Trying to Reduce Readmissions? There's an App for That

Mobile technology has major potential to address shortcomings in healthcare delivery. It has already begun to impact outcomes in chronic disease management, care coordination and population health. And, federal organizations have shown support for the potential of mobile health by initiating challenges to create mobile applications. For instance, HHS sponsored a challenge for developers to create applications that help patients and providers prevent, detect, diagnose and treat cancer. Ask Dory!, one of the winners, uses data from www.ClinicalTrials.gov, to help patients find information about clinical trials for cancer and other diseases. My Cancer Genome, the other winner, provides cancer patients with therapeutic options based on their individual tumor gene mutations.

Mobile health applications can also give patients extremely easy access to health information. For example, Text4baby provides free evidence-based health messages to pregnant women, or women with an infant less than one year old.

Mobile health's prevalence and influence on healthcare is a rapidly growing. In 2011, the mobile health market reached over $718 million in the United States alone. The growth is evident in the beneficial applications already created and in use by the healthcare industry. If expectations that the mobile health market will continue to grow, potentially at a 24 percent annual rate, are correct, there could be many implications for healthcare delivery.

One area that has not been widely tapped by the mobile health market is the widespread issue of preventable readmissions. Readmissions are costly and with new CMS regulations like the Hospital Readmissions Reduction Program and the proposed Hospital Value-Based Purchasing program, they will only become more costly for hospitals. Under the programs, providers with high levels of preventable readmission rates could lose a portion of federal payments. Both programs take effect fiscal year 2013.

Unfortunately, many factors contribute to readmissions so there is no one size fits all solution. One big factor is patient compliance with medications and treatment protocols. Even without the federal regulations, many providers are looking for ways to connect with patients and aid their post-discharge process. This is where mobile health can play a role.

The Office of the National Coordinator for Health Information Technology launched a challenge in January for developers to create applications to help patients schedule follow-up appointments and post-discharge testing before leaving the hospital. Mobile health can also help lower readmissions in another way. Applications can be an effective means for eradicating the lack of information and communication breakdown issues that cause medical noncompliance and high readmissions.

Problem
Patients do not always hear, or remember, what is communicated to them during the discharge process. Patients receive a ton of information, which can be overwhelming. If they cannot remember, or they did not have a caregiver present at discharge, the likelihood of mistakes increases.  

"Many patients miss what is communicated during the discharge process," says Cliff Pollan, co-founder and CEO of VisibleGains, a software development company focusing on tools to improve communication between organizations and consumers. "Patients are relieved to be going home. They may also be distracted from a discouraging or promising prognosis. Whatever the case, they just may not hear their treatment recommendations."

Potential solution
Mobile technology can help fix the communication breakdown at discharge by giving patients, and hospitals, a convenient medium to monitor hospital discharge instructions and double check prescriptions. Medication and treatment accuracy, a major patient safety issue, could improve as a result.

Smartphones like Android and the iPhone have mobile-based applications that offer providers and patients a method for accessing and sharing health information. There are currently more than 17,000 mobile health applications in major app stores. Some apps, such as Postwire, created by VisibleGains, can capture treatment instructions and build a HIPAA-compliant personal website where the instructions are easily accessible by the patient.

"The Postwire concept has two major components," says Mr. Pollan. "First, to capture provider instructions, either by video or audio, so a patient can review the instructions; second, to organize the content so it is easily accessible for patients at home when they need to reference or share it with family members and caregivers."

What resulted was a mobile app to capture on-the-spot content inexpensively but reliably. The app enables medical staff to record specific instructions for the patient, combined with general information the medical staff may have on the disease or condition. The information is placed on a personal website for the patient.

How the app works

The mobile application works with a camera on the smartphone or tablet to record a provider giving instructions to the patient. Once content is recorded, the smartphone user can press a button to upload the content and publish the video or audio recording through the mobile app. A personal, secure website is built for the patient. The patient and the provider are sent a secure link to access the website. The provider can even add additional resources and treatment information later on.

HIPAA compliant
Since Postwire records a physician or nurse giving instructions to a patient, the content is private and needs to be HIPAA compliant. There are a variety of different ways that mobile applications follow and meet HIPAA regulations.

With Postwire, in order to upload content to a new or previously made personal website a login id and password is required. VisibleGains can set certain requirements for login ids and passwords so they are strong and secure, says Mr. Pollan. Additionally, certain time limits can be set so that after a few months the user must create a new login id.

Mobile applications also include strategies to deal with theft, a leading cause of data breaches. "If there were ever a reason that an internet connection was lost and the device could not upload the content, the content gets deleted automatically," says Mr. Pollan. "Additionally, if the mobile device is ever lost, VisibleGains has the capabilities to wipe the app off the phone so no one would have access to any patient treatment instructions."

Many mobile health applications use the same techniques to meet HIPAA regulations.

Health information technology, especially mobile health, must still conquer problems protecting patient personal information and securing data. However, mobile health can help reduce readmissions, manage chronic diseases and improve accessibility of health information. These benefits can help providers and patients become more accountable for health outcomes.

More Articles on Mobile Health:

4 Ways Mobile Technology Can Improve Care
7 Ways to Secure Physician Text Messages
Going "Social": Monitoring and Addressing HIPAA violations on Social Media

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