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, partnership and marketing strategies.

My Expertise: 

Over 18 years ago, I moved my focus from consumer-centric technologies in other industries (i.e. financial services, retail) to healthcare technology.  

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 Planning: Product conceptualization, definition and validation through Marketing Research. Work Sessions for product suite planning with solutions from mergers, acquisitions, partnerships and purchases

> 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 online health and wellness coaching (14)

    Intelligent, On- Demand Healthcare Concierge Provides Personalized Patient Experience

     

    It all started with a simple question one day, and grew into a trusted health relationship a few short months later. Sarah was very busy at work that crisp fall morning and had only a few minutes to log in and ask about her daughter’s diabetes medication. Sarah was comforted by the response and a bit intrigued when her Health Assistant Harriet introduced herself and explained that she is a resource to help her and her family with any of her health questions or concerns. They began a conversation about her daughter’s condition and a trusted relationship began.

    Later that week Harriet made a follow up call to see if Sarah was able to pick up her daughter’s medication and asked how everything was going. Sarah mentioned that she finally got her daughter’s pills and confided that she was completely overwhelmed. Sarah shared that she was recently diagnosed with breast cancer and that her husband was often unavailable as he traveled constantly for work. She explained that she had a hard time getting to her treatments. After their call, Harriet explored and evaluated resources, and scheduled transportation to help Sarah get to her next appointment. Harriet put the appointment confirmation into Sarah’s patient portal and set up a reminder, including date and time, about the ride to her next treatment.

    This may sound like fiction in the current healthcare environment, where services are siloed and patients are burdened with making their own decisions around healthcare – often complex and costly. Sarah is relieved to have this service today. She first learned from her employer about the Accolade platform and health advisor service last summer. It wasn’t until she reached out with a simple question to her health assistant that Sarah experienced the true value of having a healthcare advisor on her side.

    A 2016 Harris Poll reveals that 84% of working families placed a value on having a single, trusted resource to help support their healthcare needs. Busy families have limited time and resources so they appreciate having one place to go to help them understand their options and sort through their healthcare decisions. 

    Personalized Patient Experience

    With the Accolade Health Assistant as the single point of contact for her family, Sarah is able to reach out to Harriet for guidance all along her and her family’s healthcare journeys.  Accolade integrates high tech and high touch to deliver a superior patient experience with lower healthcare costs. 

    Accolade Health Assistant Harriet accesses the Accolade platform to interact with and personalize her support for Sarah:

    Preferred Communication: Harriet engages with Sarah and her family based on their communication preferences. Sarah likes phone calls and email through the Accolade online portal. Sarah’s husband Sam prefers secure text messages since he can send quick messages and follow up later during his business trips.  

    Personalized & Proactive Experience: Harriet’s interactions with Sarah are driven by rich patient profile information, which contains contextual information, social determinants of health and service utilization. Sarah and her family’s profiles are updated with data collected over time and more than 150 data feeds integrated into the Accolade platform. The HIPAA-certified approach creates profiles that are continuously analyzed through sophisticated algorithms and health assistant reviews, which allow for personalized conversations around individual health needs, care gaps and obstacles.

    A recent Accolade platform trigger prompts Harriet to reach out to Sarah’s husband Sam when she notices that he is still refilling this pain medication many weeks after his knee surgery.  Harriet sent a text to Sam to inquire about his knee surgery. After a text exchange, Harriett suggested that he see his doctor to discuss his persistent pain.

    Patient Education & Connected Health: Sarah and her family can access educational information and recommended health apps. Before Sarah’s husband knee operation, Health Assistant Harriet texted Sam with a link to a video and suggested questions to prepare for his surgery and provider discussion. 

    When Harriett spoke with Sarah about her daughter’s diabetes appointment and care plan, Harriet informed Sarah about the Livongo mobile diabetes application available through her employer’s health plan. Together, they review the Livongo app, which can help Sarah and her daughter better track and manage her diabetes. With Accolade and Livongo, Sarah is able to share information from the mobile app with her daughter’s doctor, giving him insight into her problems with controlling her A1C levels.

    Continuous Connection to Clinical Resources and Support:  Harriett asked Sarah if she would like to speak with an oncology nurse to help prepare her for her upcoming oncologist appointment. Margaret, an Accolade Clinical Health Assistant and RN, joined them on the line and offered empathetic support by asking more about Sarah’s diagnosis, where she was in her care plan with her doctor, whether she had a support network and what was planned for her next appointment. Margaret provided Sarah with questions to ask her oncologist and recommended a follow-up discussion.

    Intelligent Engagement: Harriet and her Health Assistant team are continuously alerted by the Accolade platform. On an ongoing basis Accolade gathers, aggregates and models de-identified data to trigger alerts and guide Health Assistants in further personalizing their interactions with their clients.  Health Assistants are prompted to ask questions about health behaviors and emerging symptoms, applying specialized training and skillset. 

    Patient Experience Success Measures:

    Paul Csigi, Director of Benefits at Philadelphia- based Temple University Health System (TUHS), rolled out the Accolade solution in 2015 and has over 7,000 employees on the platform today.  “So much of healthcare is getting people to the right place at the right time. Accolade has created an experience where our employees build a relationship with an assistant that gives them what they need, when they need it. Accolade takes a single problem that the patient has called in about and creates a relationship to support the family on an ongoing basis. With all of the information about our employees, Accolade addresses the whole person, connects the patient with clinical resources, and continues to reach out. This helps treat our employees sooner, which is less expensive for our organization.”

    In addition to financial measures, TUHS monitors qualitative feedback from employees. With the Accolade platform outreach (phone or online), TUHS is able to capture the patient’s experience engaging with their Accolade Health Assistant:

    “I'd like to thank Temple for the Accolade program. We have been going through some really tough times…..my health assistants have been a big support and a big help to my family in helping to guide us to the right doctors to help with family issues and illnesses. I really appreciate this program. Without it, I'd really be lost.”

     “It is great having that person who is able to explain things to you and walk you through the process….It makes navigating the current health care world so much easier and less stressful. That is exactly what you need when you are dealing with a health care issue.”

     “I spoke with my health assistant and then with the nurse, and they were incredibly helpful. They spent a lot of time on the phone with me, helping me understand how to navigate the system, and what questions to ask.”

     “He [Clinical Health Assistant] made this very difficult hospitalization for my husband an easier journey. Without him, I wouldn't have been able to accomplish many things….I am extremely grateful.”

    Patient Experience Journey

    With two years of the Accolade solution under their belt, Paul Csigi and his team are considering new ways to support TUHS employees. “I have an employee population with diabetes and heart disease. I am interested in learning more about Accolade’s partnerships to bring patient data into the platform to support these populations.”  Csigi sees the benefit of bringing in data from patient devices and smart applications. Integrating this data with the patient’s medical record gives new insights to Accolade Health Assistants, empowering them to deliver even better support and drive improved outcomes.

    Carolinas HealthCare System Pilots Prevent PreDiabetes Program via Virtual Group Coaching

    OMADA HEALTH CONSUMER VIEW

    The Centers for Disease Control and Prevention (CDC) has revealed that 86 million, 1 in 3 Americans now have prediabetes, and 9 out of 10 of them don’t even know they have the condition. Unless there is an intervention, 15% to 30% of people with prediabetes will develop type 2 diabetes within 5 years. The CDC predicts that if current trends continue, 1 in 3 Americans will have diabetes by 2040.  On average, diabetes patients cost approximately $10,000 more every year than those without the condition. Like many chronic conditions, risk for type 2 diabetes can be reduced through lifestyle changes.

    “We knew that we needed a way to leverage technology to assist our employees who have prediabetes. With our employees spread across 900 locations in North and South Carolina, one huge challenge was figuring out how to motivate employees to participate in a prediabetes program that required them to go to a defined place (building) at a defined time, every week, and do this for 16 weeks.” explains Dr. Zeev Neuwirth, Senior Medical Director of Primary Care at Carolinas HealthCare System.

    Carolinas HealthCare System (CHS) was approached by Omada Health with a solution. Omada's online Prevent platform delivers a 16- week National Diabetes Prevention Program recognized by the CDC, with two years of peer-reviewed published data demonstrating effectiveness.

    Neuwirth explains further, “We were very interested in the Omada solution.  First, it had some really sophisticated and elegant behavior change mechanisms making it much easier for people to create and maintain healthier habits.  Second, it was online and asynchronous – meaning that people did not have to show up at a certain time,or certain place. They could use the program from the comfort of their home, and at any time of day or night which makes it much easier for people to sign up and stay with the program. Third, Prevent is based on a proven 16-week program. The Omada platform provides the social connection with a health coach and other participants to sustain behavior change, continuous real-time feedback and daily tasks for habit formation."

    “When I participated in the program, I looked at my weight on the Omada scale daily. This led me to be much more aware of my eating and exercise habits. But even more than that, having the bluetooth enabled scale in my house, connected to the coach, I felt like I was part of a larger community, all focused on becoming healthier. Stepping onto that scale almost felt like being transported – the social connectivity factor was much more powerful than I anticipated”, Neuwirth shares. 

    In early 2015, CHS began offering this solution to employees (called teammates) at risk for developing type 2 diabetes. To promote this new program, CHS leveraged their LiveWell Team which had trusted relationships with teammates across different locations for a “boots on the ground” approach. CHS teammates were emailed a complete Prevent program description, with their participation responsibilities clearly communicated.  

         Prevent Program includes:
    • Short online health assessment to determine if you are a candidate
    • Wireless scale provided to you, for daily weigh-ins
    • Group of peers who will be your online “team”
    • Online interactions with a dedicated, professional health coach
    • Daily and weekly tracking of your progress with your coach and team
    Interested teammates clicked on the email link to answer the Prevent screening questions. Qualified teammates enrolled into a cohort of 10-12 anonymous teammates, were assigned to a coach from Omada Health and received a Welcome package with a bluetooth scale.

    During the 16-week Prevent “Core” phase, participants complete one interactive health lesson each week, covering physiological, social and psychological aspects for change reinforced with interactive games. After the Core phase, teammates move into the “Sustain” phase with access to more education and a broader peer group for ongoing support.

    OMADA HEALTH COACH VIEWTeammates and their coach collaborate via the Omada Health platform. The coach monitors progress and gives real-time feedback via private messaging, group discussion board, text messaging or by phone. Teammates use food and activity trackers to capture high level daily eating, drinking and movement and engage in “healthy competition” messaging with other group members. Cohorts keep them motivated and accountable. Teammates can see the cohort member’s progress towards the weight goal displayed on the group dashboard by a green circle around their profile picture. Only the coach can view each teammate’s detailed progress page with tracked weight, food and activity information.

    Prevent Program Positive Response

    To date, over 400 teammates have participated in the Prevent program, with 245 completing the 16-week program. 

    “Teammates have found it beneficial to participate in the program”, explains Kati Davis, Director Benefit Planning and Wellness at Carolinas HealthCare System. “They are guided by trained coaches, supported by cohorts and can participate when it is convenient for them, from wherever they are.. at home or the work.”

    CHS is evaluating the program success through quantitative measures (i.e. weight loss, program engagement) and qualitative feedback.

    “Although the primary goal was to engage teammates in the program, we have been very happy with the results - 40% of our Prevent participants have lost more than 5% of their weight.  When you are considering the risk for prediabetes, this weight loss has a big impact on the health of the teammate.”

    “Our teammates are engaging with the Prevent platform an average of 12+ times each week, completing educational lessons, weigh-ins, tracking food/activity, participating in discussions and exchanging private messages with their coach”, Davis adds.

         Teammate comments:
    • The information has been helpful. I know that if I do what it says, I can avoid diabetes. If I don't, I am almost sure to be a diabetic.
    • Nice to have others going through the same struggles and working together for improvement
    • Currently in the 9th week of the program and I have lost 17 pounds. I love the app. I hope that at the end of the 16 weeks my scale will continue to work with the app and the tools I have been using will still be there.

    Future Direction for Carolinas HealthCare

    “We're working to move away from self-reported health activities to activities that require additional accountability and social support”, describes Davis. “We feel the support from the coach and cohort is very powerful to rejoice in the teammate’s success”.  

    CHS is currently considering to offer the Prevent program to a wider population at risk for Metabolic Syndrome, where weight is an important factor to monitor and manage.

    Neuwirth concludes, “From the perspective of a forward-thinking healthcare provider organization, we are excited about the potential of making significant improvements in the health of the multiple populations we care for – our employees, our much larger patient population, and the communities that we serve in the Carolinas.  Reducing the number of people who transition from PreDiabetes to Diabetes is one of the largest levers we have to improve the health of populations and communities. What makes this particular Omada Prevent Program attractive to providers and employers is that it makes it a lot easier and much more doable for the people we are trying to help.”

    Note: The Omada Health screen shots above do not display real health data. 

    Stanford’s ClickWell: Virtual Model for Primary Care

    In January 2015, Stanford Medicine launched ClickWell Care, a new type of Primary Care clinic which leverages technology to allow patients to virtually connect with their own Stanford primary care clinicians and wellness coaches via video or phone visits.  Patients use the MyHealth mobile app to schedule and conduct a video visit and share home health device data with the care team. Through this model, patients can choose to receive all of their primary care including integrated wellness coaching virtually, unless the physician indicates the need to come into the clinic for vaccinations, pap smears, procedures, or other physical exam needs.

    “Initially we created this virtual model for our ACO. We knew that 18-30 year olds were not interacting with primary care and were choosing to go to the Emergency Department or urgent care for their needs. During focus groups with this patient population, we learned they were so busy and didn’t have time to come into the office but really valued the relationship with their doctor. They wanted to receive care from their doctor but it wasn’t available in a way that was convenient to them.  We knew that we needed to use technology to help support this relationship and not replace it”, explains Sumbul Desai, Medical Director ClickWell Care and Vice Chair of Strategy and Innovation in the Department of Medicine at Stanford University School of Medicine.

    ClickWell clinicians and coaches support healthy patients and the ‘rising risk’ (e.g. up to 2 conditions), who are employees of Stanford University, Stanford Adult and Children’s Hospitals. With this highly educated, tech savvy patient population, there is a tremendous opportunity to leverage mobile tools to enhance the patient experience.

    Patients see a doctor for primary care visits and engage with a wellness coach on health goals (i.e. weight loss, stress, activity, and nutrition) and to receive support for chronic conditions (i.e. diabetes, hypertension and hyperlipidemia).  “The average age of a ClickWell patient is 36 years old.  However, we have a growing group of 40-65 year olds, part of the ‘rising risk’ population, who prefer to do the majority of their visits virtually. These patients feel comfortable interacting by phone or video because they have a better understanding of the healthcare system and their health goals than our younger patients”, Desai shares.

    The ClickWell Care program is designed to give patients complete control over how they want to access and interact with their doctor/coach and convenience of extended hours. Although patients have the option of scheduling a face to face appointment, they are incentivized to participate in a “no fee” virtual phone or video visit. Patients simply log into the MyHealth portal for their virtual appointment. 

    To date in the ClickWell program, there have been 2,142 visits; 43% conducted in-person, 32% through phone visits and 25% via video visits. ClickWell staff have seen 1,223 patients. Although 30% of new patients start off with a virtual visit, most prefer to meet their doctor first in-person. After an initial face to face visit, 60% opt to see their doctor virtually for their return visits via phone or video.

    MyHealth Mobile AppAll patient information from the virtual visit is transmitted to the Epic EMR and is accessible through the MyHealth portal. Patients can ask follow up questions through the portal.  When patients need to have blood work done, they are directed to the lab without having to come into the doctor’s office, and lab results are incorporated into the EMR with portal access. “Stanford was the first to use Epic’s integrated telemedicine service because we wanted this visit information available to patients in the portal and clinicians in their daily workflow”, confirms Lauren Cheung, Physician, ClickWell Care, and Medical Director, Strategic Innovations at Stanford University School of Medicine.

    “One myth about telemedicine is that many patients choose to do video visits over phone visits. The truth is that it is an extra effort for the patient to participate in a video visit since the patient needs to be in front of a computer or mobile screen versus the phone visit which can be done while walking around”,  Cheung adds.

    “Back in 2013, we rolled out video visits as part of our primary care practice but we didn’t see a strong uptake. When we conceived the ClickWell Care program, we knew that we needed to introduce wellness coaching to provide a complete overall healthcare experience and deliver a higher level of healthcare service to our patients”, describes Desai.

    Strong collaboration with IT and Operations have been pivotal in implementing this new care model. Through this collaboration, ClickWell has been able to leverage the new MyHealth app developed internally and has worked closely with IT to improve the platform and video visit capabilities to provide an excellent patient experience.

    As part of the ClickWell Care program, the MyHealth mobile app helps strengthen care collaboration. The doctor/coach prescribes the health tracking app to the patient as a way to monitor key measures which may include steps, weight and blood pressure. The patient uses the MyHealth app to upload tracking data from Withings, Fitbit and Apple HealthKit to the EMR, sharing health status between visits. “When I see a patient with blood pressure trending higher, I ask the patient to schedule an online visit so that we can discuss how to address this through diet or medication changes”, Cheung explains.

    ClickWell Lessons Learned

    The Stanford Medicine team has gained insight into ClickWell Care program usage, the telehealth platform and mobile app to bring the most value to primary care patients and providers. They understand that it is not about the technology but instead about how the technology is put into the care model through a program.

    Patients have shared many positive comments about the ClickWell Care program:

    “Video visits allowed me to continue with pressing work concerns, instead of taking time off work to travel to a clinic. Video visits allowed me to chat with a Doctor late in the evening, and appointments were very easy to get.  I felt that my virtual care was more personalized and provided a better experience.

    “I have not had many medical issues until recently. It is such a relief being able to ask questions and get answers quickly. My wellness appointments have me watching my diet and exercise regimen. Everything is done efficiently. I cannot say enough about the whole team that has been watching over me.”

    “My experience with the ClickWell Clinic has been extremely informative and remarkably efficient. The flexibility they offer works perfect for people with busy schedules, without sacrificing the quality of care. The model of the Clinic makes other forms of healthcare communication feel outdated.”  

    “I have never had better communication and quicker responses than I have since becoming part of this program. I travel a lot and therefore keeping up via phone calls is not that practical. Being able to send messages electronically and to have an appointment via video chat is ideal.”

    Doctors and wellness coaches have provided mostly positive feedback as well:

    “Overall my experience with virtual visits in the clinic has been very positive. Compared to my previous experience with only in-person visits, it seems like the virtual option may make wellness patients more likely to continue with follow-ups. The integration with the doctors is also helpful in learning more about the patients and providing well-rounded care. It is a unique experience to be able to discuss treatments so closely with the patient’s doctors and in such a timely manner.”

    “The integration of clinical care with wellness coaching has been phenomenal. I couldn’t imagine going back to health coaching without it. I am able to provide more targeted, individualized, and thorough care to my patients since I have full access to their medical records, provider notes, and work directly with their primary care physicians. Working directly alongside physicians has helped me to expand my knowledge on chronic disease management, stay up to date on clinical guidelines and recommendations.”

    “As a provider, the technologies we use in this clinic allow us to quickly connect with our patients and address concerns for our patients proactively. The extended hours also allow for expanded patient access, as well as a flexible schedule for providers who staff the clinic who may desire alternative hours outside of the usual 9-5 business day.” 

    “Through our discussions with patients, we have also heard some suggestions for change. In the beginning, we were contacting patients to convince them to switch from in person to virtual visits. This frustrated some patients and most wanted to stay with the modality that they had initially chosen”, Desai shares. 

    Future ClickWell Care

    As with other healthcare systems across the country, Stanford Medicine sees what is happening with the retail pharmacies increasing care access to patients. However, they believe this only fragments care because the visits are outside of the patient/doctor relationship. ClickWell Care is designed to be “longitudinal” and not episodic.

    In 2016, Stanford Medicine is looking to extend into specialty care. “We are interested in integrating preventative cardiology for our patients since care entails discussing and improving risk factors for cardiovascular disease, which can be done virtually. Preventative cardiology patients would also benefit from wellness coaching to improve their risk factors for disease.

    We also want to expand the use of connected health devices. Currently, very few patients upload and share their data with our care team. We are planning to incorporate this health tracking into a program for a  patient population (e.g. specific chronic conditions) and integrate this information into clinical workflow to ensure that these patients receive excellent care. With our Precision Health initiative, we are not just interested in treating illness but rather finding tools to deliver a personalized health and wellness experience to ensure the best outcomes”, Desai concludes.

    Brigham and Women’s Primary Practice Pilots New Mobile App to Drive Patient Engagement & Collaborative Care 

    Twine Health Mobile App Engages Patients with Chronic ConditionsThe story about the health decline of our citizens is being told everywhere. According to the CDC website, “as of 2012, about half of all adults—117 million people—have one or more chronic health conditions. One of four adults has two or more chronic health conditions”.

    This negative trend is driving up healthcare costs and putting an ongoing strain on our healthcare system. A 2010 Robert Wood Johnson Foundation Report on Chronic Care: Making the Case for Ongoing Care states that eighty-five percent of all health care spending was on people with chronic conditions.

    The positive part of the story is where the industry is heading. In the December 2014 PwC Health Research Institute (HRI) Report, two relevant health directions are described. The first is the “Do –It Yourself Healthcare movement” with implications for healthcare organizations to offer new patient engagement tools. The second is that “physician extenders see an expanded role in patient care”, where “doctor delegates” play an increasing role on the care team, which helps address physician shortages.

    The real opportunity is at the intersection of the two, where patients use Do- It Yourself (i.e. self- management) tools which collect and communicate patient data (e.g. chronic condition vitals, medication adherence, lifestyle choices) to “doctor delegates”, who deliver guidance and support during the 99% of the time that the patient is living with his chronic condition.  

    Innovative healthcare organizations are experimenting with new technology tools and care delivery models to bring better care to their patient populations. 

    Care Collaboration for Hypertensive Patients  

    Through Twine, patient collaborates with her nurse coach“We were looking for a way to help our Hypertensive patients get their blood pressure under control more quickly”, explains Dr. Katherine Rose, Brigham and Women’s Advanced Primary Care Associates, South Huntington. “When a patient is having trouble managing his blood pressure, we ask him to schedule a follow -up visit. We have found that some patients choose not to come in for another visit. When our nurses call patients to check- in on their blood pressure numbers, many patients don’t have them which limits the support that our nurses can provide”.

    The CDC confirms that hypertension is a growing problem in the U.S; “67 million adults (31%) have high blood pressure” and only about “half (47%) have their condition under control”.

    Dr. Rose and her colleagues were determined to find a better way to support hypertensive patients through continuous communication and collaboration with their care team. “After evaluating different ways to leverage technology with a strong patient experience, we decided to use the Twine Health platform. In October 2014, we started a 6- month pilot and plan to recruit one hundred patients to participate”.

    Twine Health is a spin- off from MIT Media Lab’s New Media Medicine Group. John O. Moore, MD, CEO and his team have designed the Twine solution with the goal of empowering patients to be an “apprentice”, learning to be “active participants in their care, par­ticularly care of chronic disease”.

    The Twine Collaborative Care Platform allows people to co-create a personalized care plan that serve as common ground for continuous collaboration with their care team; their own clinicians, family and friends, and a health coach (sometimes staffed by the clinic and sometimes provided on-demand by Twine).

    Twine Health was awarded an opportunity to pilot as a winner of the Brigham and Women’s Hospital 2014 Pilot Shark Tank competition. “We are very excited about the Twine pilot,” shares Lesley Solomon, MBA, Executive Director of the Brigham Innovation Hub. “The Brigham is dedicated to providing outstanding patient care and we believe that innovative health IT solutions like Twine will help us to improve patient experience and engagement and better enable our clinicians to address complex clinical challenges. We look forward to seeing the results of this pilot."

    Hypertensive Patient Pilot

    Dr. Rose explains that initially patients in her practice were recruited during an office visit. After hearing about Twine Health from her doctor, an interested patient worked closely with the Nurse to download the mobile app to her phone, set up her care plan, goals and select daily activities to support self- management.

    Patient recruitment efforts are being accelerated through an email campaign with a link to the Twine mobile app and through television promotional messages in the waiting room. These communications show patients how to use the Twine Health mobile app to receive ongoing support and guidance from their nurse at the practice. Patients learn that they do not need to come in for all of their visits and can communicate their blood pressure readings and health behaviors digitally for continuous care.

    Once enrolled in the Twine Health program, patient Patricia can view her daily care plan and check off activities which include completing certain activities (e.g. taking medications, walking, relaxing) and avoiding others (e.g. not eating salty foods, reducing alcohol consumption). Patricia can elect to receive reminders to take her medications, log her blood pressure readings and walk at lunch. She can monitor progress towards her goal and send a secure message to her nurse.

    Nurse monitors chronic patients needing motivation and supportNurse Nancy monitors the Twine Health dashboard to see her patient’s care plan progress and identify patients that need support (e.g. missed medications, failed to measure blood pressure, blood pressure measure out of range). Nancy sees patient’s blood pressure readings, number of days adherent and days remaining on the patient’s care plan and quickly answers patient’s questions or concerns (e.g. running out of medication, experiencing medication side effects). She sends congratulatory messages to Patricia and other patients reaching goals and encouraging messages to less engaged patients to come back onto Twine to share information and issues. Nurse Nancy creates new and modifies existing care plans working closely with her patients. She also uses the platform to check in with the patient’s doctor about care plan and medication changes.

    Pilot Considerations

    Dr. Rose and her colleagues worked closely with the Twine team to plan their pilot.

    Participant Selection:

    “Not all of our patients have a smart phone which is required to access the Twine Health platform. We also needed to choose patients who would feel comfortable using a smart phone to support and extend their care. Since Twine is currently available in English, we are only offering it to selected patients”, Dr Rose explains.

    Nurse Selection:

    “As we thought about the role of coaching and motivating our patients to better manage their hypertension, we decided to use our LPNs to support the Twine Health program. Our LPNs interface with our patients all the time and are often on their computers doing triage. At our practice, we also like to have our professional team members operating at their top of license.”

    EMR Inclusion:

    Dr. Rose wanted to incorporate summarized patient data information into their EMR and appreciated that Twine Health created a note template to capture changes in the care plan, goals and medications. The nurse copies and pastes this information into the EMR so that everyone can access the latest patient care information. 

    Pilot Evaluation

    At the end of the 6- month pilot, Dr. Rose and her team will review qualitative and quantitative feedback from patients and clinicians. “We will also look at measures to see how often the patient’s blood pressure was controlled, how many blood pressure check visits were avoided, how engaged the patients were (e.g. use the platform, make better lifestyle decisions) and how satisfied patients felt (i.e. their team took better care of them).

    Patient Feedback

    Patients appreciate encouraging feedback from their nurse, find it motivating and feel a sense of achievement when reaching their goal.  They also like being able to ask the nurse questions through the app that they may not have otherwise asked.

    “Our patients are helping us enhance Twine. For example, a patient suggested that we expand the capability to add blood pressure measurements more than once a day” describes Dr. Rose.

    Clinician Feedback

    The clinicians using Twine value understanding what is happening to the patient outside of the office visit to provide ongoing support. From a clinical perspective, Dr. Rose shares “I am excited that the app gives the patient ownership of their health.  While working with one patient on his care plan, he suggested increasing the time on his stationary bike to avoid adding a medication.  Since extending his exercising will help more than just his blood pressure, I was all for it”.

    The Twine platform gives clinicians at the Brigham and Women's practice valuable visibility into the barriers that impact the patient’s adherence. With this insight, nurses are able to better understand and provide more relevant guidance to support the patient holistically for better outcomes.

    Dr. Rose explains “there are many reasons why patients are unable to take their medications.  Some are simple—the pharmacy didn’t get the prescription, and others are more complex—the patient has concerns about a possible side effect.  As providers, we sometimes don’t hear about the problem for a couple of months which is lost time. With improved communication tools, we can address problems immediately, hopefully improving compliance and health outcomes”.

    With only two months into the Twine Health Pilot, Dr. Rose admits that they are just beginning.

    “We will be looking at the financial impact of using the Twine platform. So far we know that our nurses are spending 20- 30 minutes to set up each patient and 25- 30 minutes daily responding to and motivating patients,” confides Dr. Rose.

    She appreciates that Twine Health conducts conference calls with other healthcare organizations participating in pilot programs to learn ‘best practices’ together such as incorporating Twine into existing workflows, recruiting patients, engaging patients and trying an approach for a specific patient segment.

    “Ultimately we think that patients who are more engaged in their care and mindful of their choices will be healthier. We are excited to use new technologies like Twine to encourage that”, Dr. Rose concludes.

    Interested in seeing Twine Health results across all hypertensive patients? Twine displays this on an aggregate level through their online dashboard

    University Hospitals’ Rainbow Care Connection Engages Pediatric Patients & Family Caregivers

    In January 2013, University Hospitals Rainbow Babies & Children’s Hospital launched the Rainbow Care Connection, a pediatric accountable care organization (ACO) with a $12.7 million CMS innovation grant to support children in Northeast Ohio, a third are enrolled in Medicaid. This innovative ACO has developed several successful mobile health initiatives to drive care collaboration with patients as part of their Physician Extension Team. This blog focuses on two key mobile health initiatives; iPads Minis for children with complex chronic conditions and HealthSpotSM, a community- based telemedicine kiosk.

    iPad Mini For Care Collaboration

    “We wanted to help children with chronic medical conditions, especially those who have difficulty speaking or getting around.  For children that cannot walk, it is challenging to get them to the office. By giving them an iPad Mini, these children are able to communicate with their care team including physicians, nurses, social workers and dieticians”, explains Dr. Richard Grossberg, Medical Director of University Hospitals Center for Comprehensive Care. “Our goal with this project is to reduce office and ER visits with this video connectivity.”

    In partnership with UH’s Rainbow Care Connection, the Center for Comprehensive Care strives to pioneer innovative ways to support children with complex chronic conditions, which can often seem overwhelming from a family’s perspective. As medical care continues to grow more complex, healthcare professionals acknowledge that families may need support beyond the clinic and hospital walls in order to be successful.

    Children with complex chronic conditions make up about 5% of children who access health care services but account for up to 50% of Medicaid dollars spent. “We were looking for an additional layer to outpatient care; providing families with an opportunity to manage less acute issues in the comfort of their own home”, Dr. Grossberg shares. “Launched in December 2013, we felt that video calls would be the most innovative and cost effective solution to accomplish this and have currently distributed 10 iPad mini devices to families.”

    How do video calls work? A family uses their iPad mini to conduct a “video call” with the office. During their telemedicine visit, a Comprehensive Care nurse helps the family triage what is happening and can resolve or escalate care to a physician/nurse practitioner or acute care setting when needed. Additional applications of the video call are being trialed including conducting nutritional counseling and education by UH’s Comprehensive Care dietitians and therapeutic counseling completed by their Comprehensive Care social workers.

    After the video call, the visit summary is documented and sent to the patient’s PCP.  If a video call is escalated to include an ED or hospitalization, the UH acute care team has full electronic access to all of the video calls and assessment notes.  Having the necessary tools to help guide a family though those moments when their child’s complex conditions go awry and help them overcome barriers to care is critical to helping families receive better care, achieve better health and gain a healthcare partner to share in their patient experiences.

    HealthSpotSM Station

    UH’s Rainbow Care Connection aims to reduce ER costs by finding new ways to support patients who go the ER with minor medical problems.   

    “Since we know that 70% of Medicaid patients in the ER can be managed in a less acute setting, we were looking for an alternative to provide access to care after hours. We wanted to test offering a solution in a community setting to see if this population would feel more comfortable getting after hours care in their own neighborhood rather than from a medical setting. We felt that telemedicine would be the most cost effective solution to accomplish this”, shares Dr. Andrew Hertz, Medical Director of University Hospitals Rainbow Care Connection. We had already piloted a HealthSpotSM kiosk running in our clinic and were ready to place a kiosk into a community setting”, Dr. Hertz explains.

    “We decided on the HealthSpotSM kiosk vs other telemedicine units because of the incredible patient experience provided by the HealthSpotSM unit, including diagnostic equipment and the ability to transmit real-time vital signs and physical images.” Dr. Hertz and his team thought carefully about where to place the kiosk. “We started with a zip code analysis of patients coming into our ER to select potential locations and met with Community Neighborhood Association Leaders to discuss options. We chose the Friendly Inn Settlement (community building) in Cleveland and launched the program in October 2013.”

    How does the HealthSpotSM kiosk work? A patient and their family members step into the fully enclosed kiosk with a medical assistant who helps support them during their high-definition video conference visit with the doctor who may be located a few towns away. “Our doctor is on the computer screen, with video and audio connectivity to instruments (i.e. scale, blood pressure cuff, stethoscope, otoscope, thermometer, dermascope, pulse oximeter) and decides which tools to use and when by unlocking the door at the right time. It is cool when they unlock it. It is magical to see the door open and the instrument there. Our patients and their families see what physician is seeing as they use their different devices. It is a wonderful educational experience”, describes Dr. Hertz.

    Patients use the HealthSpotSM kiosk to take care of minor ailments and get check-ups, as an alternative to an emergency room visit. A parent/guardian can accompany a child from age three to 18 during their visit to the UH Rainbow HealthSpotSM station during weekdays from 5:30 – 11 p.m. and weekends from 1 – 11 p.m.

    Since the launch of HealthSpotSM, Dr. Hertz and his team at UH have met with over 50 patients, with problems including rashes, fever, strep throat and pink eye. 

    After the remote appointment with the doctor, the visit summary is documented and sent manually to the patient’s PCP. “Our physicians currently document the visit on paper and fax it to the PCP who may be outside of the UH network. Over 50% of these patients are not in UH Rainbow’s system so we share their information like a retail clinic. We have an interest in having HealthSpotSM integrate this visit information into our hospital EMR,” explains Dr. Hertz.  

    “Anytime we can spend time with a patient in their own environment, we can better understand and address their needs.” Dr. Hertz adds that by understanding why patients choose the ER as their source of care enables his team to identify opportunities to change that behavior and meet patient needs.  Certainly, having after-hours access to quality care in the inner city is valued by patients since the ER is often their only after-hours option. 

    Patients and family caregivers have had a very positive experience with the telemedicine visit within UH’s HealthSpotSM  kiosk. 85% have indicated that if they did not have the HealthSpotSM  visit, they would have gone to the ER. Over 90% would use it again. Here are some comments around value of the visit to them:

    It's convenient and less time consuming.

    I love the equipment and technology.

    The one on one with the doctor.

    That you get to see what's going on inside the little areas most doctors won't show you. 

    Close to home and speed of service.

    Very helpful for my community.


    Future Opportunities for UH Patient & Family Engagement  

    The team at the UH Rainbow Babies & Children’s Hospital Rainbow Care Connection is already planning ways to use the HealthSpotSM kiosk to bring care access to other patient populations. “Next we want to use telemedicine to enhance access to care in rural areas, where there are not a lot of specialists or after hours care options. We are planning to place a kiosk in a community building or a school”, Dr. Hertz adds.   

    In addition to expanding the HealthSpotSM kiosks, Dr. Hertz is interested in finding patient engagement tools that will help patients receive care through their phones to support the lower social economic population that tends to own mobile phones rather than computers. “No one has developed the mobile app for patients to receive care through smart phones which would enable a ‘meaningful clinical interaction’,” concludes Dr. Hertz.