Technology to reduce readmissions

Ferguson Mission Health, a large healthcare system in Asheville, North Carolina, decreased readmissions by more than 14% after introducing Good to Go by Vocera, which makes audio and video discharge instructions available to patients via mobile app.

Piloted in a 33-bed general surgery unit in 2014, nurses used Good to Go to record instructions for 27% of patients in 2015, says Ellen Ferguson, a registered nurse and Mission Health discharge process team member. "During that period, 11% of those patients accessed their instructions."

The decision to utilize the app was driven in part by a Mission Health review of best practices to address readmissions for high-risk patients with chronic obstructive pulmonary disease and heart failure, says Linda Anderson, director of nursing. One of the best practices identified was a finding from the Agency for Healthcare Research and Quality that recorded discharge instructions can help reduce readmissions.

Key features of Good to Go that made it appealing to Mission Health include ease of use for nurses and patients, and the ability to access instructions and attach educational materials, such as videos, says Anderson. "Hospital readmission increases a patient's risk of complication and negatively impacts satisfaction," she says, adding that readmissions also harm hospital finances.

Higher penalties for readmissions

AndersonIndeed, the imperative to reduce preventable readmissions increased in 2012 with implementation of the Affordable Care Act's Hospital Readmissions Reduction Program. It requires the Centers for Medicare and Medicaid Services to reduce payments to Inpatient Prospective Payment Systems with excess readmissions. Currently, Medicare spends more than $17 billion annually on avoidable readmissions and imposes penalties on up to 3% of inpatient claims for 30-day readmissions.

"Patients who are readmitted to the hospital within 30 days of their discharge are subject to no reimbursement from Medicare. This can become a very expensive loss for hospitals," says David Collins, senior director of health information systems, Healthcare Information and Management Systems Society (HIMSS), Chicago. "Leveraging mobile health technology serves several purposes. It provides a way to engage patients in their own care. Being discharged with a tablet and other technology allows patients to connect with their provider who can tell if the patient is complying with their new medication regimes."

Zachary Clement, Mission Health's nursing quality and safety manager, says technology can help reduce hospital readmissions through enhanced communication between patients, family and the care team. "Technology can help us communicate better with patients and families by giving them a tool that fits their needs at any desired time," he says.

NEXT: How tech can help

How tech can help

Clement Good to Go is not the only digital technology that connects remote patients to providers. Others include CareSage, a predictive analytics engine that allows health organizations to monitor and care for elderly patients through wearable devices and monitoring; and pingmd, a secure mobile communication platform for care networks to two-way message, call and video chat with their referring networks and engage with their patient population.

CareSage lets healthcare workers predict when their at-home patients might need help or intervention to prevent a serious episode or avoidable hospitalization, using both real-time and historical data from healthcare providers and Philips Lifeline.

Kimberly O'Loughlin, senior vice president and general manager of home monitoring for Philips, cautions that technology such as the CareSage tool should augment, not replace, provider care. "It is the work of the healthcare professionals with the patients that will ultimately prevent avoidable readmissions," she says. "CareSage is a tool that assists them in identifying who's at risk for transport so they can best utilize their limited resources."

ChopraGopal Chopra, CEO of pingmd, says readmissions often result from the progression of a condition that goes undetected. Patient discharge is often delayed or not optimal because care teams are hard to access, he says. Providers can use pingmd to share patient issues, admission and discharge details, images and videos for quick consults and referrals. Providers can also use the app to create communication groups such as those made up of care teams, specialty teams, staff groups, and resident groups, to communicate quickly. The information shared via the app is stored on secure servers and can be uploaded to an electronic health record as a PDF.

Collins says hospital executives interested in leveraging mobile-based remote monitoring tools should have a governance structure in place that supports the use of technology. They should also pilot the technology and make tweaks to align with behavior change and efficient use. "Don't stay in pilot mode too long," he says. "Once there are results, clinical and financial that substantiate the use of technology, move toward scalability and sustainability and roll the process to solve another issue."