Step Up App Challenge: Advancing Care Through Patient Assessments

In this Challenge, AHRQ was seeking teams to design, develop, and pilot a user-friendly application to simplify the process of collecting, interpreting, aggregating, and sharing patient-centered outcomes data related to physical function outcomes in the ambulatory care setting.

About the Challenge

Patient-reported outcomes (PROs) are defined as "any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else." PRO tools look beyond the clinical data to assess how a patient thinks about his or her physical, mental, and emotional health, measuring what patients are able to do and how they feel, via a questionnaire. To complement clinical assessments, use of PROs for guiding and improving care is especially important for patients with multiple chronic conditions, older adults, and people with disabilities, as PROs can reflect outcomes of care for multiple conditions treated by multiple providers across multiple settings of care.

Historically, most PRO data are collected via pen and paper. Though recent digital tools have been developed, lack of data standards and workflow integration have limited wide adoption. Developing an easily adoptable tool that collects and shares standardized data would solve the problem of analyzing PRO data across different practices or health systems and advance the state of PROs.

This Challenge encouraged participants to create an app that uses the technical specifications provided by AHRQ to advance the collection of standardized PRO data in ambulatory care settings. Participants were asked to draft technical specifications employing the HL7 Fast Healthcare Interoperability Resources (FHIR) Standards to develop the apps. AHRQ provided a copy of the Patient-Reported Outcomes Measurement Information System (PROMIS®) physical functioning measures for participants to use when developing the apps.

Challenge Overview and Prize Amounts

This was a three-phase Challenge with a total prize pot of $250,000.

Phase 1: Proposal—10 phase 1 winners were awarded $12,000 each and moved on to Phase 2 Development
To enter, participants submitted a business case and a presentation deck demonstrating an approach to developing a technically sound PRO data app.

Phase 2: Development—Grand prize winner was awarded $35,000 and invited to pilot their technology in a real-life healthcare system. Second- and third-place winners received $30,000 and $25,000, respectively.
In this phase, winning participants were asked to use their Phase 1 prize funds to design, develop, and demonstrate an MVP PRO app. Finalists were required to showcase a patient-facing app created using the technical specifications and PROMIS® physical functioning measures provided by AHRQ to encourage patients to enter PRO data in a standardized manner.

Phase 3: Pilot—Grand prize winner moved to Phase 3 and, in collaboration with a contractor selected by AHRQ, implemented a pilot test in a healthcare system. After meeting pilot test milestones, the final $40,000 of prize award was distributed to the grand prize winner.

Phase 3 Requirements:

• Work with contractor selected by AHRQ on the pilot test, including setting up the IT infrastructure, modifying the application if needed, and troubleshooting issues during data collection.
• Demonstrate achievement of milestones to receive the final prize payment:
  • Post an open-source version of the application’s code on the GitHub source repository to make the code publicly available.
  • Successful data collection from all pilot sites.
  • Successful export of standardized data at all pilot sites.
• Submit monthly progress report of the pilot test (25th of every month from February-September, 2019).
• Submit a final report by the due date on lessons learned, recommendations, and concrete next steps for sustainability, including commercialization and/or broadened use and how to attract patients and/or providers to adopt and use the application.

Evaluation Criteria

Phase 1 Evaluation Criteria: Team/Participant Capabilities (20%), Impact (30%), Feasibility (30%), Originality (20%).

Phase 2 Evaluation Criteria: Technical Merit (40%), Usability (30%), Deployability (30%).

Challenge Winners

Grand Prize

PRISM™

PRISM™, PROMIS Reporting and Insight System from Minnesota, is an application that enhances the quality of clinical discussion between healthcare providers and patients by allowing for continued patient engagement outside of the clinical setting. Developed by a multidisciplinary team including members from the University of Minnesota, Fairview/HealthEast Kidney Stone Institute, EMF Consulting, and digital health company PerkHealth, Prism enables patients to complete physical function and other PROMIS measures through an easy-to-use app, with value-added features including score trending, peer group comparisons, and personalized recommendations for followup actions and education materials aimed to further engage patients in their care. The platform supports and PRO instrument, and allows seamless data integration with EHRs via Fast Healthcare Interoperability Resources (FHIR) to make data available for providers to use, in real-time, in their clinical care and shared decision making with the patient.

Second Place

PEER Technologies

PEER Technologies PLLC’s application named “Back Pain Tracker” is a tool to enhance the shared decision making process for patients with chronic low back pain and their physicians. It striveds to attend to the needs of patients with chronic back pain by leveraging a user-centered design approach, benchmarked pain and function scores from the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS), and risk factor identification from the NIH Research Standards for Chronic Low Back Pain. Patients easily enter PRO data and are presented with comprehendible recommendations, including personalized estimates of normative outcomes based on patients’ age, sex, and other characteristics. The goal is to integrate this mobile app into a patient’s treatment plan by discussing scores and trends during clinical visits to inspire patient retention and continued use of the application over time.

Third Place

cliexa®

cliexa® is a HIPAA-compliant cross-communication platform that improves the quality of care, clinical workflow, and time spent with patient. cliexa-EASE helps clinics fully leveraging PRO data to integrate validated clinical assessments to patient intake and remote-monitoring processes while collecting clinical metrics and compliance data for quality reporting. The discrete clinical data and PRO data enable providers to improve clinical decision making while reducing liability and billing concerns.

Phase 1 Winners

AgilisIT: AgilisIT™'s solution focuses on patient engagement, ease of use for physicians, and EHR integration to encourage the digital collection of PRO data. The patient-centered app offers both mobile and web applications, enabling patients to receive reminders and track their own progress, while providers can receive patient health notifications and easily review data to prepare treatment plans based on patient priorities.

Asymmetrik: Asymmetrik's Phoenix Integration Platform™ allows healthcare providers to use FHIR® to leverage existing investments in data infrastructure simplify data analytics to make informed decisions across health systems and deploy secure, data-driven applications for researchers, doctors, and patients. Built on the award-winning Phoenix Server™, Asymmetrik's patient-engagement solution can help healthcare providers improve patient engagement and care coordination by exchanging PRO data with patients, targeting patients with low response rates or certain medical conditions, and analyzing responses in real time.

Booz Allen Hamilton: DEXi Care Map™ is an application designed to allow patients to interact directly with their providers, including inputs from wearables, and has an easy-to-understand interface viewable to both the patient and provider that tracks progress. Using a combination of artificial intelligence, machine intelligence, and natural language processing, DEXi Care Map can provide tailored information to patients and providers, and is able to parse user input and feedback into structured data.

Health Wizz: The Health Wizz™ solution incentivizes patients to provide sought-after data through "Campaigns" (e.g., Chronic Disease Management Campaign, Patient-Reported Outcome Campaign, etc.). Participants can choose to accept Campaign invitations and receive rewards for participation. The data can be entered and tracked on the patient's mobile device or wearable and transferred into an EHR system accessible to clinicians.

1upHealth: ProUp™ is a secure, patient-facing application developed by 1upHealth that facilitates seamless integration between EHR systems and PRO data collected via easy-to-complete PRO questionnaires.

Qidza Inc: Qidza's ProNoggin™ mobile app is designed to improve the collection of PRO data by addressing health literacy gaps via simple designs, increasing patient engagement via personalization, and improving data aggregation and sharing via FHIR integration.

cliexa: Tailored for tracking chronic disease activity, cliexa®'s Platform for Chronic Care Management enables clinicians to fully leverage patient-reported data through allowing assessment customization; EMR integration; facial and voice recognition using AI; FDA-linked databases for medication-tracking functions, body maps, and pain diagrams; and a reimbursement framework.

PEER Technologies, PLLC: PEER Technologies utilizes the Shared Decision Making process between patients and providers in a user-friendly application that strives to improve patient knowledge and satisfaction through producing benchmarked PRO scores for patients and risk/benefit evaluation when discussing surgery. Patients easily enter PRO data regarding non-specific low back pain and are presented with comprehendible recommendations, including personalized estimates of normative outcomes based on patients' age, sex, and other features.

PRISM: PRISM™ is an application developed by a multi-disciplinary team that enhances the quality of clinical discussion between healthcare providers and patients by providing the option for patients to fill out PRO questions before or during office visits via a mobile application or website. Patients can compare their health trends to the overall population, while providers and healthcare organizations have access to the PRO data from within the EHR. Providers have the ability to send individual reminders to patients, and they can use dashboards to track population trends and patient response rates.
Social & Scientific Systems PatientPort: PatientPort™ is a secure, patient-centric application leveraging a user-friendly interface to maximize engagement. The application is built to provide interoperability with user devices, regardless of operating system, and can be integrated with commercially available EHR products to promote adoption by both health systems and patients.