reCharge

Understanding The Problem

Our early considerations for this problem involved first considering the pain points of healthcare from the view of doctors and patients. We evaluated areas of repetition for doctors, and how we may eliminate some of this redundancy with technology. We also considered wearables, such as the HTC and Under Armour fitness tracker, and how such technology could alert medical professionals prior to an adverse event. Communication and collaboration was also discussed, and how creating a portal for doctor-to-doctor or patient-to-doctor communication could eliminate some of the patient frustration we discovered in our early survey and interview sessions.

Our initial direction focused on this communication portal, but our contextual research and interview with nurse Korene at PeaceHealth St. Joseph’s Medical Center in Bellingham forced a pivot. We discovered that such an internal communication interface for doctors and nurses already existed and was only days away from launching at the hospital. The EPIC hospital management system solves the doctor-to-doctor communication and collaboration gap that we initially saw as an opportunity, and as Korene pointed out, a patient-to-doctor communication resource was already in practice, although underutilized.

Despite these roadblocks in our research, Korene’s insight into the discharge process at the hospital opened a new opportunity, and the inevitable pivot that would shape the remainder of this solution. She identified two main areas within the discharge process that were lacking: (1) patients are not given ample time for recovery education, and (2) hospital resources are being underutilized for this purpose.

Leveraging The Economics

In 2015, the Centers for Medicare and Medicaid Services (CMS) penalized 2,638 medical facilities an estimated $428 million dollars in readmission penalties.

This is up from $227 million in 2014.

Research uncovered that penalties from CMS for avoidable readmissions are trending upward, and the industry is scrambling for a sustainable solution. But the need for decreasing readmissions is about more than just money.

IT’S ABOUT THE PATIENTS WHO WANT A CLEARER PATH TO RECOVERY

“I felt the surgery went really well. But it wasn’t until I returned home that I realized that my recovery had only started, and I felt unprepared for it.”

ROBERT STRAHM

IT’S ABOUT THE NURSES AND DOCTORS WHO WANT TO SERVE THEIR PATIENTS BETTER

“We start the discharge process for a patient as soon as they are admitted to the hospital. Even with this early start, we are still pressed to prepare the patient for when they leave the hospital. The result is them leaving without the proper education for recovery success.”

MARY FLYNN, R.N.

OUR AIM IS TO IMPROVE THE CARE TRANSITION FROM DISCHARGE TO RECOVERY, AND THROUGH OUR DIGITAL SOLUTION REDUCE HOSPITAL READMISSIONS BY 25%.

RECHARGE is a web-based discharge solution that informs patients, provides peace of mind to medical professionals, and offers a model that can drastically reduce readmissions due to adverse effects.

Our model focuses on hip replacement, but the long-term goal of application is to target high readmission risk conditions such as heart attacks, heart failure, and pneumonia.

Developing Insights

Further research showed the average in-patient hospital visit is now 3.5 days, as opposed to 14 days only 30 years ago. This change is due mainly to Medicare and Medicaid stay restrictions, yet one-in-five Medicare patients are readmitted within 30 days of their discharge due to adverse effects. Such adverse effects include infection, blood clotting issues, and medication errors, with medication reconciliation contributing approximately 10% to the readmission rate.

Hospitals are scrambling for a viable solution and considering everything from administrative philosophy to a new discharge department. The Re-Engineering Discharge (RED) Toolkit has developed some traction as a 12-step process for ensuring a smooth transition at discharge. But despite its forecasted 25% decrease in readmissions, it does not directly extend beyond the hospital and into the patients rehabilitation efforts. Alternatively, the consideration for a discharge department within a hospital is viewed as having high overhead; an extreme solution compared to the low-cost of a digital solution.

Generating Concepts

Knowing that our solution was going to fill the gap between discharge and a patient’s full recovery, we began to explore the interface. Research showed that our target users preferred desktops and televisions over mobile devices, and that a day-to-day calendar, or recovery checklist, would be a preferred user experience.

We created a hierarchy of information with key information available with one click, and more detailed information available in the education archive. Once the overall structure and information architecture was considered, we developed an online prototype for live testing.

Refining

Key takeaways from the testing included limiting our reliance on icons for navigation, user lack of accomplishment, a confusing date line, and inclusion of discharge notes from the hospital. From this feedback we modified our patient and administrative side interfaces and began creating the final designs.

PATIENT SIDE

User Login

Access for both patients and medical professionals.

Patient Overview

The Patient Overview provides view of physical therapy and medication schedules, with accessibility to key information via the drop down arrow on each module. The side menu provides the opportunity for more detail:

Medication and Physical Therapy

Offers access to additional details and editability within each category.

Discharge Notes

Provides the documentation that was provided by the hospital upon discharge.

Progress Journal

Access to the document that RECHARGE creates as the patient interacts with the interface, and provides detailed information on recovery that can be used by the patient’s primary care physician at follow-up.

Settings

The area where custom times can be adjusted, and where visual settings can be modified.

Physical Therapy Schedule

RECHARGE is a modular system. Doctors assign recommended modules to patients, and the interface creates the day-to-day schedule based on the user’s preferences. Visual flow is from left to right, with completed tasks either being clicked or dragged into the Completed area.

Physical Therapy Key Information

Information within RECHARGE is hierarchical. Key information is available via the module dropdown, while additional information is provided via links and the educational archive.

Physical Therapy Adjustments and Notes

Once the activity is added to the Completed area, the patient can then modify for accurate representation in the Progress Journal.

ADMINISTRATIVE SIDE

Patient Selection

Administrators include nurses and doctors, with nurses often beginning the discharge process on the first day of the patient’s hospital stay. The Patients page offers an overview of appointments for the day, as well as a search component.

Medication Modules

The modular structure allows for nurses and doctors to add medications to the patient’s RECHARGE plan.

Plan Creation

Modules are added to plan with a simple drag-and-drop.

Plan Review

Research showed that nurses are often developing the patient’s discharge program for doctor’s approval, so RECHARGE was built to be consistent with this existing workflow. In the Plan Review a doctor can view the discharge plan that was created, and because of his user preferences, is allowed to approve and confirm the plan. Once this confirmation is complete, the patient can view their plan on their device.

Doctor Approval

Hospital workflow requires doctors to approve all discharge paperwork. RECHARGE is consistent with this process in order to gain adoption from medical professionals and hospital administrators.

Evolve

Scalability opportunities that exist within this framework are vast. Patients will eventually be able to track all of their ailments from within RECHARGE, allowing for improved medication reconciliation and doctor communication via the portal. Technology integration such as wearables and the televisions within hospital rooms for orientation will also be utilized.

“RECHARGE gives me the confidence that I am headed toward a successful recovery. I feel informed and in control of my own health.”

“It’s a great feeling knowing that our patients are now prepared and educated toward a successful recovery.”

WELCOME TO YOUR RECOVERY

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