Discharge Follow-Up Appointment Challenge

About the Challenge

BACKGROUND:

The Office of the National Coordinator for Health Information Technology (ONC), in collaboration with the Partnership for Patients, seeks to support spread and adoption of promising IT-enabled solutions targeting improved care transitions in the “Discharge Follow-Up Appointment Challenge.” Nearly one in five patients from a hospital will be readmitted within 30 days. A large proportion of readmissions can be prevented by improving communications and coordinating care before and after discharge from the hospital. 

This challenge is the second in a series of challenges calling attention to care transitions, particularly the time a patient is discharged from a hospital; these challenges are seeking development and spread of IT-enabled tools that will achieve better care and better health at lower cost.  The first challenge, “Ensuring Safe Transitions from Hospital to Home,” called upon developers to create a web-based application that could empower patients and caregivers to better navigate and manage a transition from a hospital.  Information about the Challenge and the winners can be found here.

Scheduling Post-Discharge Follow-Up Appointments – Critical, But Not Easy for Patients or Providers:  Research has shown that scheduling follow-up appointments and post-discharge testing before a patient is discharged, with input and engagement from patients and caregivers, is one of the critical elements of a safe and effective transition.  While an increasing number of organizations have adopted this best practice, most patients across the country continue to leave the hospital without confirmed appointments and many providers remain frustrated by a highly manual and unreliable system. Communities struggling with the process of scheduling and securing these appointments have articulated challenges faced by the following stakeholders:

• Patients and caregivers: May not be empowered to be part of transition process leading to lack of understanding of appointment necessity, scheduling conflicts, transportation difficulties and high risk of cancelation and/or no-shows
• Discharging hospital provider: Inability to see appointment availability to assist patient and caregiver with scheduling (resulting in the need for multiple phone calls), resistance from downstream providers while trying to secure appointment for harder to place/high risk patients, lack of feedback if a no-show or cancellation occurs, burden of multiple post-discharge needs, e.g., social work, physician appointments, etc
• Downstream provider: High no-show rates or cancelations, lack of predictability of appointment requests from discharging hospital provider, and lack of information regarding high-risk or harder to place patients.

Tremendous opportunity for broad-scale adoption of IT-enabled processes: Hospitals with IT-enabled scheduling processes for follow-up appointments often benefit from being in a delivery system where a single scheduling system is shared across many care settings and providers. A growing number of innovative consumer-facing tools are becoming available for patients and care givers to schedule appointments and rate providers.  However these tools have not yet reached high levels of adoption within communities, and haven’t to date targeted the appointment scheduling needs of patients, caregivers and providers at the point of discharge from a hospital.

CHALLENGE DESCRIPTION:

In order to support broader adoption and uptake of promising IT-enabled interventions that address care transitions, ONC is challenging software developers to create an easy-to-use web-based tool that will make post-discharge follow-up appointment scheduling a more effective and shared process for care providers, patients and caregivers. In addition, developers will need to articulate a plan for broader adoption at the community level.  Submissions can be existing applications, or applications developed specifically for this challenge. The technology developed will remain proprietary to the developer and will not become open source.

Part 1:  Tool development 

The ideal application for will include the following components:

1. Easy to navigate user interface
1. Rapid search and match capability
2. Usability needs for patients, caregivers or upstream hospital care providers
3. Option to interact with patients via in-person appointment, e-mail or phone
2. Easy to navigate process for downstream accepting providers
1. Real-time updates on appointment access
2. Inclusion of diverse care providers, e.g., physicians, social services, home health, etc.
3. Information for patient and caregiver convenience and preference
1. Timing and appointment location
2. Transportation or other social service needs
3. Rating information on providers
4. Flexibility to include other follow-up interactions, e.g., e-mails and phone calls
4. Critical background information for downstream provider:
1. Patient and caregiver risk and engagement
2. Patient characteristics that may be instructive for accepting physicians
5. Messaging capabilities to minimize no-shows and cancellations:
1. Appointment reminders to patient, caregivers and scheduling providers
2. No-show and completed appointment alerts to providers and patients
6. EHR interface capabilities where applicable
1. Auto-population of patient demographics and results of appointment

Part 2: Plan for scale and adoption

To assist with pilot plan development, applicants are advised to consider the following examples as potential audiences for the challenge:

• Hospital(s) with a selection of owned or affiliated physician practices
• Community collaboratives or payment pilots focused on care transitions improvement, which could include hospitals, physician practices, community-based organizations, skilled nursing homes, etc
• Local payers focused on improving transitions at the community level.
• Partnership for Patients Hospital Engagement Networks

To anticipate the needs of a test bed organization or community, successful applicants will also need to submit a brief pilot implementation proposal (250-500 words) that addresses factors including timeline, description of pilot environment needs (e.g., types of technical capabilities, types and number of patients and providers included), and additional resource needs (e.g., staffing and technical resources).

REVIEW CRITERIA:

1. Effectively integrate inpatient data and provide structured support for self-care
2. Integrate design and usability concepts to drive patient and provider adoption and engagement
3. Demonstrate creative and innovative uses of mobile technologies
4. Demonstrate potential to improve health status for individuals and the community
5. Leverage NwHIN standards including transport, content, and vocabularies
6. Demonstrate ability to implement the intervention in a pilot setting, and ultimately to scale in a community.

TIMELINE:

• Submission Period Begins: 12:01 AM ET, Thursday, January 26, 2012
• 3 Information sessions with innovative care transitions communities between January 30, 2012 and Monday, April 30, 2012.
• Submission Period for Entries Ends: 11:59 PM ET, Monday, April 30, 2012
• Winner notified: Wednesday, May 23, 2012
• Announce the winners: May 24 or 25 (National Patient Safety Congress)
• Site visits for Challenge winner to pilot community candidate(s) and presentations to other innovative communities will be scheduled for June 2012.

PRIZES:

First Prize: Partnership consideration with a pilot test bed community candidate and up to $5,000 to support a 3-day site visit to the pilot community involving 2-3 people.

Second and Third Prizes: Showcase and learning session with innovative communities and Federal payment pilot programs focused on improved care transitions and care coordination at the community level.