Geisinger Health System launched its patient portal (MyGeisinger®) mobile app called MyChart, back in 2011. MyChart enables patients to use their smart phone to view medical information (i.e. meds, allergies, immunizations, test results, current health issues), communicate with the care team, view appointments and receive health reminders.
Following the MyChart app, Geisinger accelerated its mobile initiatives with text messaging pilots and a cardiac mobile app pilot. The mHealth team at Geisinger continues to learn how patient engagement can be increased by leveraging electronic health information to improve access, collaboration and care guidance.
Mobile Patient Data Capture
One of Geisinger’s key mhealth projects entails the electronic capture of patient reported data. “We’re using a third party tool to gather information from our asthma patients about how effectively they are managing their condition. Patients answer the five to seven question asthma control survey on their computer or mobile phone. So far, 13% of our patients are using their smartphone to respond and we expect that percent to grow”, explains Chanin Wendling, Director eHealth at Geisinger. Patients with a poor asthma control test score, indicating that their asthma may not be under control, receive an intervention call from a nurse who will help them better manage their condition. “This used to be a paper based survey which made it impossible to provide needed clinical support. Now that it is electronic, the survey can be delivered outside of the clinic and alerts can be sent to the clinician to catch problems before the patient ends up in the ER”, describes Wendling. “With this technology, we are able to check in more often with the patient. We have implemented the national best practice to have persistent asthmatic patients complete the survey every 90 days.”
Geisinger is also using mobile electronic capture to identify patients with potential health problems. When checking in for their doctors’ appointment, patients are handed an iPad to enter their health information while in the waiting room. Patients are prompted to answer certain personalized questions based on their health profile. For example, patients 65 and over with a chronic condition receive depression screening questions. “We capture and integrate the patients’ responses into their EMR so that their care team can quickly address specific needs and concerns”, adds Wendling.
Three Mobile Texting Pilots
In six short months, Geisinger has planned and launched three text messaging pilot initiatives. Geisinger will be using the findings to expand and refine the project or move onto a new mobile texting opportunity.
Last September, Geisinger started with appointment reminders to 4,000 enrolled patients total across two services areas; Pediatrics and Women’s Health. “We are currently evaluating this pilot based on the reminder’s impact on the ‘no show rate’ and more importantly on patient satisfaction. Based on the results, we plan to ask patients if they would like to receive a reminder in the future”, Wendling explains.
In September, Gesinger also launched a medication reminder texting campaign in collaboration with Geisinger Health Plan. Less than 50 patients enrolled to receive the daily text. “We expected more patients to sign up and experienced a high opt- out rate from those patient who enrolled. We learned that the daily text with a simple message to take their medication was too frequent so we are reevaluating the program. We may use the text reminders for medications which are taken less often such as once a week or month”, shares Wendling. “We are also questioning if the text message alone is enough or can we deliver more value using a set of messages for the broader disease?”
In November, Geisinger began using text messaging to support an existing program, “Conservative Weight Loss”. During this12 -week program, 240 patients enrolled to receive three texts per week; a reminder to weigh in, an educational and a motivational message. To evaluate this text message program, Geisinger will be reviewing patient satisfaction rates and weight loss results.
Conservative Weight Loss Program: Text messages Week 1
>Monday (nutrition)
“Take smaller bites and chew longer to savor food. Also eat slowly:it takes your brain 20 minutes to let your stomach know there is food in it. Text HELP 4help”
>Wednesday (self-monitoring)
“Think before you eat! Keeping food logs will help you with this. Keep honest, accurate food logs daily! Text HELP 4help”
>Friday (motivation)
“Reward yourself along the way with non-food rewards. Buy a smaller dress or a new pair of shoes, or take yourself out to see a movie. Text HELP 4help”
When texting for HELP, the patient receives a text response with the phone numbers for technical assistance and clinical assistance. “We do not yet have the option for the patient to text a question to the provider and then have the provider text or call them back. The first attempt at that will likely be a medication program with our Pharmacy team. There are a lot of operational and support issues that we have to figure out first”, explains Wendling.
Cardiac Mobile App Pilot
During the last few weeks, Geisinger has started testing a mobile Cardiac Rehab app internally to monitor the clinical data to decide whether to pursue a12- week patient pilot. The Cardiac mHealth application is designed to guide and support the patient throughout recovery. Within the cardiac app, patients can access educational information, receive medication reminders, track activity through their smartphone and provide feedback to their care team about any concerns. “Our patients in Cardiac Rehab are onsite three days a week. This is too much for many patients. During the pilot, we want to see if we can use technology to support their participation in Cardiac Rehab Program without the extensive onsite requirement throughout the 12 weeks”, Wendling explains.
Future Mobile Health
Geisinger is exploring ways to bring mobile health to different parts of its provider and payer organizations to drive patient engagement. This innovative health system is most interested in mobile health initiatives that strengthen the patient – provider relationship through the capture and sharing of information and tools to support better care decisions.
In addition to expanding texting programs, Geisinger is developing a mobile app strategy and will likely target apps around chronic disease management, health and wellness and the patient experience. In the area of chronic disease management, Geisinger is currently looking at an asthma app to connect in with care in their Pulmonary department. The app would help patients with reminders, tracking symptoms, alerts when at risk for an attack and general information about their condition. Discussions are taking place with clinical leaders on other conditions where an app may help with patient care.
“At Geisinger, we are always exploring new ways to better personalize care and empower patients. mHealth can do both, but it is not an add on. It is a complete reengineering of the health system and we are only beginning to scratch the surface of the potential for it to bring healthcare and wellness to the patient”, shares Dr Steven Steinhubl, Director of Cardiovascular Wellness at Geisinger.