Texting Program Helps Patients Give Hospital More Immediate Feedback

Recently, Neil Versel wrote about a truly horrible hospital experience his father had before his passing over on Meaningful Health IT News. It got me thinking, how many patients have terrible experiences like this, and, does the hospitals’ staff even realize it? Most hospitals give their patient’s a form to fill out toward the end of their stay to evaluate their care. A situation I was in a few months ago makes me wonder, however, how accurate those are in determining the care the patient actually received.

When my son was in the hospital during his second week of life with RSV, I was very disappointed with the care he received overall. Yes, there were a few good nurses, but for the most part, my husband and I felt several times like having our son there was an inconvenience to the hospital. One time, when I left for a few hours and my sister stayed with my son, a nurse tried to discharge us (despite the fact that my son was still on oxygen, and was being suctioned every few hours) without even consulting us. At one point, we were told they wanted more room for “more sick” patients, so they might send us home, even though our baby was still very ill. I voiced my concerns a few times but they were dismissed and I was basically told I didn’t have much of an opinion in my son’s care. However, when the time came to fill out the “confidential evaluation form” I was hovered over by the nurse as I filled it out and was given very little time to actually fill it out. What the nurse came away with was a form that would have probably insinuated that our stay was fine, seeing as I hastily finished it without much thought. I planned to complain later, but time got away from me, as it usually does with a newborn baby. I knew I wasn’t the only one to have a poor experience in the pediatrics/mother and child floor at the hospital, as everyone I spoke to who had delivered here said they had a terrible experience. However, the walls are full of notes from mothers staying how wonderful the hospital is. If nurses are hovering over patients as they fill out comment cards or are “encouraged” to fill out a thank you note, how accurate are the results? And even if the patient isn’t watched while filling it out, a piece of paper is very easy to misplace or be forgotten about.

So when I read this article about a texting program implemented at Park Nicollet Health Service in the Minneapolis-St. Paul area, I was intrigued. The program, which is called CareWire, sends text messages to patients before and after their stay, sends appointment reminders, and asks questions about the patient’s stay in the hospital. The program was implemented to increase patient satisfaction. According to this article at MedCity, the part of the texting program that proves to be most useful is a “post-discharge” text that patients receive within a few hours after the patient leaves the hospital. The patient is asked to rate their experience on a 0 to 10 scale, and then Carewire “uses an algorithm to parse of the reason for any low scores, such as the type and time of the visit, which doctor the patient saw, and other relevant data. Customer Service reps then can follow up immediately on any low scores.”

Apparently, the hospital said that the program has helped to raise the satisfaction of patients and is being offered to other facilities in the area.

I love the idea of having a texting program like this. There is no risk of being rushed to fill out a form, or being eyed by an intimidating nurse as you teeter between putting a low score on one of the questions. Many hospitals have a company call patients a few weeks after their stay to answer questions, but this texting program allows for immediate, and more than likely, honest feedback. The fact that CareWire can determine facts such as the time of visit, which doctors (and hopefully, nurses) gave care, etc. during the patient’s stay make this program even better, as it can pinpoint where specific problems may be.

While it would seem that people should be able to voice their concerns and receive immediate reconciliation of the problem, it isn’t always that easy. Sometimes it can be intimidating, especially when in the hospital, which is likely not the most uplifting situation to be in. At least, that is how I feel.

The article I first linked to talks about how other hospitals are implementing other ways to get immediate feedback, such as administering a survey through a tablet right before the patient leaves. While this is somewhat similar to filling out a piece of a paper, I feel like more people would actually fill it out because, unlike a piece of paper that can be thrown away or misplaced and never filled out, there isn’t really a  risk of that happening. The information would then be uploaded immediately to a computer, and hopefully one of the hospital’s employees could review it and help to reconcile any potential problems.

Having this immediate feedback is essential, in my opinion, for increasing patient satisfaction and helping to identify problem areas. This may increase some costs at the hospital, as Healthy Heartland, the vendor for MedCity, said it would potentially add $3 or $4 per visit to use the texting program. However, if patient’s are able to receive better care in the long run, I feel like this cost is well-worth the cost. I mean, if someone’s experience at a hospital is mediocre at best, they may not feel the need to complain or fill out a satisfaction form. However, if their response to a text indicated they could have received better care at a certain time, it might eliminate certain problems before they spiral out of control, and the horrible experience that Neil Versel’s father had could be prevented. Just something to think about.

What do you think? Do you think that this type of immediate feedback would increase patient satisfaction and, hopefully, the quality of care given at hospitals? Would you take the time to respond to a text?

May 31, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

PocketHealth Raises the Bar for mPHRs

On May 1st, Cognovant, a Missouri-based startup, announced in a press release that the initial funding for their smart phone app, PocketHealth, was complete. With this announcement, Cognovant also revealed that the app would be released for both Android and Apple operating systems this month.

PocketHealth is the latest mobile personal health record (mPHR) available for smart phones. This isn’t the first mPHR; other popular ones are mPHR 2 and My Medical. However, PocketHealth appears to be one of the first of its kind. It is untethered, which essentially means it isn’t tied to just one insurance company or healthcare provider. While untethered mPHR’s often make the user key in their own data manually, this isn’t necessarily the case with PocketHealth. What also sets this mPHR apart from others is that it was built following CCD standards. Dr. Joseph Ketcherside, the President and CEO of Cognovant, said in an interview with Mobi Health News:

 From the user interface standpoint, it might look like every other PHR. But the guts of our PHR are comparable to what you would find in the parts of an electronic medical record.

This is essential, because in the future, if medical providers have to be able to give copies of patient medical information in CCD format. PocketHealth is designed to be able to import that format. This also gives PocketHealth an advantage over other untethered mPHRs because doctors and hospitals that have EMRs integrated into their systems can simply upload the CCD, rather than having to take time to log in to a website or deal with a USB drive to read the patient’s mPHR.

One of the issues with some mPHR is whether or not the information is secure. PocketHealth tries to overcome that problem by having PocketHealth encrypt the data and be password protected.

PocketHealth is a free app, though there will be a 3.99 version that a user can upgrade to if they monitor the health of more than one person or have a complicated medical history. The free version seems good enough, however, and tracks information like immunizations, medical conditions, family and social history, information on providers, and more. In addition, the information can be exported as a report or a CCD.

Because PocketHealth has been released for the Android OS, I decided to download it. This was my first experience with mPHR. I was impressed with all the information that could be recorded, and I can definitely see the benefits of it (well, just the idea of an mPHR to begin with). Because I have no idea where my family will be in a year from now, it would be helpful to have this information available at the tip of my fingers when we visit with a new doctor wherever we move. I also see it being handy if someone is admitted to the hospital in an emergency situation and information needs to be quickly accessed.

However, I see some potential problems, such as if the information wasn’t totally correct. What if someone thought they were O negative blood type, so that was entered into the “vital stats” section, but they were actually A negative? Granted, I’m sure a medical professional would test a blood type, and not just trust the PHR, before doing something like a blood transfusion, but there is always the chance for incorrect information. I do like that PocketHealth is created on the same foundation as an EMR, so information can be directly exported from a doctor’s office. I also was a bit concerned about privacy, but the fact that PocketHealth is password protected and encrypts the data made me feel better.

One thing I didn’t like about the app was that it seemed a bit sluggish. I had to press my selections a few times before it would work, which was kind of annoying. Overall, I think I will probably upgrade to the 3.99 version, so I can track the health of my family and me and have a lot of information readily available.

The Android version can be downloaded . The version for the iPhone is still in the works but the release is expected to occur in the next few weeks.

May 29, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

A Memorial Day Message from Smart Phone Healthcare

A big thanks to all our military! We’re lucky to have so many brave people who fight for our freedoms. I found a series of Memorial Day Cartoons which each share a message of the real importance of Memorial Day. I’ll post them across the Healthcare Scene network as a way to honor and remember those people who sacrifice so much.

A really special shout out to David who’s the force behind Smart Phone healthcare. This week he’ll be given his wings in the Air Force. A well deserved honor and I thank him and his family for their sacrifice for our country!

Have a great Memorial Day and enjoy time with your family as I will do also!

May 28, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: and and .

Congressmen Ask FDA and FCC to Answer for Delays in Regulation of mHealth

Regulation of mHealth Apps is one of the biggest ongoing hot topics in healthcare.  Earlier this week we posted about regulation, and how it may very well be warranted in some areas, but may be less necessary in others.  Apparently, this is something that is even catching the eye of Congress.

Just last month, members of Congress sent a letter to the FDA and FCC asking them to clarify what exactly they are currently doing with regulation, and what they are planning to do in the future.  The letter expresses their concern that excessive regulation may slow the growth of this developing industry, which grew by 250% on iTunes alone last year.

I think it is great that Congress sees the value of this industry and is concerned with not creating any unnecessary hoops for developers to jump through.  That being said, I also don’t understand how Congress sticking their nose in everything does anything but slow the process down even more.

Is writing a response to their letter a big deal?  Probably not, but who honestly thinks that these congressmen will be satisfied with a simple response?  They will naturally want regular updates of exactly what is being done.  They will likely want to insert their two cents about every little decision that is being made.  Given the chance, they will probably try to use this as another way to create jobs for their constituents, even if it makes no real sense to do so.

I agree with Katie’s article earlier this week that there is some definite value to regulation in many cases; which is ultimately where I think the FDA will end up.  What scares me, is that Congress will force themselves into the process which will only make it that much slower and create the very delay that they are trying to avoid.

 

 

May 25, 2012 I Written By

Regulating mHealth Apps: Does it Limit Creativity?

Last year, the FDA announced plans to regulate some smart phone apps that involve medicine or health. The specific apps that would be regulated “are used as an accessory to medical device already regulated by the FDA [or] transform a mobile communications device into a regulated medical device by using attachments, sensors or other devices.” In addition, apps that suggest potential diagnoses or treatments for the person using it.

As I was perusing comment boards for various articles about this, the feelings were mixed. Some think that the FDA already has too much control. Others think it totally makes sense. A comment from someone on a Washington Post article sums up how I feel:

Yes, some software that turns a smartphone into medical use has to follow the same rules as developing a medical device — from the first moment you think about it. It’s not hard, but you had better know what you are doing because what the FDA gives you is basically the right to market the device and if you don’t follow the rules, you could end up with is a really neat program that you can’t even talk about to your customers.

I think it definitely makes sense to regulate these things. I mean, there are quack doctors out there that we don’t know about, who seem legitimate; how are we supposed to discern between a quack health app, and one that can actually be trusted? There needs to be some kind of regulation, but the question is — how much?

The issues I find with certain apps, is that if they get too advanced (such as an x-ray), people might start avoiding the doctor because they diagnose themselves. Basically, I think that without regulation, certain apps may seem awesome, but in reality, they have fatal flaws that could be just that — fatal. There shouldn’t be a chance that bad apps could possibly act as an authoritative source.

In the Washington Post article I previously referenced, Bakul Patel, a FDA adviser was interviewed. I thought he made a good point when he said:

We wanted to make sure that we are consistent in regulating medical devices so nothing has changed. If somebody makes a stethoscope on an iPhone, it doesn’t change the level of oversight we have of a stethoscope.

I mean, that totally makes sense. Just because something is digital doesn’t mean it should be able to bypass requirements. A stethoscope is a stethoscope. End of story.

Overall, I agree with the regulation. If medical and health apps are going to actually be taken seriously, we should be able to see right of the bat if it can actually be trusted as a medical device. I’m not a huge fan of the government controlling everything, so there should definitely be regulation on the apps that could actually determine the health status of a person. However, the rules shouldn’t be so strict that people can’t be creative in what they create. That’s my two cents on the issue, what are your thoughts?

May 23, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Behavior Change May Be the Holy Grail of mHealth, but Should it Be?

Sara Jackson over at Fierce Mobile Healthcare wrote an interesting piece this week entitled mHealth’s Holy Grail: Behavior change Just reading the title I thought it was a pretty obvious statement despite the apparent struggles of developers to actually achieve that.  I totally agreed with the title, but as I read the article it got me thinking about what mHealth is really trying to achieve.

Sara makes a great point that apps need to be developed in such a manner that they are encouraging rather than demoralizing.  She references a paper by Margaret Morris that describes the need for smartphones to become a friend to the users.  Rather than smartphones simply being a tool for reminders and nagging when you don’t meet your goals, they need to be the supportive friend that encourages you through your struggles.

That is where I started to think about the real value of mHealth.

It was actually sad to me at first, because in essence she is saying that a smartphone can replace people in our lives, and that is one of my biggest irritations with technology: We are removing people from the equation.

There is no doubt that mHealth applications and gadgets can be a valuable resource, but when we lose touch with people we are missing something far more valuable.  People are what inspire us to do better.  People don’t quit on us when the batteries run out because we forgot to charge it.  People provide a connection that cannot be replaced by any technology, no matter how amazing it is.

While I agree that a human element is a great attribute of any health related app, that element needs to actually be human.  Simply having the app give encouraging words is not the same thing as encouraging words from a real friend or family member.

The apps that will lead to real behavior change are the ones that will endure long after the app serves its purpose.  They will not only create habit patterns for the user of the app, but they will also establish real relationships for people who genuinely care about your health and well-being.

Social media, and the mHealth portion of it, are rapidly becoming a part of everyone’s life, and that can be a good thing.  If we use that technology to connect and support the people we truly care about then technology has truly made our lives better.  It has provided us a way to connect that was never possible before.  The money that can be  made through mHealth is as elusive as the real Holy Grail, but the impact that it can have on our lives is very real, and very important.

May 22, 2012 I Written By

Caution: Smart Phone May Cause Injuries

There are so many mobile health apps available that are designed to increase quality of life and to assist in medical care. But is it possible that smartphone usage could do just the opposite?

It’s the whole “too much of a good thing” idea. Sure, a lot of the apps are awesome. But if a person spends too much time using a smartphone, they may find themselves in the doctor’s office.

I recently read an article on MSN’s health website about this very topic.  It listed some effects of “smart phone syndrome” as the author called it. Here are a few of them:

1. Trigger Thumb: When you use your fingers for long periods of time . . . you may flame your tendons. The tendons can no longer glide through their tunnels smoothly and get temporarily stuck. This, in turn, causes the finger to lock or catch before it has a chance to open . . . which is medically a form of tendinitis.

2. Cell-phone Elbow: Elbow action plays a big role when you talk on your cell phone. Your elbow is both slightly elevated and typically flexed more than 90 degrees. The outcome . . . is that the ulnar nerve gets less blood, which, in turn, causes that nerve to short-circuit and malfunction. Common symptoms are a cold feeling and a pins-and-needles sensation, often in the ring and pinkie fingers.

3. Wrist Pain: Some tendons in the wrist are vulnerable to inflammation. This condition is often seen in parents of newborns who cradle their babies in the crook of one arm with the wrist bent and turned inward. This wrist position is similar to way people cup their smart phones . . . and it puts pressure on certain tendons that can become inflamed.

4. Exposure to Germs:  If you use a smart phone or cell phone covered with your own germs, there’s generally no harm done. But if you’re sharing phones, you may be vulnerable. . . . Only between 1 percent and 2 percent of all germs are pathogens — meaning they’ll cause disease no matter how healthy you are.

Other issues noted among avid-smartphone users were behavioral issues, such as anti-social tendencies.

Granted, these ailments are probably more likely to happen to someone playing Angry Birds or Words with Friends than someone surfing health apps. But the bottom-line is, over-use of smart phones are not going to make life easier. In order to use one, make sure you are as smart as the phone, and know what the limits are.

Personally, I use my smart phone quite a bit and really haven’t experienced any of these things, but I guess I can’t speak for everyone. Smart phones are now involved with health, for better and for worse.

May 21, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Mobile Health Apps Created to Combat Mental Illness

Mental illnesses are becoming less of a “taboo” topic than in the past, and as such, more information is becoming readily available about them. Because of this increased awareness, apps and technology concerning mental illnesses have been popping up recently.

One app has been created to help combat social anxiety. Designed by researchers at Harvard, the app is supposed to “re-condition the brain to automatically look away from, and not fixate on, hostile expressions.”

The app created to combat social anxiety “re-conditions the brain to automatically look away from, and not fixate

A phone, called Mobilyze, apparently has been designed to diagnose someone with depression. It picks up on different social situations, physical habits, and location. Using this data, it determines if you are on the verge of a depressive episode.

And even more recently, one that is supposed to help with the effects of OCD (though, at a hefty price of $79.99). The app uses a widely-used OCD treatment called exposure and response therapy. Users select challenges and exercise to help combat their OCD tendencies.

According to a the creator of Live OCD Free, Dr. Kristen Mulcahy, in a recent Mass High Tech article, between 4 and 7 million people in the United States have OCD and a large portion of those don’t have access to treatment. She said:

That was the huge reason why I thought about developing this app. There is such a huge need for those who don’t have access to a therapist.

But, is it a good idea to have people consult a smart phone, rather than a therapist, for help? Dr. Andrew J. Gerber, a psychiatrist at Columbia University, spoke with the New York Times recently about his skepticism about these apps.

We are built as human beings to figure out our place in the world, to construct a narrative in the context of a relationship that gives meaning to our lives. I would be wary of treatments that don’t allow for that.

Personally, I think that these apps could be helpful. However, I don’t think they should replace treatment with an actual therapist. They could, however, be great for a supplemental treatment, because patients can’t always be with their therapist. With Live OCD Free, it has been designed to be used concurrently with therapy sessions, and information collected from the app can be uploaded and sent to the patient’s therapist.

I don’t think anyone should spend all their time focusing on something like a smart phone, but these apps are pretty cool. I think that if they are used appropriately, many people will benefit and come closer to overcoming mental illness.

May 18, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Losing Weight on the Go: Keep Food Diary Easier than Ever

A study conducted in 2008 by Kaiser Permanente’s Center for Health Research (KPCHR) discovered that keeping a food diary increases the amount of weight a person can lose. Dr. Jack Hollis, a researched at KPCHR, said concerning the study:

The more food records kept, the more weight they lost. Those who kept daily food records lost twice as much weight as those who kept no records. It seems that the simple act of writing down what you eat encourages people to consume fewer calories.

Seems pretty simple, right? Without going into too many details in this post, I’ve struggled with my weight my entire life. Luckily, I’ve successfully lost (and kept off) about 50 pounds in the past few years. I credit some of that success to keeping a food diary and caloric intake. But let me tell you, it wasn’t always easy. When I started tracking what I ate, it was such a pain to have to look up in a book how many calories were in certain foods, not to mention carry around a notebook and pen everywhere I went. It was well-worth it but certainly not the most convenient activity.

Luckily, there are a lot of websites and apps out there that making tracking food easier than ever (at least I think so). One of the most well-known companies to make this possible is Weight Watchers. However, it is quite pricey to join. But there are a lot of other great resources out there. My favorite? MyFitnessPal.com.

I discovered MyFitnessPal a few years ago, and it has been awesome, not to mention free. The website encourages its users to interact with friends, family, and quite frankly, random strangers on the website. I’ve used it off and on since I discovered it, and found it to really help make me aware of what I’m eating, and I have lost weight. Don’t just take my word on it. Plenty of others testify of how great the website is.

Still, I don’t always have a computer with me, so I was thrilled when MyFitnessPal came out with their mobile app. Not only is it available on the iPhone and Android phones, but the BlackBerry and Windows phones, so just about anyone with a smartphone can use it. The app is super easy to use and you can literally have your food journal anywhere you go. One of my  favorite features on the app is that you can just scan the barcode of any product and it will automatically upload the nutritional information. Even if a barcode isn’t on the food (say you’re eating out), the database has over 1 million foods. Very rarely have I actually had to enter my own information on foods. Goals are totally customizable, and there is also an option to input exercise, which is also nice (because then you get more calories added to your daily goal!) I also think it’s fun to interact with my family and friends on it.

Here are some screen shots. I think it has a pretty clean interface that’s very simple to use:

App can be downloaded for:

The iPhone

Windows

BlackBerry

While the only app I use is from MyFitnessPal, there are some other awesome ones available. After doing some research, the following are the ones that seem to be most popular:

Calorie Tracker by LIVESTRONG.com — available on the iPhone and Android. Users feel like it has the most extensive food database, and that is its main draw, because it seems to lack a very good design. (cost: $2.99)

MyNetDiary — available on the iPhone, , and Blackberry. This one seems a little more savvy than CalorieTracker and has more features. However, I would expect it to almost lose the weight for me at the hefty cost of $9.99. Even then, it seems to be pretty popular.

GoMealsHD — available on the iPhone and . This one claims to have 175,000 restaurants in the database and 60,000 items. A lot of people like this one because the database is accessible offline, unlike Calorie Tracker, MyNetDiary, and MyFitnessPal. It is also free. The database isn’t quite as good as some of the others, but it seems to get the job done.

So if you want to lose weight, keep a diary. And if you want keeping a diary to be as simple as possible…download one of these apps. It makes life so much easier (and honestly, if it is embarrassing to pull out a food diary in front of people, this makes it a lot more inconspicuous.) Have you found success using a food diary app? Which one is your favorite?

May 16, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Using the Camera on Your Phone to Better Diagnose Fractures

In this modern age of new apps and devices to monitor this or control that, it is interesting to think about what can be accomplished using the simple basics of a phone.  One of the very first additions made to cell phones was the camera.  They started out not very clear, but the fact that  you could send images from just about anywhere was incredible to me.  Now, I don’t even own a camera because my phone is almost as good.

Researchers in Ireland are now using that most basic of smartphone technologies to better assess nose fractures.  Apparently, many people who go to an emergency room with a nose injury are referred to an ear, nose, and throat specialist to get a proper diagnosis.  According to the above article, as many as 80% of those people either don’t go to the appointment, or needed no further care which is an obvious waste of time and money.

Using a relatively small sample size, these researchers found that they were able to quite effectively get diagnoses through pictures taken on an iPhone.  While the results were not perfect, there was zero negative diagnoses, or in other words, everyone who needed further treatment received it.

This is by no means a ground breaking discovery, but it does make you stop and think about what uses we may be overlooking.  Sometimes we get so excited about the newest gadget or technology that we overlook the simple abilities that we already have.  What other simple technologies do you think we are overlooking that could prove useful in healthcare?

May 14, 2012 I Written By



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