The Nemours App for Asthma is the first product from Nemours's Center for Health Delivery Innovation, released as part of a new digital health strategy that provides all digital assets on a single platform for users.
Older patients might get a huge chunk of the country's healthcare dollars, but when it comes to the future of digital health, it's young people who will undoubtedly drive the trends. That's especially true for children's healthcare, where the patients and families are young.
"Families are comparing us to Amazon and Google and their banking app," says PJ Gorenc, operating officer of the Nemours Center for Health Delivery Innovation. "They are on the younger end of the spectrum and many of them are digital natives who don't know a world without convenient access to any of the organizations they interact with."
That's why last week, Nemours Children's Health System launched the Nemours App for Asthma. It's the first product from Nemours's Center for Health Delivery Innovation, and is part of a new digital health strategy that provides its tools on a single platform.
"A lot of health systems are trying to have a telehealth program, have a meaningful patient portal, and provide patient education," says Gina Altieri, CPA, senior vice president and chief of strategy integration at Nemours Children's Health System. "But what's unique to what we're trying to do is leveraging all of those assets so that it's seamless to the patients and families."
Although an asthma app is the first, many other apps are in the pipeline. So far, Nemours has spent just over $1.5 million on the platform that's being developed.
Ahead of the app's launch at last week's U.S. News and World Report Healthcare of Tomorrow conference in Washington, D.C., Gorenc and Altieri talked about Nemours' digital health strategy. Here's part one of that conversation. It has been edited for clarity.
HealthLeaders Media: Walk me through what's coming for patients and providers and what's the impetus for doing it now? What are the metrics for success?
Gorenc: We're starting with an application developed for supporting families for children with asthma. The idea is to design the experience for the families in order to support care for the chronic condition. We also want to route people to the appropriate level of care at the right moment and to support that relationship between the family and the clinician, so that there's a better understanding with what's happening with the patient in between visits.
We went about it that way because we wanted to bring together a lot of the existing digital assets that we already have that weren't really as well integrated as they could be, and certainly weren't presenting for the families the kind of experience that people are starting to expect given their experiences in other industries and their digital interactions.
We're really looking ahead. We've started to have some value-based arrangements with payers, but we're looking ahead to more and more value-based compensation models being enacted throughout the health system.
And we want to partner with our families in such a way that they are following their care plan and communicating with their clinician and sharing data back and forth to make sure that, in this case, asthma … is well controlled so that they're reducing the overall use of the system, which obviously is better for the family, better for the payer, and better for Nemours in our value-based payment model.
Gina looked ahead and said we need to be getting ready for this now. Because, as those agreements come across the table, we want to be ready with our infrastructure to play in that world.
Altieri: You mentioned metrics. From a strategic perspective, we have Nemours True North, which helps [patients] receive the care [they] need and want exactly when [they] need and want it.
Part of our True North is to measure a variety of specific True North metrics. We measure child and family experience. We measure quality and safety by measuring healthcare-acquired infections and medication errors. We [also] measure delivery.
This kind of an app provides immediate access, another thing that the millennial consumer looks for. And then we also measure costs and people and growth. So, we use our highest-level strategy to, in a sense, direct the things that we need to be doing, so that's what we're measuring, or will be measuring.
HLM: Can you tell me what those existing digital assets were or are and tell us how you've merged them?
Gorenc: We have our patient portal, called MyNemours, based on Epic's MyChart. We have a telehealth application that is called Nemours CareConnect. We have an outpatient education interface, which is branded KidsHealth. We have our consumer-facing site for the organization at Nemours.org, and finally we have a reading readiness program called Nemours Reading BrightStart!, and that is based on the idea that literacy is itself a large indicator of health outcomes.
And so, they were all freestanding digital entities if you will. A Nemours family would have to know where to go for which resource.
About two years ago at this point, Gina had pulled together all of the groups that support those entities and said, we're going to integrate not only the digital face, but the organizations that support them.
With the asthma app, we are pulling generously from each of those properties as it becomes relevant in the experience that we're designing, and that becomes our model for integration going forward.
HLM: So there will be on app on your smartphone. What will you see when you open it?
Gorenc: Right now for asthma, you get an asthma dashboard. So you're seeing things like air quality index information, and your ability to journal your symptoms and triggers related to an asthma control test that we're asking people to log on a regular basis so that clinicians can see it. You're getting access to all that you would expect to get access to from a patient portal perspective—your appointments, your medication lists and education—but we're adding functionality to that.
So that's really the point of creating this separate entity, to not just provide the medication but also medication reminders since medication adherence is such as issue.
We're also integrating remote monitoring devices so we can help folks to collect information passively about their medication use, or taking home-spirometry or peak flow readings, all around creating an easy way to either passively (or with a minimal amount of effort from the family) track and pass that information back to clinician, so that the care plan can be tailored to recognize what is actually happening with the family at home.
HLM: Will they have access to telemedicine and the patient portal through the app, too?
Gorenc: Yes, absolutely. That's one of the things we recognized early on in speaking with families, particularly when they're newly diagnosed with asthma. There's a confusion; the caregiver doesn't know how to judge an exacerbation.
We hear over and over, "My child is struggling to breathe." They don't know how serious is it, and so the natural outcome is that you wind up with a lot of people showing up in the emergency room. Some of them don't need to be there.
So the idea is if we can give them easy, one-touch access to telehealth, then we can start to use that as a triage mechanism to determine [either], 'You really do need to get to the ED,' or 'We can follow your asthma action plan right here at home and [you should] take your albuterol, and [we'll] check back in with you in a few minutes.'
Altieri: Also, you mentioned medication adherence. A lot has to do with the patient and family's ability to understand what they're supposed to do, so by having access to their patient portal, which provides access to KidsHealth through that portal, they have patient instructions that also have illustrations so that they can see, over and over and over, what it is they're supposed to do.
And they can provide those instructions to any caregiver—whether it's a parent, a teacher, community center, day care—they all can have access to that. And there are also videos in KidsHealth that are embedded in the education that they can receive through the app.
Gorenc: And we developed a series of how-to videos when it comes to different forms of inhalers … you can set up medication reminders, but you can also view how-to videos: Very short, clear videos on proper technique for using that delivery mechanism.
HLM: Why asthma as the first go-round for this?
Altieri: As we mentioned, the value-based care [is a driver]. We looked to see what chronic condition was causing the most activity if you will, or readmission, and the No. 1 diagnosis was asthma, so we thought we would start there.
We also have a group of pulmonologists that were interested and willing and able to participate in the work, so that helps as well.
HLM: When you say "the work," what did they do?
Gorenc: We're using design thinking methodology in terms of getting started and laying the groundwork for what we were building, so that involved setting up a team of advisors who were clinicians—pulmonologists, allergists, primary care, respiratory therapy, nursing—folks who could advise us on the care that they offer and the problems that they see with their patients.
We also spoke with many patient families directly. And, so, in walking through and getting a picture of what that patient journey is like, they've been giving feedback all along to us.
We went away and came up with wireframes, and went back to all those clinicians and the families and said, 'This is what we're thinking about, how does this work?' There's been an ongoing feedback process where every other week we have a meeting to show people what we're developing, so the clinicians have the constant ability to give feedback and to drive what we're doing and suggest tweaks.
We've been meeting with [those clinicians] individually also to do deep-dive walk-throughs…of the entire app as it stands and [asking] is this doing what you want? And going through…the dashboard that we've created for them so they can see the patient record. They've really been a design partner with us the entire way.
Next week will be part two of the conversation with Nemours when we discuss using telehealth as a triage mechanism, the development processes and costs, and how Nemours will measure success.
Alexandra Wilson Pecci is an editor for HealthLeaders.
