Five Ways mHealth Can Decrease Hospital Readmissions


Patients who are discharged from the hospital after a heart attack, congestive heart failure, or pneumonia have high rates of short-term readmissions. As per a provision in the Affordable Care Act, a Medicare patient with one of these diagnoses who is readmitted within 30 days for the same will trigger a denial of reimbursement for the subsequent admission.  There are many things which need to change to limit these events, though not all readmissions can be prevented, as nothing in medicine is absolute.  Identification and intensive interventions (inpatient and post-discharge) with high risk patients, better communication/care coordination, discharge processes, and patient education have been shown to produce results.  I would make a case for mHealth to become an integral part of all these components of a multi-faceted solution . here are a few ways that mHealth may be incorporated in the process:

  1. The use of bioinformatics to determine the patient’s low, moderate, or high risk of readmission can be put into a hospital app to be shared among members of a multidisciplinary transitional team, which will formulate a discharge and post-discharge plan based on this data, while rounding on the patient daily.
  2. Bedside computer tablets can be used by nurses and other providers utilizing one of the good patient education tools available.  The patient and caregiver may continue to have access to these programs at home, and tracking of the time spent with these programs can be used to study the correlation between this education and discharge instruction adherence.
  3. Mobile apps with cloud-based patient portals may be shared with the primary care physician and post-hospital institutions (nursing/assisted living, rehab, LTAC, etc) at the time of discharge, with follow-up appointments made with providers with the same program.
  4. Mobile technologies for instruction and medication adherence may be activated with the patient and caregiver prior to discharge. This will involve the caregiver before the last minute, as well as decreasing anxiety related to a hurried discharge process.
  5. Telehealth conferencing with expert providers/extenders to supplement remote sensor monitoring would benefit patients at high risk for readmission.

This is a simplistic description of a complex disruption of hospital culture.  The above ideas are neither new nor solely my own. 90% of hospitals say they are aware of and addressing the issue of readmissions. However, few hospitals are attacking this issue in a concerted and comprehensive fashion. Significant changes in the utilization of personnel, investment in technology, and a commitment to making the patient the center of healthcare are imperative for success of not only preventing readmissions, but of care in general.

About davidleescher

David Lee Scher, MD is Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in helping digital health technology companies, their partners and clients. As a former cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he is uniquely qualified to address both clinical and operational concerns of clients. Scher was Chair of Happtique's Blue Ribbon Panel which established standards for certification of medical apps in the categories of safety, operability, privacy, and content. He is a well-respected expert in mobile and other digital health technologies and lectures worldwide on technology and its impact on patients and healthcare systems.
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10 Responses to Five Ways mHealth Can Decrease Hospital Readmissions

  1. Janice Flahiff says:

    Thank you Dr. Scher for this…
    On a related note, I just finished reading an article in the November Issue of the Atlantic where mHealth innovations (as wireless scales) and low tech procedures (toenail clipping) have significantly reduced hospital readmissions…
    The Quiet Health-Care Revolution
    (http://davidleescher.com/2011/12/16/five-ways-mhealth-can-decrease-hospital-readmissions/)
    While legislators talk about “bending the cost curve,” one company serving Medicare
    patients has discovered how to provide better care at lower cost—with wireless scales,
    free transportation, regular toenail trimmings, and doctors who put the patient first.

    While there are many challenges in cost efficient equitable delivery of health care to all….
    insightful columns as yours go a long way…

    Thank you, I am reblogging your column (with attribution!) hoping you don’t mind,

    Best,

    Janice

    PS I am trying to work out in my mind the differences btw mHealth and eHealth. Is there any? Is mHealth just a subset of eHealth? or is mHealth replacing eHealth?
    Thanks for considering an answer here.

    • Thanks for the thoughtful comment. Your blog is excellent. The reference to the Atlantic article was not found in your comment here. eHealth is what I consider a slightly broader term that some interchange with mHealth. mHealth may be thought of as an industry ‘dedicated to creating value and improving health, globally, through the convergence of communications technologies, consumers, caregivers and all sectors of the life sciences and technology environment.’ This is a broad definition from the Wireless Life Sciences Alliance, a significant nonprofit trade organization. Thanks for your interest, and stay tuned. Many things are going to happen in this arena.

    • Thank you so much for this, Chris. Welldoc is a company making a difference and demonstrating it in a way that payers, providers, and others understand and will respond to. Congratulations.

  2. Hi David,

    totally agree. With consumer priced connected devices interfacing to the existing (and sometimes new) services this trend is accelerating. The latest mHealth summit in DC showed this with a massive degree of partnering between different businesses in the value chain to bring together total solutions.

    • Yes, Brian. The Summit was very stimulating, seeing many developing technologies. What I did not see there was any significant representation from physicians, or evidence of any large clinical studies, which would bolster support from physicians, payers, and hospitals. Companies like yours are making products that will definitely impact the transitioning patient and even more so, possibly preventing the initial hospitalization in rural areas or in patients with poor access to care.

  3. For the sake of fewer technologies and interfaces, would there be an advantage to including the patient & caregivers on the same cloud server accessed by the hospital and post-acute centers? Information would obviously need to be protected for privacy but it might make sense that all three would use the same program. Thoughts?

    • Thanks, Chris. There is a telehealth product and is called Share The Visit where a visit itself is shared. There are EHR products which do what you are describing as well on the outpatient side. There is one that bridges inpatient-outpatient and involves the caregiver called Patientsafesolutions.

  4. Pingback: http://www.mhealthtalk.com/2012/01/mhealth-next-moon-flight

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