Flip the Script: Prescribing "Digital Care" to Duke Health patients
This article originally was published on the Duke Mobile App Gateway for Digital Health Website on May 31, 2019.
By: Katie D. McMillan, MPH
What if instead of a pill, your doctor could prescribe you an app? What if instead of receiving a paper mountain of pre-op and post-up instructions, you could manage each step day by day on your phone? What if you could watch a video in the comfort of your home about your medical condition or upcoming procedure?
All of this is now a reality due to a new partnership between Duke Health and Xealth, a Seattle-based company that enables the auto-ordering or prescription of digital care tools to patients. In the near future, the Xealth platform will also enable ‘contextual awareness’, which will present relevant content to a physician in a patient’s chart based upon their medical information and reason for their visit. The platform went live in mid-April, with Weight Loss Surgery, the Duke Eye Center, and Physical Therapy as early adopters. These clinical teams were excellent candidates for launch due to their existing patient education content that the Xealth platform enabled the broader distribution of. At publication, there have been 1,433 digital care orders prescribed to patients.
I spoke with Matt Roman, Chief Digital Strategy Officer, about everything you need to know as a Duke clinician and patient to maximize the benefit of this new offering.
WHAT IS THE DIGITAL STRATEGY OFFICE?
The Digital Strategy Office, or DSO, is a team within Duke Health Technology Solutions that is focused on three core initiatives:
Patient Engagement
Provider Engagement
Support the Health System Initiatives
The group is actively engaged across clinical departments as well as with health system leadership to imagine and implement the creative use of technology at Duke Health. We want to enable productive relationships between our patients and their providers so we can care for ourselves, our loved ones and each other.
WHAT ARE THE BENEFITS OF XEALTH?
There has long been a gap in how patients are interacting with the rest of their world through digital technologies – such as learning how to change a tire on YouTube, depositing checks on their phone, and tracking fitness goals using a connected watch with an app – and how they interact with their healthcare providers. We recognized the opportunity to improve patient education and engagement through the expansion of our digital offerings and patient portal app, MyChart. We also can provide insights to our clinical teams on the utilization of articles, videos, apps and connected devices through analytics dashboards. These data will allow them to adjust individual care plans as well as departmental offerings to really serve our patients well.
WHAT KIND OF THINGS CAN I SHARE WITH MY PATIENTS?
Right now, you can ‘prescribe’ a PDF, video, or mobile app. These can be materials created at Duke or licensed from outside companies. We have a mix of these in our pipeline, and are also looking to add some e-commerce options, linking to services like Lyft or smoking cessation programs, as well as bringing in remote monitoring data from products like glucometers, blood pressure cuffs, fitness trackers and more. Another benefit is that we can partner with Duke School of Medicine researchers to leverage the platform to distribute apps to research participants and invite patients to clinical trials.
WHERE DOES THIS NEW FUNCTIONALITY LIVE IN MAESTRO CARE?
Clinicians can find “Digital Care,” which is a new tab, in the activity tabs section of Maestro Care. The activity tabs are the buttons furthest to the left in a patient’s chart in Epic. The Digital Care activity tab allows providers to assign digital assets as well as monitor the usage of those assets. Currently this is only visible and available to clinicians in the departments that have provided Xealth assets, such as the early adopter groups mentioned, but new assets are being added regularly. In the near future the Digital Care activity will be a repository for health-system-wide digital assets, such as educational videos, mobile apps, questionnaires, surveys, etc. available to all clinicians for direct prescription to patients.
WHERE CAN PATIENTS SEE APPS, VIDEOS, AND EDUCATION MATERIALS FROM THEIR CARE TEAM IN MYCHART?
On the mobile app, as soon as you sign in you will see a Digital Care tile. All patients will see a summary of what Digital Care is, even if they don’t have any prescribed content or assets yet. When assets are available they will see a card describing the tool and the associated materials.
On the Duke MyChart web app go to Health in the top navigation, then Medical Tools, and listed under Medical Tools is Digital Care.
HOW DO I REQUEST TO ADD A NEW DIGITAL TOOL TO THE LIBRARY?
We are actively engaging with many different clinical care teams and departments across the health system and are open to any ideas! Send an email to the Digital Strategy Office at digitalstrategy@duke.edu. Someone from the Digital Strategy Office team will set up an initial consultation meeting to understand your goals. From there the Digital Strategy Office team will help development a deployment plan of your assets.
WHAT IS THE KEY TO SUCCESS IF YOU WANT TO ADD A NEW DIGITAL CARE ASSET FOR PATIENTS?
A strong clinical champion is the key to moving a project forward. We can provide the technical and project management expertise to add new videos, apps, and tools for patients, but we rely on our clinical leads to define the needs and benefits for their patients, as well as to gain buy-in from their department leads and colleagues. We also enjoy working with people with imagination. As I mentioned, right now we are helping with written materials delivered via PDF, videos, and mobile apps, but the field is wide open to consider other opportunities and partnerships. Finally, we are highly focused on impact, and we think planning for metrics to measure the impact of these tools is essential.
Many thanks to Matt Roman for his insights. We are excited about this new capability to help our patients!