Q&A with Gina Altieri on Nemours Children's Health System's digital agenda

Nemours Children's Health System is charging ahead with a digital agenda that aims to fully engage patients—and clinicians—in a mobile world. The Jacksonville, Fla.-based system already had its well-used KidsHealth website, which offers a plethora of educational and interactive materials. Now Nemours has launched a mobile app that lets asthma patients not only track and update their health information, but connect with a doctor immediately. The app ties directly into Nemours' electronic health record system. The app will roll out to other chronic conditions, but according to Gina Altieri, senior vice president and chief of strategy integration at Nemours, the ultimate goal is for it to become an integral part of care across Nemours' patient population. Altieri recently spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.

Modern Healthcare: Looking at digital health, what are your goals in the context of consumerism and its impact on healthcare organizations?

Gina Altieri: We've developed a digital health strategy that is complementary to what already exists as far as our clinical care and our commitment to treating the whole child. What we want to do is take these digital tools that we believe the consumer is demanding and put them in their hands to meet them where they are.

We all know that today's consumers love convenience and love their digital tools. We want to help patients become better engaged in their care, as well as help the providers be able to be better involved in the patients' care.

MH: You say the consumer is demanding it. How do you know that they are demanding this kind of interaction?

Altieri: We have engaged them in this process from the beginning through a variety of forums. We use our KidsHealth platform to conduct surveys. We also conducted a variety of focus groups and interviews and we engaged our advisory councils, which include parents as well as patients. We've run this by them every step of the way.

MH: Were there particular things that you heard patients were most interested in?

Altieri: What we heard is that they don't really sit at a PC much anymore. They try to do everything from a mobile device. So we needed our digital properties to be responsive. We also heard that they would investigate. So they want transparency; they want to know what other people are saying about you. And they want it to be convenient. They'd like to see who the providers are and understand a little bit more about them; not just a static photo, but actually learn more about them.

MH: You also wanted to help providers. What's happening on that front?

Altieri: We are seeing some uptake. They are using telehealth; they find it to be simple and convenient. And they're also helping us launch the asthma app. We kicked off the asthma project a year ago. And we were able to actually launch a viable product last month.

MH: Can you describe the app a little bit? It's integrated into the EHR, but how does it work and what is the user experience?

Altieri: The integration into the EHR is our distinguisher. Everybody's starting to dabble in some of these digital experiences, but what we were able to do—having had our KidsHealth website for 20 years full of content and instructions for families—we were able to integrate all of those separate digital experiences into one experience using asthma as our proof of concept.

When children are diagnosed … a specialist advises them to track what's going on in their life through their mobile device. If they are having some kind of a problem, they don't have to leave our app and go into the telemedicine app. They just press a button and they get a video visit. They can also access instructional videos. They can see their own medical record, all through the app. They don't have to go in and out of different apps to get the information and to communicate with their providers.

MH: As a user, are they uploading daily data to their care team?

Altieri: Yes, and then the provider would see a simple dashboard, whether it's days, weeks, months since their last visit. And they can see what might be triggering some of their problems. Maybe they went to grandmother's for one week and their asthma was triggered because they live in a different area, or they have pets. They can see all of that and it helps them stay healthier. And it helps the physician understand what's going on. It also helps keep children healthy in the sense that it keeps them out of the emergency room. And it gives them direct access to their care provider.

MH: Why did you start with asthma?

Altieri: When we engaged the physicians, that was something they really were frustrated with in the sense of a problem that we were trying to solve: How do we get the patients more engaged? How do we get the providers to know what's going on between visits? Asthma kept coming up as one of the most frequently diagnosed conditions. So we thought that we could really make a difference. Diabetes is probably our next chronic disease.

MH: Is this something that you would try to license to other organizations?

Altieri: Yes, we've been talking about that. We did not develop it as a white label, so we've only been talking about it. But we do think this could have a tremendous impact and scale. And we have that special sauce of engaging our clinicians and our patients and families. Tech companies don't have that. They can develop the technology, but they don't really have the healthcare perspective—what clinicians face every day and then the patients and the families. Healthcare is complicated. We really do have a leg up over any technology company that is trying to disrupt this industry. So we have been talking about the possibility of really taking this global.

MH: You mention disruption. We are starting to see some of that with Apple and others, who have that consumer-centric focus.

Altieri: But they don't have the healthcare experience.

MH: So do you see collaborations with them, with companies like that?

Altieri: Yes, but there's nothing definitive. There's no big story here. I don't have anybody in mind.

MH: Where do you see your app development and digital strategy going? What do you think a parent is going to have on their device in a couple years?

Altieri: What we'd like to do in a couple years is have a well-child app. So as soon as a woman knows she's pregnant, she has her health coach in the palm of her hand. This Nemours experience—digital experience—is helping parents, as well as all their care providers, raise the child together. It's nice to be able to go somewhere where the advice and the information they receive is legitimate. It's vetted by clinicians and it has the Nemours brand behind it.

MH: What does all this do to the strategy for an organization that still has bricks and mortar? How are you thinking about that?

Altieri: That is a strategic discussion at our highest levels. Right now, it is complementary; we do not see it replacing our bricks and mortar. We're still building, but as we build, we include the digital capabilities. So if you're at the pediatrician's office and need a specialist, you can obtain that while you are there. It will probably slow down the building plans at some point.

As inpatient shifted to outpatient and now outpatient is switching to virtual, we will have a different balance. But we definitely see this as complementary to the existing operations, not a replacement.

MH: Is there a capital plan for the digital health platform?

Altieri: Yes, but we've made such an incredible investment in technology that we've been able to continue and just tweak it a bit. We haven't had to add tens of millions of dollars in one year, which I know other organizations are doing. Some of them didn't even have an enterprise-wide EHR, so they had to at least get everybody on the same platform. We've been making those investments over the past 20 years, so this didn't feel like such a gouge to our budget.