St. Louis-based Ascension is doubling down on innovation with digital nudges for patients and clinicians and an increased focus on virtual care and remote patient monitoring.
To that end, the 121-hospital system recently launched a Clinical Innovation Institute to enhance the digital patient and provider experience.
“A lot of times, healthcare can be transactional: You get sick and get an appointment, it’s time for your follow-up appointment, but there’s a lot that happens in between,” Mitesh Patel, MD, vice president and chief clinical transformation officer of Ascension, told Becker’s. “So there are things we can do to support you.”
Ascension sends digital nudges to patients to, for instance, help prep them for upcoming appointments or care for a new baby. Ascension is also heavily invested in remote patient monitoring, supporting patients at home with biometric devices and text messaging to keep them connected to clinicians, and expanding virtual care across the system.
For its digital nudges, Ascension texts or emails patients and clinicians with information to fill care gaps. The health system built the platform in-house using Salesforce. A behavioral scientist on Dr. Patel’s team helps craft the messages with input from clinical departments.
Ascension has scaled mammogram and colon cancer screening nudges systemwide, and also launched previsit primary care messages. For the latter, the health system scans the patient’s EHR and reaches out with potential topics to discuss during their visit — say, the need for a blood test or a flu vaccine.
The messages were associated with a 20% hike in follow-through on primary care needs, a 17% drop in no-shows and cancellations, and a 2% net promoter score increase, according to a May study in NEJM Evidence.
“Sometimes you might say, ‘I have nothing to talk about. I’ll just cancel this appointment,'” Dr. Patel said. “Now we’re sending you a list of like, ‘Hey, here are three things that we should talk about that not only helps you prepare for this, but it helps you understand, like, why it’s important to get preventative care, because we need to talk about vaccination, cancer screening, diabetes management — things like that.’
“And we’ve heard that patients will come in and be like, ‘Hey, I got your care plan,’ and they’ll show them the phone. … So they really feel like it’s a personalized communication from their doctor, and that helps to make the discussion richer, and [improves] shared decision making, as opposed to them feeling like this is someone else’s agenda. … So it kind of cocreates the plans.”
Ascension decided to use the text-based system rather than a patient portal because not all patients are signed up for those platforms. “Overwhelmingly, patients want this, because text messages are just easier for patients, and they’re used to it,” Dr. Patel said. “It was a big effort for us to do this, but it’s starting to unlock a lot of things that we can do that maybe other health systems can’t do, where the EHR is enabling it.”
Ascension is also rapidly expanding virtual care. The health system is aiming to proactively identify visits that could be a virtual appointment. Ascension is also expanding teleneurology, already one of its largest hospital-based virtual care programs, and telepsychiatry, as well as adding virtual maternal infectious disease care.
“Ascension does not have the luxury of innovation for the sake of innovation,” Thomas Aloia, MD, executive vice president and chief clinical officer of Ascension, told Becker’s. “So all of our innovation programs have to touch on one of four values: Does it improve the patient experience or the provider experience? Does it improve safety and quality, and does it grow the business by opening up new access points like virtual care, for example, or extending our reach into the community? And then the fourth pillar is getting a double win at value-based care and really investing in population health.”
During remote patient monitoring, nudges give patients care reminders and physicians notifications to follow up after patients reach out to nurses for support. Ascension has launched three remote patient monitoring programs at scale, also via Salesforce.
For hip and knee replacements, the platform texts or emails to check in with patients before surgery then afterward every three months to track their recovery.
For postpartum mothers, the health system sends 12 care reminders that taper in frequency over the first four weeks after birth. About 90% of moms receive the full set of messages through 30 days, and about 20% of the women reach out to Ascension after getting a message. “We ask them just to pause, let them know that Ascension is here for them,” Dr. Patel said. “We give them one-click access to send us a secure message, and we also give them a phone number to their doctor’s office. And we say, ‘Here are the two or three things you should be thinking about this week. … If you have any issues on these things, please call us. We’re here to help.'”
Ascension piloted medication adherence nudges in Indiana and Tennessee before beginning to roll them out across the system, starting with statin patients and pregnant women. “It builds upon almost a decade of clinical trials that our teams had run … using this idea of gamification — making it fun and engaging, but leveraging these behavioral science principles and nudges,” Dr. Patel said. Patients pick up to four times a day to receive medication reminders, then reply “yes” or “no” to indicate whether they’ve complied. If they haven’t, a care team member will follow up. Patients can also respond “help” and be connected to an Ascension nurse in less than a minute.
Ascension also plans to pilot Bluetooth-enabled vital sign monitoring for patients both in the hospital and at home.
In addition, the health system is using AI for ambient note summarization and to help patients book and schedule appointments. Ascension is also exploring the deployment of conversational AI to triage patients.
“One of the fastest-moving areas of AI in our organization is to streamline the handoff process,” Dr. Aloia said. “For example, our nurse community may spend up to two hours of their eight-hour shift preparing the handoff for the next team. So we’ve implemented an AI pilot that will summarize the data in a number of seconds, and provide the nurse with that summary, where they can make edits over minutes of time. The idea of spending hours preparing for a handoff is in the past. So these things weave together, as we talk about work-life balance and the work health of our associates at Ascension, and particularly our nurses.”
The health system is also incubating new technologies. Ascension’s innovation tournament selects the most promising ideas from frontline staffers and puts them in front of leadership every six to 12 months. The health system’s innovation incubators work with service lines to identify and accelerate new needs.
“Everything is transforming these days with all the advances in digital health and AI … and we need to think about, ‘How are we going to design the future of care?” Dr. Patel said. “And so this gives us a hub to be able to bring these ideas, have a discussion, have an engaged group of leadership that’s able to say, ‘OK, this is highly aligned with what we’re looking to do. It’s good for patients, and it’s going to have a big impact. Let’s go ahead and accelerate the work.’ And so I see it really as adding focus and acceleration to a lot of the emerging things that we want to do at scale.”
— Becker’s editor Erica Cerutti contributed to this report.
