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 support (14)

    Dartmouth- Hitchcock’s ImagineCare Platform Leverages Wearables, Connected Health & Analytics for Personalized Patient Care

    Dartmouth-Hitchcock (D-H), an innovative New England healthcare system with 1,000+ providers is committed to creating a “sustainable health system”, which proactively engages patients through new care models to achieve the triple aim.

    Over the years, D-H has invested in technologies that empower patients to collaborate with providers through shared decision tools and Telehealth, treating “patients and their families as partners in care”.

    D-H has been a pioneer in innovative payment models with both the government and commercial payers.

    In early 2015, D-H’s leadership team committed to create a truly patient-centric healthcare organization, which delivers high quality proactive personalized care to the patient beyond the hospital walls.

    “Dartmouth-Hitchcock purposefully set out to assemble a team of employees with backgrounds from other consumer industries like hospitality and retail that would augment the world-class capabilities of our clinical staff, to improve the health care delivery experience”, explains Vin Fusca, COO, ImagineCare.

    With their consumer- centric “healthcare without boundaries” vision, D-H management has designed a truly “care- driven” solution.  ImagineCare, a cloud- based platform, enables providers to closely collaborate with each patient to meet her care goals at any time and from anywhere.

    ImagineCare treats the patient holistically through the active and passive collection of a comprehensive set of patient data. In addition to condition specific evidence-based care pathways (i.e. ImagineCare Hypertension Pathway, COPD Pathway, CHF Pathway, Diabetes Pathway), D-H incorporates a “Core Health Pathway” to capture steps, heart-rate activity, sleep, and stress (Behavioral Health), providing contextual insight into the patient’s health.  

    With ImagineCare, the Provider and patient have a window into the latest health status for insight and action. In the background, ImagineCare collects information from the patient (i.e. sensor- based devices, apps), combines it with EMR data (i.e. patient visits, labs, meds) and processes it through complex clinical care algorithms with machine intelligence to pinpoint when the patient is at risk. High tech meets high touch when ImagineCare notifies the RN or Health Navigator to reach out to the patient for real-time support and intervention. 

    “ImagineCare leverages the best available technologies to assist with care, but does not replace the importance of the human touch to drive behavior change. ImagineCare seamlessly combines these components to help patients achieve their health goals”, shares Dr. Ethan Berke, Chief Medical Officer, ImagineCare.

     Patient Experience

    During her recent doctor’s visit, (patient) Pam decides to participate in D-H’s new ImagineCare Program to help her lose weight and proactively manage her hypertension.

    Within 48 hours, Pam receives an email to quickly enroll in ImagineCare and a welcome call to discuss her personal health goals. Two days later a personalized ImagineCare Kit (box) is delivered to her door containing a program overview, a wireless blood pressure cuff and an activity band, devices which fit her selected health goals. Pam follows the instructions to connect her devices to the ImagineCare app.

    During enrollment, Pam’s shares her profile information such as personal health goals, challenges, communication preferences, family support, and defines her “medical neighborhood” (i.e. Providers, pharmacy, caregivers). She adds more information when responding to daily questions to create a rich picture about her health needs and resources required to tackle care plan activities.

    Anxious about her attempts to lose weight, Pam indicates in the mobile app that she only wants to receive texts to help her stay on track with her weight-management goal.

    Through the ImagineCare mobile app, Pam answers daily questions about how she is really doing, while her wireless blood pressure cuff and activity band retrieve and send real-time measures. Pam receives nudges, encouraging messages and digital check-ins to ensure she stays on track with her care plan. Yesterday’s text asked Pam if she was okay since she hadn’t provided her blood pressure as expected.

    D-H’s RNs and Health Navigators continuously monitor Pam’s health status, review her trends, and respond to risk warnings by reaching out via text which is her communication preference. Since Pam designates her daughter as a personal health representative within the mobile app, ImagineCare’s RNs are permitted to speak with her about Pam’s health.

    ImagineCare Success Measurement

    ImagineCare is designed to empower a health care organization to right-size provider visits, lower ED utilization and decrease admission and re-admissions. ImagineCare provides a more engaging solution to help health care delivery systems increase quality of care, decrease cost and improve patient experience.  

    In addition to these quantitative measures, D-H actively gathers qualitative patient feedback to understand the patient experience. Comments from patients about engaging in the ImagineCare program include:

    “I monitor my blood pressure every day, and after a particularly stressful day at the office I went home, took my blood pressure, and five minutes later one of the nurses called and talked me through an immediate care protocol.”

    “It has improved my ability to manage my health…The ability to connect with people for support and also send information to my healthcare providers, makes it easier.”

    "I am extremely impressed with the ImagineCare phone app. It is very easy to use and seems very intuitive”.

    ImagineCare Future

    ImagineCare is constantly updating its services and products based on patience engagement data, clinical data, and new technological capabilities coming to market. In a digital health landscape that is becoming more fragmented, ImagineCare will continually create holistic, customer-centered health services to better care for patient populations.

    D-H’s team has packaged up the ImagineCare platform for other providers, payers and (self- insured) employers to deliver personalized patient care for better outcomes.  

    Virtua Navigates Orthopedic Patients Pre- & Post-Surgery with Improved Patient Engagement and Care Coordination

    WELLBE PLATFORM FOR PATIENT ENGAGEMENTWith an aging population and increase in chronic conditions including obesity, the demand for hip and knee operation is increasing dramatically. A study in the Journal of Bone & Joint Surgery estimates by 2030 “demand for total hip arthroplasties to grow by 174% to 572,000 and demand for primary total knee arthroplasties by 673% to 3.48 million procedures”.

    Responding to this strong demand and high procedure expense, CMS launched the Comprehensive Care for Joint Replacement (CJR) payment bundle April 1st, focusing on cost and quality over a 90-day period beginning with the hospital admission. The CMS CJR Payment bundle is initially for about 800 selected hospitals across the country. 

    Although Virtua, one of New Jersey’s largest health systems with hospitals, surgical and rehabilitation centers, is voluntarily participating in the BPCI payment bundle, their investment in the orthopedic patient experience at their Joint Replacement Institute (JRI) started long before the payment model changes. 

    Virtua Health’s Orthopedic Patient Care Journey 

    Back in 2000, Virtua adopted the Six Sigma methodology and launched the STAR initiative to deliver an "outstanding patient experience”.

    “When we look at how we can change and improve a process, we focus on the patient and understand what they need, not what we think they need,” explains Kate Gillespie, AVP of Virtua’s Orthopedic Service Line. 

    With a commitment to enhancing the orthopedic (hip, knee) surgery experience, Virtua listened to patients discuss their challenges and needs. Through focus group research (Spring 2015), Virtua learned:
    • Orthopedic patients need a lot of information to get ready for their surgery but are overwhelmed when inundated with too much at one time.
    • Patients place a high value on their doctor’s suggestions to achieve best results.
    • Patients that are prepared are more confident and will participate in the process leading to improved outcomes.
      
    “We learned that as patients prepared for surgery, they were asked many of the same questions by different members of our care team,” said Gillespie. “We needed to improve the patient experience and ensure the consistency of information shared along the patient journey. We also wanted to engage the family to support the patient before and after surgery and decided to require that each patient has a ‘care partner’.” 

    The Virtua JRI team looked for technology to continuously engage patients and families, from on-boarding before surgery, to educating and guiding them from discharge through recovery.  The tool needed to be actionable, collecting essential information from the patient (i.e. concerns, pain levels) and informing Nurse Navigators when patients fall off track.

    Virtua JRI chose to implement a Connected CarePath for Total Joint Replacement from Wellbe, a solution provider in Madison, Wisconsin. Working closely with Wellbe, Virtua customized their CarePath with their own health history and sleep apnea surveys, scheduling and care plan content (delivered via “CareCards”). 

    Patient Journey 

    PATIENT CREATES CARECIRCLE ON WELLBEDuring the initial visit to the surgeon’s office, patient Patty is given information about Wellbe, a personalized care plan for her pre-and post-surgical journey. She signs up with the Nurse Navigator and receives a Welcome email. Patty shares this information and invites her family ‘Care Partner’ to join her CareCircle to access her resources.
     
    Pre- Surgery: Beginning 4-6 weeks prior to surgery, Patty views a care plan with a personalized set of “CareCards” explaining the operation and process to successfully prepare including preadmissions testing and health clearance forms. She receives a “CareCard” introduction to her Nurse Navigator. Every CareCard is delivered “from” her doctor or another member of her care team to motivate compliance. Patty receives reminder messages and checklist items leading up to the surgery and can refer to any completed CareCards in the “library” such as “How to prepare for the day of surgery.”  

    “Our patients really like the library feature. Before we launched the Wellbe platform, patients were given a Joint Replacement booklet. Now patients and families have all the surgery information at their fingertips.  Patients traveling to our Institute can prepare for their surgery by viewing videos instead of attending an in-person class,” adds Gillespie.  

    Post –Surgery: Within Wellbe, Patty views discharge information such as symptoms to watch for and completes surveys so that her care team can manage her recovery. Patty’s Nurse Navigator monitors her “Progress Report” with required actions and contacts her with any concerns. 

    “We believe this post-surgery engagement is important to prevent readmissions by ensuring the patient understands how to take medications, manage pain and follow outpatient physical therapy,” Gillespie shares.
     
    Patient Engagement Results

    Since launching the Wellbe platform in December 2015, Virtua JRI has enrolled 700 patients.  Patients span every socio-economic level and range from 40- 90 years old, with the majority in their 70s. 

    “We are signing up 86% of our surgery patients which is much higher than we expected. The remaining patients either did not have an email address or didn’t have a friend or family member to help them,” explains Gillespie.
     
    Virtua is evaluating success based on a few factors. Through a Wellbe survey, they are measuring how prepared the patient feels using the platform. With Wellbe reporting, Virtua is also measuring the patient’s engagement and compliance with required CareCards.

    Patients have shared positive comments about their experience using the tool - “grateful for the support received”. Nurse Navigators have also provided feedback - the Wellbe platform has helped them be more efficient in their patient care. Through “one tool”, nurses are able to “organize and track patient progress and communicate with the rest of the team” (i.e. physician office, pre-admission testing department). 

    Virtua has received suggested enhancements such as “defining an end time for a patient to be on the platform” and removing the medication form since patients “already gave the medication list to my surgeon.” Virtua has also added a link to the “Virtua Orthopedic Endowment”, giving patients an opportunity to give back. 

    Future Opportunities 

    Virtua initially launched the Wellbe platform without tying it into their Electronic Medical Record. “We are considering integrating Wellbe into our EMR so that the patient’s surgical chart will be easily available on one site for our Nurse Navigator.”   

    “Wellbe provides a key to patient engagement by keeping them engaged and participating towards a successful surgical journey. Virtua is determining where we can use this tool in other service lines such as Spine, Bariatric, Oncology and Maternity, which are all education-intensive clinical episodes.” 

    “This program aligns with our vision in keeping our focus on the patient /family experience, and provides us with an opportunities to participate in their surgical journey”, Gillespie concludes.  

     

    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

    Innovative Providers Use Technology to Stay Connected with Patients Pre- Surgery through Recovery 

    Healthloop Virtual Patient Check in

    Healthcare reform has placed increased demands on doctors who are already managing increased patient loads. As a result, doctors are spending less time with their patients.

    Patients are being asked to take on more responsibility in managing their care. This is particularly challenging before and after a surgical procedure. A patient typically leaves the hospital with a stack of paper discharge instructions about medications, the follow- up visit and a list of symptoms to monitor with directions to contact the doctor if problems occur. Throughout recovery, the patient is often left to figure things out because she "doesn’t want to bother the doctor".  When the patient makes uninformed decisions about medications or readiness to begin an activity level, it can set her back on her recovery path or lead to costly hospital readmissions.

    Other than checking in with patients during the follow- up visit, providers are in reactive mode; patients calling with complex problems or heading to the ER.

    Since patient satisfaction, care quality and costs are impacted by the current process, providers are motivated to find a solution that virtually supports the patient's needs for guidance, education and shared decision making.

    Virtual Patient Support

    It all started in 2007 when Dr. Jordan Shlain was treating a patient who wasn’t feeling well. After discussing her symptoms, he gave the patient his cell number and asked to please call him if she felt worse by morning. He discovered a few days later that she had developed pneumonia. From this experience, Dr. Shlain learned that although he wanted to be proactive with his care, he couldn’t depend on the patient to call with an update. His began texting patients asking “do you feel the same, better or worse?” Dr. Shlain did not take any chances and assumed that a non- response from the patient indicated there may be a problem.

    After speaking with providers about not really knowing how a patient is doing post discharge, they expressed interest in daily virtual interactions with the patient as a way to increase patient engagement and prevent readmissions. Patients loved the idea of interacting electronically with their doctor on a daily basis since it would give them unprecedented access to communicate concerns and address problems in a quick and convenient way. This was the backdrop that led to the development of Healthloop.

    “Since late June, we have been using Healthloop for patients who have hip and knee replacement surgery”, shares Dr. Mohan, Surgeon for a large Integrated Delivery Network. “Our team was looking for a solution that would enable us to share the experience together with our patient. We also wanted to put the patient in the driver’s seat and give them control, while we were in the passenger seat as an observer and navigator.” Dr. Mohan’s orthopedic patients are on Healthloop before surgery and throughout recovery which tends to be 1-3 months.

    Dr. Andrew Goldstone, ENT Surgeon at Greater Baltimore Medical Center started using Healthloop in February with his adult and pediatric patients throughout recovery which typically lasts 2-4 weeks. Healthloop electronic communications are delivered to the parents of his young patients for ongoing support. "HealthLoop, in a technologically modern way, tries to mimic the old days when we admitted patients a day or so before and kept them as many days as we or they wanted to stay after surgery. This gave patients and their families a comfort level that most current M.D.s have never witnessed. The same goes with patients who, after ambulatory surgery, pay at the next window and go home. They have no clue how patient friendly it used to be having an extended ’hand holding‘  before returning home. I view HealthLoop as an attempt to recreate that extended comfort,” explains Dr. Goldstone.

    Patient Experience

    HealthLoop enables the physician to support the patient before surgery and monitor him post discharge and between visits, engaging each patient “as if he is the most important person”. With the goal of delivering guidance when the patient needs it, Healthloop works closely with the provider organization to define the questions that patients ask at each step of the recovery process. Together, they review typical calls at day 1, 2, etc., determine the appropriate response and set up the schedule to deliver the information to the patient right when they need it.

    Taking a closer look at the patient experience, Gary is referred by his primary care physician to a specialist about knee surgery. After deciding together to move forward with the operation, the surgeon quickly enrolls Gary in Healthloop to guide him before and after the surgery. Gary receives an email to complete his enrollment including his preferences for receiving Healthloop communications (i.e. email, text). 

    Before surgery, Gary answers questions about risk factors and receives guidance and checklists to prepare for his operation. For example, he learns how to to prepare his house to easily navigate when he returns home following surgery.

    After surgery, Gary receives a daily electronic communication with a set of questions to understand how he is feeling (i.e. pain level, specific symptoms, problems with meds, etc.), personalized education materials, activity and medication reminders and a checklist of To Dos. Based on Gary’s feedback and progress, his care plan is updated and his next day’s check-in is automatically prepared. 

    Healthloop is designed for two way engagement. If Gary experiences any health problems, these are gathered through his check- in responses and trigger an SMS message to his care team for intervention and support.

    With recent integration to Apple’s Healthkit, patient information is extended beyond daily check- in responses to include health tracking data. For example, Gary’s doctor has instructed him to take steps while healing from his knee operation. Gary’s tracker information is combined with his daily check-ins to give his care team more insight into his health status. Concerned about not enough movement, his clinician may call and learn that Gary is not moving enough because of his medication side effects which can be addressed through a prescription change. 

    Pilot Feedback; Patients & Providers

    Healthloop wants to deliver a truly patient- centric communication channel and uses patient feedback to enhance the solution. After hearing a patient comment that the messages felt “too robotic” and “do not sound like they are coming from my doctor”, the communications were refined to be more conversational.

    Another patient commented that the messages were using doctor’s words which resulted in changes to incorporate more patient vocabulary and experience. For example, questions about a blood clot were replaced with “feels like a cramp in my calf”.

    Patient Comments

    Healthloop has delivered over 57,000 daily check-ins to patients and has received positive feedback about the experience:

    Guidance: “I wanted to be able to say ‘I have this” and have someone come back and say that is normal and here is the process. Then all of my negative energy goes away”, “easy way for me to make sure that I was on the track with my recovery”. “The questions promoted me to be more aware of my situation”.

    Convenience: “Without Healthloop. I would have called (doctor) 5- 7 times”, “This saved me a trip to my doctor”.

    Access: “It was an extension of my doctor so instead of talking to a nurse and having her get back to me, I had a direct conduit to my doctor.”

    Provider Comments

    Healthloop Clinician Dashboard

    “As our team developed our Healthloop, we charted out what a recovery really is. With this, I know what my patient is going through, can emphasize and say with confidence that over half of my patients have their pain under control after day 4”, explains Dr. Mohan. “We also participate in a Medical Destination Program with patients traveling to our hospital, often from out of state. After staying in a hotel for 10- 14 days, they come to see me for a follow-up visit before returning home. We are now thinking about how we can use Healthloop to manage their care from a distance to make sure that the patient has a successful recovery.”

    Comments from other providers:

    Patient Satisfaction: “My patients told me that they looked forward to their daily Healthloop check-ins because it felt like ‘someone was watching over me’ who really cared”.

    Operational Efficiency: “For my practice, the volume of calls from patients has dropped tremendously. I notice it and my staff notices it too.”  “I am thinking about eliminating the 2 week follow-up visit and to just see the patient at the 6 week visit since I can check in on their pain management, incision and any other issues through Healthloop.”

    Better Quality: “Helps us pick up complications much sooner. It reinforces a plan with what to do and reminders”, “We are raising the bar on care by ensuring that we are giving the patient the pre and post-surgery education and care that they need”.

    Success Measures

    Providers using Healthloop are evaluating a set of success factors based on their program goals. In addition to lower costs which is measured over time, providers are monitoring:

    Patient Engagement; Patient Satisfaction using the net promoter score.

    Better Quality; Benchmarking patient progress, measuring patient’s perceptions of care quality received

    Operational Efficiency; Call reduction to the practice 

    Regarding patient engagement, some providers are leveraging positive ratings through social media. Patients who give the highest scores (5 Star Ratings) are encouraged to share their ratings and experiences through the link provided to public review sites such as HealthGrades and Vitals. Patients who give average or below average score are asked to explain how the provider can improve. Patients have commented on everything from old waiting room magazines to being put on hold for too long when they call.

    With Healthloop, “my patients tell me that they are happy with the surgery because I was right there with them. I also notice patients are much more relaxed during their follow-up appointments. That is so important to me”, Dr. Mohan concludes.