Bolstering the Structural Heart Paradigm
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Bolstering the Structural Heart Paradigm

Douglas Gregory, RN, MBA, BSN, NEA-BC, CCRN-K, FACHE Kevin Wall, MBA, BSN, RN, EMT Amar Patel, MD, FACC, FSCAI, Wellstar Health System
Douglas Gregory, RN, MBA, BSN, NEA-BC, CCRN-K, FACHE Kevin Wall, MBA, BSN, RN, EMT Amar Patel, MD, FACC, FSCAI, Wellstar Health System

Douglas Gregory, RN, MBA, BSN, NEA-BC, CCRN-K, FACHE Kevin Wall, MBA, BSN, RN, EMT Amar Patel, MD, FACC, FSCAI, Wellstar Health System

I had a professor in my MBA program once tell me that all innovation is derived from a pain point. Structural heart therapies have revolutionized the way we approach patients today. The continued advances in cardiovascular imaging and device technology have made the unthinkable our new reality. Patients who were previously considered at elevated risk for an open surgical procedure now have minimally invasive transcatheter options available to them. Other potentially life-altering transcatheter therapies involving intra-cardiac shunts or left atrial appendage closure have benefited many thousands by reducing morbidity.

So, what’s the big problem? With any new technology or procedure, there is an adoption growth curve that consists of the innovators, early adopters, early majority, late majority, and laggards. Professor Dr. Geoffrey Moore, an organizational theorist, has suggested a chasm between the early adopters and the remaining majority, in essence, turning a typical bell curve into an S curve. It was further explained that each segment, as in the case of medicine, needs its own “marketing” or outreach strategy. What that means to us is that there is a large population of patients with whom we can help, but are not afforded the opportunity due to a lack of awareness. Clinical trial enrollment often lags behind expected completion times secondary to lower than expected patient enrollment. Much of the time, patients would be open to considering a clinical trial if their doctor approached them about it. Commercially available therapies also suffer from low adoption rates after FDA approval for similar reasons.

Medical technology companies utilize many resources to build awareness of these therapies in referring communities and patients alike. The most likely reason to explain the lower than expected adoption rates centers around one primary concept: education & awareness.

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From a structural heart perspective, we needed to be able to connect with our referring network using an obvious but different approach, making it easy to connect a referring physician to our providers

   

 

Several approaches have been applied in hopes of improving awareness among the referring community. Within the medical technology industry, therapy awareness representatives, online education tools, social media campaigns, and even television commercials are utilized. Health care systems and practices also struggle with awareness in engaging their referring network. Provider education events (lunches, dinners, Grand Rounds), paper marketing collateral, social media outlets, and search engine optimization techniques are explored with variable success. Health systems have an additional challenge in that, as the network grows, providers begin to lose touch with one another, and by proxy, the capabilities offered within that system. Patients may not be adequately treated or may be sent outside of the system to receive treatment elsewhere.

From a structural heart perspective, we needed to be able to connect with our referring network using an obvious but different approach, making it easy to connect a referring physician to our providers. Given the explosive growth in structural heart therapies and the number of potential patients, we had to find a better way to engage and educate our referring network. We utilized the approaches above and were able to leverage the efforts of our industry partners. Nothing we did provided a sustained mechanism for awareness, referral, and communication in a single tool. Knowledge of the procedures we offer and streamlining the referral process to one of our four outpatient structural clinics for evaluation was essential. We found that this issue was not only a problem for our program; this was a pervasive problem throughout cardiology, and in reality, many other specialties as well.

The WellStar structural team began using an app called Loop created by Clinical Softworks, a healthcare startup company. Loop is a HIPAA compliant mobile app the care team used to help improve the awareness and communication of new therapies within the referring community and the physicians within our clinics. During therapy awareness events with referring providers, our business development and referral coordinators invited members from our referring practices onto the Loop platform. Providing this app not only provided visibility to members within the structural heart program, but it offered an intuitive contact mechanism for referral for other cardiovascular therapies such as chronic total occlusion, complex and high-risk percutaneous coronary interventions, advanced electrophysiology, and heart failure.

Over time, as referring providers became comfortable with our structural heart services, they began using the app to directly refer patients to the other types of cardiologists within Loop. This was helpful in that incoming referrals were going to the correct physician the first time around. 25-30 percent of the time, patients are sent to the wrong physician. When a patient was referred, the coordinators would be simultaneously activated, allowing them to accept the referral on behalf of the physician. Therefore, if the accepting physician was not immediately available, by the time they were available, the patient had already been called, an appointment set up, and pertinent data was being collected. Better yet, the office staff was able to communicate with the referring care team via a secure inapp messaging system to inform them of the next steps. If the patient supplied an email address, they received secure communication about their upcoming appointment. This outlined important information about why they were referred to a specialist, including information about their condition. This simplified the referral process significantly and improved the patient experience in terms of knowledge transfer and on-going communication.

Another significant area of opportunity the app addresses is clinical trial visibility and enrollment. The biggest issue clinical trials face is lower than expected rates of enrollment, secondary to lack of awareness. Loop has a dedicated portion of the app focused on clinical trials. Pulling information from national databases, care team members can search and learn more about a particular clinical trial. Loop also allows for a direct referral pathway into participating sites.

The Clinical Softworks team has developed a feature-rich application for all types of medical practices to address the common problem of improving communication and awareness. This powerful tool covers over 30 specialties, contemplates many workflows, and improves our ability to take care of patients. We will be further distributing this app to our internal and external referring networks in hopes of easing patient access into our facilities.

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