Formed in 2019 through the alignment of Catholic Health Initiatives and Dignity Health, CommonSpirit Health is one of the largest nonprofit health systems in the U.S. It has more than 1,000 care sites serving 20 million patients in 21 states.

At CommonSpirit, the acceleration of new mediums of care delivery enables patients to live healthier via virtual asynchronous care and evidence-based, digital-enabled therapies. 

CommonSpirit is developing the digital capabilities and clinical and administrative processes to provide these services, which will enable patients to have greater control over their care, empower education, increase engagement, target improved clinical outcomes and further support population health management.

"Propeller Health's FDA-cleared platform is one of the digital therapeutics services that is offered to help our patients and their clinicians in the disease management of chronic asthma and COPD and to help improve clinical quality outcomes and reduce costs of care," said Dr. Francisco Rhein, vice president of innovation and digital care transformation at CommonSpirit Health.

"The platform has proven to help reduce overuse of rescue inhalers and help patients achieve more days without symptoms, overall contributing to the enhancement of their quality of life," he continued. "Using Propeller's Bluetooth-enabled sensors with key medications, CommonSpirit clinicians have a line of sight into a patient's rescue and controller medication use in real time."

Sensors passively sync with a user's smartphone and ultimately produce reports and alert notifications that allow a patient's care team to intervene in order to reduce the likelihood of an acute event or exacerbation between outpatient visits.

THE PROBLEM

"The platform helps keep patients informed and engaged in their care, leveraging machine learning algorithms to help identify symptom patterns and disease triggers, sharing personalized tips and medication reminders, and supporting 'find my inhaler' functionality for location of misplaced devices," Rhein explained.

"Although Propeller Health's solution is available for patients across CommonSpirit Health and has been used for many years by select Dignity Health Medical Foundation physicians in California, Arizona and Nevada, implementation has historically been on a practice-by-practice basis, and we recognized the opportunity to attract new patients and to provide existing patients with enhanced access and experiences to improve care outcomes and engender loyalty."

"The provider can launch the Propeller SMART FHIR app to view their patients' data right from within the patient's chart, including rescue and controller medication uses, and to track trends."

Dr. Francisco Rhein, CommonSpirit Health

Despite the benefits CommonSpirit was seeing, it noted there were barriers to adoption due to the innate disjointed workflow and administrative burdens for the care teams to offer this chronic-disease-management program to their patients when they must perform additional steps to login to the Propeller portal in order to complete a patient enrollment and view their enrolled patients' results in real time.

PROPOSAL

First, CommonSpirit worked with its frontline healthcare workers, clinical sponsors, clinical informatics team, a business team and a population health team to better understand and proactively address some of these workflow barriers at the points of care and handoff, innovating together to create a path for a more scalable enterprise product offering that is more seamless for both care teams and patients to access.

"We proposed to improve integration into Dignity Health's electronic health record system so that care teams can interact with the Propeller platform as a part of their native clinical workflow with the EHR," Rhein noted. 

"We identified an opportunity to enhance the experience of our patients and providers by developing and deploying a SMART FHIR application embedded directly within the patient's electronic chart.

"This app would allow the care team to identify and directly enroll patients who could benefit from access to Propeller self-management tools, and also to remotely monitor their patients' real-time data, alerts and messaging, making it easier for them to identify who would benefit from clinical intervention, all embedded within their EHR workflows," he added.

The desired experience was an increased ease of use and a more seamless and appropriate workflow for providers. The expectation was that this would empower scaling the service for patients with more agility and increasing patient enrollments and beneficial outcomes.

MEETING THE CHALLENGE

"Partnering closely with our provider champions, national informatics team and population health team, we identified future state workflow and codeveloped a SMART FHIR API-enabled application embedded directly within Dignity Health's Cerner EHR," Rhein said. "This integration has enabled providers to interact with the Propeller platform as part of their native clinical workflow.

"We designed and deployed several phases to address current barriers and help make it more seamless to connect patients to the program, addressing identification, recruitment, enrollment and setup," he added.

Patients with asthma or COPD who have had a recent respiratory-related ED visit or hospitalization, or who have poor disease control and may benefit from the program, are more likely to use Propeller when a member of their healthcare team recommends it. Staff members have enabled it so that providers or clinical staff can now place an order for remote patient monitoring directly from within the patient's EHR.

"Clinic staff members will then receive a task on the Multi-Patient Task List (MPTL) to enroll the patient in the Propeller program," Rhein explained. "Care team members can quickly create a patient's account by launching the Propeller SMART FHIR app, which is able to streamline enrollment by pre-populating information from within the patient's chart.

"Patients will receive an automated welcome email from Propeller, and then Propeller ships sensors to the patient's address after they download the Propeller app on their smartphone or tablet and sign into their account."

Once a patient has enrolled in the program, Propeller makes it easy for patients to adhere to a prescribed treatment plan by leveraging sensors that attach to the patient's inhaled controlled and rescue medications, he added.

"These sensors collect and provide data back to the patient and care team, allowing them to monitor adherence to and appropriateness of treatment to ensure optimal outcomes," Rhein said. "The provider can launch the Propeller SMART FHIR app to view their patients' data right from within the patient's chart, including rescue and controller medication uses, and to track trends.

"Following release of the remote monitoring MPage into production, we sought additional ways to enhance the care team workflow and implemented message-center integration to eliminate the need for emails," he continued. "Propeller patient activity messages can be sent to the clinics message pool associated with the patients account, removing the need for staff to monitor daily emails and document receipt in Cerner."

RESULTS

CommonSpirit has observed a reduction in acute care utilization as part of a year-long clinical trial of asthma patients who used Propeller's inhaled sensors at one of CommonSpirit's Dignity Health medical groups, showing a 54% decrease of asthma-related patient emergency room visits for patients enrolled in the program, and a 57% decrease in hospitalization resulting from asthma ER visits, after a year on the program.

"Further outcomes after one year showed patients had achieved 74% reduction in rescue medication usage, indicating they have learned how to avoid triggers, and require their rescue medication less frequently than when they began the program," Rhein said. "In addition, patients had a 19% increase in symptom-free days.

"Patients also demonstrated 56% adherence to their controller medication," he continued. "As a result of enrolling in the Propeller program, patients have taken their controller medication more reliably, which helps lead to reduced need for rescue medications. Adherence percentage is 2.4 times greater for patients enrolled in the program than the national average for patients with asthma and COPD.

This integration has been fully implemented in seven communities served by Dignity Health physicians and clinics in Arizona and California. With the EHR integration and ability to leverage the repeatable and standardized deployment of this SMART FHIR API, Dignity Health and Propeller could potentially scale the tool to hundreds of physicians who care for thousands of patients with an eligible diagnosis.

"Now, the Propeller solution can be ordered and managed through the EHR like any other medication or treatment," Rhein explained. "Enrollment is streamlined for providers and staff, as they don't have to leave their clinical workflow. It now takes two minutes to enroll a patient, which is a 75-80% reduction in time. We look forward to our learnings and proving out that this is a key model for all our current and future digital therapeutics.

"Physicians who are managing their patients with the Propeller program report added benefits of the EHR integration, including the greater ability to understand their patient requests for medication refills by connecting these requests with data from Propeller to better manage symptoms, establish severity and reduce risk of exacerbations."

ADVICE FOR OTHERS

"Organizations considering how to integrate digital therapeutic platforms and solutions should consider the importance of developing a scalable model," Rhein advised. "We have established pilot programs within our care teams, leveraging EHR integration and APIs, resulting in clinically led, digitally-enabled workflows that allow us to take advantage of the repeat and standardized deployment needed to launch for scale.

"Using this approach, we focus less on point solutions and more on solutions that can integrate into the care pathways and the workflows of our care teams."

The partners one chooses to work with – from vendors to stakeholders – are also critical to the success or failure of digital transformation, he said.

"A good partner listens to the care teams on the frontlines and supports co-innovation on the points of handoff," he said. "With our clinicians leading the way, we are able to reimagine how to use technology to be more successful in serving our communities. This leads to greater potential for impact across the care continuum and along the patient journey.

"Finally, to be successful, health systems must make the right thing the easy thing," he continued. "This requires us to demonstrate an understanding of the needs and experiences of our providers and care teams and ensure digital solutions we build can address and support their workflow, reduce administrative burdens, and help them to practice at the top of their license."

This will help ensure the organization delivers better care and outcomes for patients, and more frictionless journeys, he concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.