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Patient Discharge Plans Move Out Of The Hospital

Technology is changing the way patients receive education about their post-hospital regimen.

When a patient is discharged from the hospital, they're not in an ideal position to receive medical information about their discharge plan. They can be medicated or confused, or even try to rush the process to get out of the hospital as soon as they can.

"Today, 90% of patients won't be able to report back basic medical guidance they receive when discharged," said Steve Jackson, VP and general manager of care experience at Vocera. Vocera develops technology tools for patient education. "There are cultural disparities, a lack of medical literacy, and a lack of effective communication."

Hospitals and vendors are developing technology to bridge this gap in care. With a shifting payment model in healthcare, keeping patients out of the hospital is more important than ever before, and successful communication of discharge plans can help achieve that goal.

[ The big question: Do Patient Portals Improve Healthcare?]

"The focus on this issue began when hospitals started being penalized for high readmission rates," said Deborah Robin, medical director at Lumeris, a care management firm. "That got everyone's attention and people started to come up with technology solutions."

Vocera's product started as a discharge app and has evolved into a patient education platform. It tailors the discharge plan and educational content to the patient's preference, either video or print.

"During the average length of a patient's stay, a nurse will spend less than 28% of time on actual patient care," Jackson said. "There's little time spent on patient education. We need to do a better job of providing tools for the care team to more effectively engage patients about their disease."

Boston Children's Hospital developed a discharge communication platform called DisCo (Discharge Communication) to stay connected with patients post-discharge. The pilot debuted in April 2013, with 130 families enrolled (160 families were approached). The families select text or email as their communication preference and receive a message from Boston Children's within 24 hours of discharge. The message sends a link to a secure portal that asks three questions: if patients received medications, if they followed up with a primary care provider, and if they have any problems.

"One of the benefits is that patients still feel connected to the hospital," said Naomi Fried, chief innovation officer at Boston Children's. "That enhances the patient experience, which means increased patient satisfaction."

Before DisCo, a designated nurse would call each individual family to check in on the patient. Those calls were difficult to maintain and often the family couldn't be reached. DisCo enables direct post-discharge communication.

Boston Children's FastTrack Innovation in Technology (FIT) team built a program that keeps personal information de-identified and integrates that information into Boston Children's Cerner and Epic electronic health record systems.

"We had to consider how to get information from patients' devices back to us in a secure and HIPAA compliant way," said Alexandra Pelletier, a FIT program manager. "We worked with the security architecture and compliance committees to develop a program that fit those guidelines."

Nurses have access to a DisCo dashboard that allows them to send inquiries, receive responses, and make calls.

"Right now there's a perfect storm of policies being put into place that are enticing," said Geeta Nayyar, CMIO at Patient Point, which developed a care coordination platform for hospitals. "The consumers are saying, 'In every other retail industry out there, I can make educated decisions about my services and use technology. Why not in healthcare?' "

Though the online exchange of medical records is central to the government's Meaningful Use program, the effort to make such transactions routine has just begun. Also in the Barriers to Health Information Exchange issue of InformationWeek Healthcare: why cloud startups favor Direct Protocol as a simpler alternative to centralized HIEs. (Free registration required.)