‘We re­ally do have a leg up over any tech­nol­ogy com­pany that is try­ing to dis­rupt this in­dus­try’

Modern Healthcare - - Q&a -

Ne­mours Chil­dren’s Health Sys­tem is charg­ing ahead with a dig­i­tal agenda that aims to fully en­gage pa­tients—and clin­i­cians—in a mo­bile world. The Jack­sonville, Fla.-based sys­tem al­ready had its well-used Kid­sHealth web­site, which of­fers a plethora of ed­u­ca­tional and in­ter­ac­tive ma­te­ri­als. Now Ne­mours has launched a mo­bile app that lets asthma pa­tients not only track and up­date their health in­for­ma­tion, but con­nect with a doc­tor im­me­di­ately. The app ties di­rectly into Ne­mours’ elec­tronic health record sys­tem. The app will roll out to other chronic

Gina Altieri, con­di­tions, but ac­cord­ing to se­nior vice pres­i­dent and chief of strat­egy in­te­gra­tion at Ne­mours, the ul­ti­mate goal is for it to be­come an in­te­gral part of care across Ne­mours’ pa­tient pop­u­la­tion. Altieri re­cently spoke with Mod­ern Health­care Man­ag­ing Ed­i­tor Matthew We­in­stock. The fol­low­ing is an edited tran­script.

Mod­ern Health­care: Look­ing at dig­i­tal health, what are your goals in the con­text of con­sumerism and its im­pact on health­care or­ga­ni­za­tions?

Gina Altieri: We’ve de­vel­oped a dig­i­tal health strat­egy that is com­ple­men­tary to what al­ready ex­ists as far as our clin­i­cal care and our com­mit­ment to treat­ing the whole child. What we want to do is take these dig­i­tal tools that we be­lieve the con­sumer is de­mand­ing and put them in their hands to meet them where they are.

We all know that to­day’s con­sumers love con­ve­nience and love their dig­i­tal tools. We want to help pa­tients be­come bet­ter en­gaged in their care, as well as help the providers be able to be bet­ter in­volved in the pa­tients’ care.

MH: You say the con­sumer is de­mand­ing it. How do you know that they are de­mand­ing this kind of in­ter­ac­tion?

Altieri: We have en­gaged them in this process from the be­gin­ning through a va­ri­ety of fo­rums. We use our Kid­sHealth plat­form to con­duct sur­veys. We also con­ducted a va­ri­ety of fo­cus groups and in­ter­views and we en­gaged our ad­vi­sory coun­cils, which in­clude par­ents as well as pa­tients. We’ve run this by them every step of the way.

MH: Were there par­tic­u­lar things that you heard pa­tients were most in­ter­ested in?

Altieri: What we heard is that they don’t re­ally sit at a PC much any­more. They try to do ev­ery­thing from a mo­bile de­vice. So we needed our dig­i­tal prop­er­ties to be

re­spon­sive. We also heard that they would in­ves­ti­gate. So they want trans­parency; they want to know what other peo­ple are say­ing about you.

And they want it to be con­ve­nient. They’d like to see who the providers are and un­der­stand a lit­tle bit more about them; not just a static photo, but ac­tu­ally learn more about them.

MH: You also wanted to help providers. What’s hap­pen­ing on that front?

Altieri: We are see­ing some up­take. They are us­ing tele­health; they find it to be sim­ple and con­ve­nient. And they’re also help­ing us launch the asthma app. We kicked off the asthma pro­ject a year ago.

And we were able to ac­tu­ally launch a vi­able prod­uct last month.

MH: Can you de­scribe the app a lit­tle bit? It’s in­te­grated into the EHR, but how does it work and what is the user ex­pe­ri­ence?

Altieri: The in­te­gra­tion into the EHR is our dis­tin­guisher. Ev­ery­body’s start­ing to dab­ble in some of these dig­i­tal ex­pe­ri­ences, but what we were able to do—hav­ing had our Kid­sHealth web­site for 20 years full of con­tent and in­struc­tions for fam­i­lies— we were able to in­te­grate all of those sep­a­rate dig­i­tal ex­pe­ri­ences into one ex­pe­ri­ence us­ing asthma as our proof of con­cept.

When chil­dren are di­ag­nosed … a spe­cial­ist ad­vises them to track what’s go­ing on in their life through their mo­bile de­vice. If they are hav­ing some kind of a prob­lem, they don’t have to leave our app and go into the telemedicine app. They just press a but­ton and they get a video visit. They can also ac­cess in­struc­tional videos. They can see their own med­i­cal record, all through the app. They don’t have to go in and out of dif­fer­ent apps to get the in­for­ma­tion and to com­mu­ni­cate with their providers.

MH: As a user, are they up­load­ing daily data to their care team?

Altieri: Yes, and then the provider would see a sim­ple dash­board, whether it’s days, weeks, months since their last visit. And they can see what might be trig­ger­ing some of their prob­lems. Maybe they went to grand­mother’s for one week and their asthma was trig­gered be­cause they live in a dif­fer­ent area, or they have pets.

They can see all of that and it helps them stay health­ier. And it helps the physi­cian un­der­stand what’s go­ing on. It also helps keep chil­dren healthy in the sense that it keeps them out of the emer­gency room. And it gives them di­rect ac­cess to their care provider.

MH: Why did you start with asthma?

Altieri: When we en­gaged the physi­cians, that was some­thing they re­ally were frus­trated with in the sense of a prob­lem that we were try­ing to solve: How do we get the pa­tients more en­gaged? How do we get the providers to know what’s go­ing on be­tween vis­its?

Asthma kept com­ing up as one of the most fre­quently di­ag­nosed con­di­tions. So we thought that we could re­ally make a dif­fer­ence. Di­a­betes is prob­a­bly our next chronic dis­ease.

MH: Is this some­thing that you would try to li­cense to other or­ga­ni­za­tions?

Altieri: Yes, we’ve been talk­ing about that. We did not de­velop it as a white la­bel, so we’ve only been talk­ing about it. But we do think this could have a tremen­dous im­pact and scale. And we have that spe­cial sauce of en­gag­ing our clin­i­cians and our pa­tients and fam­i­lies. Tech com­pa­nies don’t have that. They can de­velop the tech­nol­ogy, but they don’t re­ally have the health­care per­spec­tive—what clin­i­cians face every day and then the pa­tients and the fam­i­lies. Health­care is com­pli­cated. We re­ally do have a leg up over any tech­nol­ogy com­pany that is try­ing to dis­rupt this in­dus­try. So we have been talk­ing about the pos­si­bil­ity of re­ally tak­ing this global.

MH: You men­tion dis­rup­tion. We are start­ing to see some of that with Ap­ple and oth­ers, who have that con­sumer­centric fo­cus.

Altieri: But they don’t have the health­care ex­pe­ri­ence.

MH: So do you see col­lab­o­ra­tions with them, with com­pa­nies like that?

Altieri: Yes, but there’s noth­ing de­fin­i­tive. There’s no big story here. I don’t have any­body in mind.

MH: Where do you see your app devel­op­ment and dig­i­tal strat­egy go­ing? What do you think a par­ent is go­ing to have on their de­vice in a cou­ple years?

Altieri: What we’d like to do in a cou­ple years is have a well-child app. So as soon as a woman knows she’s preg­nant, she has her health coach in the palm of her hand. This Ne­mours ex­pe­ri­ence—dig­i­tal ex­pe­ri­ence—is help­ing par­ents, as well as all their care providers, raise the child to­gether. It’s nice to be able to go some­where where the ad­vice and the in­for­ma­tion they re­ceive is le­git­i­mate. It’s vet­ted by clin­i­cians and it has the Ne­mours brand be­hind it.

MH: What does all this do to the strat­egy for an or­ga­ni­za­tion that still has bricks and mortar? How are you think­ing about that?

Altieri: That is a strate­gic dis­cus­sion at our high­est lev­els. Right now, it is com­ple­men­tary; we do not see it re­plac­ing our bricks and mortar. We’re still build­ing, but as we build, we in­clude the dig­i­tal ca­pa­bil­i­ties. So if you’re at the pe­di­a­tri­cian’s of­fice and need a spe­cial­ist, you can ob­tain that while you are there. It will prob­a­bly slow down build­ing plans at some point.

As in­pa­tient shifted to out­pa­tient and now out­pa­tient is switch­ing to vir­tual, we will have a dif­fer­ent bal­ance. But we def­i­nitely see this as com­ple­men­tary to the ex­ist­ing op­er­a­tions, not a re­place­ment.

MH: Is there a cap­i­tal plan for the dig­i­tal health plat­form?

Altieri: Yes, but we’ve made such an in­cred­i­ble in­vest­ment in tech­nol­ogy that we’ve been able to con­tinue and just tweak it a bit. We haven’t had to add tens of mil­lions of dol­lars in one year, which I know other or­ga­ni­za­tions are do­ing. Some of them didn’t even have an en­ter­prisewide EHR, so they had to at least get ev­ery­body on the same plat­form. We’ve been mak­ing those in­vest­ments over the past 20 years, so this didn’t feel like such a gouge to our bud­get. ●

“We all know that to­day’s con­sumers love con­ve­nience and love their dig­i­tal tools. We want to help pa­tients be­come bet­ter en­gaged in their care.”

Ne­mours’ asthma app syncs with the sys­tem’s EHR and lets pa­tients con­nect with doc­tors.

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