Video App Improves Physician-Patient Communication, Engagement

Northwell neurosurgeon develops app that enhances patient encounters and improves satisfaction scores.

Ten years ago, David Langer, MD, a Northwell Health neurosurgeon, began videotaping patient encounters so they could recall details of information exchanged following their visit. Today, his patients depart appointments with essentially a three- to five-minute highlight reel, delivered via Playback Health, a smartphone app Langer helped create.

After the appointment, 90% of patients access the app and share the recording with family, friends, and other providers on their care team. The videos help patients understand and recall details that are often complicated. It allows them to review MRI, CAT scan, and other diagnostic images, accompanied by the audio of the physician explaining their problem and treatment. There is no extra charge to use the app.

Following surgical procedures and hospitalizations, nurses on the neurology unit use the same technology to capture discharge instructions as they review details with the patient. Use of the app has improved HCAHPS inpatient scores and Press Ganey outpatient scores by as much as 12.9%.

Through its investment arm, Northwell Ventures, Northwell Health has become a major backer of the startup company, investing $500,000 to further develop and commercialize what the founders refer to as a "clinical multimedia creation and communication platform."

Retention During Medical Encounters Presents Challenges
 

Neurosurgery is a complex profession, and Langer knew patients struggled to recall details of their encounters after appointments. The physician is chair of the department of neurosurgery at Lenox Hill Hospital; director of the Moyamoya Center of the Northwell Health Neuroscience Institute, and professor of neurosurgery and radiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He also co-founded Playback Health and serves as the company's medical director.

Before turning to video, Langer's patients would often call the office after appointments, seeking to refresh their memories.

Retention of knowledge presents challenges under normal circumstances, the neurosurgeon says. He cites the Ebbinghaus Forgetting Curve, a seminal study conducted in the late 1800s that has been verified over time. The Curve demonstrates that nine hours after hearing something, two-thirds of the knowledge is lost, according to Playback Health's CEO, Gregory Odland.

"I would argue this curve is even worse in healthcare," Langer says, due to unfamiliar medical syntax and a patient's emotions when they are learning about adverse health circumstances. The neurosurgeon determined that a video recording of sessions could help close this gap.

An App is Born
 

While informal videos sufficed for a while, Langer's idea continued to progress, and the process moved to a platform that was introduced and tested in 2014.

Another technology leap occurred a couple of years ago, when Odland, a long-time acquaintance of Langer's, broke his shoulder in a biking accident and also suffered a concussion. He had to return to the hospital twice to pick up the discharge instructions he left behind as well as the CD-ROM of his x-rays for a surgical consult. When the surgeon wasn't looking, Odland snapped a picture of the x-rays on his smartphone, so he could view them later at home.

When Langer mentioned he made patient videos for such circumstances, a light bulb went off in Odland's mind. The idea for an app was born. Since Langer taped his first video a decade ago, technology and social media had advanced remarkably. Consumers were sharing images via apps like Snapchat, and hospitals now had a secure way for patients to access information via HIPAA-compliant cloud platforms.

Further Development Underway
 

Playback Health was established earlier this year, and moved to the current platform, which is being refined. A commercially viable product is expected late this year, and Northwell will roll it out to other units in its system.

The platform consists of four separate apps. The first, a patient app, contains videos, images, and many other features, such as lists of the care team members, the diagnosis, and patient responsibilities. A web-based app will be created in the future.

Providers have three additional apps: mobile, desktop, and an administrative resource to create, store, and share pertinent information and images. While physicians and discharge nurses can devise their own approaches, Langer sets aside specific time during the patient visit to review the diagnosis, share diagnostic images, and explain treatment. These concise summaries are recorded and delivered to the patient's app.

In addition to patient-physician encounters, the app is also used in the hospital during patient discharge.

Cynthia Liapes, ACNP-BC, supervisor nurse practitioner in the department of neurosurgery at Northwell's Lenox Hill Hospital, who has done discharges for 20 years says a similar inability to retain information occurs as patients leave the hospital setting.

The app helps patients understand their experience, their medications, and wound care, says Liapes, "and the patient and their families can replay it repeatedly." As a result, she says compliance has improved and the app enhances patient experience.

Improved Patient Satisfaction Scores
 

While the app receives positive feedback from patients, according to the company's founders, the proof lies in patient satisfaction scores. Both HCAHPS and Press Ganey scores have demonstrated a significant upswing among patients using Playback Health.

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

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

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

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

This is not only good news for the healthcare system, it also can impact outcomes and reduce readmissions, says Odland. "Patients reporting high patient satisfaction scores and good patient-provider communication were 39% less likely to be rehospitalized, according to a 2017 study by Massachusetts General Hospital," he says.

The Competitive Landscape
 

With a need to enhance communication, the company's founders assume that others are working on solutions to capture physician encounters via video. So far, none have the 10-year history behind Playback Health or the ability to deliver a solution in a HIPAA-compliant platform that also incorporates the consumer-friendliness and usability of a social media app.

With the proliferation of smartphones, which Playback Health estimates are owned by 77% of the U.S. population, today's patients are recording visits with physicians anyway, sometime surreptitiously. An August 8, 2017, report in the Journal of the American Medical Association explores the legal issues involved. Yet patient-recorded video lacks the robust features of the Playback app.  

Epic is working on a solution to capture videos and embed them in the patient record, but they don't yet have the ability to deliver such files in a consumer-friendly app, according to Odland. In addition, the founders are aware of at least one company that offers the ability to capture an entire patient encounter, but Langer says that approach "isn't effective. It's just too much nonspecific data, that's not relevant," and puts the onus on the patient to wade through an entire appointment to determine what's important.

"Our secret sauce— and what differentiates us from other companies—is the fact that David [Langer] is using the images, the video, and the audio that he thinks is important to the patient," says Odland. "When the patient goes home, they have the basis of what they need to be engaged in and educated about their own care. That's what bridging the communication gap is all about. It's not giving them everything that you do in an office visit; it's giving them the relevant information they need to be more successful."

Editor's Note: This article has been revised to correctly identify David Langer, MD, as a neurosurgeon, rather than a neurologist.