Why Phoenix Children’s turned in-house to create and deploy RPM apps

Keeping up with the demands of an increasingly digital healthcare landscape can be an uphill task. While some health systems turn to partnerships with digital health companies, others take over the reins of innovation and develop digital health tools in-house.

Phoenix Children’s Hospital in Arizona took the second route, developing remote patient monitoring (RPM) applications for its pediatric population amid the ongoing digital healthcare boom.  

Phoenix Children’s Hospital has seen first-hand the benefits of digital tools like RPM for its pediatric population.

One significant benefit? Alleviating transportation burdens.

“What we heard was some incredible stories from families [dealing] with chronic illnesses with their children who were living two to three hours away from the hospital…but two or three times a week having to drive in that three hours,” said David Higginson, chief innovation officer at Phoenix Children’s Hospital, in a Healthcare Strategies podcast. “And moms and dads telling us their whole life was devoted just to driving in.”

Not only that, but children who have to undergo invasive procedures and multiple surgeries also start to have negative associations with the hospital, making it more challenging for families to bring the kids back for follow-ups and other services, he added. RPM enables clinicians to glean valuable patient data while they remain in the safety and comfort of their homes.

Phoenix Children’s innovation and IT teams took it upon themselves to create disease-specific apps to maintain care quality while easing burdens on pediatric patients and their families. Though creating apps in-house is no small lift, there are undeniable advantages to crafting digital tools specific to your organization's needs rather than deploying the latest turnkey solution.

HOME-GROWN RPM APPS CURRENTLY IN USE

As Phoenix Children’s digital health strategy has evolved over the past decade, it became apparent to hospital leaders that data is invaluable. But, there is no reason to bring patients into the office to capture that data.

“In fact, you can take care of the patient in a much more effective way if you just get a little bit of information in between,” said Higginson. “And so, home monitoring for us has very much been the focus of how do we get those key data points in between the visits, keep assessing, and if the patient doesn't need to come in, don't make them come in every three months.”

Among Phoenix Children’s home-grown RPM apps is a ketogenic diet therapy app for patients with drug-resistant epilepsy. The hospital is one of the few in the country that will put pediatric patients on a ketogenic diet and not require them to be hospitalized, Higginson noted.

A ketogenic diet focuses on lowering carbohydrates, thereby depriving the body of glucose, while increasing fats, which produce an alternative fuel called ketones. The app monitors ketones, blood glucose, and developing symptoms.

“When we make the switch to the ketogenic diet and start changing the nutrition elements for these various sick kids, it's really, really important for us to know what's going on, kind of, in the moment,” Higginson said.

The hospital also offers a cleft palate app that tracks a baby’s feeding and food intake and a leukemia app that tracks symptoms, such as nausea and vomiting, as well as pain control, medication adherence, and symptoms of infection.

Additionally, the hospital created an app targeting headaches among children. According to Higginson, headaches are the fourth most commonly treated condition in pediatric hospitals, and while numerous medications address headaches, finding the right combination and dosage is a “bit of a crapshoot.”

So, Phoenix Children’s headache-focused tool enables clinicians to track patient reactions to medications and make real-time adjustments, providing quicker pain relief to young patients.

“At a very big scale, what these apps mean for us is filling in that data gap with meaningful things that are going on with that patient to decide when we need to see you again, and not making you come all the way from three hours away if we don't need to see you,” said Higginson. “At the same time, if something's out of control, and we need to monitor it, maybe come in every week until it gets [in] control. I think that's a far more effective strategy to take care of children than just saying come on this routine schedule.”

A LOOK INTO THE IN-HOUSE DEVELOPMENT PROCESS

Digital health technology development at Phoenix Children’s begins with identifying the problem.

“We don't try and chase a solution that we think is very glamorous,” Higginson said. “We wait till we’ve got a real clinical problem. And then we decide what works.”

The hospital discovered that in most scenarios, what works is asking the right questions in ways that are easy for patients to access and answer. Higginson explained that the central framework for each app is questions that will elicit responses to provide insights into health outcomes. The team develops an initial set of questions, pilots the app, and then adjusts accordingly.

“[If] the family only fills out three of the 15 questions, and so, okay, you know, you need to shrink that question base,” he said. “There's a little bit of that [in the] first couple of weeks, where we're looking at the data coming back, we're looking at the impact we're making.”

The team also considers language barriers, offering different language options for the apps.

Further, Higginson noted that keeping the barrier to entry low is vital. For example, patients do not have to download the apps themselves. They are prompted with text messages that provide a link to the app's web page.

Another critical element of developing the RPM apps is considering the clinician workflow. Higginson noted that in many cases, healthcare organizations employ wearable devices, sending their clinicians large amounts of data that they do not have time to look at.

“As we build [the apps] out, we very much think about what's the workflow, not about the technology, not about the wearable,” he said. “What are we going to do when we get this data back? Because, you can imagine, how bad would it be to be getting this data and then not acting on it? It's almost the worst-case scenario.”

CONSIDERATIONS FOR IN-HOUSE APP DEVELOPMENT

The decision to create RPM apps in-house rather than partner with a third-party digital health company was relatively clear-cut, primarily because innovation is necessary in the pediatric care space.

“Children's hospitals [are] often a hotbed for innovation because many of the big companies aren't interested in building a product that's just for 40 children's hospitals, right?” Higginson said. “There's not a big enough market. And I understand that. But children are not little adults — they have their own special set of needs. And so we often have to be innovative.”

A significant advantage of developing digital health tools in-house is that the solution can be tailored to the organization’s specific needs. While it feels risky, Higginson pointed out that using solutions from third-party vendors carries its own risks.

“I think what a lot of people forget is those small software companies may only have one or two people working there,” he said. “And you're just as much at risk as you are with someone leaving internally; you just don't see it.”

However, Higginson cautioned that using only home-grown digital tools is unrealistic, as supporting upgrades and other architecture maintenance processes can prove challenging. However, there are opportunities in the pediatric care space that technology-first companies have yet to target, leaving a gap.

That said, if a third-party company offers a better solution than one Phoenix Children’s has developed, the hospital is not afraid to switch, Higginson said.

The demand for digital healthcare is alive and well, and embracing innovation will be critical to enhancing healthcare outcomes and reducing costs. For Higginson and the team at Phoenix Children’s, the efforts to develop pediatric-specific digital health tools reap an additional reward: improving patient and caregiver experience.   

“When you get chance to talk to the families and the patients, and you see in their faces, the differences made, and you hear about the stories, [that] makes it all worthwhile,” Higginson said.