex personalizes the experience based upon what the member inputs into the virtual health advisor from their metabolic screening results report.

    Members have given positive feedback using Alex:
    "This was the best explanation of these issues that I have ever seen."
    "Love this type of learning module. Great!"

    2. Lifestyle Social Community is an online monitored area where members share personal experiences, successes and support. Aetna has a Coach serve as the community moderator, sharing information, as well as, guiding individuals to resources when needed.

    Members with Metabolic Syndrome participate in the Aetna Healthy Community on the Lifestyle Social Community platform. Coaches are trained and specialize in areas such as weight management and Metabolic Syndrome.
     
    “Within our Lifestyle Social Community which on the Café Well platform, we have a private log-in area where members participate in online group coaching and communicate with others in their support group”, adds Coppola.

    “This becomes an access point for health education, wellness coaching which focuses on individual success, goal setting, removal of barriers, and building in a support system to help each individual to be successful. Typically each coach supports approximately 15-20 members".

    Aetna members can participate in the main social community regardless of whether they are in the coaching program. "It's available 24/7 and we hope to engage more members through this channel who may not have otherwise engaged in the face-to-face or phone coaching modules. It is  another resource with peer to peer support for our Aetna members" Coppola explains.

    3. Virtual Classroom for “Metabolic Health in Small Bytes” Program, an evidence-based online program is designed to help consumers (i.e. members, employer’s employees) learn mindfulness techniques to address Obesity and learn about the emotional, nutrition, exercise and motivation elements.

    Metabolic Health in Small Bytes uses a virtual online classroom setting, conducted via the Internet - in real time. Participants access the classroom through the Live Meeting platform and use their phone and written comments to interact with each other and the instructor. Classes are highly interactive. Participants engage via streaming video and can hear, speak to and interact with both the "live" expert instructor as well as other class participants, sharing information or asking questions.

    The Metabolic Health in Small Bytes Program which was piloted with 600+ Aetna employees, was developed from Aetna’s research study with Duke Diet & Fitness, Duke Integrated Medicine and eMindful.

    Member comment:
     "Like the little engine that could I know I can, I know I can, thanks to you (instructor name) and the great supportive group with all the tips and great ideas."

    Insights from Aetna’s Metabolic Syndrome Initiatives

    Alex, Virtual Health Assistant is very new to Aetna’s wellness portfolio. “We announced it in February 2013.  We continue to monitor its use and feedback from members.  We will plan for enhancements as we feel is needed once we gain more experience”, Coppola shares.

    Lifestyle Social Community was first piloted with Aetna employees 2011through 2012. “We’ve typically seen more involvement from individuals who have higher risk (e.g., see more chronic weight personal challenges vs. more casual weight loss)”, explains Coppola. Aetna has learned that it is important for the success of the participants to feel supported and have the opportunity to share in a safe environment. “Being anonymous helps members to feel secure in their sharing and providing encouragement to others. We are working through our future technology enhancements to the social community. We want to meet the needs and goals of the participating members, while providing a platform that includes the latest technology and makes it easy for members to engage with the coaches. We do know that individuals learn and are motivated differently and want to ensure our platform and the technology supports those needs”, adds Coppola.

    With the Virtual Classroom's “Metabolic Health in Small Bytes” Program, Aetna has defined ways for participants to stay engaged between sessions. “Participants are given short homework ‘at-home practice’ assignments at the end of each class. They are asked to complete these short assignments prior to the next class. This has helped reinforce the skills and techniques taught during the classes and has given participants the tools long after the class ends. Participants have enjoyed the program so much that we are continually asked if they can participate a second time”, Coppola concludes.

     

    Social Engagement Strategies for Consumer eHealth Workshop

    Pinnacle Health Social

    mHealth + Telehealth World 2013- World Congress

    July 24- 26, 2013 in Boston

    Join our 2- hour Workshop to explore Social Engagement Strategies that activate consumers to participate in their health; sharing and tapping into peer lifestyle experiences and gaining expert guidance. You will see what healthcare leaders are investing in today, explore social eHealth opportunities for consumer engagement in the future and discuss how to launch a social strategy within your organization.

    During the Workshop,

    • Learn about key Social Engagement trends including social segmentation, social connect (programs & experts) and social data
    • See examples of Social Engagement Approaches used by Healthcare Innovators; Payers & Providers
    • Hear a Case Study of a Provider solution that “meaningfully” engages consumers with a private social community integrated with personalized content and communications
    • Participate in a Social Engagement Planning Discussion; Considerations, Approaches and Mobile & Tele-health tie-in Opportunities
    • Participate in a Group Innovation Exercise: Collectively define a specific social engagement initiative to positively impact consumer health (Workshop participants shape exercise)

    Workshop Leaders:

    Sherri Dorfman, MBA, Chief Executive Officer & Consumer eHealth Engagement Specialist, Stepping Stone Partners

    Lucy Reynales, Director, Wellness Layers

    Shelley Marshall, Web Marketing Manager, PinnacleHealth