Health care software company Phytel has introduced Hospital Readmission Management, an application that tracks patients' care after they leave the hospital and makes automated outreach phone calls to prevent a repeat stay.
Phytel develops population health-management tools that let physicians track a patient's chronic conditions, as well as their recovery from acute episodes.
Hospital Readmission Management enables physicians to view results of patient surveys through a SaaS (software as a service) portal that Phytel hosts. An analytic engine allows doctors to track patients' conditions and determine which patients are at risk for readmission.
Patients who decline to answer the survey are at higher risk of readmission, Russell Olsen, Phytel's vice president of product management, told eWEEK.
Hospitals are looking to avoid penalties from CMS (Centers for Medicare and Medicaid) that will begin in 2012 for readmission of patients within 30 days of discharge. Nearly one in five Medicare patients is readmitted to an acute-care hospital within 30 days after leaving the facility, according to a CMS study.
The readmission software generates reports based on patient responses to determine which patients need additional follow-up care or communications.
A sample message might read "John Doe was discharged for congestive heart failure; he has said that he is not taking his meds," Olsen explained. "They'd see John Doe at the top of the list and engage him with the human touch, which is always the most important."
The application generates survey questions tailored to each patient based on a particular condition, such as a heart ailment or a broken arm. Questions may include: "Have you filled your medications?" or "Have you followed up with your primary-care doctor?"
Phytel officially announced Hospital Readmission Management July 28.
"Up to now, there has been relatively little automation of post-discharge care processes designed to make sure that patients understand their discharge instructions and act on them," Phytel CEO Steve Schelhammer said in a statement. "Phytel's new hospital readmission management services are simply a natural extension of the proven capabilities we provide to enable our customers to intervene and engage patients across the full care continuum."
The readmission application for hospitals integrates with data from the company's current applications for primary-care doctors to enable continuity of care. Data in the physicians' patient registry links with a Phytel care-management work list and with hospital databases.
The service sends patient-satisfaction surveys to patients within 72 hours to make sure patients understand their care instructions. Patients can choose to speak with a hospital nurse or a call center worker. If patients don't respond to the survey, hospital staff will follow up.
Patients are frequently readmitted to a hospital because they didn't understand their post-care instructions, or fail to follow up with doctors on their own, Olsen said.
"Once a patient leaves the hospital and is discharged, often the follow-up is manual, inconsistent or unreliable, which causes the patient to end right back up in the hospital because the care didn't continue appropriately," Olsen said.
Although the surveys are currently delivered via the phone, Phytel may offer them through email or text messaging in the future, he said.