Jeni Williams

Learn how mobile applications and technologies are improving quality of care, patient satisfaction, safety, and convenience-and reducing costs.

At a Glance  

Hospitals should keep three considerations in mind when developing a mobile app or tool:

• Focus on a tool that can help patients determine whether a physician visit is needed.
• Have finance professionals play a supporting rather than a leading role in the development of in-house mobile health apps.
• Keep it simple (for instance, by limiting the number of steps patients have to go through to use a mobile app or tool).

Disruptive innovation in health care-the introduction of new technologies, products, and services that make care more convenient, accessible, and affordable-is marking the move toward a value-based delivery model, says Jason Hwang, MD, coauthor of the book The Innovator's Prescription: A Disruptive Solution for Health Care. And the emerging use of mobile applications and devices in hospitals and clinics is one sign of the disruptive innovation taking place.

Across the country, innovative organizations and clinicians are using mobile apps and devices to provide more convenient, safer, and higher-quality care. Private investment in healthcare technologies-particularly technologies that can reduce healthcare costs by improving quality of care-is increasing. A report released in late 2011 shows that the mobile health applications market has experienced substantial growth since 2010, when these applications recorded revenues of $230 million; by 2015, revenues from mobile health apps are expected to reach $392 million (Analysis of the U.S. Broadband mHealth Applications Market: Revolutionizing the Evolving Health IT Ecosystem, Frost & Sullivan, Dec. 21, 2011).

"Disruption in business models has been the dominant historical mechanism for making things more affordable and accessible, and for generating corporate and economic growth," says Hwang, executive director of health care at Innosight Institute, which recently studied successful integrated health systems to determine their critical factors for success. Hwang gave a presentation on disruptive innovation to healthcare leaders at HFMA's Thought Leadership Retreat this past October.

"Healthcare technologies matched to the right business models can deliver convenient, accessible care," Hwang says. To improve value in health care, he says, these technologies should be "taking the simple stuff off the plates of your most highly skilled specialists and allowing them to spend more time on high-value work with patients."

How are some hospitals and health systems taking the lead in using medical apps and technologies to improve value in health care? Here, organizations share their innovative approaches.

eVisits for Patients

At UPMC in Pittsburgh, an innovative tool is facilitating online interactions between patients and physicians that can eliminate the need for a visit to a physician's office, urgent care center, or emergency department (ED).

UPMC's eVisit program allows patients of UPMC physicians who have signed onto the health system's patient portal to complete a detailed questionnaire from any Internet-enabled device regarding their ailments. Physicians worked with IT professionals to create a list of questions specific to 17 conditions ranging from colds, ear infections, and conjunctivitis to upper respiratory infections, shingles, and erectile dysfunction.

Patients receive a response quickly-often within minutes, and usually within about four hours. If a prescription is required, the order is transmitted electronically to the patient's pharmacy.

The price for an eVisit is $40, "about the same as a copay for a physician office visit, to make it more attractive for patients to try this," says Ann Marie Evans, CFO for UPMC's physician services division. Since August 2008, more than 4,000 eVisits have been recorded; monthly visits topped 100 for the first time in October 2010 and 200 in December 2010. Women between the ages of 30 and 49 are the most frequent users of eVisits; patients between the ages of 50 and 64 are the second-highest group of users.

eVisits has reduced wait times in physician offices and UPMC's ED and has steadily become a hit with patients and employers in the Pittsburgh area. "Our community does not jump on the bandwagon for every virtual thing that's put before them, but they've found value in this tool," Evans says. "Employers are beginning to get more energized about eVisits now that they've seen that it helps employees to avoid leaving their workspace when they have a cold and need to see their physicians. And it's so convenient from a patient standpoint."

Early 400 primary care and internal medicine physicians participate in eVisits, and the health system plans to branch out to include specialty physicians in what UPMC promotes as its "digital house call" service.

Launching the program wasn't easy. "The most difficult aspects of designing the eVisits program were having the right clinical platform from which to do this, having clinical experts weigh in and agree upon the algorithm for asking the right questions online, and making sure that eVisits would fit into physicians' workflow," says G. Daniel Martich, MD, UPMC's chief medical information officer. "And certainly, we wanted to get paid for these visits."

One of the keys to success of the initiative was that physicians were actively involved in determining the content and design of the tool. Once the tool was launched and physicians saw that the workflows associated with eVisits would not adversely affect their ability to manage in-office visits and that patient information would be kept secure, participation in the program grew.

The majority of the insurance market doesn't recognize eVisits: Just one commercial insurer has agreed to pay UPMC for eVisits on an every-time basis. "We went ahead with the program in spite of that," Evans says. "We have some passionate physicians who are very innovative and see this tool as an opportunity to lower the cost of health care."

Patients appreciate both the convenience of eVisits and the reduced wait times for in-office appointments that have resulted from use of the tool-and knowing that patients find value in eVisits makes it attractive to physicians as well.

"It's a differentiator for us," Evans says.

PineApp for Patients

Want to know the wait times at urgent care centers or hospital EDs in the area? At Baptist Health South Florida, a mobile app created by the health system provides the answer.

Two years ago, Baptist Health South Florida designed a "PineApp"-a play on the health system's pineapple logo-to help patients quickly scan the "door-to-doctor" wait times at nearby EDs and urgent care centers in the Baptist Health network (eight EDs and 13 urgent care centers in the Miami-South Florida area) and to access driving directions and contact information for the facilities from a mobile phone or iPad. Wait times are provided in 15-minute intervals for urgent care centers and one-hour intervals for hospital EDs.

Exhibit 1

"We have a very innovative COO who received a call from his son asking for the location of the closest urgent care center. Twenty minutes later, his son called back: 'Thanks, Dad. You sent me to one that is closed.' That's when the idea was born: 'How about an app that can answer that basic question, give people directions on how to get there, and even help them choose the facility with the shortest wait time? If consumers had this information, they might even drive a little extra distance for a shorter wait.'" says Mimi Taylor, vice president of IT and CIO for Baptist Health South Florida. "We decided to invent something that we could put on an iPad, iPhone, or Android device that would make it easy for people who are in need of urgent or emergency care to see what the wait times are in deciding where to go for treatment. And we wanted to ensure that the wait times that we posted were the times from the moment a patient enters the department to the time he sees a physician, because that's the waiting period that patients are most interested in-not the amount of time it takes to be triaged."

Since the PineApp was launched in October 2010, it has been downloaded more than 12,000 times. Wait times at Baptist Health South Florida EDs were most often 50 minutes or less between May and December 2011, the first time period in which wait times at the EDs were tracked. Patient satisfaction at both the health system's EDs and its urgent care centers has increased, and although health system officials are not certain how much of a role the PineApp has had in this increase, "I think some of the satisfaction can be attributed to the PineApp," Taylor says.

Exhibit 2

Baptist Health South Florida spent six months developing the prototype for the tool and another two months tweaking it before it went live. At first, the health system had a manual procedure for calculating the wait times and entering the data into the app; there were fears that using the ED tracking and documentation system to automatically calculate these times would put too much stress on the system. However, in May 2011, the health system developed a way for the ED tracking and documentation system to automatically calculate these times down to the minute and feed them into the app, creating time savings for staff.

Staff and physicians were initially concerned that the app would give patients unrealistic expectations of how long it would take for them to receive care. "Knowing that we were going to give estimates of the time it would take to be seen by a physician, rather than the time it would take to be triaged, put those concerns at ease," Taylor says.

They also feared the app would prompt unhealthy competition among the health system's EDs and urgent care centers in the quest to have the lowest wait times possible. "There is healthy competition among the emergency departments and urgent care centers. No one likes thinking that it might take 10 minutes to be seen by a physician at another site when it might take an hour to be seen at yours," Taylor says. Posting the times in half-hour intervals, rather than down to the minute, alleviates some of this concern and helps to ensure that patient expectations are realistic.

"It really is amazing that as an industry we've gotten to the point where we're able to provide real-time information regarding wait times on a mobile device," Taylor says. "This is a great example of the value that technology brings to the healthcare industry and to the patients and communities we serve."

Medication/Patient Care App for Nurses

At 135-bed Jane Philips Medical Center in Bartlesville, Okla., nurses are preventing medication errors and adverse drug events with the help of an app they can access from an iPod Touch.

Nurses carry the devices in their pockets as they deliver patient care. When medications are administered, they use the device to scan the barcode of each drug, then scan the patient's barcode and wait for the device to signal that the right medication is being given to the right patient at the right time, using information from the patient's electronic health record for verification.

The app also has the capability to track specimen collection, infant care regimens, care interventions, and care team communications and to view and manage the patient's care plan.

Jane Phillips Medical Center participated in a beta test of the app for the company that manufactures the device in the fall of 2010, deploying the device in the hospital's cardiology unit. "I was concerned that more experienced nurses would have trouble adapting to the device, but the technology is so intuitive that even nurses who didn't have an iPhone or an iPad could grasp how to use it right away," says Susan Herron, chief nursing officer for the hospital. "All of the comments we received from nurses were very positive: It fits into their pockets and is user friendly, and it's very techno hip."

The hospital implemented the device hospitalwide in February 2011. In 2011, the hospital pharmacy dispensed about 750,000 drugs. The hospital's medication error rate was just 1.84 per 10,000 doses. "That means that 9,998 times out of 10,000, we're giving patients the right drug at the right time in the right route, which is pretty impressive," Herron says. The use of bedside barcode scanning in general has enabled the Jane Phillips Medical Center to enhance its medication administration, which has resulted in timely, efficient care and improved patient safety.

"We have been able to use the medication verification features of this device to better ensure medication accuracy and upgrade the overall hospital stay, furthering patient safety benefits for those who seek care as well as those who provide it," Herron says. "Eliminating medication errors not only improves quality of care and patient safety, but also protects a hospital financially."

The ability to document near-misses-medication errors that are stopped before harm can occur-through the device is perhaps its greatest source of value for the hospital.

"Technology such as this gives nurses peace of mind. They can go home after their shift and know with certainty that they were accurate and effective in their work," Herron says. "Anything that assures them that all is well is a good thing."

Mobile Drug Reference Tool for Physicians

Jason Hughes, DO, used to carry a box of books with him when he went to hospitals to round on patients, so he could review references for potential drug interactions and the side effects that patients might expect from the medications he prescribed.

Now, he carries an iPad.

A mobile app that Hughes can access via an iPad or smartphone gives him the ability to review drug prescribing and safety information for thousands of medications, check for the potential for harmful drug-drug interactions with other medications the patient is taking, view images of a drug, refresh himself on the effects of a drug on certain areas of the body, and review potential side effects of a medication.

"This resource is phenomenal: It's thorough; it's simple; it's easy to use," says Hughes, an internist with Koolauloa Community Health and Wellness Center, Kahuku, Hawaii. "Within a hospital, time is an issue: You need to be able to look up drugs and access information about medications quickly and efficiently. This tool provides an immeasurable value in my work with patients." Physicians who use the resource in a hospital or physician office setting say the tool enhances quality of care and patient safety. "It helps me in knowing what to do and when to do it," Hughes said. "The drug interactions feature is especially helpful in ensuring that the medications I'm prescribing don't combine in a harmful way with medications the patient is already taking."

Exhibit 3

The company that created the tool also has designed apps for referencing diseases, interpreting laboratory and diagnostic tests, looking up billing codes, accessing recommendations for treatment of infectious disease, and more.

Jacob Varghese, MD, a family practice physician with Southeast Permanente Medical Group, Atlanta, uses the tool with "at least half of my patients on any given day."

"When I see that a patient is coming in with a diagnosis, I can recap the condition before I greet the patient, especially if the condition is something I haven't seen in a while," Varghese says. "I can quickly review information regarding appropriate testing, common symptoms, and treatment options, so that when I walk into the room, I can have a more informed discussion with the patient. And if I'm about to prescribe a medication to a patient who presents with five or six different medications that were prescribed by another doctor, I can say, 'Hey, let's make sure these medications you're already taking aren't going to interfere or interact badly with the medication I'm about to prescribe.' Often, I'll discover interactions among the medications the patient has already been taking. It provides an opportunity to discuss medication safety and tolerance and things of that nature.

"Patients appreciate that I'm taking the time to be thorough and to help them be better informed as well," he says. "To me, this is an invaluable tool that is opening a door to patient safety that might not have been broached before."

Varghese has found that he spends more time visiting with patients in his office when he uses the mobile reference apps, but "I look at the time as an investment," he says. "Patients really appreciate knowing the potential side effects of a drug, and the discussions I'm having while they are in the office are probably saving me a lot of phone calls afterward, because patients have a better idea of what to expect.

"Tools such as this help to build a better doctor-patient relationship-and that's priceless."

Lessons Learned

How can hospitals provide greater value to their communities through mobile apps and technologies? Here are a few tips.

Focus on a tool that can help patients determine whether a physician visit is needed. "Giving patients the tools they need to determine whether to schedule an appointment with their doctor is one of the biggest ways hospitals can improve value," says Jason Hwang. "It could be that a webcam interview or an online chat with a nurse practitioner will suffice-and organizations could charge for this service."

Have finance professionals play a supporting rather than a leading role in the development of in-house mobile health apps. UPMC's eVisits program exemplifies this point. "Because this tool is so clinically focused, it's not something that a group of finance professionals could dream up and make happen," says Evans of UPMC. "Finance really has to function more as a supporting role in the design and implementation of a tool like this."

Keep it simple. "If we had designed something with 1,000 steps for patients to complete to get through the process, it would have hindered our success," Martich says of UPMC's eVisits tool. "The physicians who helped design eVisits were really focused on creating a tool that not only would be convenient, but also would provide the information they needed to treat a patient appropriately."

Jeni Williams is associate managing editor, HFMA's Westchester, Ill., office.

Publication Date: Friday, June 01, 2012