Take an App and (Don't) Call Me in the Morning

How can perioperative mobile apps can increase patient compliance while saving money?

The passage of the American Reinvestment & Recovery Act (ARRA) in 2009 brought an influx of federal dollars as health systems and providers received incentives for purchasing electronic health records (EHR) systems.

So where is the healthcare industry a decade later in terms of electronic records, interoperability, and better workflows for clinicians?

Ask a physician about their EHR system, and you’re likely to get an earful. A recent Harris Poll of over 500 primary care physicians revealed that nearly 60% believe EHRs need a complete overhaul and half think they detract from clinical effectiveness. When seeing patients, physicians say they spend 62% of that time using the EHR.1

But interoperability between an EHR and ancillary systems is getting better as health system technology matures, allowing greater automation of formerly labor-intensive tasks. Imagine “prescribing” an app for perioperative patients that would send reminders or important dates, procedure location and pre- and post-op instructions. Responses recorded in the app would be written to the EHR, allowing clinicians and schedulers to manage exceptions, rather than remind each patient at each step of the perioperative journey. The health system would save money through fewer no-shows and fewer 30-day readmissions.

The continuing maturation of health system technology infrastructure and more responsive healthcare mobile apps are making this possible.

EHRs are becoming more sophisticated

The HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) scores hospitals and health systems on an 8-stage scale (0 to 7) in terms of utilizing EHR functions and interoperability.2 The goal for each facility should be achievement of Stage 7, but the ability to share information among systems grows as the facility advances on the scale.

A 2014 analysis of hospital maturity on the EMRAM scale showed an expected peak of Stage 4 that year, with a Stage 5 peak by 2019 and Stage 6 by 2026. However, the study predicted that “most hospitals” would achieve Stages 5, 6 or 7 by 2020.3

Interoperability among healthcare IT systems has been advanced by such industry groups as Carequality and CommonWell Health Alliance, both of which promote connections that allow interoperability among healthcare IT systems and provider networks. According to their websites, the entities have more than 13,000 partner sites.4,5

Competition from all corners

With more than 80% of the US population now living in urban areas,6 competition is heating up among health providers. But competition is also coming from non-hospital organizations such as CVS Health, Optum, and Amazon. A recent survey of hospital and health system executives showed that nearly 9 in 10 are worried about competition from such entities, especially their ability to provide more consumer-friendly offerings.7

Hospitals aren’t technology companies, per se, but they do have sophisticated technology at their disposal to diagnose and treat patients. Patient information from the EHR can power customized mobile apps that increase adherence to medications or treatments while reducing the burden on caregivers.

Overall smartphone ownership is 81% among Americans, with ownership in the 18-29 and 30-49 age groups topping 90%.8 And those who are using smartphones spend 90%of their time with mobile apps.9

Nearly all of us are accustomed to doing things ourselves, everything from booking flights and hotels to buying a cartload of groceries for later delivery. Should the way we access healthcare be any different?

Increasing adherence while saving money

About 60% of a hospital’s revenue derives from surgical procedures. But getting patients to show up on the right day and time, at the right location, and after having completed any necessary pre-op procedures presents an ongoing challenge. There also are post-op instructions to carry out that should also be monitored.

Hospitals face lost revenue through no shows and through 30-day readmissions caused by insufficient follow-up care. However, changes are beginning to occur that can help clinicians work more efficiently while helping health systems and surgery centers save money on surgical procedures by focusing on perioperative care.

Research from MobileSmith Health shows that hospitals using perioperative mobile apps can save up to $300 per procedure through a 40% reduction in same-day cancellations and a 7% reduction in 30-day readmissions.

When a secure mobile app has read/write access to information from an EHR, the app can do the heavy lifting for pre-op care, increasing adherence while improving clinician workflows. While using our smartphones, many of us are programmed to open any app that has a dot next to it to view the new information, so the dot goes away. A dot denotes an action item.

Rather than staff checking in with each patient at each step of the perioperative journey, an app can do the work. For example, a dot on the app appears a week out for patients on warfarin or other blood thinners, reminding them to cease those medications. When the patient views the information or checks a box, the EHR records that. This leaves staff to contact those who haven’t taken the desired action instead of every single patient.

The time savings can be tremendous. Think about a large gastroenterology practice that schedules hundreds of colonoscopies a month, each of which requires several perioperative steps that patients must follow. Prescribing an app beforehand not only alleviates staff time checking in with each patient, it also allows the patient to be more involved in his healthcare, making him more likely to show up for the procedure.


Although frustration with EHRs remains high among clinicians, there is hope on the horizon. EHR vendors are pushing for data sharing at a time when IT infrastructure at health systems and hospitals is maturing. Routine data sharing that allows read/write access to EHRs opens a world of new possibilities, including mobile apps that can shift perioperative adherence checklists from clinicians to patients. It’s a classic win-win that benefits both staff, who can manage exceptions rather than each step on a patient’s perioperative journey, as well as time-pressed patients.

1. The Harris Poll. How doctors feel about electronic health records. https://med.stanford.edu/content/dam/sm/ehr/documents/EHR-Poll-Presentation.pdf. Accessed June 24, 2019.

2. HIMSS. HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM). https://www.himssanalytics.org/emram. Accessed June 25, 2019.

3. Kharrazi H, Gonzalez CP, Lowe KB, Huerta TR, Ford EW. Forecasting the maturation of electronic health record functions among US Hospitals: Retrospective Analysis and Predictive Mode [published online August 8, 2018]. J Med Internet Res.doi: 10.2196/10458.

4. Carequality. Who uses Carequality to share health data? https://carequality.org/active-sites-search/. Accessed June 25, 2019.

5. CommonWell Health Alliance. Who is Connected. https://www.commonwellalliance.org/who-is-connected. Accessed June 25, 2019.

6. US Census Bureau. New census data show differences between urban and rural populations. https://www.census.gov/newsroom/press-releases/2016/cb16-210.html. Accessed June 26, 2019.

7. Kaufman Hall. 2019 State of consumerism in healthcare: The bar is rising. https://www.kaufmanhall.com/ideas-resources/research-report/2019-state-consumerism-healthcare-bar-rising. Accessed June 26, 2019.

8. Pew Research Center. Mobile fact sheet. http://www.pewinternet.org/fact-sheet/mobile/. Accessed June 26, 2019.

9. Smart Insights. Mobile marketing statistics compilation. https://www.smartinsights.com/mobile-marketing/mobile-marketing-analytics/mobile-marketing-statistics/. Accessed June 26, 2019.


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