About This Blog

 

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

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

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

MY EXPERTISE:

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

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

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

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

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

Follow me on Twitter @SherriDorfman

 

 

 

 

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    Entries in personalization for health and wellness (22)

    Geisinger Takes Mobile Patient Engagement to the Next Level

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

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

    Piloting Mobile App Supporting Bariatric Surgery 

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

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

    Patients have shared positive comments including:

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

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

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

    Building Mobile Apps Ourselves

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

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

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

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

    Mobile App Development Journey

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

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

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

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

    Future Mobile Health Roadmap

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

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

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

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

    RediClinic's Connected Health Weight Loss Program Designed for Continuous Consumer Engagement

    You cannot turn on the television or look at a newspaper today without being reminded of the obesity epidemic facing our nation. According to a CDC study, over 37% of U.S. adults are obese, while about 70% are overweight.

     Obesity has been associated with certain chronic conditions such as diabetes (type 2), cardiovascular disease and stroke. Last summer, American Medical Association classified Obesity as a disease, and the National Heart, Lung and Blood Institute recently published guidelines recommending that primary care physicians provide obesity counseling to all patients with Body Mass Index over 25 (which classifies them as overweight).

    Many Americans try to lose weight but do not have the tools or professional guidance to be successful. Most physicians don’t have the training or tools to provide a comprehensive weight management program in their practice, and sometimes refer patients to commercial programs that are not clinically supervised.

    RediClinic has stepped in to help. “We have developed a medically supervised program which is not just about weight loss but about health management”, explains Danielle Barrera, Chief Operating Officer at RediClinic. “When we developed this program in 2009, we noticed that many programs on the market were missing critical elements of a successful weight management program, and did not incorporate healthcare professionals, who are well positioned to have a significant impact on their patients’ lifestyle and health decisions.”

    According to IDC’s Connected Health 2014 Predictions, “Retail Clinics Will Disrupt the U.S. Healthcare System”. Most people think about Retail Clinics as a place for getting flu vaccinations or addressing acute problems such as strep throat or ear infections. Retail Clinics are bringing more services to the community and some are now offering preventive services (i.e. physical exams) and chronic disease monitoring.  

    Over the past two years, RediClinic has been offering a weight management program called Weigh Forward. Shoppers walk into one of their 30 locations inside grocery stores to sign up for the 10- week program. During the initial visit, the clinician does lab work to establish a base line to monitor progress in key health measures.  Throughout the program, the clinician provides guidance and teaches life skills not only to lose weight, but keep it off.

    “Our program is a ‘Connected Health’ model. Participants use the MyWeighForward  platform to access educational information, track food and physical activity, and receive online coaching and social support between visits to the clinic. During weekly visits to RediClinic, the clinician reviews the participant’s program information (i.e. goals, lab work, tracking information and eCoaching activity) to deliver personalized guidance.”

    RediClinic’s Weigh Forward program incorporates four key components which are reinforced both in- person and online through the program’s technology platform – myWeighForward.com: 

    RediClinics Patient Portal on MyWeighForward Platform

    1. Medical. Initial medical assessment with a comprehensive set of lab work, regular biometric monitoring and measurement, and weekly counseling by healthcare professionals.

    2. Behavior Modification. Proprietary assessment tool developed at Yale's Prevention Research Center by Dr. David Katz (WeighForward’s Medical Director) to identify and address individual barriers to success and readiness to change, to create a personalized weight loss plan.   

    3. Diet & Nutrition. Online educational information on food choices, weekly meal plans with 500+ recipes, and access to a diet/nutrition e-coach.

    4. Physical Activity. Customized activity plan based on preferences and abilities, access to fitness videos and the capability to collaborate with a fitness e-coach.

    Consumer Experience with the Weigh Forward Program

    Deborah Hastings signed up for RediClinic's 10- week Weigh Forward program to start shedding 60 pounds. Deborah's daughter is getting married in six months and Deborah wants to get around without pain in her knees and to fit into a new dress for this special event.

    During her first appointment, she meets with a clinician for a comprehensive evaluation to discuss her health and weight loss goals and determine her overall health status and readiness for change. She learns that her cholesterol and blood pressure are both high and that she is at risk for Metabolic Syndrome.

    She uses the MyWeighForward.com portal to follow a meal plan suggested by the clinician and dietician eCoach, view exercise videos, and to track both her food and physical activity.  

    Patient prepares for visit with clinician at RediClinic

    Deborah is preparing for week #5 visit which is teaching her that it “takes a village” to help her achieve her goals, and she needs support from family, friends and office co-workers. She inputs her Visit objective, completes her checklist of specific tasks and selects a "Barriers to Bust", how to deal with family when they are sabotaging her diet. This barrier is posted on her Visit Plan which she will review with the clinician during her RediClinic visit. While Deborah finishes her homework, her clinician reaches out to the eCoach that Deborah has been working with to discuss nutrition concerns. Within the private clinical portal on the Weigh Forward platform, they discuss strategies for Deborah. During the upcoming visit, Deborah will work with the clinician on the barrier she has selected and will consider suggestions from her eCoach. 

    Deborah has taken advantage of the social community capabilities on the Weigh Forward platform. She created a profile with demographic information and indicated how much program information to share with other participants. Deborah has decided to share the “Busting the Barrier” badges that she has earned each week. Deborah searched to find others like her and has connected with over a dozen new friends. She has also found an online group with her same barriers and is looking to gain some new real life strategies to address them.

    During her week #9 visit, her clinician will take a blood sample to compare key biometric markers to those measured at the beginning of the program. She will be able to view these measures and see her progress in reducing her cholesterol and Metabolic risk in her MyWeighForward program account .

    With several months before her daughter’s big event, Deborah is motivated to extend the program. She is planning on paying for the "Boost Maintenance Program with ongoing access to MyWeighForward with e-coaching as needed, monthly clinician visits and weekly in-clinic visits for "body composition analysis/biometrics".  

    Connected Health Program Engagement & Results

    Although the Weigh Forward Program was launched in 2011, it wasn’t until RediClinic moved to the new MyWeighForward Platform powered by Wellness Layers in October 2013 that they were able to offer enhanced functionality and support for patients and clinicians including: 

    • Personalized Consumer Experience & Outcome: Participants create their own mini- electronic health record which collects program information, preferences, visit planning, tracking data, social engagement and progress through health measures. Program participants have the convenience of seeing different clinicians within the same clinic based on appointment availability or in a different location since all RediClinic clinicians have access to the participant’s program information to deliver a consistently high quality and personalized experience.
    • Social Engagement: WeighForward participants use the platform 24x7 for ongoing emotional and educational support through their weight loss journey.
    • Clinician Support and Collaboration: Clinicians have their own portal, giving them access to information to support and consistently deliver the program and to privately and securely collaborate on care. RediClinic's Clinician Portal on MyWeighForward Platform
    • Care Continuum: Participants can access a Program Summary with their program health measures to send to their own doctors. “If the patient has secure messaging with their physician, they can share this information to include in their EMR”, adds Barrera.

    “Our results have been very positive. On average, our patients are losing 1- 2 lbs per week which is considered to be a healthy rate of weight loss, and are significantly improving their cardio-metabolic risk factors. In many cases our patients have moved from pre-hypertensive and hypertensive to normal and pre-diabetic to normal”, exclaims Barrera.

    Comments from Program Participants 

    What I liked about the online part of the program was that it gave me homework to do to keep me accountable and focused.

    I had been the 'queen of couch potatoes.' The best things about the program were the accountability each week, recipes and shopping list, and incredible support from the staff

    Dr. David Katz's lesson on Trial by Aisle taught me to check ingredients lists for hidden sugars and salts, and to pick the shorter lists. The best thing about the program was it provided me with information to change my unhealthy lifestyle into a healthy lifestyle.

    Future plans: New Business Model, New Technology Platform Capabilities

    Today, most program participants walk into to RediClinic. However, RediClinic is now licensing the Weigh Forward program to other healthcare providers. “We’ve had significant interest and many pilot commitments from large healthcare systems and physician groups, as well as companies that operate retail, urgent care and worksite clinics. Everyone is looking for a turn-key weight and lifestyle management solution for their patients because obesity is so pervasive and expensive. Weigh Forward is one of the few comprehensive programs that is designed to be delivered by clinicians with no previous background in weight management,” Barrera adds.

    Regardless of where the consumer is seen, in the clinic or in their PCP’s office, RediClinic is extending the capabilities of the WeighForward technology platform. “We are continuing to enhance the social networking capabilities of the platform, will introduce a mobile version later this year, and are beginning to develop modified versions of Weigh Forward that address chronic diseases, since the platform we’ve built is flexible and extensible”, concludes Barrera. 

    Mayo Pilots myCare iPad App for Cardiac Surgery Support, Engaging Patients & Families

    A team of clinicians at Mayo Clinic designed an iPad app to help cardiac surgery patients and their families participate in the pre and post surgery process, creating a patient-sided driver of successful recovery. 

    Dr. David J. Cook, a Mayo Clinic anesthesiologist leading the Discovery Project team had personal inspiration for this application. “My mother had cardiac surgery and shared her experiences. As a patient gets ready for surgery, there is a tremendous amount of anxiety and uncertainty. We ran focus groups with patients and heard about the frequent disconnect between patients and providers about what to they can expect during the hospital stay. Patients may be poorly informed about what will happen over the course of a hospitalization or what they can expect any given day and it is difficult for patients to manage information and learn when they are under stress. With this iPad application, we clearly communicate what is happening today, what to expect during your stay, what patients need to know, and what a normal recovery looks like.”
     
    The Mayo myCare iPad application displays a personalized “Plan of Stay” showing patients and their families what is planned each day. Specifically, the patient’s Plan of Stay is organized into four sections each day; “Clinical Milestones, “Gaining strength”, “Education” and “Planning my Recovery”.  “In 'To Do' Lists, we give patients knowledge, self-assessments (i.e. pain level)  and self reporting tools to facilitate and document their participation in their recovery plan.  We can tell them how much to walk each day, ask them how much they walked and measure it remotely”, explains Dr. Cook. “We want to help our patients feel more in control and part of the process, as a partner with their care team. This significantly shifts the nature of the medical relationship as patients become more educated. They can now ask questions about any step in the surgery process because they are better informed”.  

    While in surgery, the myCare iPad is used by the patient’s spouse, child or other family member to better understand what to expect that day, thru surgery and upon discharge. “We worked closely with our discharge planners, social workers and therapists to recognize the barriers that patients and families face and developed modules to help drive critical conversations, such as the who, how and when of preparing for the patient’s needs when they leave the hospital.  We identify barriers such as driving limitations or need for support with other daily activities. These are critical conversations to have and yet they often fly under the radar screen for physicians who typically focus on the specifics of surgical recovery,” emphasizes Dr. Cook.    

    The myCare iPad application presents clinicians with a care population and an “individual recovery dashboard” to monitor the patient’s progress through recovery.  It aggregates data on the patient’s use of the education, recovery planning and self-assessment tools and provides alerts when patients did not, or were predicted to not, meet recovery expectations.  The direct patient input and data aggregation enables providers to get an earlier look at progress and allows for rapid mobilization of resources to address patient needs. This was an important factor in reducing hospital length of stay in the patients using the program.

    Pilot Success Measures & Evaluation

    The Mayo Clinic iPad Pilot was conducted with 149 cardiac surgery patients from early February 2012 and through mid-November. Pilot patients ranged in age from 52 to 85 years old, with an average age of 69 years old.

    One important success measure for Mayo is patient and family satisfaction. Mayo sent separate surveys to patients and their families and received an over 90% satisfaction rate.  Questions were asked about the overall hospital experience, satisfaction with their care, but also how well informed they were and how easy it was for them to use the technology they were provided with. Even though this was an older population more than 80% of patients said felt very comfortable using the program after a day or two. Here are some of their comments: 
    The IPad was a valuable addition to overall patient care and provided a more confident “going home” feeling for us.

    I would strongly recommend the MyCare IPad, it helped me to understand each day what to expect instead of the high anxiety of wondering if what my husband was going through was normal.  

    ..is was very nice to see day to day what my Dad should be doing to recover from surgery so I can help him improve, also the knowledge that we had helped us figure out what step to take next

    In addition to patient and family satisfaction, Mayo is measuring care quality, care cost and length of stay. “A principal driver in the care cost are the people resources required to support the patient. Acquiring and managing data in this way allows for the more appropriate and targeted use of personnel resources. One of our patient participants was a physician hospital administrator who indicated that his ability to do his own discharge planning assessment before surgery had the potential to more wisely use hospital resources and direct those valuable resources to other patients who needed them more. In fact he completed and scored his discharge planning assessment (with what is typically a provider tool) before he was ever seen by a discharge planner. This and other patient self-assessment tools such as daily mobility accomplishments, have implications about how we assign resources to patients based on their needs. With this app, we can now focus our personnel on patients with more need”, shares Cook. 

    Future Engagement Opportunities with iPad App

    The Mayo iPad application currently supports the patient while in the hospital. Mayo has not moved this outside of the hospital because they are “proceeding carefully” and working through the privacy and security issues that come with moving data outside their firewalls. “Over the year, we are planning to address those issues so we can extend the iPad recovery support program 30 days post discharge to prevent readmission and in two years we are looking to support longer term care management.

    We developed this iPad solution with patient education, self assessment and reporting and we are planning to extend this solutions into 5 or 6 different care areas in the near term”, explains Cook.” On the tracking side, we have already built in FitBit integration so that we know how much our patients are moving. In the future, we will enable the solution to be configured with remote monitoring devices for patients who are obese or have diabetes for example”. 

    Dr. Cook feels that this represents a new model for health care delivery. “Making patients knowledgeable, giving them the tools for self-assessment and setting expectations that they participate in their care is the model for managing health care in this country and bending the cost and quality curve.”

    Connected Mobile Health Apps to Sustain Consumer Engagement

    World Congress Leadership Summit on Mobile Health, July 25-27th in Boston

    Over the past three years, I have participated in this interesting event by running a workshop or panel.

    During my panel this summer,  you will learn how health care organizations are investing in the drivers for continuous consumer engagement: 
    • Connecting multiple mobile apps to personalize the care shopping, decision making and care collaboration experience. 
    • Connecting mobile into chronic care programs with integrated tools for self management, shared decision making and coaching support.
    • Connecting mobile into wellness programs with capabilities to harness social community influence, digital coaching and incentives for motivation.
    Moderator:
       Sherri Dorfman, CEO & Consumer eHealth Engagement Specialist,
       Stepping Stone Partners

    Panelists:
    • Dan Brostek, Head of Member and Consumer Engagement, Aetna
    • Michael Yetter, Director, eBusiness, Independence Blue Cross
    • Nick Martin, VP Innovation and R&D, UnitedHealth Group
    • Patrick Feeney, Director, Mobile and Emerging Technologies, Blue Cross Blue Shield Illinois 

    Evolving Web Based and Mobile Tools to Engage Consumers in the Shared Decision Making Process

     

    World Congress Leadership Summit on Shared Decision Making

    September 23, 2011

    Panel Session:

  • Piloting and evaluating SDM tools in the Patient Centered Medical Home to drive physician- patient collaboration for better outcomes
  • Testing an online platform for shared decision making with health coaches across different consumer segments and conditions for ongoing behavior change
  • Designing an integrated experience as consumers use SDM tools across multiple channels and multiple care touches
  • Leveraging a mobile decision support tool to effectively educate consumers and enable them to evaluate their care options while on the go.
  •  

    Moderator:

    Sherri Dorfman, MBA, Chief Executive Officer, Stepping Stone Partners

    Panelists:

    • Mark L. Robitaille, MBA, Head of Care Management Support & Engagement, Aetna
    • Changrong Ji, Senior Solutions Architect, CareFirst BCBS (Mobile strategy)
    • Zev Lavon, PHD, Director Solution Architecture, CareFirst BCBS (Web strategy)
    • James J. Mis, MBA, Communications Manager, Health Care Services, Independent Health