New system for surgical patients helps them prepare, recover faster

TORONTO – A new computerized system, designed to help patients prepare for their operations before surgery and to help monitor their recovery afterwards, is proving to be highly effective.

The Toronto East General Hospital tested the platform, called SeamlessMD, in a trial involving 70 thoracic surgery patients that began December 2013. The test had already resulted in fewer missed appointments.

It also reduced patient anxiety – not a minor task, when patients are often worried sick about appointments, preparing for the OR and conducting wound-care in the weeks following surgery.

“We surveyed 30 of the patients, and we got a 100 percent satisfaction rate,” said Mari Iromoto, director of improvement and innovation at Toronto East General.

Iromoto noted that in a three-month timeframe prior to the trial, there were six appointment cancellations for the three participating surgeons. By contrast, during the trial of patients using the app, there were zero no-shows.

Based on telephone consultations, Toronto East General also anticipates there will be a reduction in emergency room visits, as patients will be able to care for themselves better than before by using the computerized system.

SeamlessMD is the brainchild of physician-turned-entrepreneur Joshua Liu, MD, and his colleagues Philip Chen and Willie Kwok, respectively an engineer and computer scientist. The trio has been developing the app to improve the surgical experience and to reduce re-admissions – which are traumatic for patients and costly for hospitals and healthcare systems.

Dr. Liu said the average re-admission of a surgical patient costs $10,000. Re-admissions in Canada cost in the neighborhood of $1.8 billion annually, while in the U.S. they cost an astonishing $25 billion.

Toronto East General is conducting the first pilot test of Toronto-based SeamlessMD in a Canadian hospital. The app is also being used at medical centres in the United States.

For its part, Toronto East General created the content for thoracic surgery patients, and adapted it to run on the SeamlessMD app. It instructs patients about what to do before their operations, when and how to contact their care-givers, and how to look after themselves once they’ve been through the operating room.

Most hospitals give patients a thick envelope full of text-heavy papers to prepare for surgery. For many patients, the tome is daunting and difficult to understand.

But SeamlessMD takes a different approach. It stores all of the needed content on the patient’s smartphone, tablet or desktop computer, and the information is presented in a highly graphic and interactive way.

In many cases, the patient is directed to a video, where a surgeon explains what will happen and what is required of the patient.

In this way, patients can easily educate themselves about what they need to do before and after their operations.

“Our patients feel they’re continuing their relationship with their surgeons,” said Iromoto. “And they’re absorbing the information better in this way.”

She noted the hospital has many patients whose first language is not English, and written materials are harder for them to understand than videos and graphics. For this reason, SeamlessMD is a more effective way of learning.

The system also has text messaging about appointments, and will alert patients when they have an upcoming meeting with the surgeon or another caregiver. That’s a big help to patients and prevents them from missing appointments.

SeamlessMD enables the patient’s family, close friends and caregivers to access the system, so they can be aware of the protocols the patient needs to follow, as well as the appointments that are booked and the progress the patient is making after surgery.

In this way, it creates a well-informed support system for the patient.

“This was a nice surprise for us,” said Iromoto. “We discovered that the system not only reduced the anxiety of the patient, but it also kept the whole care-circle informed about what was going on.”

Importantly, the app guides patients on self-care during the post-op period by using a daily checklist. Each day, the patient logs in and goes through a series of questions about his or her health. Included are questions about temperature, breathing, and the state of the surgical wound.

“Depending on your responses, it tells you to continue what you’re doing, or it links you to the videos we’ve created, or it may tell you to go right to the ED,” said Iromoto.

That’s already improved self-care in the cohort of patients, and has reduced their anxiety about what they should be doing.

“We’ve gotten feedback from patients saying they wouldn’t even have looked at their wounds as often,” said Iromoto. “Now, they’re invested in the care of their wounds.”

In the future, the app could be used to take photos of wounds, which could be transmitted to the surgeon for a look. That would reduce visits to the hospital, and would also help reassure many patients that their incisions are healing normally. TEGH is holding off on the photo sharing function for now, as it is still investigating the patient privacy implications.

As well, future versions of the app’s checklist could be connected to care-givers, with real-time alerts. For example, if a patient notes an emergency, nursing staff could be informed right away through the app, and they could respond immediately by contacting the patient. “It has two-way capabilities, but we’re not there yet,” said Iromoto.

The SeamlessMD trial has had the full backing of TEGH’s chief of surgery, Dr. Carmine Simone. As Iromoto said, “Dr. Simone is very enthusiastic about using technology to enhance the patient experience.”