Interactive tools, new apps being used to improve health care #ahcj13

Lori Houston

About Lori Houston

Lori Houston is an editor at Pacific Health Magazine. She is attending Health Journalism 2013 on an AHCJ-California Health Journalism Fellowship, which is supported by The California HealthCare Foundation.

Using technology in health care to interact with people certainly opens up new avenues of communication and yields more data than ever. The intriguing question of whether and to what degree such interactions actually influence health behavior and improve health remains to be answered. Panelists in a Health Journalism 2013 session on the topic shared their highly varied experiences in applying technologies and social media tools to address specific concerns.

To reduce hospital readmissions by ensuring that patients know what to do when they go home,. Brian Jack, M.D., chair of family medicine at Boston University School of Medicine Boston, created an interactive tool for patients as part an initiative called Project RED or Project Re-Engineered Discharge. Virtual patient advocates interact with patients at their bedside on a touch screen, reviewing discharge information to prepare patients, then confirming their understanding by asking questions. Patients express near unanimous satisfaction with the tool, finding it easy to use even for those who have never used a computer.

Project RED also introduced a checklist for hospitals to use with elements known to reduce readmissions, such as identifying correct medications and a plan for taking them, as well as an after-hospital care plan and color-coded calendar that patients and families love.

Introducing Project RED at BU Medical Center led to a 30 percent decrease in hospital readmissions and emergency room visit. It has become a national model for reducing readmissions, now used in hundreds of hospitals.

“Hospital readmissions are the low-hanging fruit for patient safety,” Jack said. Reducing the number of Medicare patient hospital readmissions by just 5 percent could save $17 billion over a four-year period. “We know what we need to do; the question is how to implement it.”

Elissa Weitzman, assistant professor at Boston Children’s Hospital Informatics Program, developed an application to engage online communities in diabetes research.

Given the 75 percent of adults are online and more than half of those are seeking support and information for chronic conditions, Weitzman wanted to see whether people already engaged in online diabetes communities would be willing to provide information to address gaps in diabetes care and support.

Weitzman’s team developed Tuanalyze, a tool offered through www.Tudiabetes.org that enables members of that site to track and report their own information such as their A1c levels, as well as participate in surveys. One in five site members started using the app right away. Now there are 3,500 national and international users, 95 percent of whom are willing to be contacted for follow up, not typical for most patient research projects.

These participants provide important information about as quality of care and the safety and efficacy of treatment and medical devices, Weitzman said. Their participation may contribute important missing information for improving diabetes treatment. Establishing this channel with diabetes patients provides opportunities not only to pull information and data from them, but also to push needed information and education back to them. While the app also represents a tool to enable and encourage behavioral change in diabetes patients, evidence of this is not yet available, Weitzman acknowledged.

T. Bernard Kinane, M.D., chief physician of Massachusetts General Hospital for Children’s pediatric pulmonary unit, decided to set up a Facebook-like yet private support group for his young patients after observing how frequently and more openly his medical students and his own children communicate through social media.

Many of his adolescent patients are not inclined to take needed medications consistently, and he knew from experience that they often simply don’t listen to their parents. He figured out through feedback from focus groups that patients in the support group were most receptive to information delivered by knowledgeable fellow diabetes patients rather than an authority figure such as a doctor.

He also discovered that the online social environment yielded a lot more information about how his patients are doing – quality, important information than most providers would never get from kids by asking directly.  For that reason, he considers the effort highly successful.

“I learned more than my patients learned from me.”