The problem we solve: Care coordination has been lauded by health policy experts as a method for achieving cost containment and quality improvement. Here, care coordination is defined as improving access to health care services, facilitating communication between providers, focusing on total healthcare needs and clarifying patient instructions. This requires coordination of tasks between providers and allied health professionals including case managers, social workers and discharge facilitators, who are under similar pressures that necessitate the use of project management methods in non-healthcare industries. Project management software is designed to help teams collaborate, execute in a timely manner and manage resources and cost. With regards to healthcare specifically, poor care coordination leads to negative outcomes which include, but are not limited to, delivering below-standard care, unnecessarily extending hospital stays and prescribing non-covered meds at discharge.
About our solution: Ardha is a hospital-based project management web application. Ardha tracks, coordinates and displays task completion by providers (physicians and nurses) and allied health professionals (case managers, social workers, research coordinators and discharge facilitators). It focuses on tasks not discretely described by electronic medical records including regulatory requirements, insurance coverage of outpatient meds and clinical trial participant screening. Future applications could potentially involve utilization review (e.g., to track high utilization of low value interventions like ordering CT scans for low back pain). In its pilot study, Ardha will be deployed at an UC Irvine Medical Center inpatient psychiatry unit. Further studies and deployments are planned for other specialties and units within the hospital.Progress to date:
Ardha has progressed from brainstorming to design to app development within the previous three months. Design has been informed by focus groups and interviews with multiple stakeholders including hospital administration and staff (including physicians, nurses, case managers and social workers). Ardha is scheduled to begin a pilot study at an UC Irvine Medical Center inpatient psychiatry unit in November 2018. The study will investigate key pre- and post-deployment measures including average length of stay, percent task completion and percent clinical trial participant screening. With further funding, Ardha will continue to undergo development for deployment in additional departments.
Creator: Cameron Escovedo
Education: David Geffen School of Medicine UCLA
Bio: Cameron is a General Pediatrician and Clinical Informatics Fellow at UCLA. He graduated AOA from the David Geffen School of Medicine at UCLA, and completed Pediatrics Residency including a Chief Resident year at UCLA. His interests include provider EHR experience, and has performed at-the-elbow workflow analyses for numerous providers including pediatricians, surgeons, and anesthesiologists, as well as allied health professionals including case managers and care coordinators.
Hospital Affiliation: UCLA Health System
Title: Chief Information Officer
Advanced Degree(s): MD
Chief Executive Officer, MD
Biography: Drew is currently a senior psychiatry resident at the UC Irvine Medical Center. He has experience with digital health startups, having founded and navigated Q-Cigarettes, Inc., which produced a tobacco use cessation mobile app and medical devices, to an exit in 2015. Drew has an interest in clinical informatics, digital health and clinical research, having multiple peer-reviewed articles published. Drew also graduated as a top-10 student from the University of Iowa Carver College of Medicine.
Title: Chief Executive Officer
Advanced Degree(s): MD
Patients benefit from improved care coordination by being delivered higher rates of clinical best practices and experiencing lower rates of preventable hospitalizations. In its pilot study, Ardha will focus on a number of key areas. First, Ardha is designed to decrease unnecessary hospitalization days due to administrative oversights including updating long-term care facilities and caregivers of clinical status changes previously preventing discharge. Second, it will prompt reviews of health insurance including coverage of discharge medications. Third, it will prompt potential clinical trial participant screening. And fourth, it will verify the transmission of completed discharge summaries to outpatient providers. Future directions include tracking high utilization of low-value and potentially harmful interventions, e.g., ordering CT scans for low back pain.
Physicians benefit from improved care coordination by decreasing labor cost of and improving execution of team communication. Team communication occurs throughout the work day in rounds, interdisciplinary meetings, pages, text messages and e-mails. Ardha generates a dashboard of tasks updated in real time by ancillary staff. These include process-of-care quality measures including CMS quality measures. Furthermore, it directly involves staff not present at point-of-care, e.g., research coordinators. And finally, Ardha tracks post-discharge actions including verifying transmission of inpatient provider recommendations to outpatient providers.
Hospitals benefit from improved care coordination primarily by tracking staff member performance and process-of-care quality measures completion. Individual staff member performance is tracked for performance reviews and remediation. Tasks are definitively assigned to staff members, e.g., case managers and social workers have overlapping duties which may be neglected without clear assignment. Real time tracking obviates the need for retrospective data gathering required for CMS and Joint Commission reporting. Furthermore, a guideline is generated for consideration of alternative placement for long-term patients. Future directions include prompting billers and coders to provide documentation feedback to providers.
Health insurers benefit from cost reductions and improved patient outcomes. They are likely to experience these benefits as a result of decreased lengths of stay (due to administrative oversight), coordination between inpatient and outpatient providers and improved patient compliance (e.g., verifying insurance coverage for post-discharge care).
Affiliation(s)We are currently partnered with the University of California Irvine Medical center to launch a pilot study of the Ardha app in an inpatient psychiatric unit. Key pre- and post-deployment measures will be measured and analyzed including average length of stay, percent task completion and percent clinical trial screening.
Key Milestones Achieved and PlannedArdha was conceived, and has progressed to design and development stages within the past three months. As mentioned above, focus groups and key stakeholder interviews have informed multiple iterations. The app is scheduled to begin a pilot study at an UC Irvine Medical Center inpatient psychiatry unit in November 2018. Future directions include deployment in other departments and expansion to involve coders and billers as new user types. Ardha is currently a web app, but another future direction is to convert the app to make it available on the Epic EMR app store.
Our Competitive AdvantagesArdha’s main competitors are other project management apps. They are primarily deployed in non-healthcare settings, but include large company publishers of Asana, Slack and Trello. Numerous other apps are available on the market, and even more have been developed and deployed in internally at companies across the globe. Ardha’s advantages it meets security requirements of and is specifically tailored for deployment within a hospital network. Furthermore, Ardha is customizable to the specific needs of client departments. Additional competitors include electronic medical records (EMR) publishers including Epic and Cerner. These companies have signaled in product development and in shareholders letters a desire to integrate with and host third-party apps on their respective app stores.
Barriers to EntryArdha’s design process discovered specific needs from multiple stakeholders at the UC Irvine Medical Center. The pilot study is customized to an academic center inpatient psychiatric unit’s needs, and is planned to discover and meet those from multiple specialties and levels of care. The pilot study is intended to capture measurable data regarding savings in lengths of stay and gains in stakeholder performance. Lastly, Ardha has been built to be hosted by hospital servers and hence meets HIPAA data security requirements. This final point is a barrier to entry by out-of-the-box, non-healthcare management software.
Funding, Partners and Alliances To DateArdha app development to date has been funded by bootstrapping. Following pilot study deployment, the company seeks to raise $200 K in angel investment to develop a saleable product. An ideal strategic investor profile is a healthcare-focused angel investor who can potentially make introductions to regional hospital, health insurer and physician group executives for potential additional pilots. Our first and primary partner is UC Irvine Medical Center, and we are receiving business advising from Paul Orlando, the USC Incubator director.
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