Hospital apps becoming more patient-friendly, actually being used

Cincinnati Children’s Hospital Medical Center started developing the idea for a patient and family experience mobile phone app in 2016, after receiving some negative feedback from patient families.

They said “it was very difficult to navigate our healthcare system,” said Melissa Cloud, Cincinnati Children’s director of integrated operations, calling out pain points like keeping track of paper parking tickets and finding their way to their appointments.

The answer, at least for some patients, was an app. That way, patients and their families could carry around that information in their pocket, without having to gather stacks of paper throughout their visit.

Four years later, 37,000 people have the app, dubbed Caren, loaded onto their smartphones.

“The strategy around the Caren app was really focused on: ‘How can we improve the patient and family experience?’ ” Cloud said. “Taking out those stressors.”

As smartphones have become tightly intertwined into so many Americans’ lives, hospital executives have realized that to play a central role in their patients’ health, they need to meet them where they are—via their phone.

Having an app to engage patients is “table stakes,” said Tom Kiesau, leader of the digital transformation unit at the Chartis Group. But while most health system app strategies historically have centered around the electronic health record’s patient-specific patient portal, a growing number of systems have wanted to offer more customized apps.

Customizing an app can help to differentiate a health system’s brand, tie in new functionalities, and try to engage patients earlier—sometimes, before they’re even patients. For many systems, that’s meant purchasing an off-the-shelf patient experience app to customize for the organization and its patient populations.

But for a growing subset of hospitals, it’s meant actually developing an app themselves. That’s a serious undertaking that shouldn’t be taken lightly. App development is an ongoing process that involves maintaining, refining and adding new features to a product on a regular basis, not to mention costs that add up depending on the app’s complexity.

And, if the app doesn’t work out and patients don’t respond to it, that work and expense can feel like it was for nothing.

“It’s a really big undertaking,” Kiesau said. “There’s a strategic intent there that has to be supported long-term.”

Cincinnati Children’s launched the first version of Caren in 2018, after building a prototype and conducting a 100-person pilot to test whether the product was helpful.

“We knew that if we launched a product that wasn’t right the first time, it would never have gained traction,” Cloud said.

Patients and families have been responding well to Caren—a play on words with the word “care”—she said. Each week, roughly 1,100 separate users visit the app.

That said, the project wasn’t cheap. Cincinnati Children’s spent around $500,000 to develop the app, with $300,000 in ongoing annual costs for maintenance and adding new features. The system continues to release updates to its app on a quarterly basis, according to Cloud.

Baylor Scott & White Health launched its patient app, called MyBSWHealth, in 2016.

Leaders at Baylor Scott & White, based in Dallas but with 52 hospitals across Texas, wanted to provide patients with a central site to manage their healthcare.

Baylor Scott & White released the first version of its app after three months of development, with a goal of launching a minimum viable product it could iterate on. “We tried to really think like a startup,” said Nick Reddy, the system’s chief digital officer. “One of the things we take pride in is trying to move really fast and trying to get things to the market.”

The app is now in its sixth version.

The first iteration was more focused on letting patients complete one-off tasks like viewing medical records. Today, the system is working to make it more interactive, with options for scheduling appointments, conducting telehealth visits, paying bills and symptom monitoring for some conditions, without having to log into multiple accounts or portals.

“The older ones look silly,” Reddy said. “Today, it’s a lot more sophisticated.”

There are multiple layers to building a patient app, all of which could involve a mix of in-house staffers or support from an outside company.

Baylor Scott & White has an in-house digital team that determines how the MyBSWHealth app works and what it looks like. The team also heads up building the app’s technological architecture, though the system has tapped programmers from outside companies to assist.

Bolstering an organization’s internal workforce with outsourced support is a common approach among health systems developing custom apps.

Outsourcing is typically more cost effective than hiring new staffers, particularly for specialized skills like app development that might not require daily work.

El Camino Health in 2018 started working with a third-party IT services and application development firm to create a patient app as part of its shift toward consumerism.

A custom app can provide a “common look and feel” for patients, said Deb Muro, chief information officer at the Mountain View, Calif.-based system. That way, patients see consistent branding from El Camino Health, rather than a mix of separate apps that they would download and log into piecemeal.

“Instead of the patient having to decide what apps to use when and where and how, we want the digital front door app to help guide that process,” Muro said.

The technology firm, SADA Systems, builds the El Camino Health app with input from El Camino’s clinicians, patient experience team and patient advisory council.

It made sense for El Camino to work with SADA Systems to build the app, since the work volume “ebbs and flows,” Muro said.

Michael Ames, senior director of healthcare and life sciences at SADA Systems, said hospitals have turned to custom apps in part because off-the-shelf tools aren’t always able to integrate all of the systems and functions that they want. But they also provide a branding opportunity for systems looking to show patients their organization is convenient and easy to navigate.

Advocate Aurora Health offers patients access to patient records, a COVID-19 symptom checker and telehealth through its patient app, LiveWell. It’s an outgrowth of an app developed by Advocate Health Care prior to its merger with Aurora Health Care in 2018.

Aurora Health Care didn’t have a custom app; its patients had used a patient portal app from the health system’s EHR vendor to connect with the health system.

The LiveWell app is designed to integrate the patient portal, but also extend beyond it—with general health and well-being resources like guided meditation and healthy recipes.

“(We were) really looking to be that … app that could not only provide new offerings to consumers, but also could aggregate all of the many different touch points where consumers were having to go to access health and wellness (information),” said Kelly Jo Golson, chief marketing officer at Advocate Aurora who oversees consumerism and the LiveWell app.

App development, while exciting, isn’t all fun. There are serious long-term considerations.

When a health system develops its own app, “you have to maintain the code,” said Amanda Jones, digital product manager in the digital engagement team at Danville, Pa.-based Geisinger Health. “You build it, you have to maintain it, and when you’re integrating different vendor solutions—or even your own home-grown-built code, or both—there’s more room for glitches.”

Geisinger uses a patient portal from Epic Systems Corp., called MyChart, as its main patient app. The system has cut down on the custom work it does in its patient portal in recent years, as Epic has started to offer the same features.

Patients are able to access a Geisinger account—called “MyGeisinger”—within Epic’s MyChart app, where they can access their Geisinger health records and schedule appointments with a Geisinger physician, among other functions. In January 2021, 68,000 separate patients had logged into a MyGeisinger account via the MyChart app.

That approach to patient apps could change, as Geisinger works on refining a digital strategy for patient engagement and streamlining how people access Geisinger as a provider, health plan and pharmacy.

Geisinger is considering a range of possibilities for how apps could fit into that consumer access strategy, Jones said. It could include continuing to use Epic’s MyChart app, releasing a specific MyGeisinger app built on MyChart or developing a custom app.

“We’re still exploring that,” Jones said.

There are 455 healthcare organizations that offer a patient portal through MyChart, according to Epic, most of which—like Geisinger—offer that access through the MyChart app. Thirty-seven of those 455 customers also “white-label” a version of the MyChart app that’s specific to their organization—meaning it’s an app developed by Epic but branded with the health system’s name.

And 48 organizations have gone live with a separate app that integrates with MyChart, according to Epic.

For now, Geisinger is planning to stick with using the MyChart patient portal as the main way patients connect with the health system. That’s in part because of an update Epic released last year, overhauling the user interface for its MyChart app—a mobile app it first launched in 2010. Patients have responded well to the new look and easier-to-navigate functions, Jones said.

Health systems shouldn’t start investing in app development if they’re not sure it will be a long-term part of their strategy, experts stress.

“An app is like a puppy—they’re really fun at the beginning,” said Matt Johnson, a director in consulting firm West Monroe’s technology practice. “If you help them grow, they’ll be great. … If you don’t, they can be a mess.”