Challenges of using consumer technology for improved care transition

Today I had a reminder that we should not take consumer technology for granted when using it to improve care transition to reduce readmissions.

As I mentioned in my previous blog posting, in our pilot with a Boston-area hospital for recently discharged congestive heart failure (CHF) patients, we provide the patients with an iPad mini which acts as a communications hub to deliver daily care plans to the patient, as well as to collect self-reported patient data and biometric data from Blue Tooth-enabled weight scales and automated blood pressure cuffs.  The iPad mini communicates with our cloud-based application and database via a Verizon Wireless connection (we can’t depend on a wifi/Internet connection in our patients’ homes).

Over the past week, we noticed that some of our patients’ data were not being transmitted to the cloud.  When we contacted the patients to see what was wrong, we observed that although their iPads seemed to be working correctly and were showing several bars of the wireless signal from Verizon, no data were being transmitted, and testing the iPad's Safari browser showed that it could not connect to the network.

When we checked with our partner at Verizon Wireless, we discovered they were upgrading the capacity of cell towers in the area around our partner hospital in which these patients lived.  A good thing, certainly, and kudos to Verizon Wireless for their continuing improvements in wireless coverage.  Apparently in the process of implementing these improvements, the band of the radio spectrum to which the iPads were connected had been “repurposed”, and the tablets were “confused”.  Our partner at Verizon Wireless assured us that if the iPads were simply turned off, and then turned back on, they would connect with the new correct band, and all would be well.  We tested this, and it worked.

Just turn it off, and turn it back on. Simple, right?

Not.

Many of the CHF patients in our pilot are elderly, and in some instances are not facile in the use of the latest consumer technology.  We have spent a great deal of development effort on the patient application user interface and the training protocols to make our application as simple to use as possible for any patient, including the elderly.  But we did not include specific instructions on how to turn off the iPad and turn it back on (when we give the iPads to patients, they are turned on, we show the patient how to use the app and devices, and how to plug in the charger).  It turns out that it isn’t intuitively obvious how to turn off/turn on the iPad for someone that has never done it before.

I listened to Dr. David Lebudzinski, our Chief Medical Officer, on the phone walking a patient through how to turn his iPad off and then back on to correct the connection problem.  It was a very enlightening 15 minute experience.  First of all, the "power button" isn’t a button at all in the classic sense that elderly patients expect – it isn’t round, it is a very small bar (NOT a "button") that is not at all obvious on the side of the bezel of the iPad.  It has to be held down for about 5 seconds, and then a slider appears that says “slide to power off”.  Slide?  It means touch it and drag your finger to the right.  A little spinner will appear in the middle of the screen - wait until it disappears.  Then push the power button – um, power bar – again.  An apple will appear – now just wait.  When a “slide to unlock” slider appears – touch it and drag your finger to the right.  The main screen should appear.  Good, now touch the iGetBetter icon just to make sure that it is working right.  Great, you are connected again.  Yes, this was a 15 minute conversation, replete with mistakes and the need to start a step over several times.

You can bet that this power off/power on procedure will be included in the patient training protocol from now on.  And that we will continue to think about ways to make modern consumer technology that many of us take for granted more accessible and less confusing to elderly patients.  Undoubtedly we will continue to be surprised.  But we are learning to get it right, and the rewards are worth the effort.

Win Burke, President and CEO