The majority of patients receive verbal and/or paper-based instructions they are often left to implement without oversight. Though this impacts every patient, it becomes particularly problematic when patients undergo procedures. Inadequate patient preparation results in inferior outcomes for patients and avoidable costs due to poor adherence with instructions (e.g. missed appointments, last minute cancellations, and repeat procedures). For instance, on a practice level, a late cancellation for a colonoscopy will cost on average between $1000-$1500 and for a surgical procedure will cost on average between $3000-$4000. These numbers do not and cannot fully account for the inferior outcomes patients experience. Elaborating on the colonoscopy example, a patient who is poorly prepared for a colonoscopy often needs a repeat procedure and has a lower adenoma detection rate. Countless studies published by various specialty groups have shown the ability to significantly impact key metrics by using a variety of methods that generally involve increased oversight by the part of the care team. Though encouraging, such outcomes are not realistically achievable in practice due to limitations on staff time and budget restrictions in an era of managed care.
Medumo is a mobile and web-based platform that delivers timely instructions and reminders with links to easy-to-follow checklists and videos. By giving patients the right information at the right time using methods they prefer (e.g. email and SMS) we believe they will be able to better manage their care during the peri-procedure period. The educational function of the software is supplemented by digital check-ins at key points to ensure they are on track and not experiencing an issue. All of the content is customizable and delivered automatically according to a customizable timeline. Should the patient indicate there is an issue during a check-in or the software determine the patient is not interacting with the software sufficiency, Medumo will notify a predetermined provider (e.g. nurse, physical assistant) on the care team to facilitate a timely intervention on the part of the staff.
We are particularly excited about the data being generated. By understanding how patients interact with the software and how they answer key structured questions, Medumo will be able to determine when and why patients are having issues. This will guide improvement in the software as well as provide invaluable insight care teams about issues patients experience. We also hope to utilize demographics to determine which type of instructions work best for a particular patient (e.g. alternative languages, reading level, etc) as we recognize patient engagement is not “one size fits all.”
What could this mean?
For patients, this could mean having critical information delivered in a patient-centric way using the methods of communication they prefer (e.g. email, SMS text, and eventually phone calls). It also means patients will be able to check in and receive additional support if needed.
For providers, it means knowing which patients are having issues and what those issues involve. This allows the care team to focus limited resources to improve outcomes by addressing issues as they come up.
We have completed a pilot study at Cambridge Health Alliance that showed a 93% activation rate, 81% engagement rate, 90% reduction in the cancellation rate, and 95% of patients indicating they had a positive experience. We are also beginning enrollment for a 10,0000 patient trial at the Brigham & Women’s Hospital designed to use Medumo to improve outcomes for colonoscopy. We are also going to be implementing Medumo at Massachusetts General Hospital, Beth Israel Deaconess Medical Center, Children's National Medical Center, and various private practices in New England. Finally, we recently won the Massachusetts Health Challenge @ Pulse.
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