5 Tech Tools That Could Change the Way Your Hospital Delivers Care

HealthLeaders examines five healthcare technologies that are useful to patients, while simultaneously creating value for healthcare organizations.

This article appears in the January/February 2019 edition of HealthLeaders magazine. We invite you to also read a digital expert's commentary on these tech tools and the trends driving their development.

Sometimes the shortest distance between a patient and an improved outcome is technology. As innovations make their way from novelty solutions to mainstream usage backed by clinical evidence, devices, apps, and gadgets are helping bridge the gap to better healthcare.

In an annual roundup, HealthLeaders examines five healthcare technologies that we think are useful and appealing to patient-consumers, while simultaneously creating value for healthcare organizations. The featured devices seem to have potential to transform the way healthcare is delivered at health systems and hospitals.

When deciding on which devices to feature, healthcare technology solutions developed by providers working at health systems carried more weight. We did not include software-only or systems-based solutions that work within or as an adjunct to the EHR. Some of the featured items are innovations to keep an eye on as they are not yet commercially available, but should be in the near future, while one has been in use for years and is already deployed at hundreds of hospitals. It is featured because a plethora of clinical studies and reports from health systems verify its effectiveness.

For easy reference, each tech tool is labeled by the category it impacts—for example, patient experience, chronic disease management/population health, patient safety, and patient engagement.

Here's a look at the five healthcare technologies that made the cut.

1. Patient Experience: Playback Health Captures Highlights of Patient Encounters
 

The Concept

Playback Health is a secure, HIPAA-compliant, cloud-based multimedia platform that delivers video highlights of physician-patient encounters to patients' smartphones or computers, capturing physicians' explanations of diagnoses, treatments, and procedures, as well as diagnostic images. Patients can review the video and images through an app, which includes other features such as a list of care team members and patient responsibilities. Patients can share this information with family members, other providers, and friends. There is no charge to the patient for the app.

The platform is also used by nurses at discharge to record an overview of patients' hospital experience, medication instructions, and homecare. Providers have access to three additional apps: mobile, desktop, and an administrative resource to create, store, and share pertinent information and images.

Behind the Innovation

Northwell Health neurosurgeon David Langer, MD, chair of the department of neurosurgery at Lenox Hill Hospital, co-founded Playback Health and serves as the company's medical director. Langer began videotaping sessions to share with patients a decade ago. The first platform was introduced in 2014, and the company was established in 2018. The latest version of the app is being tested in the Lenox Hill neurosurgery and gynecological oncology departments before rolling out to other areas of the hospital, then to the entire Northwell health system.

The team is working on back-end integrations that will deploy Playback Health using the new HL7/FHIR standard for exchanging healthcare information electronically. The product will be available to other health systems during the third quarter of 2019 as a software-as-a-service (SaaS) platform solution. Pricing has not yet been established.

Outcomes

Among patients using Playback Health, both HCAHPS and Press Ganey scores have shown a significant improvement in key categories as indicated below.

HCAHPS top box scores (the highest option a survey participant can select) related to inpatient discharge instructions increased:

• 7.2 percentage points for patients' understanding the purpose of medications
   
• 7.3 percentage points for patients' understanding of their responsibilities for managing their health
   
• 8.6 percentage points regarding whether patients would recommend the hospital to family and friends

Press Ganey top box scores measuring satisfaction with outpatient experiences increased:

• 9.0 percentage points regarding patients' understanding of medications
   
• 10.7 percentage points related to providers' efforts to include the patient in decisions about treatment
   
• 12.9 percentage points for concern providers demonstrated for patients' questions or worries

Why Your Organization Needs It

• Aids in patient retention of complex medical information
   
• Enhances patient compliance with medications and discharge instructions
   
• Minimizes patients' follow-up calls to providers for clarification following their office visits

Who's Backing It/Investment

$500,000 was secured from Northwell Ventures plus individual investors. Additional institutional investors are pending. Physician and staff training are necessary to use and deploy the platform; licensing fees are being determined.

2. Chronic Disease Management and Population Health: Spire Health Tag Features Wearable Technology
 

The Concept

Spire Health Tag, a wearable device the size of a key fob, measures patients' breathing, heart rate, sleep, and movement, and conveys data to a clinician-monitored dashboard or a smartphone. This remote patient-monitoring solution can be attached to clothing such as undergarments, requires no recharging, and survives accidental damage, such as cycles through the washer and dryer. While worn, Health Tag collects and analyzes data, and uses artificial intelligence (AI) to detect physiological patterns that are early warning signs of problems or illness.

The U.S. Department of Health and Human Services (HHS) hopes that one day this device will detect and issue alerts that an individual may be coming down with the flu or other illness before he or she is even aware. In addition, health systems are exploring how to use it as part of their chronic disease management programs for conditions such as COPD and congestive heart failure.

Behind the Innovation

Spire CEO and co-founder Jonathan Palley conceived the idea for Health Tag. The device is already commercially available to consumers, with more than 100,000 units purchased. Now that Medicare is reimbursing hospitals for remote patient monitoring, Spire executives are talking to hospital and health system representatives about how the device can be used in chronic disease management programs, the purpose for which it was designed.

Outcomes

In a peer-reviewed study published by IEEE International Symposium of Medical Measurements and Applications on June 11, 2018, researchers confirmed the validity of respiratory data transmitted by the device. The study concluded, "The results indicate that ... the device in question produces [respiratory] data within a clinically acceptable range of error across both cognitive and physical activity … This is the first known validated technique to monitor respiratory effort continuously at this level of granularity while theoretically reducing patient burden to afford longitudinal capture and analysis."

Other studies are underway to prove the effectiveness of the device for COPD and congestive heart failure.

Why Your Organization Needs It

• Ability to prevent readmissions based on data that could lead to early intervention when a patient's condition changes
   
• Potentially useful resource for chronic disease management
   
• Possible role in value-based care and population health initiatives
   
• No action required on the part of the patient once the unit is attached to regularly worn clothing

Who's Backing It/Investment

Investors include Pacific Health Investment, Inc.; angel investors, including Rock Health; and confidential strategic industry investors. The Biomedical Advanced Research and Development Authority, a division of HHS, made a $62,200 grant to Spire to determine whether patterns exist that can predict the onset of illness. Health Tag is available to consumers for $49 each, or $299 for an 8-pack.

3. Patient Engagement: EASE Delivers Families Updates from the OR
 

The Concept

EASE (Electronic Access to Surgical Events) is a Snapchat-like app that enables surgical teams to communicate with family members during surgery, sending HIPAA-compliant messages and images that disappear once reviewed on a smartphone. Created by doctors at Orlando Health Arnold Palmer Hospital for Children in Florida, EASE decreases waiting room anxiety by updating families about a patient's progress with video, photos, and text messages from the OR during surgical procedures. It also can be used by clinical teams in other areas of the hospital such as preop, PACU, NICU, ICU, and the medical floor.

EASE messages last for 60 seconds of view time. To enhance security and protect privacy, all messages are deleted from consumer phones and servers forever and cannot be saved. Typically, a nurse sends messages at 30-minute intervals throughout a procedure, ending with a quick video recap from the physician. Before sending messages, the nurse scans the barcode on the patient's wristband to ensure the message is delivered to the correct recipients. Patients or families can create a network of individuals to receive the updates.

Behind the Innovation

Three physicians at Arnold Palmer Hospital for Children were involved in development and testing of this app, including Kevin de la Roza, MD, a pediatric cardiac anesthesiologist who is the co-creator and chief medical officer of EASE Applications; Hamish Munro, MD, FRCA, a pediatric cardiac anesthesiologist, co-creator and chief clinical innovation officer of EASE Applications; and William M. DeCampli, MD, PhD, chief of pediatric cardiac surgery. The app has been used by the children's hospital for about three years and is now used throughout the Orlando Health system, as well as outside hospitals. Altogether, more than 35 hospitals have implemented EASE.

According to a study Orlando Health conducted, families want updates from surgery about every 30 minutes, says Holly Stuart, director of patient experience at Orlando Health. "The alternative is sitting in a waiting room, scared, with a bunch of other scared families staring at a door, waiting for someone to come in," she says. "EASE completely changed that. We have absolutely seen that the imagination is much worse than the reality of what's happening."

Outcomes

In a six-month comparative study of 3,585 patients conducted by Orlando Health, the app raised the average scores on responses to nine HCAHPS questions. Collectively, scores were raised by the indicated percentages for the following selected questions:

• +13% Doctors explained in a way you understood
   
• +7.4% Physicians addressed your concerns, questions, worries
   
• +7.5% Physicians kept you informed
   
• +6.1% Staff addressed emotional needs
   
• +4.3% Likelihood of recommending the hospital

In a separate study, the Texas Children's Hospital perioperative services team studied the impact of EASE. After implementation, patient satisfaction for "information provided the day of surgery," as reported on the Press Ganey survey, increased from 87.5% to 96.7% between January and September 2016.

Why Your Organization Needs It

• Enhances engagement and communication between clinicians, patients, and patient families
• Improves the patient and family experience
• Boosts HCAHPS and Press Ganey scores

Who's Backing It/Investment

EASE is a privately held company based in Orlando and self-funded. This product is available to health systems as a SaaS platform solution by paying a subscription fee based on the number of beds and operating rooms. Nurse training is necessary to use and deploy the platform, and the training is included as part of the subscription fee. Hospitals using this app provide it at no charge to patients.

4. Chronic Disease Management and Population Health: Kaia COPD App Helps Patients Manage Their Health
 

The Concept

The Kaia COPD app helps patients self-manage their disease through clinically validated guidelines that address the physical and psychological factors impacting their health. The app includes:

• AI-based video physiotherapy with exercises to help patients build muscle and promote a healthy cardiovascular system. A machine-learning algorithm adjusts the support based on each patient's disease profile.
   
• Psychosocial support through audio-based relaxation exercises to manage anxiety and depression, plus access to an app-based coach.
   
• Patient education about multiple topics, including breathing and coughing techniques, nutrition, and the impact of air pollution.
   
• Medication tracking and alerts with video instructions to perfect inhaler administration techniques.

Behind the Innovation

The app was originally developed in Switzerland as an entrepreneurial venture by Jonas Duss, in partnership with David Boutellier, who is now head of product at Kaia. Duss is in charge of strategic international partnerships for Kaia. An English version of the app is in development, and Duss will launch Kaia's U.S. headquarters in New York City this year.

Outcomes

In a peer-reviewed, clinical pilot study, published November 2018 in the International Journal of Chronic Obstructive Pulmonary Disease:

• Users who completed only 20 therapy days with the Kaia COPD app had a clinically significant improvement in their Health-Related Quality of Life (HRQOL) scores, compared to their baseline values.
   
• The digital intervention improved Chronic Respiratory Questionnaire (CRQ) scores in areas related to emotion function, mastery (having control of breathing problems), and fatigue by more than 0.5 (the minimal clinically important difference for this score).
   
• Those completing 20 days of therapy with the app improved their COPD Assessment Test (CAT) scores by -2.5 points (lower scores are better). By comparison, in a separate study, patients who completed 42 days in a conventional pulmonary rehabilitation program experienced a CAT score reduction of -2.2 points—less than the app users—as reported in the July 2012 issue of the journal CHEST.

Why Your Organization Needs It

• Enhances access to care: Access to pulmonary rehabilitation is limited due to inadequate resources and cost constraints. This app expands availability to any patient in need, including those with transportation challenges or located in rural areas.
   
• Opportunity to address a costly disease: Total national medical costs attributable to COPD during 2010 were estimated at $32.1 billion annually, which is expected to rise to $49 billion by 2020, according to a study published January 2015 by CHEST.
   
• Potential to reduce readmissions: There are approximately 700,000 COPD-related hospitalizations in the U.S. each year, with one in five patients readmitted within 30 days, according to a study published January 11, 2015, by the journal Chronic Obstructive Pulmonary Diseases.

Who's Backing It/Investment

Kaia is a privately held, venture-backed company based in Munich, Germany. While the app is currently available only through payers in Germany, Kaia representatives are meeting with American insurers and pharmaceutical firms interested in the technology. Kaia is developing an outcomes-based payment model, enabling the company to work with payers to analyze claims data before and after app usage to capture actual cost savings. Pricing will be based on this and other relevant outcomes. No fees will be charged if patient outcomes are not favorable.

5. Patient Safety: AvaSys TeleSitter Reduces Patient Falls
 

The Concept

This mobile device, a continuous virtual patient safety and engagement platform, includes a two-way camera and speaker on a rolling unit, similar to an IV pole. Developed by AvaSure, the AvaSys TeleSitter Solution enables remote monitoring of patients at risk for falls, helping organizations improve patient safety by reducing falls.

Trained telesitters can monitor up to 16 patients simultaneously, replacing the need—and cost—for most bedside sitters, while also expanding the number of patients that can be monitored. Telesitters can speak directly to patients or nurses, activate an automated message if a patient tries to get out of bed while the sitter is speaking to a different patient, or sound an alarm to alert nurses on the floor to attend to the patient.

The camera has the ability to tilt, zoom, and pan. While some facilities opt for equipment that is permanently installed in a room or portable, wall-mounted units, the mobile option offers flexibility and convenience to quickly transport technology to beds where it's most needed.

Behind the Innovation

The solution was created by CEO Brad W. Playford, who founded AvaSure a decade ago to develop a clinical solution for his video surveillance company. The AvaSys TeleSitter Solution has been deployed in hundreds of U.S. hospitals.

Outcomes

Numerous health systems, hospitals, and rehabilitation facilities report a reduction in falls, as well as reduced expenses for bedside sitters because telesitters are able to monitor more patients simultaneously:

• Ochsner Health System reported to HealthLeaders a 51% reduction in falls on monitored units and a 26% reduction in the overall system fall rate during a December 2018 interview with Anita Campbell, director of Ochsner's critical care telemedicine and telesitter program. The health system began using portable units in 2016, and Campbell says that 91% of Ochsner patients are less likely to fall due to the TeleSitter program.
   
• TIRR Memorial Hermann experienced a 60% reduction in bedsitter costs by using telesitters (who could monitor multiple patients simultaneously) as reported in the July 1, 2015, issue of Healthcare Risk Management. The facility also had a corresponding 54% reduction in staff injuries related to the care of brain-injured patients, which the hospital attributes to the ability to remotely interact with patients rather than intervene in person.
   
• By using the device and trained telesitters, UC San Diego Health decreased bedsitter costs by $2.5 million over two years as published in the June/July 2015 issue of The Journal of Nursing Administration.
   
• Sunnyview Rehabilitation Hospital experienced a 20% reduction in falls and saved $186,000 in telesitter costs as reported in the March/April 2018 issue of Rehabilitation Nursing Journal.  

Why Your Organization Needs It

According to the Agency for Healthcare Research and Quality, 700,000 to 1 million patients suffer a fall in a U.S. hospital each year. Some 30% to 50% of these falls result in injury, according to a Sentinel Event Alert published by The Joint Commission on September 28, 2015. The TeleSitter technology:

• Reduces the risk of patient falls
   
• Reduces labor costs for bedside sitters
   
• Conserves nursing resources
   
• Prevents patient elopements

Who's Backing It/Investment

AvaSure is a privately held company based in Belmont, Michigan. The device is available for purchase or lease with the cost based on how many mobile units are obtained. Staff training by AvaSure RNs is included in the price, as well as on-site presence during launch. Online training modules also are available to train staff hired after the go-live date. An online database is available at an additional charge, enabling health systems to compare their data with other hospitals.