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The largest gathering of healthcare technology professionals worldwide, HIMSS24 descended on  Orlando with decades of health tech innovation permeating through the halls filled with 35,000 passionate professionals. While Disney World offered a backdrop, that was where the fantasy ended. Digital innovation now has the results to back it up – as shown by speakers, including our COO and Co-Founder Aaron Sheedy and ChristianaCare’s Chief Health Information Officer and VP of Digital Clinical Transformation Dr. Timothy Shiuh in their joint session “Using Digital to Fill White Space Between Appointments.” 

Dr. Shiuh and Aaron shared the substantial opportunity that digital health presents in empowering and engaging patients with their health and care teams in between appointments, and how ChristianaCare chose to implement digital health programs, leveraging a digital health platform to organize, distribute and help measure program success. 

The average U.S. adult has 7.7 acute or ambulatory care visits per year. Using digital to fill the white space that occurs between episodic visits and deliver actionable insights for continuous care can assist patient retention and treatment adherence. In fact, 63% of U.S. adults have used an app for a health-related purpose in the last year.

Attendees for this popular session learned tips to evaluate strategies and pathways for digitally engaging patients, create an organizational foundation for determining and measuring success, and measure utilization by tying into existing clinical workflows.

Digital impacts patient engagement in all areas surrounding appointments – pre-visit by helping with scheduling and registration, during the visit and after the visit with communication, surveys and billing. Digital tools augment and strengthen the trusted relationship between care teams and patients and ChristianaCare is currently building out a digital formulary for specific clinical lines, including chronic heart failure, maternity care and primary care. 

Chronic Heart Failure

Dr. Shiuh explained that patients treated with goal-directed, evidence-based therapy have better outcomes, decreased mortality and hospitalizations. Goal-directed therapy traditionally requires intense outpatient follow-up and multiple visits with concern for patient destabilization from medication changes between appointments. 

Digital helps ChristianaCare deliver an evidence-based, goal directed care plan with pro-active biometric and symptoms monitoring and automated escalations to care team as needed. There is also bi-directional communication, reminders between appointments and virtual coach/support. This has resulted in:

  • Overall engagement: 91%
  • Daily engagement rate 77%
  • Average days enrolled:  370 days

Maternity Care 

ChristianaCare delivers about 60% of the babies born in Delaware. Infant mortality and maternal morbidity and mortality rates are still an area of opportunity despite major improvements over the past decade. This observation prompted ChristianaCare to utilize the digital white space to improve perinatal education, adherence to care protocols and monitor at risk mothers. Leveraging a maternity care app, expectant mothers receive digital perinatal education and resources, digital care pathways, and gestational diabetes and post-partum hypertension monitoring. 

Utilizing this maternity app via ChristianaCare’s digital health platform has helped the team remove about three appointments from the typical maternity journey and: 

  • Digital maternity app engagement: About 60%
  • Pathways
    • Post-partum Hypertension: >2,800 patients 
      • PRE: Black women 1/3 of deliveries, but account for 2/3 of readmissions
      • POST: Reduced disparity by 2/3
    • Engagement with other care pathways
      • OB induction: 92%
      • OB c-section: 88%

Primary Care & Building a Digital Health Formulary

Primary care is on the front lines of patient care for impacting care gaps, social determinants of health (SDoH) and mental illness. Mental health disorders can worsen the course of chronic disease and are associated with increased risk of morbidity and mortality. As Dr. Shiuh shared, addressing SDoH are also critical for improving health outcomes and reducing health disparities. 

Primary care providers often feel under equipped and under resourced to help address SDoH and mental health disorders within the confines of a visit and there are significant challenges with accessing behavioral health specialists in the community once a need is identified. ChristianaCare recognized the opportunity to leverage digital for helping address this gap. 

A digital intake and screening platform provides depression and SDoH screenings at check-in, automates referrals and notifications and offers a social care connection platform with referrals to community-based resources. mHealth apps and delivering digital follow up, including symptom check, monitoring and care plan adherence. This has resulted in: 

  • Depression screening
    • 3-fold increase in number of patients screened for depression
    • 3-fold increase in number of positive PHQ-9
  • SDoH screenings and referrals during annual visit
    • 6000+ screenings
    • 34% identified with 1+ social care need and referred to community resources

Dr. Shiuh shared that it utilizes a centralized digital health formulary that makes digital tools available within clinical workflow through an EHR integration. Recommended digital tools are presented during the visit depending on the patient information, eliminating the need to hunt for solutions or leave the EHR. Remote patient monitoring (RPM) and patient activity data is presented inside the patient record.

ChristianaCare established a digital health advisory group for developing the framework and process for reviewing and monitoring digital health tools. This internal board guides the path forward, helping ensure it’s well-received by clinicians and patients.

Tools should augment the patient-provider relationship, not create new points of friction and fragmentation. Using Xealth’s digital health platforms creates substantial benefits from automation, staying within workflows and monitoring patient utilization and their condition. It also simplifies the IT lift for rolling out new programs and reduces clinician time in engaging patients with them.

Contact the Xealth team to learn more about how it helps strengthen provider relationships with patients and partners – scaling and automating digital health efforts, accelerating the benefits to patients, providers and the organization.  

 

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