Using Patient Engagement Apps to Reduce Hospital Readmissions

Back when Christopher Meckel, MD, an orthopedic surgeon with Monterey Spine & Joint was a resident, joint replacement surgery didn’t center the patient the way it does today. Most of the considerations happened inside the surgeon’s head, foregoing patient engagement and raising the risk for hospital readmissions.

“The surgeon had an idea of what they wanted to do, and they did it, but it was a surprise to people—sometimes the patients, even the nurses,” Meckel told PatientEngagementHIT in a recent interview. “The whole process was there, but it was all living in the surgeon's head.”

Leaving patients out of the healthcare conversation can have its consequences, Meckel added, particularly because patients don’t know how to take care of themselves once they leave the hospital. A patient who’s gotten a hip or knee replacement, for example, might not know when or how to remove their dressing or recognize the signs of a blood clot.

A serious, acute episode might not get caught early on, landing the patient in the costly emergency department, or finding themselves readmitted to the hospital. That readmission could spur out-of-pocket patient costs and hamper clinical quality measures and reimbursement rates for the hospital.

Things have evolved quite a bit since then, first with medical manuals that patients theoretically could access—although it wasn’t always understandable, Meckel noted—and now to patient engagement apps.

“So current day is really about the notion of getting people the information, all of it, they need to know in advance, but then not relying on their memory necessarily to know what they need to remember and when,” Meckel explained.

Meckel and his colleagues at CHOMP use a patient engagement app from Force Therapeutics that let patients view patient education material that will help them take care of themselves before and after a total joint arthroplasty (TJA), generally a hip or knee replacement.

According to Meckel, apps like this work well because they are patient-facing and they remind patients of key self-care information when they’d need it during their recovery journey. For example, seven days after getting TJA, a patient might get an in-app message with a video explaining it’s time to remove their bandages and how to do that safely.

“In an ideal world, we would have about 10 patients in our practice. We would call them every day, check in and see how they're doing, make sure they're okay, and answer questions,” Meckel said.

But that’s not realistic, especially considering the clinician burden and staffing shortages plaguing the industry today. Patient engagement apps can do that for clinicians, and using asynchronous communication features patients and providers can communicate when something abnormal pops up.

“Patients and people are, one, getting the really important information in advance,” Meckel remarked. “That's getting reinforced at the time they need to know about it, and they get reminders. It also allows us to do better for more people without ignoring anybody.”

“If we get a poor response, well, then we're on it,” he continued. “We're going to call that patient and we're going to find out, how are you feeling? What's wrong? Why are you having so much pain? How are you taking your medicines, et cetera?”

That works in reverse, too, Meckel said. A patient might send a secure message through the app asking about a problem, and the clinician can clarify that issue is normal. This keeps patients from going into the ED and offers them some peace of mind.

In order to keep that communication running smoothly, Meckel said surgeons need to practice team-based care. As a surgical lead, Meckel can’t answer every single question that comes into his inbox. The patient engagement app he uses will push out a patient message to the entire surgical team, from medical assistants to nurses, and it’s on him to empower his team to answer them.

“The number of questions that I answer that couldn't be adequately answered by well-trained staff, it's probably in the 5 to 10 percent range,” Meckel estimated. “Taking responsibility for your team as a surgeon is very important. We've spent years training and then years practicing, and that's how we learned this stuff. It's on us to train the people we work with well, so they can answer these questions, which then reduces our burden over time.”

It's also important to remember that answering patient messages is key to delivering quality clinical care, even when it adds to provider workload, Meckel pointed out. Providers can streamline workloads by creating designated times for answering messages, he recommended.

“The reality is, we have to focus on caring for the patients,” Meckel asserted. “If we're really in this business to do the right thing, then we need to care for those patients and we need to care for them at the time they need to care. That doesn't mean you have to stay up all night every night, but if you just break down, you can check your phone for messages between cases.”

Meckel said his patients truly appreciate it when he can answer a question, a significant draw to the app. Of course, there are some patients who are reticent to use it, but Meckel asserted it’s his job as a clinician to help these patients understand the benefits that an engagement and communication platform can have for their overall outcomes.

“We have to be better communicators. We have to explain to the patients that we're caring for, that this actually helps their outcomes, this helps them do better,” he stated. “And if it's a little bit of a hassle to answer some of the questions or whatever things might come up that they complain about, it's all for a purpose. And the purpose is to have them do better, feel better and then not have to deal with us ever again.”

So far, the proof is in the data. After adopting the patient engagement app, CHOMP saw 14 percent lower hospital readmissions for highly engaged patients, for people who used the app more than 24 times during their 90-day care journey.

Moving forward, Meckel said he envisions an app that is even better at patient engagement than it already is, particularly by offering messaging in other languages. CHOMP has a notable Spanish-speaking population, so having the app work in Spanish would be key.

“We have a moderately large population of Spanish-speaking patients, so we really want to get the platform into Spanish as well,” Meckel concluded. “That's a big task because there's a lot of information out there, but that's our goal. As much as we can to get language appropriate, would be really helpful.”