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Design a Model for the Delivery of Digital Health Guidance

Session # 63, February 12, 2019

Kaley Johnson, Principal Business Analyst, Mayo Clinic

Olivia Peavler, Health Systems Engineer, Mayo Clinic

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Kaley N. Johnson, MS

Has no real or apparent conflicts of interest to report.

Olivia P. Peavler, MPH

Has no real or apparent conflicts of interest to report

Conflict of Interest

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Agenda

Learning Objectives

Interactive Care Plan Value Proposition

Interactive Care Plans at Mayo Clinic

Framework

Challenges/Barriers

Lessons Learned

Conclusions

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1. Design processes and structures to support the design and

implementation of a mobile health management application

within a healthcare organization

2. Assemble and engage a multidisciplinary team with the goal of

translating clinical expertise into an interactive tool to promote

continuity of care and patient-provider collaboration

3. Describe challenges and lessons learned for creating a health

guidance application for use in multiple clinical areas

Learning Objectives

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Mayo Clinic

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The Center for Connected Care

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A tool designed to support the longitudinal management of a patient and his or her conditions

What is a Care Plan?

Facilitate patient /

provider engagement

Support care team

collaboration

Enable integrated care

experiences

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A digitally-enabled, actionable record of guidance that is an extension of a person’s care

What is an Interactive Care Plan (ICP)?

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NephrologyNephrology

GIGI

NeurosurgeryNeuro

surgery

CardiologyCardiology

OncologyOncology

DiabetesDiabetes

GeriatricsGeriatrics

OB/GYNOB/GYN

Cardiac

Surgery

Cardiac

Surgery

UrologyUrology

Mental HealthMental Health

PulmPulm

OrthopedicsOrthopedics

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Patient Journey

EHR

COPD

Tasks View/Edit

Questionnaires View/Edit

Education View/Edit

Timeline View/Edit

Devices View/Edit

Add to care planAdd to care plan

This is Gary. Gary travels to Mayo Clinic to meet with a pulmonologist with hopes of

discovering the root cause of his respiratory distress over the last

several years.

After completing an assessment, evaluation and review of diagnostic

tests that were ordered, the pulmonologist diagnoses Gary with

Chronic Obstructive Pulmonary Disease (COPD).

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Patient’s conditions

Current and past

medications

Relevant history

Care team and contact

information

Patient’s scheduled

appointments

Enrollment Criteria

Patient Education Content

Questionnaires

Patient Monitoring

Decision Logic &

Escalations

Provider View

EHR

Gary’s Task List

Be active reminder Daily

Watching and reporting symptoms Daily

Slow pursed-lip breathing Week 2

Symptom follow-up questionnaire Week 1

Road to better health with COPD Monthly

Traveling with oxygen Week 4

Edit care planEdit care plan

AddAdd

AddAdd

Tobacco Use Questionnaire

Mindfulness Questionnaire

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Gary’s temperature

is high.

You’re

experiencing

symptoms.

You indicated that

you’re experiencing

chest tightness today,

and your recorded

temperature is high.

Please answer a few

questions for your

care team.

Answer Questions >

While at home, Gary indicates in his

daily symptom check-in questionnaire

that he’s experiencing some chest

tightness.

He is prompted to take his temperature,

and he inputs the reading into his

interactive care plan.The abnormal entry triggers a

notification to Gary containing a

few questions to gather some

context for the care team.

Gary’s care team is alerted to the

abnormal entry and is able to view

Gary’s responses. The team can use

this information to adjust his

medications and care plan

appropriately.

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Personalization based on:

Condition, symptom, lifestyle

impact priorities

Questionnaire delivery time and

frequency preference

Learning style and preferred

educational content

Behaviors and eventsAfter a month, Gary becomes

non-adherent to his care plan.

Time to get

back into it!

We’ve noticed you

haven’t been

sticking to your

care plan. We’re

here to help. Here

is some useful

information to get

you going again:

Managing COPD >

Exercising with COPD >

The schedule and education

content being delivered to Gary is

adjusted to help him become

more engaged again.

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Framework

People

TechnologyProcess

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People

People

TechnologyProcess

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Interactive Care Plan

(ICP)

Leadership Team

Clinical Subject Matter Experts (SME)

Core Project Team

Technology Partner

Patients/

Caregivers

People – Key Contributors

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Role Title Responsibility

Leadership • Center for Connected Care

Administration

• Physician Champions

• Setting vision and direction

• Collaborating with the practice to set priorities on

upcoming ICPs

• Defining objective and scope for the ICP

Clinical Subject Matter Experts

(SME)

• Physicians / Providers

• Nursing

• Therapists

• Contributing clinical expertise to inform ICP

development and content

• Gathering internal consensus

Core Project Team • Project Manager

• Business Analyst

• Health System Engineer

• Clinical Nurse Specialist

(CNS)

• Information Technology (IT)

• Patient Education Specialists

• Content Strategists, Managing

Editors

• Executing the development of an ICP

• Collaborating with clinical SMEs

• Developing and setting strategy for content within the

ICP, dependent on goals of individual ICP

• Working with clinical SMEs to understand the patient

experience via the clinical workflow

Technology Partner • IT Developer • Providing guidance on how the ICP can be executed

once defined

Patients/Caregivers • End Users • Describing needs and expectations when using a

mobile health application

• Participating in usability studies to inform product

design and functionality

People – Roles and Responsibilities

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Key Takeaways – People

Defining roles, responsibilities and timing of hand-offs between project team members is necessary to ensure an efficient process

Initial development of ICPs has been resource intensive and involved team members from multiple disciplines

Mayo Clinic is a consensus-driven organization; in order to take a platform approach, we sought endorsement from key clinical stakeholders across the organization

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Process

People

TechnologyProcess

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Creation Process

Intake Content Build / Test Production Revision

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Intake Process

Idea Triage Discovery Assessment Prioritization Roadmap

Does this

align with

department

strategy?

What service

line?

Tool: Intake

Form

Is the ICP

platform

appropriate to

support the

idea?

Tool:

Discovery

Questionnaire

Does this ICP

align with our

strategic

priorities

today? If not,

when?

Tool:

Prioritization

Matrix

When do we

initiate the

ICP

development

process?

Tool:

Product

Roadmap

Assess

readiness

based on:

1. Content

2. Scope

3.Technical

needs

4.Resources

Tool: ICP

Assessment

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Content Development Process

Assess

readiness

based on:

1. Content

2. Scope

3.Technical

needs

4.Resources

Tool: ICP

Assessment

Clinical

NeedsReview &

Sign-off

8-12 Weeks8-12 Weeks

Requirements

Eligibility

Criteria

Eligibility

Criteria

Business &

Functional

Requirements

Business &

Functional

Requirements

Decision Trees & LogicDecision Trees & Logic

Education

Education

Inventory

Education

Inventory

Componentized

Content

Componentized

Content

Other

Copy

Other

Copy

Education

Goals

Education

GoalsContent CalendarContent Calendar

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Key Takeaways – Process

Avoid scope creep! Establish and agree upon the scope before development

A playbook is key—use a comprehensive resource that promotes traceability and standardization

Processes should be iterative and refined based on stakeholder

feedback

Patient education strategy should align with clinical goals/objectives outlined in intake process

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Technology

People

TechnologyProcess

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Clinical Content

Technical Solution

Interactive Care Plan

Technology

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• Intuitive/easy to use

– “I would use this app. It makes it a lot easier and I take my phone with me wherever I go. It’s very easy to use.”

• Personalized content

– Tailor education content based on the patient’s level of experience with, and knowledge about, their condition

• Customizable, integrated and compatible

– Patients expect it to be fully customizable (especially regarding push notifications), fully integrated, secure and compatible with other devices

• Remote monitoring

– “It would be great to be able to check up on a family member, even if they live down the street. You're just not sure if they've taken their medications...”

– “As a caregiver, it would be great to say ‘Don't worry. Remember, you have an injection or pills to take or a doctor's visit.’ The app would serve as an addition to my brain helping me help him.”

Technology – Feedback and Recommendations

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Key Takeaways – Technology

Utilize a template to document clinical knowledge to establish standardization and traceability between all components

Solicit feedback from patients and providers in multiple ways and on a continuous schedule

Develop a feedback and development pipeline to inform and prioritize future product development

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Challenges/Barriers

Defining roles and responsibilities of a large, multidisciplinary team

Simultaneously managing an aggressive timeline and changing scope

Developing consistent methodology for eliciting and documenting requirements

Attaining clinical practice consensus on care plan objectives and content

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Conclusion

PeoplePeople

ProcessProcess

TechnologyTechnology

• Built a multi-disciplinary team

• Sought enterprise-wide endorsement to gain support

for, and increase awareness of, this product

• Built a multi-disciplinary team

• Sought enterprise-wide endorsement to gain support

for, and increase awareness of, this product

• Established an intake process to clarify clinical

objectives and manage development scope

• Used tools to streamline creation process

• Established an intake process to clarify clinical

objectives and manage development scope

• Used tools to streamline creation process

• Standardized the documentation of clinical content and

established traceability

• Developed a feedback pipeline to inform and prioritize

future product development efforts

• Standardized the documentation of clinical content and

established traceability

• Developed a feedback pipeline to inform and prioritize

future product development efforts

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We would like to thank the Center for Connected Care leadership

team and all those with whom we have worked to develop Mayo

Clinic’s interactive care plans.

Acknowledgements

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• Images retrieved from: Mayo Clinic MAUD Database

• Images retrieved from: Mayo Clinic Brand Strategy and Creative Studio

• Icons retrieved from: www.flaticon.com

• Research retrieved from:

https://ww2.frost.com/files/3214/8830/8451/2017_Frost__Sullivan_Predicti

ons_in_Digital_Health.pdf

• Research retrieved from: www.advisory.com

• Research retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4376208/

• Research retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4704953/

• Research from Mayo Clinic Center for Innovation

• Research from Mayo Clinic Department of Planning Services

References

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Kaley N. Johnson, MS

Principal Business Analyst

Email: Johnson.Kaley@mayo.edu

LinkedIn: www.linkedin.com/in/kaley-johnson-1004a4122

Olivia P. Peavler, MPH

Health Systems Engineer

Email: Peavler.Olivia@mayo.edu

LinkedIn: www.linkedin.com/in/oliviapeavler

Questions