Foxi

Having experienced trauma to a loved one back when I was a teenager, there were certain gaps in communication, I wish were bridged during my hospital stay. This sense of despair was echoed hearing about caregivers restlessly waiting for their children as they underwent surgery, the fear of the unknown due to the lack of updates and the sense of impending doom does not make a very pleasant experience during the hospital stay. From the patient's perspective, being disconnected from friends/school/relatives is alienating to say the least, plus the intimidating prospect of having strangers care for you.

This app serves to bridge this gap, by creating a sense of security for the loved ones to keep abreast of their children's treatment in the hospital and serve as a sidekick for basic treatment protocols post discharge. The app also serves as a bridge to the outside world, where well wishers can reach out to the patient and remind the child that he is missed and there are people waiting for him/her to get better.

Prototype Link https://marvelapp.com/2jd1914 Video Demo https://www.youtube.com/watch?v=2aJDjB-0MGQ

Copy of document submission below

The app consists of two parts: 1. In Hospital:

Home Page: The first thing a patient sees on their homepage is their patient ID and their current assigned room #.

In addition there are three rows underneath: 1. Care Team - In the NYP presentation, one of the nurse leaders mentioned the need for pediatric patients to easily see and learn their clinician caregivers on an app rather than being intimidated by strangers. Clicking this tab allows the patient to see their current assigned care team. 2. Greetings - In the info session, the two most common fears of hospitalized children were Strangers (which is addressed with the previous feature) and separation anxiety. Being a child in a hospital is tough, friends may not be able to visit due to school/distance, we have made it simple for the patient to just click this tab and see messages that were left by their friends/family. 3. Resources - NYP has a lot of resources available to the patient - clicking this tab allows the user to quickly see a list of relevant resources available to them at their hospital.

Care Team: The patient can see a list of clinicians and caretakers assigned to the patient. The patient can click on the + sign to add a new person in, simply by taking a picture of the clinicians ID card. The idea here is for the patient to interact with their caretakers as they are added to the list. If the patient is shy, they can alternatively scan the QR code at their bedside tablet pc - as shown in the patient electronic boards that were launched at NYP (http://www.innovatenyp.org/patientelectronicboards)

Greetings: As explained in the homepage section, the patient can quickly see greetings sent by loved ones.

Resources: Clicking on this menu item, the patient can see a list of resources available to them and clicking on any of these options, will show you what room number they are available at. The only exception to this rule, is clicking the counselors tab, doing so the patient will be given an option to schedule a meeting with a counselor.

Procedure Tracking: In the info session, it was mentioned that there is a lack of communication for guardians when a child is in surgery. To address this, we have created a timeline that shows guardians which part of the process their child is in. This feature is possible thanks to the requirement of nurses updating the EMR during a procedure. Also, we are able to give notifications to the guardian to report to a waiting room/nursing station based on the needs of the situation.

BONUS: As a guardian, it can be incredibly stressful knowing that your child is undergoing surgery, and we understand this. The guardian is asked if they are feeling stressed, in which case they are directed to the “relaxation zone” and given a guided meditation exercise through their phone. (We are cognizant of the fact that some patients may be hearing impaired, and closed captions are provided as well.)

Moods: It can be helpful for counselors to have basic data on the patient's mental well being, here the patient is asked whether they are happy/stressed/sad. All of their responses are recorded, which in turn could be used to trigger a counselor to reach out. Happy: If a patient says they are happy, they are just given a notification thanking them for their input. Stressed: If a patient is stressed, they are directed to the “relaxation zone” and given a guided meditation exercise through their phone. (We are cognizant of the fact that some patients may be hearing impaired, and closed captions are provided as well.) Sad: If a patient is sad, they are directed to the counselor appointment section where they can request a meeting with a counselor. In addition they can access their greetings from loved ones from here as a quick emotional pick me up.

2. Post Discharge:

Home Page: In the info session, medication tracking was stressed as a problem post discharge, to address this we have focused on simple medication management on the home page itself. The guardian/patient can see the medications that are due for that day as well as suggested times for them. A patient has to click the + sign when the drug is being taken, and if a patient is taking a medication that is not due yet, they are sent a notification alerting them to the fact that it's not time yet. In addition the patient can access a medication diary here.

Medication Diary: In this sample use case, there are only two medications being taken by the patient, as such they are visible on the homepage of the app, but for more complicated cases that require multiple drugs, this may not be the case. In those scenarios, the medication diary can clicked to see the other medications that need to be taken later in the day and the homepage will only show the next two medications that need to be taken during that time of the day. Alarm: Another feature that is accessible here, is the ability to setup notification alerts, clicking on the clock, the patient can setup an alarm for the different medication that have been assigned to them. This simple alarm feature serves as a reminder to take medication X at its preferred time. Refill: There are multiple API’s that allow for instant refill prescriptions to be ordered from the nearest pharmacy to a patient based on their location. To make it convenient for the user, we have included a one click “order refill” button. Full history: Clicking on this in the medication diary page leads the patient to see a list of all the medications that have been prescribed to the patient for the past few years, this serves as a simple drug history while visiting a physician.

Education: From our own experience of working with chronic patients, we have learnt the value of short modules in educating patients of managing their disease. To that end, we have included an education section to this app. These are concise modules (less than a page of text each) that a patient can click to quickly learn about and help with them managing their disease. This feature is meant more for the guardians as well as the older patients (teenagers).

Avoid These: Some medications have special dietary requirements, in this sample use case, we talk about ciprofloxacin dietary restrictions, which includes milk (a common ingredient that children drink), instead of just showing a list of items to avoid, we also explain the intricacies of the restrictions, in this case of dairy products, the patient is only restricted from consuming milk/yogurt but can take meals that have dairy in them such as a lasagna for e.g. This list of dietary restrictions can be quickly pulled from existing API’s, if needed these databases also have the ability to alert a clinician for possible adverse drug reactions, for simplicity sake, we haven’t demonstrated that use case scenario here.

Moods: Similar to the in hospital app, this feature is the same except when you click on Sad, you get access to greetings that were sent to you during your hospital stay rather than meeting a counselor since that option isn’t possible after discharge.

FHIR (Fast Healthcare Interoperability Resources)

FHIR resources that will be helpful for the implementation of this app: Patient (including PCP reference), Medication Dispense, Encounter (including participant reference), Procedure (performer reference). In addition, there are multiple API options that can be used for prescription refills and foods to avoid. As the rules of this contest don’t allow us to mention them by name without explicit permission, we have omitted their names.

We have kept the app within the New York Presbyterian design guidelines and have used the same color schemes along with a simple beautiful UI.