Mobile apps helping reduce readmissions

'Readmissions represent a failure to optimize patients' clinical condition for discharge or set them up with appropriate post-discharge care'
By Sherree Geyer
07:24 AM
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Cynthia Deyling, MD, chief quality officer at Cleveland Clinic, sees burgeoning use of mobile technology at the health system.

While emphasizing that, of course, "some readmissions are clinically appropriate and necessary," Deyling says Cleveland Clinic, like so many other hospitals and health systems these days, is putting a focus on "reducing preventable readmissions through improved patient education, follow up, communication and care coordination."

Smartphones are playing a big part in helping them get there.

"We have apps in development that will support access by allowing patients to quickly identify local Cleveland Clinic resources, including on-demand scheduling," she says. "Other tools, including apps that promote patient wellness and chronic disease management, are also in use."

A 2014 study from the Mayo Clinic showed that patients who used smartphone apps to record weight and blood pressure – and participated in cardiac rehab – lowered cardiovascular risk factors and 90-day readmissions. According to the study, 20 percent of the app-user patients experienced readmission compared to 60 percent of patients who completed rehab only.

Another mobile technology survey from HIMSS this year suggests "healthcare organizations are widely beginning to deploy mobile technologies with the aim of engaging patients." Use of mobile technology continues to interest providers as a way to meet requirements for meaningful use and Medicare reimbursement requirements, the study shows.

Andrey Ostrovsky, MD, CEO of Boston-based Care at Hand, developer of an app-based care coordination system, says the move toward value-based payments drives efficient use of affordable, accessible technologies, such as mobile apps.

"Our company wouldn't exist if not for Affordable Care Act," he says.

Indeed, the rise in mHealth technologies correlates with ACA's plan to to reduce preventable, excessive readmissions with cuts to the Inpatient Prospective Payment System in 2012. Medicare spends more than $17 billion annually on avoidable readmissions with penalties that total up to 3 percent of inpatient claims for 30-day readmissions.

"Payers have begun penalizing healthcare providers for readmissions in excess of the national average, but, more importantly, readmissions represent a failure to optimize patients' clinical condition for discharge or set them up with appropriate post-discharge care and services," says Deyling.

The Cambridge, Mass.-based Institute for Healthcare Improvement has shown how discharge planning and transition (moving patients from one care setting to another) can reduce avoidable re-hospitalization. It calls for "Improving transitions and care coordination at the interfaces between care settings and enhancing coaching, education, and support for patient self-management."

"It is important to keep people stable and healthy who are living with serious chronic conditions," says Joanne Lynn, director, center on elder care and advanced illness at Ann Arbor, Mich.-based Altarum Institute. "They need to spend more time at home and less in hospitals. To the extent that readmissions result from poor discharge processes and limited support in the community, we should fix those things."

Lynn questions the viability of hospital-wide mHealth solutions.

"If they support processes, they would be helpful," she says. "If they're a patch thrown into an error-prone system, they will be expensive and frustrating."


According to that HIMSS survey, organizations "continue to struggle to effectively engage patients using existing mobile devices, noting that app-enabled portals allowed 73 percent of respondents to engage with patients, but that only 36 percent described that engagement as 'highly effective.'

"Many respondents reported a need to fully optimize and leverage the wide capabilities that mobile technologies and platforms offered," according to the report.

Another wrinkle is that 2 percent current mHealth solutions achieve the IHI's Triple Aim of improving the patient experience and population health and reducing per-capita costs – with "only 23 percent having any peer-reviewed research evidence for their claims," says Ostrovsky.

He offers the following guidelines to help direct effective technology selections. Technology should:

  • be evidence-based
  • validate quality improvement claims within six months of deployment;
  • support National Quality Forum Committee measurements;
  • produce positive outcomes for reimbursement;
  • identify risk factors for patients;
  • improve workforce quality and satisfaction;
  • be platform agnostic;
  • adhere to interoperability standards;
  • sustain long-term supports and services and
  • provide technical assistance for baseline capacity.

Mobile apps represent "a natural home for medication information" and patient appointments according to "The ROI of Patient Engagement: Readmissions Reduction" from Axial Exchange, a Raleigh, N.C. developer of hospital mobile technology.

Noting that 37 percent of discharged patients don't know the purpose of their medications and those without an appointment number 50 percent of readmitted cases nationally, it calls apps a simple way to help patients, one that doesn't require complicated integration.

"Cleveland Clinic is beginning to have success using decision support tools in our EHR to ensure a patient is ready for discharge," says Deyling. "These checklists ensure key activities, assessments, hand-offs and interventions take place. Technology that supports standardized, evidence-based care plays a role in preventing readmissions."