Other chronic conditions and well-child tools are next in the development process.
The Nemours app for asthma from Nemours Children’s Health System is part of a new digital health strategy at the organization that provides its e-health tools for patients on a single platform.
This article is part two of the conversation with Gina Altieri, CPA, senior vice president and chief of strategy integration at Nemours Children’s Health System, and PJ Gorenc, operating officer of the Nemours Center for Health Delivery Innovation.
Part one of the conversation covered topics such as the impetus for creating the asthma app, including considerations about value-based payments.
In early November, Gorenc and Altieri talked about Nemours' digital health strategy at the U.S. News & World Report Healthcare of Tomorrow conference in Washington, D.C., ahead of the app's launch.
This conversation has been edited for clarity.
HealthLeaders Media: What’s the full timeline? When did you start the development process?
PJ Gorenc: We convened the team of developers and designers that are working on this on September 12, 2016. We took the remainder of 2016 to do the groundwork: All of the interviews and initial designs and conceiving of this. We’re starting with asthma, but this really needs to be the framework or an infrastructure that can be the interface for Nemours with patient families. We just happened to be starting with asthma. There was a lot of conception that needed to happen in terms of how that would all work.
We started writing code for asthma and developing that app the second week of January this year [2017].
HLM: Was there any feedback that surprised you from patients and families in terms of what they expected from functionality?
Gorenc: We weren’t really surprised with anything functionality-wise. I think the thing that opened our eyes was understanding that journey. Asthma—when it is reasonably well controlled—sort of becomes routine for people, and I think it’s challenging to modify behaviors once people are in that frame of mind. We realized early on that … the sweet spot for establishing good behaviors and teaching people was right after diagnosis.
When we did the interviews [with families], you could just hear the strength of the language that people were using. When they see their child struggling to breathe, they’re using words like “terror.” The fear becomes palpable, even when people are describing this six, seven years after the fact. They think back to that initial feeling.
It became apparent how absolutely critical telehealth was going to be to provide instant access to a physician who could see and hear the child, and provide guidance in the case of early exacerbations. As we’ve been describing, a lot of the tools that we’ve developed are really around establishing the right behavior patterns. If we can get those people when they’re newly diagnosed, I think we have a solid opportunity to establish the right patterns and get people to follow their plans maximally and reduce the number of exacerbations and their use of the system. Everybody wins.
HLM: How do you plan to get people using the app?
Altieri: PJ and [his] team are trying to make [the app] as simple as possible, and if we can show how effective it is and it’s simple to use, they are going to want to use this.
HLM: Where are these patients?
Gorenc: Patients don’t need to be on-site. That’s really what we’re shooting for. They can download the app from anywhere and actually get themselves up and running without needing to interact with someone on-site, so long as they already have a patient record here.
Altieri: We have a huge primary care network throughout Delaware and Pennsylvania and Philadelphia, as well as throughout the state of Florida. We will use those pediatricians and encourage use [of the app] among their patients.
Gorenc: The clinicians themselves, I think, will start to recommend it. They already have.
HLM: What were the development costs for this?
Gorenc: We have used a small team of contractors. So far we’ve spent just over $1.5 million, relatively small in terms of the platform that’s being developed.
HLM: And conceivably, a lot of the work for the next several platforms will have already been done, right?
Gorenc: Right, basic functionality is there when we take on the next condition, which is already being noticed by other areas in the organization, who are starting to lobby to be the next condition.
HLM: Do you know what the next condition will be?
Altieri: We’re looking at maybe one or two other chronic conditions or one program where we really want to market it, but immediately thereafter we’re going to work on well child. It’s not just for sick children. This is how families have a healthcare coach in the palm of their hand.
HLM: How are you going to measure success?
Gorenc: For asthma, the basic clinical outcome answer to that question is if we can show that asthma is better controlled [among] people using the app or not. But certainly, ED use is some[where] we expect a net reduction. But again, it’s about getting the appropriate level of care. We don’t want people showing up in the ED if they don’t need to be there, but we want everyone showing up who should be there.
Altieri: And at some point, we will measure the app’s usage and consider that a success when people are using it, a lot of people.
HLM: Right now, are those other functionalities available as standalone apps?
Gorenc: For telehealth and the patient portal, MyNemours, they’re both available as apps. The other properties are available via the web.
Altieri: The integration of all of it is what is unique. A lot of health systems are trying to have a telehealth program, have a meaningful patient portal, provide patient education, and a marketing website. But what’s unique to what we’re trying to do is leverage all of those assets so that it’s seamless to the patients and families.
HLM: You talked at the beginning of our conversation about the expectation of millennial parents. What are those expectations?
Gorenc: It’s all around ease of use, and the integration that Gina’s talking about is absolutely critical.
Providing what people need when they need it and thinking that through—and that harkens back to that True North goal that Gina had said of providing what they need and want and how and when they need and want it—we should be doing that digitally as well.
Families are comparing us to Amazon and Google and their banking app. There’s some blocking and tackling that we need to do in healthcare to get the transactional piece where it needs to be so that we’re at parity with other industries that consumers are interacting with.
Our users, our families are [in their] childbearing years. 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. We need to be mindful of that.
HLM: Will anything change on the provider side, for how they interact on the other side of the app?
Altieri: They will have to be responsive to communications, whether it’s through the portal or email. They have to be much more responsive and recognize that that is now part of the patient experience.
Gorenc: I think one of the things that will also change is that there are manual tasks that are happening on the staff side today that can be automated. We are streamlining some of those tasks and taking them off of people’s desks and automating the process, which gives us as an organization more time to focus on patient care and less time to focus a manual administrative or functional transactional task.
I’ll use our asthma action plan as an example. Our clinicians will do an asthma plan for their asthma patients in the patient record, but it’s not provided to the family unless clinicians think to create it as a note and put it in a notes section for the family. It’s a manual task that the clinician is doing to provide that in a form that [the family] can easily print out at home.
We’ve just automated that by pulling the information from the action plan in Epic. We’re giving them an interactive form of it in the app, so that they can easily walk through four questions: If they tap through, they know whether they’re in their red, yellow, or green zone.
But we’re also giving it to them with two taps: With one tap, you download the action plan in a printable format. [There’s] another tap to share it out. if you’re leaving the child at school, or with a coach, or with a caregiver—somebody that you want to know what to do if your child has an exacerbation. We’re making it easy to share and that doesn’t require any manual task from a clinician.
You can apply that thinking to school apps and forms, immunization records, or sports physical forms that again require a manual task of a call to the office staff. And then your office staff is spending time on the phone, getting something together, somebody’s got to come get it or you send it to them. No need for that, that can all be automated.
HLM: Are clinicians generally OK with the idea that they’ll have to be more responsive to email, etc.?
Gorenc: Yes, that’s been happening with MyNemours, with the existing patient portal. There was initially concern about “am I going to be inundated?” But I think they’ve realized that the volume is reasonable and it turns out to be a good way to get some questions answered for folks.
Alexandra Wilson Pecci is an editor for HealthLeaders.
