- The Nemours Children’s Health System has added mHealth to its cardiac care program, giving providers, patients and parents a connected health platform to improve care management and coordination outside the hospital.
The Jacksonville, Fla.-based health system, consisting of the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and the Nemours Children’s Hospital in Orlando, Fla., has launched a mobile health app for patients with single ventricle disease and their families. The digital health platform, the second in a series planned by the health system, serves as a link between the hospital and the home for care guidance, resources and real-time communication.
“The app answers a lot of problems we have in healthcare delivery,” says Dr. David Hehir, chief of Cardiac Intensive Care at Nemours, by connecting patients and providers when they most need to collaborate.
The cardiac care app was modelled after the health system’s asthma app, launched earlier this year as part of a long-term effort to integrate digital health tools with the health system’s telehealth and telemedicine platforms. That app now has more than 300 enrolled users, and health system officials hope to have 400 using it by the end of the year.
PJ Gorenc, the operating officer for the Nemours Center for Health Delivery Innovation, says it has exceeded expectations in patient engagement.
“We see almost three logins per month per user,” he said. “And the engagement tools are working; for example, we saw an uptick in July engagement when air quality conditions triggered alerts out to users, so we are seeing the behavior we hoped to see. And better engagement will lead to better outcomes for our asthma patients.”
Gorenc says the health system’s cardiac teams asked for an app for their single ventricle disease patients after seeing a demo of the asthma app.
“They felt strongly that high-risk cardiac patients were an appropriate population for this kind of technology,” he says.
Unlike the asthma app, which is a chronic care management tool, Gorenc and Hehir say the cardiac care app targets a fragile population that requires quick intervention when things go wrong. Six patients and their families are now using the app, and the health system hopes to have 10 families on board by the end of the year.
The app acts as “an early warning system,” Gorenc says, “that allows clinicians to identify as quickly as possible if there has been any degradation in the patient’s health so they can get care right away, thus increasing survival rates.”
“Single ventricle patients typically undergo three surgeries in the first few years of life to repair their defect,” he adds, noting the app is designed to help families through those three surgeries. “The highest mortality occurs between the first and second surgeries – about 12 percent nationally. The goal of the app is to push mortality to zero.”
The app is integrated with Nemours’ electronic medical record platform and monitors weight gain, output and oxygen saturation. It also features tools for appointments, messaging and medication, and a daily video log that allows clinicians to see the babies’ breathing and incision in real time.
It has already proven its value. Gorenc says one family pointed out an area of redness around their baby’s incision in the video log; their doctors saw the video and immediately ordered treatment for an infection.
“For the families of fragile babies, it can be scary to leave the hospital,” Gorenc says. “Early users have said it makes them feel much better about taking their baby home.”
“It empowers patients and their families,” adds Hehir, noting parents are traditionally sent home with several pieces of paper but often ask for that “one-pager” – one document that encapsulates what they need to know. With access to digital information and the ability to communicate with their care team when needed, he says, they can take more control of their care at home and take actions to improve outcomes.
Hehir says Nemours, which already has a well-established telehealth and telemedicine platform, decided to launch mHealth apps because its patients and their parents are asking for more resources at home. They want that connection to their care team outside the hospital or doctor’s office to better fill in the blanks between in-person visits, and to give that care team insight into what happens every day, and what a normal day feels like.
“They’ve told us they’re ready for this,” he says. “These are parents of children who need to be seen quite frequently by multiple providers. This gives them a better opportunity to manage that” and play an active role in care coordination.
Nemours also drew on the experiences of its patients with the asthma app to improve the platform for the cardiac care app.
“With asthma, we realized midway through design that we had to go back and make the sign-up process more automated and easy to use,” Gorenc says. “We took on a degree of complexity, automating parts of the provisioning process that previously required human review, to ensure usability.”
“The cardiac functionality is part of the same app serving our asthma patients, so our cardiac families are able to onboard themselves,” he notes. “That’s what we want. If users find onboarding complicated or need coaching from the get-go, they may not follow through and use the app. Conversely, if onboarding is easy and intuitive, once they get started, they will use it.”
Gorenc says the cardiac teams are so happy with the functionality that they’re planning to apply the app to other complex cardiac conditions. Health system officials, meanwhile, say they’re planning other apps as well, the next one targeting diabetes.
“In 2019 our primary focus will be on well child care,” he says. “With well child care, we are creating a truly complete mobile solution for our families who have signed up for our CareConnect and MyNemours portals, so we’re talking about appointments, medications, vaccinations, health history, encounters, films, reports, etc. We’d like to complete these apps as close to the end of 2019 as possible.”