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CHICAGO – A gastroenterologist-founded tech firm is making big waves in digital health care as Rx.Health, a spinoff from Mount Sinai Hospitals, New York, partners with the American Gastroenterological Association and other professional societies to deliver health solutions to the palms of patients’ hands.
“I would make the argument that disruption doesn’t have to come from the West Coast. It can come from savvy East Coasters, as well as Midwesterners, as well as Southerners,” said Ashish Atreja, MD, MPH, chief innovation officer of medicine at Mount Sinai Hospitals, New York.
At his home institution, where Dr. Atreja also serves on the gastroenterology faculty at the Icahn School of Medicine, the discussion about digital health began as Mount Sinai experienced rapid expansion. “So that has been a learning ground for us – to say, ‘What is happening across different hospitals? How are we going to standardize care?’ ” he said, speaking at the AGA Partners in Value Meeting.
“We’re looking at digital health to do it,” and the digital initiative dovetails perfectly with the strong value-based health mission of Mount Sinai, he added. “We say that, if our hospital beds are filled, then we are failing,” although the institution’s biggest revenue stream is from inpatient care. “We really have to look beyond the four walls of the hospital to provide care.”
The digital innovation laboratory at Mount Sinai was set up about 6 years ago, making it one of the first such centers in the country. It took about a year to build a team that had the technical skills to build apps in house, but once the ball got rolling, “it has been a fascinating journey,” said Dr. Atreja.
Innovation doesn’t always mean adoption
When Dr. Atreja and his colleagues took apps that were powerful data collection tools and put them out for general patient use, “We only saw 6% adoption ... because the patients forgot the names. They mistyped the names. They got lost in 60,000 apps. They forgot the activation code.
“And even if they got all of this, 20% of patients didn’t have space in their smartphones anyway.”
That’s when Dr. Atreja and his collaborators realized they didn’t really have an innovation problem, but rather a transformation problem – they needed to change the existing digital patchwork into a clinically meaningful intervention.
At this turning point, the Mount Sinai digital innovation team realized physicians could use evidence-based apps “and actually prescribe them – much the same way that you prescribe medication. ... So this was our ‘aha’ moment 3 years ago,” said Dr. Atreja.
Now, at Mount Sinai, apps are integrated with the electronic health record and can be prescribed with a few clicks. With the integrated digital prescription platform, patient activation of the apps has increased to 92%, said Dr. Atreja.
Currently, about 25 projects using this integrated system are being initiated within the Mount Sinai health system, and 35-50 external projects are underway in association with Rx.Health, a spin-off of the Mount Sinai efforts. Dr. Atreja serves as chief strategy officer for Rx.Health.
In all, 22 health systems are using the app platform at present, which bundles many facets of digital health – health education, remote monitoring, telehealth, secure messaging, to name a few.
The unified platform, said Dr. Atreja, “allows all of us – clinicians, business drivers, tech, researchers – to become creators and digital practitioners.”
Case study: Colonoscopy
After a particularly discouraging day in the endoscopy suite in which six of seven patients had inadequate bowel preparation for colonoscopy, Dr. Atreja dug a little further into Mount Sinai’s endoscopy data. “I realized we were losing one million dollars a year because of no-shows and inadequate bowel preparation,” he said.
A higher success rate could be achieved with bowel preparation if enough staff time is dedicated to repeat phone calls, he conceded. “But you are spending $300,000 just on a brute force solution” of massive staff resources, he said.
In the Mount Sinai example, when all missed opportunities are considered, “you’re looking at 4 to 5 million dollars that we’re leaking because we are not able to engage patients at the right time.”
Gastrointestinal procedures are a major source for revenue leaks, he said. Patients may miss procedures or be late; up to 1 in 4 patients may have poor bowel preparation, and sometimes patients arrive without a plan for a ride home after a procedure that requires sedation.
Other care gaps include the 30%-70% of patients who don’t return at recommended screening intervals, and patients who have positive fecal immunohistochemical testing but don’t receive a colonoscopy. Some patients have colonoscopies ordered, but never scheduled, and still others are never offered any colorectal cancer surveillance testing at all.
It’s no wonder patients are confused, said Dr. Atreja, providing an example of one center’s colonoscopy preparation instructions for split-dose polyethylene glycol bowel preparation. Patients must closely follow a full page of bullet points to be completed at precise time intervals. “One in four patients actually loses the paper by the time they need it before the procedure,” he said. Another 40% don’t look at instructions until it’s too late to prepare adequately or to line up an escort to bring them home post procedure.
This scenario, he said, shows that “it’s not in the science of medicine, but in the practice of medicine, that we are failing. ... So how about we completely change the game and create a real-time digital navigation for the patient?”
The digital alternative to the slip of paper is a real-time patient navigation tool that guides patients through the entire colonoscopy preparation process. “Based on where the patient is at that point in time, and the procedure, and the bowel prep,” the app gives the patient timely and relevant information: what the procedure is like, why bowel preparation is important, and how preparation is correctly performed, explained Dr. Atreja.
A reminder to arrange an escort arrives on the patient’s phone a full 10 days before the procedure, with subsequent nudges. Patients even receive driving and parking directions. The day before the procedure, a last-minute query checks on transportation. “So we’re working with Uber to actually make an ... integration with Uber so they can pick up the patient if they have transportation issues.”
Post procedure, patients are asked about their experiences, and a plan for appropriate patient recall is integrated into the app as well. “The best part is, this has not been designed by anyone [other] than those in the health system. Because we already know the recommended guidelines, we know the best practices.” This, he said, is where the value of digital apps is truly created.
Early evidence gleaned from a dashboard that’s part of the digital health solution from one site using the app shows a 24% improvement in bowel preparation. Importantly, the rate of aborted procedures has been cut in half, and patient satisfaction rates are at 93%.
The endoscopy suite as digital transformation center
Now, in partnership with AGA, Dr. Atreja and his collaborators are planning a roll-out to multiple sites to see whether the savings and return on investment are replicated at other endoscopy sites. The vision expands beyond reducing revenue leaks to creating “digital transformation centers,” he said.
Digital health solutions such as this afford powerful opportunity for data collection, not only for practice optimization but also for research, said Dr. Atreja. He cited the example of endoscopic retrograde cholangiopancreatography, where procedural details could be linked to postprocedural admission rates in the service of fine-tuning one of the endoscopist’s greatest procedural challenges.
“You can create all of those clinical trial networks for devices right on the fly,” he said. In devising a clinical trial for an app-based intervention for anxiety – prevalent in those with irritable bowel disease – Dr. Atreja and his colleagues opened trial enrollment at 8 a.m., hoping to enroll 20 patients. By the end of the day, over 200 had enrolled. “We over-subscribed our trial by 10 times” in 1 day using the digital platform, he said.
Dr. Atreja is currently working with the American College of Cardiology on digital solutions for home monitoring of heart failure patients. “Partnerships with other health systems and societies are key for learning and rapid transformation – a rising tide lifts all boats,” said Dr. Atreja. “Digital medicine is not digital medicine. It is medicine. Because the practice of medicine is medicine.”
Dr. Atreja reported receiving funding from AbbVie, Janssen, Pfizer, Takeda, Astrazeneca, UCB, and Roche; the RxUniverse app has been licensed from the Icahn School of Medicine at Mount Sinai to Rx.Health.
AGA has partnered with RxHealth to support gastroenterologists’ ability to provide patient care and improve patient adherence by creating up-to-date, evidenced-based digital tools that can be prescribed at point of care. Dr. John I. Allen, the Editor in Chief of GI & Hepatology News, is on the advisory board of RxHealth and recused himself from review and approval of this story. Learn more about the program and how to become a pioneer site at https://rx.health/GI or Engage@Rx.Health .
CHICAGO – A gastroenterologist-founded tech firm is making big waves in digital health care as Rx.Health, a spinoff from Mount Sinai Hospitals, New York, partners with the American Gastroenterological Association and other professional societies to deliver health solutions to the palms of patients’ hands.
“I would make the argument that disruption doesn’t have to come from the West Coast. It can come from savvy East Coasters, as well as Midwesterners, as well as Southerners,” said Ashish Atreja, MD, MPH, chief innovation officer of medicine at Mount Sinai Hospitals, New York.
At his home institution, where Dr. Atreja also serves on the gastroenterology faculty at the Icahn School of Medicine, the discussion about digital health began as Mount Sinai experienced rapid expansion. “So that has been a learning ground for us – to say, ‘What is happening across different hospitals? How are we going to standardize care?’ ” he said, speaking at the AGA Partners in Value Meeting.
“We’re looking at digital health to do it,” and the digital initiative dovetails perfectly with the strong value-based health mission of Mount Sinai, he added. “We say that, if our hospital beds are filled, then we are failing,” although the institution’s biggest revenue stream is from inpatient care. “We really have to look beyond the four walls of the hospital to provide care.”
The digital innovation laboratory at Mount Sinai was set up about 6 years ago, making it one of the first such centers in the country. It took about a year to build a team that had the technical skills to build apps in house, but once the ball got rolling, “it has been a fascinating journey,” said Dr. Atreja.
Innovation doesn’t always mean adoption
When Dr. Atreja and his colleagues took apps that were powerful data collection tools and put them out for general patient use, “We only saw 6% adoption ... because the patients forgot the names. They mistyped the names. They got lost in 60,000 apps. They forgot the activation code.
“And even if they got all of this, 20% of patients didn’t have space in their smartphones anyway.”
That’s when Dr. Atreja and his collaborators realized they didn’t really have an innovation problem, but rather a transformation problem – they needed to change the existing digital patchwork into a clinically meaningful intervention.
At this turning point, the Mount Sinai digital innovation team realized physicians could use evidence-based apps “and actually prescribe them – much the same way that you prescribe medication. ... So this was our ‘aha’ moment 3 years ago,” said Dr. Atreja.
Now, at Mount Sinai, apps are integrated with the electronic health record and can be prescribed with a few clicks. With the integrated digital prescription platform, patient activation of the apps has increased to 92%, said Dr. Atreja.
Currently, about 25 projects using this integrated system are being initiated within the Mount Sinai health system, and 35-50 external projects are underway in association with Rx.Health, a spin-off of the Mount Sinai efforts. Dr. Atreja serves as chief strategy officer for Rx.Health.
In all, 22 health systems are using the app platform at present, which bundles many facets of digital health – health education, remote monitoring, telehealth, secure messaging, to name a few.
The unified platform, said Dr. Atreja, “allows all of us – clinicians, business drivers, tech, researchers – to become creators and digital practitioners.”
Case study: Colonoscopy
After a particularly discouraging day in the endoscopy suite in which six of seven patients had inadequate bowel preparation for colonoscopy, Dr. Atreja dug a little further into Mount Sinai’s endoscopy data. “I realized we were losing one million dollars a year because of no-shows and inadequate bowel preparation,” he said.
A higher success rate could be achieved with bowel preparation if enough staff time is dedicated to repeat phone calls, he conceded. “But you are spending $300,000 just on a brute force solution” of massive staff resources, he said.
In the Mount Sinai example, when all missed opportunities are considered, “you’re looking at 4 to 5 million dollars that we’re leaking because we are not able to engage patients at the right time.”
Gastrointestinal procedures are a major source for revenue leaks, he said. Patients may miss procedures or be late; up to 1 in 4 patients may have poor bowel preparation, and sometimes patients arrive without a plan for a ride home after a procedure that requires sedation.
Other care gaps include the 30%-70% of patients who don’t return at recommended screening intervals, and patients who have positive fecal immunohistochemical testing but don’t receive a colonoscopy. Some patients have colonoscopies ordered, but never scheduled, and still others are never offered any colorectal cancer surveillance testing at all.
It’s no wonder patients are confused, said Dr. Atreja, providing an example of one center’s colonoscopy preparation instructions for split-dose polyethylene glycol bowel preparation. Patients must closely follow a full page of bullet points to be completed at precise time intervals. “One in four patients actually loses the paper by the time they need it before the procedure,” he said. Another 40% don’t look at instructions until it’s too late to prepare adequately or to line up an escort to bring them home post procedure.
This scenario, he said, shows that “it’s not in the science of medicine, but in the practice of medicine, that we are failing. ... So how about we completely change the game and create a real-time digital navigation for the patient?”
The digital alternative to the slip of paper is a real-time patient navigation tool that guides patients through the entire colonoscopy preparation process. “Based on where the patient is at that point in time, and the procedure, and the bowel prep,” the app gives the patient timely and relevant information: what the procedure is like, why bowel preparation is important, and how preparation is correctly performed, explained Dr. Atreja.
A reminder to arrange an escort arrives on the patient’s phone a full 10 days before the procedure, with subsequent nudges. Patients even receive driving and parking directions. The day before the procedure, a last-minute query checks on transportation. “So we’re working with Uber to actually make an ... integration with Uber so they can pick up the patient if they have transportation issues.”
Post procedure, patients are asked about their experiences, and a plan for appropriate patient recall is integrated into the app as well. “The best part is, this has not been designed by anyone [other] than those in the health system. Because we already know the recommended guidelines, we know the best practices.” This, he said, is where the value of digital apps is truly created.
Early evidence gleaned from a dashboard that’s part of the digital health solution from one site using the app shows a 24% improvement in bowel preparation. Importantly, the rate of aborted procedures has been cut in half, and patient satisfaction rates are at 93%.
The endoscopy suite as digital transformation center
Now, in partnership with AGA, Dr. Atreja and his collaborators are planning a roll-out to multiple sites to see whether the savings and return on investment are replicated at other endoscopy sites. The vision expands beyond reducing revenue leaks to creating “digital transformation centers,” he said.
Digital health solutions such as this afford powerful opportunity for data collection, not only for practice optimization but also for research, said Dr. Atreja. He cited the example of endoscopic retrograde cholangiopancreatography, where procedural details could be linked to postprocedural admission rates in the service of fine-tuning one of the endoscopist’s greatest procedural challenges.
“You can create all of those clinical trial networks for devices right on the fly,” he said. In devising a clinical trial for an app-based intervention for anxiety – prevalent in those with irritable bowel disease – Dr. Atreja and his colleagues opened trial enrollment at 8 a.m., hoping to enroll 20 patients. By the end of the day, over 200 had enrolled. “We over-subscribed our trial by 10 times” in 1 day using the digital platform, he said.
Dr. Atreja is currently working with the American College of Cardiology on digital solutions for home monitoring of heart failure patients. “Partnerships with other health systems and societies are key for learning and rapid transformation – a rising tide lifts all boats,” said Dr. Atreja. “Digital medicine is not digital medicine. It is medicine. Because the practice of medicine is medicine.”
Dr. Atreja reported receiving funding from AbbVie, Janssen, Pfizer, Takeda, Astrazeneca, UCB, and Roche; the RxUniverse app has been licensed from the Icahn School of Medicine at Mount Sinai to Rx.Health.
AGA has partnered with RxHealth to support gastroenterologists’ ability to provide patient care and improve patient adherence by creating up-to-date, evidenced-based digital tools that can be prescribed at point of care. Dr. John I. Allen, the Editor in Chief of GI & Hepatology News, is on the advisory board of RxHealth and recused himself from review and approval of this story. Learn more about the program and how to become a pioneer site at https://rx.health/GI or Engage@Rx.Health .
CHICAGO – A gastroenterologist-founded tech firm is making big waves in digital health care as Rx.Health, a spinoff from Mount Sinai Hospitals, New York, partners with the American Gastroenterological Association and other professional societies to deliver health solutions to the palms of patients’ hands.
“I would make the argument that disruption doesn’t have to come from the West Coast. It can come from savvy East Coasters, as well as Midwesterners, as well as Southerners,” said Ashish Atreja, MD, MPH, chief innovation officer of medicine at Mount Sinai Hospitals, New York.
At his home institution, where Dr. Atreja also serves on the gastroenterology faculty at the Icahn School of Medicine, the discussion about digital health began as Mount Sinai experienced rapid expansion. “So that has been a learning ground for us – to say, ‘What is happening across different hospitals? How are we going to standardize care?’ ” he said, speaking at the AGA Partners in Value Meeting.
“We’re looking at digital health to do it,” and the digital initiative dovetails perfectly with the strong value-based health mission of Mount Sinai, he added. “We say that, if our hospital beds are filled, then we are failing,” although the institution’s biggest revenue stream is from inpatient care. “We really have to look beyond the four walls of the hospital to provide care.”
The digital innovation laboratory at Mount Sinai was set up about 6 years ago, making it one of the first such centers in the country. It took about a year to build a team that had the technical skills to build apps in house, but once the ball got rolling, “it has been a fascinating journey,” said Dr. Atreja.
Innovation doesn’t always mean adoption
When Dr. Atreja and his colleagues took apps that were powerful data collection tools and put them out for general patient use, “We only saw 6% adoption ... because the patients forgot the names. They mistyped the names. They got lost in 60,000 apps. They forgot the activation code.
“And even if they got all of this, 20% of patients didn’t have space in their smartphones anyway.”
That’s when Dr. Atreja and his collaborators realized they didn’t really have an innovation problem, but rather a transformation problem – they needed to change the existing digital patchwork into a clinically meaningful intervention.
At this turning point, the Mount Sinai digital innovation team realized physicians could use evidence-based apps “and actually prescribe them – much the same way that you prescribe medication. ... So this was our ‘aha’ moment 3 years ago,” said Dr. Atreja.
Now, at Mount Sinai, apps are integrated with the electronic health record and can be prescribed with a few clicks. With the integrated digital prescription platform, patient activation of the apps has increased to 92%, said Dr. Atreja.
Currently, about 25 projects using this integrated system are being initiated within the Mount Sinai health system, and 35-50 external projects are underway in association with Rx.Health, a spin-off of the Mount Sinai efforts. Dr. Atreja serves as chief strategy officer for Rx.Health.
In all, 22 health systems are using the app platform at present, which bundles many facets of digital health – health education, remote monitoring, telehealth, secure messaging, to name a few.
The unified platform, said Dr. Atreja, “allows all of us – clinicians, business drivers, tech, researchers – to become creators and digital practitioners.”
Case study: Colonoscopy
After a particularly discouraging day in the endoscopy suite in which six of seven patients had inadequate bowel preparation for colonoscopy, Dr. Atreja dug a little further into Mount Sinai’s endoscopy data. “I realized we were losing one million dollars a year because of no-shows and inadequate bowel preparation,” he said.
A higher success rate could be achieved with bowel preparation if enough staff time is dedicated to repeat phone calls, he conceded. “But you are spending $300,000 just on a brute force solution” of massive staff resources, he said.
In the Mount Sinai example, when all missed opportunities are considered, “you’re looking at 4 to 5 million dollars that we’re leaking because we are not able to engage patients at the right time.”
Gastrointestinal procedures are a major source for revenue leaks, he said. Patients may miss procedures or be late; up to 1 in 4 patients may have poor bowel preparation, and sometimes patients arrive without a plan for a ride home after a procedure that requires sedation.
Other care gaps include the 30%-70% of patients who don’t return at recommended screening intervals, and patients who have positive fecal immunohistochemical testing but don’t receive a colonoscopy. Some patients have colonoscopies ordered, but never scheduled, and still others are never offered any colorectal cancer surveillance testing at all.
It’s no wonder patients are confused, said Dr. Atreja, providing an example of one center’s colonoscopy preparation instructions for split-dose polyethylene glycol bowel preparation. Patients must closely follow a full page of bullet points to be completed at precise time intervals. “One in four patients actually loses the paper by the time they need it before the procedure,” he said. Another 40% don’t look at instructions until it’s too late to prepare adequately or to line up an escort to bring them home post procedure.
This scenario, he said, shows that “it’s not in the science of medicine, but in the practice of medicine, that we are failing. ... So how about we completely change the game and create a real-time digital navigation for the patient?”
The digital alternative to the slip of paper is a real-time patient navigation tool that guides patients through the entire colonoscopy preparation process. “Based on where the patient is at that point in time, and the procedure, and the bowel prep,” the app gives the patient timely and relevant information: what the procedure is like, why bowel preparation is important, and how preparation is correctly performed, explained Dr. Atreja.
A reminder to arrange an escort arrives on the patient’s phone a full 10 days before the procedure, with subsequent nudges. Patients even receive driving and parking directions. The day before the procedure, a last-minute query checks on transportation. “So we’re working with Uber to actually make an ... integration with Uber so they can pick up the patient if they have transportation issues.”
Post procedure, patients are asked about their experiences, and a plan for appropriate patient recall is integrated into the app as well. “The best part is, this has not been designed by anyone [other] than those in the health system. Because we already know the recommended guidelines, we know the best practices.” This, he said, is where the value of digital apps is truly created.
Early evidence gleaned from a dashboard that’s part of the digital health solution from one site using the app shows a 24% improvement in bowel preparation. Importantly, the rate of aborted procedures has been cut in half, and patient satisfaction rates are at 93%.
The endoscopy suite as digital transformation center
Now, in partnership with AGA, Dr. Atreja and his collaborators are planning a roll-out to multiple sites to see whether the savings and return on investment are replicated at other endoscopy sites. The vision expands beyond reducing revenue leaks to creating “digital transformation centers,” he said.
Digital health solutions such as this afford powerful opportunity for data collection, not only for practice optimization but also for research, said Dr. Atreja. He cited the example of endoscopic retrograde cholangiopancreatography, where procedural details could be linked to postprocedural admission rates in the service of fine-tuning one of the endoscopist’s greatest procedural challenges.
“You can create all of those clinical trial networks for devices right on the fly,” he said. In devising a clinical trial for an app-based intervention for anxiety – prevalent in those with irritable bowel disease – Dr. Atreja and his colleagues opened trial enrollment at 8 a.m., hoping to enroll 20 patients. By the end of the day, over 200 had enrolled. “We over-subscribed our trial by 10 times” in 1 day using the digital platform, he said.
Dr. Atreja is currently working with the American College of Cardiology on digital solutions for home monitoring of heart failure patients. “Partnerships with other health systems and societies are key for learning and rapid transformation – a rising tide lifts all boats,” said Dr. Atreja. “Digital medicine is not digital medicine. It is medicine. Because the practice of medicine is medicine.”
Dr. Atreja reported receiving funding from AbbVie, Janssen, Pfizer, Takeda, Astrazeneca, UCB, and Roche; the RxUniverse app has been licensed from the Icahn School of Medicine at Mount Sinai to Rx.Health.
AGA has partnered with RxHealth to support gastroenterologists’ ability to provide patient care and improve patient adherence by creating up-to-date, evidenced-based digital tools that can be prescribed at point of care. Dr. John I. Allen, the Editor in Chief of GI & Hepatology News, is on the advisory board of RxHealth and recused himself from review and approval of this story. Learn more about the program and how to become a pioneer site at https://rx.health/GI or Engage@Rx.Health .
EXPERT ANALYSIS FROM AGA PARTNERS IN VALUE 2019
