Olive View-UCLA Medical Center recently launched ProACT(Prospective Action in Care Transitions), an initiative to improve care transitions by using automatically-triggered emails when a patient-centered medical home (PCMH) patient visits the emergency department (ED) or urgent care clinic.
Successfully helping patients avoid ED visits
Our primary care clinic had a patient with cirrhosis who required frequent, elective paracentesis, which is a procedure to remove abdominal fluid that can be performed in a clinic with appropriate equipment by trained providers. Unfortunately, our primary care clinic does not have this capacity – our unique patients often go to the ED every 2 to 4 weeks for paracentesis. The automated email notification system through ProACT helped our clinic better understand this patient’s relationship with the ED. Recognizing this patient’s repeat ED usage solely for paracentesis, clinic staff made an arrangement with an outside provider who could perform paracentesis on a scheduled basis, making it both more convenient for the patient and less expensive for the health care system.
Using Empathy Tools
In part 4 of this blog series, we shared methods to understand and frame problems by defining stakeholders and empathizing with them. We applied these methods to ProACT. After narrowing our scope of potential users, and gathering insight from a bulletin board and word cloud, how did we begin to determine user opinions and potential issues?
We wanted to get a 360-degree view of the problem of care transitions, complete with images and stories. To do so, we used a combination of online and offline tools.
Digital Ethnography Mobile Application
We used Gravity Tank’s digital ethnography mobile app “dScout.” Since many people have smart phones, a mobile app was an easy way for stakeholders to capture snapshots of processes and pain points on-the-go and in real-time.
Clinic, inpatient, and ED doctors used dScout to post responses to the following questions pertaining to a person or item they photographed through the app:
- What is this?
- What role does this item or person play in the post-ED or post-inpatient visit communication process?
- What do you like about this item or the person’s role in this process?
- What do you dislike about this item or the person’s role in this process?
- On a scale of 0-100, how helpful is this item or person in the post-ED or post-inpatient visit communication process?
- What would you do to improve the role this item or person plays in the post-ED or post-inpatient visit communication process by adding to it, removing from it, or otherwise changing it?
Interviews Confirm Technology Tools
We also held interview sessions, both one-on-one and in a group. We used CCI Innovation Guidebook tools such as the “Journey Map.” Stakeholders described the processes of patient, information, or communication flow by using diagrams that highlighted pain points.
Through these methods, we found a desire for improved communication via technology. Some respondents expressed the following:
- We don’t know when and if appointments get scheduled. We need to get an email from whoever schedules appointments to alert if a patient has an appointment already scheduled.
- I would change the post-patient visit process by sending the PCP an email that the patient was in the ED or an inpatient setting.
Takeaways – Users, Infrastructure, Evaluation
We knew patients would be the true end-beneficiaries of improved ED-to-PCP communication. Stakeholder responses helped us decipher who the actual primary users would be: coordinators of post-ED or post-inpatient care. We saw that this technology infrastructure already existed: staff and providers had emails and smartphones; ED information system existed; but there was no connection between the care teams, the patient, and the ED.
How did we move from transforming a problem into a working idea? Stay tuned for the next installment, which will highlight the next stage: Ideation and Prototyping.