Developers of EASE share how they scaled their innovation at Orlando Health.
Five years ago, physicians might have raised an eyebrow if they heard about a colleague who was texting patients from the operating room. Today, with a new HIPAA-compliant app designed just for such communication, many are climbing aboard, using the technology to ease the anxiety of family members anxiously waiting for updates.
EASE (Electronic Access to Surgical Events) is a Snapchat-like app that providers use to communicate with family members during surgery, other procedures, and hospitalizations, sending messages, images, and videos that disappear once reviewed on a smartphone. Today, the app has been used with more than 23,000 patients and is available to physicians throughout the Central Florida-based Orlando Health system, a $3.4 billion not-for-profit healthcare organization with more than 2,400 beds and eight wholly-owned or affiliated hospitals and rehabilitation centers. EASE is also available to other hospitals as a SaaS platform solution by paying a subscription fee based on the number of beds and operating rooms.
The device was featured in HealthLeaders' January/February magazine cover story, 5 Tech Tools That Could Change the Way Your Hospital Delivers Care. Following are further insights into how the app was developed and scaled across the enterprise—information that could be helpful to other health system innovators who are introducing their own apps.
1. Start With an Unmet Need: An App Is Born
EASE started with a single text more than four years ago. A pediatric cardiologist at Orlando Health's Arnold Palmer Hospital for Children, wanted to update a patient's family about the surgical progress of their child. After seeing the relief the parents experienced, he continued the process with other patients. Soon, a couple of his colleagues began doing so as well.
"People's expectation of communication these days is instantaneous," says Holly Stuart, director of patient experience at Orlando Health. "That applies to the operating room as well."
It didn't take long for the physicians to realize they were onto something. Enter Patrick de la Roza, whose previous experience includes working as executive director of digital marketing strategy for Adventist Health System (now AdventHealth). He helped the cardiologists develop an initial version of the app to use as a proof of concept.
A 50-patient study produced positive results, and they decided to move forward with development, launching the venture by forming a private company, EASE Applications, for which de la Roza now serves as CEO.
2, Roll Out Slowly; Gain Proof Points
Working in partnership with Orlando Health, testing—and a slow rollout—continued.
Once pediatric cardiac surgeons and their nursing teams at Arnold Palmer Hospital for Children were comfortable using the app, other pediatric surgeons began adopting it. Over a year, usage expanded.
Gaining physician acceptance was a significant key to progress.
"Once the physicians recognizes the value of it from a communication standpoint for their patients, it is clearly something that helps them do their job better," says Stuart.
The app made the leap to Orlando Regional Medical Center (ORMC) about three years ago when the families of patients who had used it at the children's facility began inquiring why the communications tool wasn't employed by surgeons operating on adults.
Gaining acceptance by physicians was only one piece of the equation. Measuring outcomes in terms of improved satisfaction scores was another.
"The alternative is sitting in a waiting room scared with a bunch of other scared families, staring at a door waiting for someone to come in," says de la Roza. "EASE completely changed that."
- In a six-month comparative study of 3,585 patients conducted by Orlando Health, the app raised the average scores on responses to nine HCAHPS questions, including a 13% increase to the question about whether doctors explained information in an understandable way, and a 4.3% increase regarding the likelihood of recommending the hospital, reports Stuart.
- In a separate study, the Texas Children's Hospital perioperative services team reported that responses to the Press Ganey question about "information provided the day of surgery," increased from 87.5% to 96.7% when then app was used.
After achieving acceptance and success at ORMC, about two years ago, the app was made available to the entire Orlando Health system.
The HIPAA-compliant app also enables the care team to communicate with family members who are unable to be at the hospital, as well as a larger circle of family and friends—approved by the patient or parents—who could be located anywhere around the world. "It expands the size of your waiting room," says de la Roza.
Today, the usage of EASE has expanded beyond what its inventors had envisioned. It's being used in rehab facilities and for procedures like sedated MRIs to keep concerned families informed. "It's interesting how EASE has really grown organically and gotten into areas that we weren't even expecting," says de la Roza.
3. Train, Refine, and Adapt
Training is an essential aspect of the program and includes online educational sessions, which help distinguish appropriate types of message from inappropriate ones. While physicians decide whether they want the technology, nurses are the actual users, employing electronic tablets stored in nursing stations. They activate the system by scanning the barcode on a patient's wristband, then issue the updates. Because this procedure is similar to the process they use to administer medications, there is minimal disruption to workflow.
Originally designed to be used for surgeries that lasted more than two hours, the app is now used for surgeries that last as little as 60 minutes because de la Roza says those families tend to experience the same anxieties. Updates are issued about every 30 minutes.
Messages are limited to 200 characters, and might communicate, for example, that a child is now safely asleep, along with a picture of her wearing her face mask.
"That literally makes mom and dad feel like they are in the OR holding her hand," explains de la Roza. "While nothing gruesome, or overly graphic, is shown, it does open up a window into the operating room for families. Some surgeons will send videos of the heart beating, which may seem kind of startling, but if you have a sick child and that heart is now off bypass with a great steady rhythm, and you send that to mom and dad, it is one of the most beautiful moments for them."
Physicians typically ask families whether they want pictures and videos, and de la Roza says that one doctor queries whether they want conservative or "extra spicy" updates.
New technology, like EASE, requires a culture shift, cautions de la Roza. "You're switching to a culture of transparency. Five years ago when we started this and we wanted to send texts, pictures, and videos from the operating room, it was something that was very foreign. In many ways the operating room was a black box, and no one was allowed to see inside of it." EASE has changed that, he says. "Orlando Health really made a commitment to transparency in their communications."
Mandy Roth is the innovations editor at HealthLeaders.