Interview with Nurse Practitioner About Patient Reported Outcomes

Health Helm’s CEO, Pamela McNamara, sat down with a Nurse Practitioner in a pain management practice in New England, to discuss patient centered care, patient reported outcomes, and how these could enable her patients to receive a more holistic approach to care.

close-up-doctor-health-42273-300x300 The Importance of Patient Reported Outcomes from the Perspective of an NP

What does patient centered care mean to you and your practice?

We follow the CDC guidelines and apply judgment given the risk factors. For example, we ask patients how long they have been on pain medications — opioid or others. We treat each patient holistically, considering her/his situation: How functional are they, are they working or disabled? What activities do they want to be doing with or without medication? What are they doing to avoid pain? What other medical considerations, such as social and mental health ailments are they affected by?

We consider and encourage trying alternatives to opioids for each patient, such as aquatic therapy for an osteoarthritis patient, chiropractic care for a younger patient, acupuncture, massage and/or yoga.We also attempt to use other pain management options including non-opioid prescription including over-the-counter aspirin, ibuprofen and acetaminophen, pain creams and patches. Medical cannabis including CBD creams and oils can be beneficial for chronic pain helping patients with anxiety, sleep and muscle spasms. We offer surgical procedures high-tech treatments using radio waves and electrical signals or implantable spinal cord stimulation. Unfortunately not all patients have access to these alternative therapies. Many of these therapies are not covered by insurance or these patients have access to care issues causing barriers to receiving this type of care.

How would a mobile patient reported outcomes tool fit in to your practice: supporting you as a clinician, while aiding in the treatment and management of your patients, as well as enabling them to better manage themselves?

A top priority for our patients is to gauge the extent to which they are trying to manage themselves and deal with their pain, and pain-related issues, rather than solely seeking more pain medications. If we know a patient is trying, we can work with them to utilize alternative approaches to opioids.

One benefit of patient reported outcome data will be to see evidence of how the patient is trying to manage their pain and with what result.

This patient reported outcome data can provide me, as a clinician, with a better basis for building an ongoing relationship with my patients to manage their pain and make progress.
Patient reporting would enable me to track their pain and other medication, track the extent and circumstances in which pain meds including what doses, numbers, and pills are being taken.

How would the PRO tracking work in your practice?

Typically we see a patient on chronic opiate therapy monthly. Patients on non opioids therapy are followed every three to six months.

During that four week period, we monitor their pain using pain scale tools. The use of a pain scale can help guide the clinician in creating a treatment plan as well as measure the effectiveness of the treatment. Indications a treatment plan may be ineffective include if a patient scores a 10 consistently (on the traditional pain scale of one to 10), the patient also reporting that they’re repeatedly out of medication early? The mobile tracking would help us monitor that more closely.

A mobile tool to monitor patient reported outcomes would be useful during the middle of that two month period, to alert us if problems are occurring. For other patients, patient reported outcome data is useful just before or during the four week follow-up visit to assess clinical status, progress, or problems, and to focus the patient visit on key issues. In preparation for this type of patient, the data would be scanned for sleep pattern variations, increased or decreased activity levels, issues related to ambulation, and responses to questions such as “ Do the current medication you are keep you functional and able to perform the daily tasks you need to do?”

The clinician would look at a snapshot for that patient over the prior month and be better prepared for a discussion about what’s going on, what can be changed in the pain management regimen, and what may need to change in other related activities.

Patient Engagement Leads to Successful Outcomes

One clear way to dramatically improve health outcomes is to avoid unnecessary emergency department (ED) visits and hospital readmissions.  Beyond the HHS penalties, delivering the right care to the right patients makes for good sense and good healthcare.

Clinicians indicate that following surgery or a procedure, the initial five to seven days is the critical period during which most complications occur.  Difficulties or confusion during these transitions in care, as well as poor or non-existent follow-up communication can exacerbate the risks of avoidable clinical complications. 

Strong communication between clinicians and their patients is an essential prerequisite to attaining the best possible health care outcomes.  We recognize this deep truth and seek to facilitate exactly this type of clinician/patient communication.

In order to be most effective, such communication must be systematic, frequent and immediate. For this reason, Trusted Patient Coach (TPC) delivers detailed, customizable questionnaires to patients up to multiple times per day. These allow patients to self-report and communicate changes in symptoms and progress along care plans with immediacy, thus maximizing the accuracy of the collected data. In addition, this immediacy allows clinicians to see and take decisive action on adverse developments well before they otherwise could.  Thus, this strong communication forms the bedrock for actionable and timely clinical intervention that can reduce inefficient resource utilization such as unnecessary ED visits, which frequently lead to avoidable hospital readmissions.

Patient – Clinician Connection Reinforces Successful Patient Outcomes

But strong communication can be just a start. Strong communication can grow into a strong connection. And this connection can strengthen care outcomes even further.

We see overabundant evidence of these connections throughout the messages exchanged between TPC-using patients and their clinicians. Patients are thrilled to get their questions answered and their worries addressed. They react by deepening their rapport with their doctors and nurses, forming a higher level of engagement that is shown to produce better health outcomes (Hibbard, Greene, 2013). Patients forming these connections are among the most enthusiastic users of TPC.

In a recent TPC study involving 75 post-surgical patients, clinicians reported actively avoiding medically unnecessary ED and office visits for 11 of those patients.

One such patient, N.L., writes to his doctor,

“Thank you for messaging with me. I feel better knowing I’m on the right track and to expect good and bad days.”

Another, J.B., writes,

“Thank you for your support and advice. It’s nice to have doctors that are so involved.”

Patients N.L. and J.B. were both spared unnecessary ED visits after establishing a connection with their doctors through Health Helm’s Trusted Patient Coach mobile app.

Clinician/patient connection, driven by strong and immediate communication, can lead to reduced readmissions and to outstanding medical care.

 

Hibbard, J.H., Green, J.  (2013). What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data on Costs.  Health Affairs, 32(2), 207-214.

A Patient May Be Using EMR, But What About Post-Surgery or -Procedure Communication?

Patients are more savvy users and consumers of their medical records thanks to EMR systems. If the patient’s physician is connected to the network’s EMR system, the patient is solicited to register on the patient portal.

There are many advantages to doing this. The patient can reorder prescriptions, update her prescription list, see her latest lab results, check her next scheduled appointment, verify the insurance information on file, ask for a referral – all without having to call the office. Easy, convenient management of her static health records.

But what does the patient do after a procedure or surgery?

She goes home with discharge instructions. She follows them – sometimes. What happens when something doesn’t feel right a week into her recovery? She calls the office. She leaves a message on the nurse’s line. Three times. She then dials “0” to get the front desk. But she gets put on hold for 10 minutes.

Frustrated, she hangs up and sends a message to her primary physician via the patient portal. She thinks, “Ok. This can wait until tomorrow. Perhaps I’m overreacting.”

She goes online to find information. Nothing. Sleepless into the night with increasing pain and discomfort, she finally decides at 4am to go to the ED. The patient’s surgeon and office staff have no insight into this scenario whatsoever. And no control to do anything about it.

Preventing Readmissions with Trusted Patient Coach and Patient Reported Outcomes

Let’s rewrite that scenario.

The patient is discharged with discharge instructions. She downloads the Trusted Patient Coach™ mobile app recommended by her clinician onto her own mobile device – phone or tablet. She reports her symptoms immediately after getting home starting on day 1.

She follows her discharge instructions, which are reinforced by Trusted Patient Coach’s daily questionnaires and tasks. She reports her level of fever, pain, swelling and other common post-surgical indications of problems.

Her doctor now has real-time daily data to know that his patient is still experiencing fever and swelling after 7 days. The doctor messages – directly – to his patient: “Please send me a photo of what your incision looks like.” He doesn’t like what he sees and replies: “Please come into the office. Nurse John will be waiting for you this afternoon.” ED visit and potential readmission avoided.

This is a real scenario of preventing readmissions using real-time Patient Reported Outcomes.

  • It creates direct communication from patient to clinician.
  • It records recovery progress with daily, real-time reports directly from the patient.
  • It provides trending so that clinicians can spot potential issues.
  • It creates a better patient experience.
  • And it reduces costs by allowing the clinician to intervene before the ED visit.

Learn more about Trusted Patient Coach™ as an integral piece of your healthcare solution.

 

The article below is reposted from Southcoast Health, with a quote from our CEO, Pamela W. McNamara above.

Health Helm is excited to be partnering with Southcoast Health System to offer Trusted Patient Coach (TPC) to their surgical patients. We are confident that TPC enables patients to stay connected with their clinician teams, leading to a better recovery and a positive patient experience.

Southcoast Health is introducing a mobile app to help patients with the process of recovery from surgery after being discharged from the hospital.

The Trusted Patient Coach™ Mobile App is designed to improve surgical outcomes and reduce the need for emergency department visits by enabling clinicians and patients to easily connect 24 hours a day.

“We are pleased to partner with Health Helm to offer this latest in health care communications technology to our patients and their clinicians,” said Keith Hovan, president and CEO of Southcoast Health. “The Trusted Patient Coach Mobile App is one more way that Southcoast Health is using technology in innovative ways to improve patient care.”

Because it supports 24-hour, two-way connection between a patient and clinician, the app will shed light on the ‘zone of darkness’ that often occurs when surgical patients return home from the hospital.

Currently, clinicians do not know if their patients are complying with the care plan they received at discharge, and patients or family members can be uncertain if symptoms are serious or just part of the normal healing process. The result can be a visit to the emergency department or complications that could be avoided if symptoms were identified early.

The patient or designated “coach,” who will usually be a family member, will download the app to a phone or tablet before the procedure. The app is password-protected and HIPAA secured to ensure privacy.

Communication will start as patients are preparing for the procedure, and after discharge clinicians will be able to monitor their patients’ condition and care plan compliance through a daily survey of 12 questions.  Patients will also be asked to report the medications they take every day.

Clinicians will monitor the patient’s progress and communicate with the patient or family member as needed. Patients or their coach can ask questions through the app.

Last month, our CEO, Pam McNamara, shared her insights into the European mobile healthcare market with Springboard Enterprises’ blog on Medium. The article can be found here and is also posted below.

As CEO and leader of high growth healthcare and technology businesses that have operated successfully in the US, European, and global markets, I share 5 key lessons that have made the difference in scaling profitably and successfully into Europe.

ball-shaped-bokeh-geography-893179 5 Tips to Expand Your Business to the European Market Successfully

Leverage entry and “adoption” opportunities recognizing market drivers and maturity from one market to others

Mobile health in the early 2000s was leading edge in Europe, where clinicians and patients alike were adopters of the earliest generations of smartphones, while US clinicians still used old fashioned pagers. In my last company, we drove early adoption of mobile health for e-patient reported outcomes in Europe in part by demonstrating solid patient compliance and clinical evidence that would ultimately earn our product platform credibility in the US market. Today’s market needs point us in the other direction: our Health Helm mobile health enables prevention of unnecessary Emergency Room visits and hospital readmissions. These are a priority in the US today, but not yet in Europe’s country markets, which are likely to be tackling similar cost and quality initiatives in the future. And, we are leveraging best software and cyber talents through our strategic partnership with development partner, based in Prague — another facet of our cross-Atlantic strategy.

Navigate the Regulatory Environment with Seasoned, Practical Leaders — Experience Counts

During the last 15 years, mobile health has grown in a regulatory landscape shaped by the US Food and Drug Administration, the European Medicines Agency, and the General Data Protection Regulation (GDPR, implemented May 25, 2018), among others. Regulatory insights and experience is a critical element to develop, deploy, maintain and service products, processes and solution platforms — to doing the right things in a thorough way. A key member of our team is our GDPR expert, a trained/qualified Data Protection Officer brings deep and practical regulatory and quality expertise. While we are currently focused on the US customers, our regulatory expert’s guidance, we are staying ahead by reflecting GDPR requirements in plans, product development and operations.

Respect and embrace local culture and practices — Viva Les Differences!

Regional and country market differences can be major or more subtle — navigating these and choosing the most practical, feasible and impactful entry markets (with savvy local tactics) enables smarter, rapid scaling. Cultural norms and people differences are key. For my businesses, understanding local clinicians and patients has been essential: how to gain their early adoption? What barriers must we overcome? What are their fears, concerns and preferences? We have built sales teams nimble in navigating these distinctions professionally and with integrity.

Build your team: who think globally, act locally

Recently, I’ve been asked to address how to cultivate high performance teams. Critical to any successful team is a combination of bright, curious minds, shared passion about our business and our core purpose, outstanding skills and expertise to get the job done and shared common values. Entering new markets — into EU country markets from the US or going the other direction — these attributes combined with local knowledge, acumen and integrity make all the difference. We define clear goals and accountability, enabling local team members to make local decisions while trusting them to confer/connect when needed. They must be “utility” players with a primary focus (e.g., sales or delivery) and the ability and initiative to cover local business needs, e.g., controller/finance, human resource matters, other issues as they arise.

Achieve credibility with compelling, locally relevant evidence and early wins — Scoring early and impactful “wins” in a new local market with great customers, followed by delivery excellence, builds the credentials for a locally knowledgeable team. This ultimately translates to a successful record. Our experience is to string the “pearls” of local market successes to build an effective, competitive regional position.

In my businesses, we have achieved impact and speed by embracing the lessons from each market, driven by a diverse, bright team to navigate successful entry into new markets. We’ve done this by competitively positioning our products and services to fit local needs while leveraging global best practices.

Yankee Alliance announced a new agreement with Health Helm, Inc. to offer its members Trusted Patient Coach™ (TPC), Health Helm’s configurable mobile app and clinical platform, offering patients and clinicians a closed loop care-management and communication system.  Health Helm is using TPC to solve major problems facing health care today. TPC provides solutions to high readmission rates, poor coordination of care, patient post discharge confusion, and low compliance by offering a care plan adherence system that can be tailored to clinical work flow .  TPC is a secure, HIPAA-compliant communication system that uses daily reminders and questionnaires to help patients’ improve their compliance post discharge, manage chronic conditions and improve patients’ outcomes and experiences. 
 
About Yankee Alliance
Yankee Alliance is a member-driven healthcare group purchasing organization founded in 1984 on a belief in collaboration, that working together can achieve more than working alone. Our mission is twofold: to work with members to reduce supply and operating expenses through aggregation of data, purchasing, ideas and knowledge and to excel in strategic innovations that continually assist members in reducing their cost while recognizing their individual needs. Today, Yankee Alliance remains true to the foundational belief in collaboration and has grown to over 15,250 members in all classes of trades across all 50 states. For more information visitwww.yankeealliance.com.

Health Helm, Inc. Internship

Health Helm is seeking a QA/Operations Support Intern for June 2018 through August 2018, with the potential for future additional work.  Our company has developed mobile software to support patients along with their physicians and caregivers in managing their post-acute and chronic health conditions.

Job Description:

  • Assist in designing and executing test plans for IOS, Android and Web-based apps.
  • Effectively communicate status, metrics, and issues on a regular basis.
  • Travel to customer sites to support, train and comprehend end user needs and product knowledge.
  • Review and edit documentation as needed.
  • Assist in planning other cloud-based system functionalities such as documentation and customer registration processes.
  • Perform other duties to support Operations and Product Manager as needed.

Requirements:

  • Basic understanding of Quality Assurance life cycle, cloud-based technologies and mobile apps.
  • Ability to dedicate 30 to 40 hours per week.

Stipend/pay to reflect experience.

Please forward your resume and cover letter to:

Lisa McCarron, Operations Lead

Email: lisa.mccarron@thehealthhelm.com

Jan Immerman, Product Manager

Email: jan.immerman@comcast.net

Company Contact

Pamela McNamara, CEO/CoFounder, Tufts Alum

Email:  Pamela.mcnamara@thehealthhelm.com

As CEO and leader of multiple early-stage, high-growth healthcare and technology businesses, here are 5 key lessons that have made the difference in scaling profitably and successfully.  As CEO of CRF Inc., a mobile patient/clinician platform for clinical trials, and now at Health Helm, Inc., a mobile patient/clinician platform for self reporting and communications, my toughest lessons have involved balancing:  achieve milestones, demonstrate clinical evidence and impact while stretching resources to achieve results.

1. Listen to, learn from our customers – in our case, our patients and their clinicians

Our mobile software platforms over the last 15 years are designed to enable and motivate patient-reported-outcomes (PRO) or self-reporting.  The Food and Drug Administration has prioritized PRO in healthcare because of better outcomes and health, in large part because patients know themselves best and they pay attention to what they track.  In any business, the “voice of the customer” is key: seeking it, being open-minded to learn from it, even when the feedback is negative or contrary. We constantly strive to gain insights from our patients and clinicians.  What can we learn from their stories? What impact are these things making in their lives? And how can we make a difference? Every team member every day is driven by our patients and clinicians, gathering and analyzing their data and clinical evidence, and applying that to making that difference.  This is basic fuel to scaling our business engine!

2. Build a shared vision

Our company’s vision is to make a measurable improvement in the quality of our patients’ health.  We are a data-and-results-driven team with a platform that produces the evidence demonstrating better outcomes, lower costs and more satisfied patients and clinicians.  The data and continuing analytics, in turn, enable our patients and clinicians – and our company – to learn, adjust and improve. I had the privilege of working with and learning from Bryan Smith, a co-author of “The Fifth Discipline Fieldbook,” about creating a core purpose or destiny for our businesses.  With my teams, we shape our core purpose into a shared vision, and continually evolve it as we learn and gain insight from our customers. Successful scaling requires continual evolution of our shared vision, tracking our progress against the vision, and transparently reporting meaningful results (good, bad and ugly) while growing profitable revenues.

3. Grow a high-performance team

In my last blog, I talked about high-performance teams.  Critical to any successful team is a combination of bright, curious minds, shared passion about the business’ or team’s core purpose, and the right mix of skills and expertise to get the job done.  Our team members share common values, have mutual respect for one another, while demonstrating both conviction and being open-minded to new points of view or data. Especially in rapidly scaling business, we have intentionally mixed a combination of “been-there-done-that,” more seasoned team members and “fresh” perspectives (new to this domain or earlier in their careers) – this combination enables us to move smarter, faster.

4. Deliver operational excellence

Operational excellence is obvious, a “no brainer,” but is a challenge for rapidly scaling businesses.  Clearly mapping each step of the operations, clear roles, accountabilities for us, our customers and any third parties, setting clear expectations and metrics at each step – all are critical to success. Setting clear expectations with our customers – and not overpromising – and managing and communicating continually are keys.  Bumps will occur; we must be prepared for them, own up to our part in those, and fix them quickly. This is where our team of “seasoned” and “fresh” experiences can make a difference: we define what quality and success look like, how to measure and report them, what potential risks and failures lie ahead, and how to prevent or mitigate bumps when they occur.

5. Cash is “king” (or “queen”)!

In all businesses, and especially in rapidly scaling businesses, cash is king. Managing cash smartly, spending where it makes real impact to build value, conserving it for uncertainties – these are the ways to achieve pivotal milestones: with customers, in the market, building assets and value for shareholders.  How many earlier stage companies raise a round of financing only to blow through their cash too rapidly, falling short of value milestones? I have been very fortunate with CFOs, investors and financially attuned team members aligned around making the smartest use of cash.

In conclusion, my balancing these five critical success factors to achieve forward momentum and results is key.

Article was originally shared on INC Blog by Springboard Enterprises.

The Megan House Foundation founder Timothy Grover announced an innovative program launched in partnership with Health Helm, Inc. to provide its Trusted Success Coach mobile health support for its residents recovering from substance use disorder. During the initial 4 months of the program, residents and graduates have demonstrated strong, sustained compliance of 69% in self reporting daily questionnaires and tasks.

Megan’s House is a comprehensive residential recovery treatment home for young women between the ages of 18 and 26 who are recovering from drug dependence and other co‑occurring disorders. Its multifaceted approach to the treatment of substance use disorder includes evidenced-based practices to build each young woman’s foundation for meaningful, substance-free lives. Megan’s House considers aftercare placement (including to its affiliate Success Home, Erin’s House) and ongoing recovery support a vital component to long-term recovery. 

Grover and The Megan House Foundation team aim to provide mobile support, care coordination, and communication between Megan’s House Success Coaches and their residents, graduates at Erin’s House, and other alumni living independently after treatment through Health Helm’s mobile app, Trusted Success Coach.  “Staying connected to a trusting and supportive team is a key element for successful recovery,” states Tim Grover, Founder of The Megan House Foundation.  “We are excited to offer our residents and graduates this opportunity,” he continued.

Current residents and graduates using the Trusted Success Coach app report,

  • “I feel connected.  It’s good that [Coach] reaches out to me.  Good to have someone who cares; who keeps me on my toes.”
  • “It keeps me on track.”
  • “It keeps me motivated when I’m having a tough week.”

The Success Coach using the platform reports, ” “The TSC app allows me to better support our residents and graduates.  It provides me a view into their recovery and lives I wouldn’t have otherwise.”

“Using the TSC app keeps me connected to our residents and graduated. It creates a level of comfortability that permits an open dialogue between myself and these young women.”

Health Helm, Inc. — a growing digital health company successfully commercializing a superior post-acute care plan adherence solution — announces its expansion into the chronic care domain with the signing of new customer The Megan House Foundation.  “Joining forces to support its treatment of young adults struggling to overcome the devastation of substance use disorder is a natural fit. Our mobile app and web-based portal are easily configurable and provide a strong closed-loop communication link between clinicians and their charges. The app collects daily lifestyle and behavior choices from those in recovery and maps those choices against the adherence goals of their individual treatment plans.”

“People seeking treatment for addiction are a large, growing, and underserved population,” Ms. McNamara continues. “It complements our continued dedication to the post-acute care market and post-operative markets, like orthopedics, where we continue to invest heavily.” The Megan House Foundation implementation joins together its evidence-based treatment approach with Health Helm’s rich data collection and analytics capabilities.

 

About The Megan House Foundation, Inc. 

The mission at Megan’s House is to improve the quality of life of its residents through an evidence-based substance abuse treatment program that emphasizes individual dignity, self-respect and empowerment. In doing so the treatment team utilizes flexibility, support and outstanding client services to meet individual needs and establish a culture that promotes wellness and success.   http://themeganhouse.org/

About Health Helm, Inc. 

Health Helm, Inc. has developed its proprietary Trusted Patient Coach and Trusted Success Coach software platform to address the growing problems of high post-discharge hospital readmissions and non-adherence by patients to medications and care plans. This platform closes the communication loop between patients and their clinicians, is configurable to post-acute and chronic conditions, and uses real-time analytics and other functionality to support patients, clinicians, and providers. Health Helm, Inc.TM is led by a team with extensive healthcare, clinical trial, and patient adherence experience.

Last month, our CEO, Pamela McNamara, spoke at the U.S. Navy’s Naval Sea Systems Command (NAVSEA) Leadership in a Diverse Environment. The agenda addressed the challenges and opportunities that women face in leadership positions, both in the Navy and beyond.

McNamara was excited to be involved as NAVSEA launches this empowering movement, at a time where it is more critical than ever. As Admiral John Richardson, Chief of Naval Operations noted, “Diversity shines light on the biases and barriers” faced to win in today’s competitive environment.  Admiral Richardson highlighted the move towards autonomous systems, and the changing role of leaders that can interpret complex situations, adding value and opinions to situations that robots cannot, and executing smart, timely decisions.  

The talks at the event were inspiring, especially one by Nicole Manson, Legal Counsel at the National Oceanic and Atmospheric Administration, on “Leading with Courage, Confidence and Competence”.

McNamara’s own talk was titled, “Creating Your Personal Vision and Using it to Build High Performance Teams for Success”. Drawing from her own personal experience as CEO of industry leaders such as Arthur D. Little, CRF Health, and Cambridge Consultants, she spoke about harnessing the ‘common ground’ of her team members’ ‘personal visions’ to achieve bold results. Referencing work by Peter Senge and colleagues (in Senge et al’s book, Fifth Discipline Field Book), McNamara and those in her seminar shared experiences harnessing the power of personal visions and the common ground in mission-driven businesses and teams to achieve major impact and make a sustained difference.  

Mission- and Service-driven teams and businesses, when aligned around a core purpose or goal and when harnessing the best talents and thinking of a diverse team, achieve enormous and lasting results.  McNamara concluded her session spotlighting Health Helm’s mission to support patients and their caregivers in successful recovery.  The recovery journeys of residents are a long, tough road for those living at Health Helm customer, Megan’s House in Lowell, Massachusetts.  Use of Health Helm’s Trusted Patient Coach mobile app is making a difference keeping residents connected to their coach and community, and on track in that recovery journey.