mcare: The Results of a Secure, Bi-Directional Mobile Phone Messaging System for U.S. Army Wounded Warriors

Transcription

1 mcare: The Results of a Secure, Bi-Directional Mobile Phone Messaging System for U.S. Army Wounded Warriors United States Army Medical Research and Materiel Command (USA MRMC) Telemedicine and Advanced Technology Research Center (TATRC) Fort Detrick, MD James Tong mcare Project Officer Ke aki Technologies LLC Slide 1

2 Disclaimer The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Army, or Air Force, the Department of Defense, nor the U.S. Government. This presentation does not imply any Federal/DOD endorsement. Slide 2

3 mcare Relationships Slide 3

4 mcare Project Overview What it is: What it is not: Synchronization over distance of: mtbi patients Other Wounded Warriors Military care team members Issuing soldiers cell phones Expecting patients to perform complicated technology tasks Uses patients EXISTING cell phones Text messaging (SMS) of PII or PHI Secure, HIPAA compliant messaging Expecting care team members to text message the patient Simple patient responses (typically 1 character or one click) Device-autonomous Care team uses a website to access information Mobile device-agnostic Slide 4

5 mcare IT Structure Summary Slide 5

6 mcare Sites and Regions N=477 N = N= Slide 6

7 mcare at a Glance Slide 7

8 Mobile Device Requirements Screen resolution of 240 x 320 pixels or higher Text messaging service Data service Tier 1 cell phone carriers Smartphone & feature phone compatible Slide 8

9 Mobile Interface Slide 9

10 Web Interface Slide 10

11 mcare Toolbox Slide 11

12 mcare Dashboards Slide 12

13 mcare Charting Cell phone user feedback accessed through the web portal dashboard Slide 13

14 mcare Pilot Project Wounded Warrior Enrollment mcare Message Volume Aim to enroll 100 users Improve patient-care team contact rates Observe performance on all carriers Observe performance on all device classes Observe feasibility of software updates Assess acceptance & utilization Completed in April 2011 Enrolled 600 users Surpassed 100,000 messages Transition to clinical outcomes study Slide 14

15 Pilot Project Message Utilization 24 hrs prior 90 mins prior 24 hrs post Administrative Command Status updates Scheduling Post-Deployment Injury/Disease specific Maintaining profile Promote healthy behaviors Slide 15

16 mcare Patient Appointments Appt Reminder Times Appropriate? Appt Feature Easy to Use? mcare Patient Appointments N=87 N=87 Self-Reported Usage N=88 At end of 2011 Q1: Web (62%), Mobile (38%) Patients share responsibility with care team Slide 16

17 mcare User Devices Carrier Distribution Smartphone Operating System Smartphone vs Feature Phone Slide 17

18 mcare User Demographics Age Millenials (18 34) Gen X (35 46) Young Boomers (47 56) Older Boomers (57 65) 60% N = 600 Duration of Usage 45% N = 600 Rank % of Users 30% 15% N = 600 0% 0-1 Month 1-2 Months 3-6 Months 6-9 Months >9 Months Slide 18

19 Patient Acceptance Patients Prefer Morning Messages User Response 80% 70% 60% 50% 40% 30% 20% N = 90 Consider military schedule Allows time for actionable tasks Time of delivery influences nature of message Consider disease/injury Leverage store-and-forward design 10% Setup patient for success 0% 8:00am - 12:00pm 12:00pm - 4:00pm 4:00pm - 7:00pm Message Times Slide 19

20 Patient Acceptance Messages Patients Find Most Useful 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Appointment Reminders Unit Announcements Contacts Health and Wellness Tips Fun Stuff Patients need to be incentivized with relevant information N = 87 Websites Goals Information needs to be timely Patients use mcare to access health information Slide 20

21 Patient Acceptance 40% 35% How often do you read your Health & Wellness Tips? N = 86 45% 40% How many times a week do you open your mcare application? N = 88 Percent Response 30% 25% 20% 15% 10% 5% 0% Percent Response 35% 30% 25% 20% 15% 10% 5% 0% Slide 21

22 Patient Acceptance On a scale of 0 10, How much do you feel mcare Improves your CBWTU experience? Improves your communication with your unit? N = Provides you with valuable and relevant information? Appointment reminders improve your ability to attend appointments? % Response % Response N = 87, to 3 4 to 7 8 to to 3 4 to 7 8 to 10 User Scores (0 low, 10 high) User Scores (0 low, 10 high) Slide 22

23 Care Team Acceptance 45% 40% Do you think mcare allows you to provide information to your patients in an effective manner? N = % 40% Have you seen an improvement in the appointment attendance in your patients who use mcare? N = % 35% User Response 30% 25% 20% 15% User Response 30% 25% 20% 15% 10% 10% 5% 5% 0% Strongly Disagree Disagree Neither agree or disagree Agree Strongly Agree 0% Strongly Disagree Neither Disagree agree or disagree Agree Strongly Agree Slide 23

24 Care Team Acceptance 50% Does the HIPAA-compliant security provided by mcare give you comfort that your patients information is secure? N = % Would you refer patients to mcare? N = % 40% Percent Response 30% 20% Percent Response 30% 20% 10% 10% 0% Strongly Disagree Disagree Neither agree or disagree Agree Strongly Agree 0% Strongly Disagree Disagree Neither agree or disagree Agree Strongly Agree Slide 24

25 Clinical Outcomes Study Objectives Determine whether mcare will positively impact CBWTU case management care and overall WT wellbeing. Evaluate differential benefits derived from TBI patients' utilization of mcare, as compared to that of the non-tbi patients Timeline 9 months per WT 4 month enrollment Initiated 18-April-2011, Expected Completion June 2012 Inclusion/Exclusion Criteria Not tied to diagnosis Compatible cell phone Randomization-Stratification Stratified by in-processing TBI (or no TBI) diagnosis Randomized into Control (no mcare) or Experimental (mcare) group Slide 25

26 Lessons Learned Completed Pilot Project in April 2011 Need wide carrier and operating system compatibility to facilitate wide adoption Need a thorough understanding of business practice to overcome paradigm shift Staffing a nurse (regional mcare POCs) assisted in overcoming paradigm shift Implementation practices are as important to adoption, as the technology itself Information timing and information relevance are important factors in keeping users enagaged Patients and care teams can work together to build data sets mcare can be used by patients across age and profession Patients prefer early morning messages, to allow action if required Patients like to feel connected to their care team/army unit mcare can help improve patients case management experience mcare improves patient-care team communication mcare improves patients ability to attend appointments Care teams recognize mcare as a reliable method of communicating with patients Care teams acknowledge the improvement in appointment attendance amongst mcare users Care teams value the security layers built into the mcare system Slide 26

27 mcare Team Acknowledgements Ms. Holly Pavliscsak Ms. Jeanette Rasche Little LTC Lynne Lowe Mr. Mike Bairas Ms. Joyce Bennett Ms. Mabel Cooper COL (ret) Eileen McGonagle Ms. Cynthia Gilley LTC Challis Smith Dr. Fran McVeigh COL Ron Poropatich Ms. Lois Goldstein Mr. Kurt Huttar Ms. Celicia Thomas COL (ret) Dr. Johnie Tillman Slide 27

28 It prevents you from feeling alone; it just tells me I m in contact. This is a hard process and I know that I have issues that won t ever get fully resolved. But mcare is just comforting. When the messages pop-up, you know someone s there. Wounded Warrior Thank you! James Tong mcare Project Officer james.tong@amedd.army.mil Slide 28