An app to fill the care instruction gap

There’s many a slip between a physician’s instructions, a care manager’s plan and the patient’s recollection.

Now there are apps to reduce that slippage.

Wellpepper’s entry in the space provides regular communication between clinicians and patients about their treatment plans. Like many information technology-based medical innovations, there’s a personal story behind its creation.

“My mom contracted a rare autoimmune disease and spent six months in the hospital,” said Anne Weiler, cofounder and CEO of Seattle-based Wellpepper. “She was sent home with no instructions, and a month before she had her next check-in. I thought, ‘This is ridiculous.’ ”

It also was common, she said. So Weiler and company co-founder Mike Van Snellenberg, now the chief technology officer, launched Wellpepper in December 2012.

The Wellpepper app runs on mobile devices with either Google’s Android or Apple’s iOS operating systems. The company collaborates with provider organizations to customize the app to fit their needs.

“We don’t have any content,” Weiler said. “We work with health systems to implement their own protocols, and they personalize it for each patient.”

For clinicians, the app aggregates and categorizes patient-reported data on dashboards so physicians and care managers can keep track of patient performance. For patients, the app offers instant feedback about their care instructions.

Patient-engagement app developers like Wellpepper “(are) on the right side of history,” said Dr. Joe Smith, chief medical and science officer at the West Health Institute in San Diego. “The boomers are not just familiar with this technology, they expect information to come to them that way. If we think we’re going to get away with instructions poorly written on paper, that’s a big mistake.”

Wellpepper was chosen as one of six finalists among 120 apps entered in the first Mayo Clinic THINK BIG Challenge. The developer competed for a $50,000 top prize at Mayo’s Transform 2015 con- ference, which was held last week in Rochester, Minn.

The app’s performance is being scientifically tested during a 30-month trial by researchers at Boston University, Brandeis University and the Spaulding Rehabilitation Hospital, a Harvard Medical School affiliate. Wellpepper will be tried with senior citizens who face a loss of mobility.

The app, housed on an iPad provided to each rehabilitation patient, will contain a recorded video of the individual correctly performing physical exercises under the guidance of a therapist. At home, the test enrollees will be able to review the videos so they continue to exercise properly. They will also record and report their performance on a variety of metrics, such as how far they can walk in six minutes.

“We end up losing about 40% to 45% of potentially eligible patients,” said Dr. Jonathan Bean, an associate professor of physical medicine at Harvard Medical School. Patients can’t make it to local rehab centers because of the distance, lack of transportation, and their diminished mobility. Using the app could enable those patients to keep up with their rehabilitation plans, he said.

With providers increasingly being rewarded or penalized based on their level of patient engagement, lost or forgotten care plans can be costly for their bottom lines, as well as for patients’ health. An estimated 40% to 80% of patient instructions are immediately forgotten, and some of the rest is remembered inaccurately, according to a recent article in the Journal of the Royal Society of Medicine by Roy Kessels, a professor of neuropsychology at Radboud University in the Netherlands.

Wellpepper is competing in an increasingly crowded space, said West Health’s Smith. Reflection Health in San Diego, Force Therapeutics in New York City and HealthLoop, Mountain View, Calif., are also marketing post-care instruction apps.

Physical therapy apps are “a wonderful opportunity to personalize healthcare, as well as move the site of care to the patient’s home, instead of seeing a physical therapist all the time,” Smith said. “Tools that make it a little more automated and coordinated and connected are the right approach.”