trackER: a novel mobile health solution harnessing geolocation technology to catalyze information exchange in the ED to eliminate redundant healthcare utilization

Kyan Safavi ksafavi@partners.org
Sounok Sen ssen1@partners.org
Michael Lindsay michael.d.lindsay@gmail.com

Abstract

Background

In the U.S., one in five patients is readmitted within 30 days of discharge resulting in more than $41 billion in losses to Medicare annually.(1) It is estimated that over 836,000 patients each year are readmitted under “preventable” circumstances with a potential savings of $17 billion.(2) Moreover, patients view readmission as a failure of the healthcare system.(3) The emergency department (ED) is at the forefront of this problem because it is where decisions about readmissions and early, expensive testing are made, yet it is often where the least information is available about the patient.(4-6) While several products have attempted to reduce readmissions with at-home monitoring, a significant opportunity to reduce preventable readmissions exists at the very moment the patient arrives at an ED. trackER, a mobile health solution, is designed to intervene at this moment to improve information exchange.

Aims

To reduce preventable readmissions and redundant testing in the ED within 30 days of discharge by catalyzing information exchange in real time from the previous inpatient team that discharged the patient to the ED team actively caring for the patient. The mobile technology has the ability to:

1.    Enable the exchange of medical data in the form of the patient discharge summary

2.    Enable previous providers to directly call the ED when a patient arrives

Methods and Design

ED arrival geolocation service- The geolocation service on the patient’s smart phone tracks the patient’s location for 30 days. It automatically alerts the discharging provider in real time when detecting that the patient has arrived at a hospital ED.

Provider notification system- The patient’s previous discharging team is immediately notified that their patient has arrived at an ED, their time of arrival, as well as the ED name and location.

Medical data exchange feature- Upon arrival to the ED, the patient is given the option to transfer the discharge summary to the ED clinician via a secure pathway.

Inter-provider communication feature- When the previous discharging team is notified that the patient is in the ED seeking care, he or she is given the option to call the ED provider to transfer clinical knowledge about the patient. Furthermore, trackER enables other providers (PCPs, specialists, care coordinators) to be connected at this time to enable a safe and comprehensive clinical plan.

Measures of Impact

Patient post-discharge migration patterns- where and when patients tend to seek care post-discharge  

Patient measures- satisfaction with post-discharge experience, satisfaction with ED experience

Provider measures- time saved, rating of ability to deliver quality care

Hospital measures- readmission rate

Novelty of Design

Patient empowerment- the patient transforms from a passive to an active participant in their own care by transferring their medical information and connecting their providers

Timely information exchange- geolocation enables real-time recognition of when information exchange is needed, enabling the ED team to receive relevant, timely data prior to decisions regarding testing and readmission

Overcoming the traditional barriers to information exchange- geolocation and data transfer happen regardless of hospital, electronic medical record, or geographic location

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