Having an Emergency? Get an Ambulance, Get to ER and Get Treated. Sounds as simple as 1-2-3, right? Well, we all have stories to tell about our ER experiences, don’t we? Unless you’re dying or been shot, time in ER can take forever, and most of the time that isn’t the only reason for delay. From the minute you dial 911 or decide to go to ER on your own, there are many reasons that affect time and quality of care and your memories of the hospital:
- Patient’s Severity.
- Hospital Specialty.
- ER Congestion.
- Repetitive Paperwork.
- Insufficient Information.
Well, it doesn't need to be this way! Our team has created a robust ER app prototype called myERBuddy that guides patients in an emergency to the most appropriate ER or Urgent Care facility based on certain questions they answer. Our Big Idea is to decongest ER, increase patient engagement and improve NY Presbyterian Hospital’s ER Ratings. By integrating myERBuddy into NYP’s system, we can provide better Information based on real-time user input, thereby increasing Patient Engagement and improving ER ratings for the Hospital system.
How it works
*PLEASE REFER TO DROPBOX LINKS FOR SOURCE CODE AND VIDEO OF TEST SHOT.* In an emergency, patients go or get sent to the nearest ER. But many times, that MAY NOT be the best option. Why? Patient Severity + Hospital Specialty + Traffic Time + Wait Time inside ER = Time Before Evaluation. In just a few clicks, myERBuddy guides a patient or EMS to an ER or the Urgent Care facility based on Patient’s Condition, Hospital’s Specialty, traffic conditions, and estimated wait times.
Step 1: Are you experiencing any of these conditions (“Critical Conditions”) – If answer Yes, app dials 911 for an ambulance, emails PCP, and txt messages two emergency contacts.
Step 2: If GPS activated, automatically gives 2-3 nearest ER locations based on Hospital Specialty, Wait Times and Traffic conditions. If GPS not activated, need to enter “Current Location”. This would be helpful to family members, Good Samaritans or even EMT’s following the 911 routing protocols.
Step 3: If answer No to Step 1, app asks if you would like an ambulance anyway to give patients a comforting choice. If Yes, then Repeat Step 2
Step 4: If Patient Says “Unsure”, then ask “Are you experiencing any of these conditions (“Non-Critical Conditions”). If Severe; provide 2-3 ER choices & directions, If Mild; provide 2-3 Urgent Care choices & directions.
Step 5: Once at ER, one-time registration begins. Info is stored securely which then maybe emailed by the patient to the ER front desk and for future use. Idea is to reduce/eliminate repetitive paperwork. Also Time Tracker included log-in time taken to get to ER v/s the estimate we provided.
Step 6: For information purposes only, we’ve included Triage Flow for both Critical (Fast Tracked) and Non-Critical Patients. We can’t control what happens inside ER, but would be good to inform patients on the process inside. Also Time Tracker included log-in time taken inside triage.
Step 7: Patients can request medical records and discharge instructions via email that will get stored in their myEmail tab. Also Time Tracker included log-in time taken for discharge.
Step 8: If a patient needs Care at Home Services, they can use our recommender engine to get a targeted 3-4 caregiver recommendations based on selected criteria.
Step 9: Request patients to provide HCAHPS feedback.
Challenges I ran into
As we were building the myERBuddy prototype, following few challenges came up during the ideation and flowcharting phase:
Defining Scope of the Application - Initial flowcharts we created looked at the continuum of care from going to the appropriate ER to Triage Flow to In-Patient Engagement Tools to Post-Discharge Care at Home recommendations. While the care-flow logic made sense, creating prototype screens became overwhelming, and so by consensus, we decided to eliminate the In-Hospital Patient Tools we wanted to create, and only focused on improving ER experience.
Tech Resources - Due to time and other constraints, we had to prioritize how much coding we’re able to show for the prototype we’ve built. Many of the tools such as the Waze real-time traffic tracker, gamification elements, and Hospital internal maps will have to be incorporated at a later stage.
Regulatory Challenges - Innovation in other industries is so much easier due to limited regulations. HIPAA, Medicare/Medicaid reimbursements and other issues needed to be considered carefully while any innovative solutions were thought of. Privacy laws, data integrity, portability and safety, requirement to treat uninsured patients at ERs are some of the practical challenges that needed careful navigation while we were thinking of implementation.
User Considerations - Senior Citizens are among the heavy users of ER’s. As per CMS data, 30% of the ER users account for 70-80% of the resources spent. Given this statistic, any ER related solution needs behavioral adjustment, training, easy to use navigation for seniors as well as their aides & family members. Having tech tools that balance different users' learning curves across devices was certainly challenging.
Accomplishments that I'm proud of
While there were some challenges as discussed above, what we’re really proud of is how well we assembled a team of 7 individuals with full-time careers, varied skills residing in NY, Abu Dhabi and Buenos Aires. Through Hackathons, Meetup groups, and online portals, we met and formed a cross-cultural, distributed team and then worked seamlessly without any friction or disagreements through emails, Skype and phone calls.
All team members had some sort of prior experience or opinion about ER’s, and they all contributed with their unique perspective and ideas on how to best leverage technology to create a happier, engaged patient experience. We also got invaluable feedback from enthusiastic, prospective users and customers.
What I learned
As a team we learnt Project Management and Product Management skills for distributed teams within the stipulated 10 week time frame. Other things we learnt specific to this project were:
Healthcare Innovation – To improve Patient Engagement, we studied and incorporated many innovative elements such as screening Hospitals & Urgent Care Centers by Specialty, directing Patients as per their Conditions, giving real time traffic updates, providing estimated ER wait times, Time Trackers at few different stages to compare estimated times v/s actual times.
Value-based Reimbursements – As CMS shifts the reimbursement model from volume based to outcome and value focused, patient ratings and feedback will be more important, especially related to readmissions.
Patient Expectations – One of the eye opening things for us was that while NYP’s Specialty Departments got good overall ratings, the ER ratings were quite poor across all facilities. By integrating myERBuddy into NYP’s system, we can provide better Information based on real-time user input, thereby increasing Patient Engagement and improving ER ratings for the Hospital system.
Triple Aim – myERBuddy works really well within the Triple Aim framework towards: a. Improve Patient Experience; b. Better Care; and c. Lower Costs.
Compliance – Healthcare is a heavily regulated field impacting life & death situations. This was both a humbling and a learning experience for us while developing myERBuddy prototype.
What's next for Care at Home Services
We’re hoping that we’ll make it to the InnovateNYP Demo Day. Would be great to work with NYP’s Innovation and IT teams in implementing myERBuddy towards a better Patient Engagement outcome. We would like to approach other institutions and NY City Agencies to improve Continuum of Care citywide.