By JULIE MINDA
As palliative care clinicians, Dr. Matthew Gonzales and his colleagues at Providence Little Company of Mary Medical Center in Torrance, Calif., have found that many of the topics their patients need to understand — such as advance directives, goals of care and dementia — can be very complex and emotionally difficult to process.
Clinicians can prescribe this video from ACP Decisions electronically using the Xealth technology platform. The platform allows clinicians to easily share curated medical information on topics relevant to patients' particular situations.
The clinicians have discovered that patients and their loved ones get a much better grasp of such topics when they view short, well-produced videos on the subjects.
Initially, the clinicians tried finding time to play the videos for patients during medical visits at the hospital or in the office, but other health matters took priority and few patients ended up viewing the videos.
That all changed about a year ago, when — using new technology incubated in a division of Providence St. Joseph Health — Gonzales and his colleagues gained the ability to "e-prescribe" videos and other resources. Patients access the content through an email link or the "My Chart" portal to their electronic health record. The software records in the patient's medical record if the resource has been viewed. The clinician can discuss the content and answer any questions at patients' follow-up appointments.
In a three-month span last year, a Providence clinic proactively contacted Little Company of Mary primary care patients over age 65 who did not have an advance care directive on file, to provide them with a link to educational videos on advance care planning. The clinic emailed the link to thousands of patients (though not all patients viewed the content).
Prescription for learning
The technology Gonzales and his colleagues are using to prescribe and promote this and other videos and medical education materials is from Xealth — pronounced "zealth" — a start-up company that had been incubated by Providence St. Joseph Health's Digital Innovation Group since around 2016 and then spun off in June 2017 as a private company.
Xealth provides a platform that allows clinicians to prescribe customized health care content to patients, and do so just as seamlessly as they prescribe medications. Prescriptions can be for everything from articles, to apps, to services, to care management tools, to referrals. While the focus initially is on palliative care and obstetrics, the plan is to provide access to information across the spectrum of medical conditions and specialties.
Aaron Martin is chief digital officer of Providence St. Joseph Health, and Mike McSherry is chief executive of Xealth. They explained that the Xealth platform is integrated into the electronic medical record system — Epic in Providence's case — so the platform can draw information from patients' medical records to flag for clinicians the apps or other resources that may be useful to patients based on their diagnosis or stage of treatment. Xealth will be rolling out the platform for other electronic health record systems beyond Epic in the future.
Xealth's platform also has data analy–tics capabilities that can aggregate patient data to assess the impact of the resource prescriptions.
The Seattle-based Digital Innovation Group that incubated Xealth is one of several Providence St. Joseph divisions focused on seeking out, developing, incubating, marketing and investing in digital innovations for the health care sector.
Providence St. Joseph hired McSherry as an executive-in-residence in its Digital Innovation Group several years ago. He brought in three executives he'd led at Swype, a company he co-founded and later sold. The group developed Xealth while they were executives-in-residence and moved with Xealth when it was spun-off from the Providence incubator. Executives-in-residence is an ongoing Providence program.
The venture capital firm DFJ; Providence Ventures, Providence St. Joseph's venture capital arm; the UPMC Enterprises innovations group; Hennepin Healthcare System and Froedtert Health provided $8.5 million in first-round funding to Xealth.
The health care organizations in this investor group also are the inaugural customers of Xealth. They include Providence St. Joseph, with 50 hospitals primarily in the western U.S.; the University of Pittsburgh Medical Center, with more than 30 academic, community, and specialty hospitals throughout Pennsylvania and Western New York. Hennepin Healthcare System, which operates a teaching and safety net hospital in downtown Minneapolis; and Froedtert, which runs an academic medical center and two hospitals in southeastern Wisconsin.
Work in progress
McSherry said Xealth team members "work very closely with physician work teams and are constantly talking to clinicians about evolving the technology. That's a huge benefit we have, having been born in a health system. We intimately understand the clinicians."
When the Xealth team learns of apps and other resources popular with clinicians, and when promising apps prove to be very well-received during pilot testing with clinicians and patients, Xealth works to integrate the apps into the Xealth platform.
The Xealth catalog currently includes the advanced care and palliative care videos that Gonzales uses and an app called Circle that provides expectant mothers with personalized health information from pregnancy through pediatrics. For instance, during the prenatal period, it tells the mother what she might be experiencing, such as nausea; what stage of development her baby is in and what she should be doing, such as scheduling milestone prenatal appointments. The app is tied into a mother's electronic medical record, and so it can provide information pertinent to her particular case. For instance, if she has gestational diabetes, the app would provide content related to that condition.
Another app provides education and recovery information to joint replacement patients. Soon to come is an app that enables clinicians to educate patients with sleep disorders on the use of continuous positive airway pressure, or CPAP, machines. Clinicians already can remotely monitor the patients' use of the devices using the Xealth platform.
Xealth is working on adding an app to its platform to address the problem of appointment no-shows, with a special focus on the Medicaid population.
While the Xealth catalog is in its infancy, the start-up's executive team and advisors foresee multiple uses for the platform, including providing materials that support cancer survivors, educate about diabetes prevention and explain the use of numerous medical and monitoring devices.
McSherry said Xealth holds real promise for coordinating care for vulnerable populations. Apps could point elderly patients toward meal delivery services, handymen, personal grooming services and other home services that could enable people to avoid long-term care placement. Other resources on the platform could direct low-income patients to transportation aid, or help people with prediabetes find a nearby gym.
McSherry said, "We could become a referral engine to direct people to community services. As we look at mission-based and community services, it's now disjointed," but Xealth can give providers the tools to track and respond to people's needs.
He added that the concept is important for the many health care systems now taking on risk and becoming financially responsible for patient health outcomes. Pointing people to services they need to improve their health and to address the social determinants of health is increasingly important, and Xealth will provide a platform to help do this, McSherry said.
Xealth platform provides new tools for patient education
A chart illustrating the flow of information on the Xealth platform.
Clinicians can order Xealth resources to prescribe to patients, using an interface like this one.
The clinicians can monitor whether and how a patient has acted on the prescribed information, using an interface like this one.
Copyright © 2018 by the Catholic Health Association
of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3490.