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MIDP students develop patient care app prototype

Posted by on Thursday, April 20, 2023 in MIDP, Student Initiatives, Third Year .

Three medical students in white coats stand next to a medical school seal

Third-year Medical Innovators Development Program (MIDP) students Emma Neal, PhD, Sarah Ouadah, PhD, and Noah Thompson Orfield, PhD, used patient-centered insights to develop a new health care app for improving team care and communication

By: Lexie Little

In a hospital setting, patients encounter many faces and care teams: from physicians, residents, and medical students to nurses, therapists, pharmacists, and social workers. The number of health care workers entering a room or rounding on a patient can be daunting for both the patient and their family members as they try to understand the role of each team member and their goals for the day.

Three Medical Innovators Development Program (MIDP) students at Vanderbilt University School of Medicine identified this problem during their second-year clerkship rotations.

“As part of the second year in our MIDP curriculum, we take a class called Innovation, Activism, and Altruism alongside our core clerkships. With each core clerkship, we identified problems that we saw throughout the hospital,” M3 Emma Neal, PhD, said. “We generated a lot over the year, and they were all very different. The goal was to ultimately choose one problem that we all felt passionate about and spend three months in our IDEA Lab course with Dr. [Ryan] Buckley going from ‘Here’s a problem’ to ‘Here’s a workable solution.’”

Each problem they identified could be defined under one primary theme: inhibitors to patient dignity.

Starting with an idea

From immodest hospital gowns to gaps in communication, Neal and classmates Sarah Ouadah, PhD, and Noah Thompson Orfield, PhD, explored challenges they could address to support the dignity and respect of patients in clinical spaces. During the IDEA Lab course, they interviewed patients, families, physicians, nurses, and essential members of care teams in hopes of finding an altruism-based project.

“We started talking to people, and something we started to steer towards was patients not knowing what was going on in the hospital and who they were talking to. That’s where we started,” Ouadah said. “We kept talking to people, kept hearing that theme coming up. Patients just not knowing what was going on with too many anonymous faces. The next step – we accrued more than 100 interviews that we did with people including patients, families, physicians, and health care workers, starting mostly with physicians and residents, then going to patients and their families. We tried to also talk to physical therapists, occupational therapists, nurses, anyone you could encounter in the hospital. At that point, we started to come up with really simple prototypes to start testing and see what would happen.”

The MIDP team drafted information packets that outlined care team members and their backgrounds, accompanied by photos to help patients learn more about who might be coming to evaluate or speak to them. The packets also included a blank sheet with five bullet points for teams to identify the patient’s care plan for that day like monitoring cardiac activity or seeing how the patient reacted to a new medication.

Rounding with the General Medicine Teaching Service (Morgan), Neal, Ouadah, and Thompson Orfield delivered the sheets to patients and families before rounds to gauge their interest and potential for such a model to improve care and comprehension.

“We had the hypothesis that patients would be happier with more information, the information that we as professionals wanted to know about a patient’s hospitalization,” Thompson Orfield said. “That’s sort of what the patients told us; they wanted to be in the loop and have someone they trust tell them about what’s going on when they’re in the hospital. But we found that our packets didn’t really resonate with the patients…We started talking to patients to hear what they thought about our prototype. We discovered that nurses were using the plan that we were leaving in the room more than the patients were. They were interested in what the team had said when they came to visit the patient and appreciated having that information sooner than they get it in the current system. We started doing more interviews with nurses and patients, and we found that patients get so much of their information from their nurses. Even if we give patients information, they are likely to ask their nurses about their care plan or ask questions that would have been answered by the paper.

“We took that opportunity to step back with the data we collected and say, ‘Maybe the best way we can help patients is to make sure their entire care team is better informed about what these teams that are rounding on patients have to say and what’s going on in the background.’”

Ideas in practice

New information led to a new hypothesis, which in turn prompted the MIDP students to develop a second prototype. With the support of faculty like Buckley and Travis Crook, MD, they tested new models, incorporated quick feedback through the IDEA Lab course, and designed the prototype of a simple mobile phone app – SharePlan – to record information for patients and teams on their services.

“Watching the students go through multiple iterations to find the stress points and discover solutions was exciting,” Crook said. “The most impressive aspect was that while Emma, Sarah, and Noah had a guiding vision, they showed remarkable adaptability and fluidity in their thinking.  Snags and problems were not setbacks; they were targeted opportunities to refine their product and their idea to ensure that it was properly addressing the issues from all concerned stakeholders…They had the wonderful forethought to identify all of the key individuals in the project in their different roles and then allowed them to dictate what the solution should look like. The humility in this approach not only creates buy-in to the solution, but also ensures that the end product will be functional and useful to everyone as a universal tool and addresses the needs at a health systems science level.”

Making their way around Monroe Carell Jr. Children’s Hospital at Vanderbilt with the pediatric general medicine team, the students typed information into the app as the team rounded, creating a care plan for the patients to provide additional context to nurses and team members.

Neal explained that their goal with the application is not to replace an order set but to provide information beyond the chart to set expectations for teams, families, and patients alike.

“The nurses can’t be everywhere the teams are, and the teams can’t give a solid answer of like, ‘I’m going to be at a certain patient’s room at 9:05,’ she said. “That’s not how things work in the hospital. But everyone was much happier if they just had an idea of the overarching goal for the day. Say the main goal is to see how a patient’s electrolytes do after taking them off fluids or to continue antibiotics. It wasn’t meant to replace notes or order sets. This was not the place to wax poetic on thought processes about why to do x thing or what study informs the decision. It truly is ‘What do I need to know right now so that I can help my patient, and to whom do I need to ask questions, and how do I get in contact with them quickly?’”

Beyond members of the primary care teams entering a patient’s room, the third-year students centralized information between those teams and consulting teams. Ouadah said having information in one location to which everyone could refer with updates in real time felt helpful, especially given the number of pages that go back and forth each day between physicians, residents, and team members. Keeping privacy and capacity in mind, the threesome now turns attention to finding financial support and feasible ways to build the app into patient informatics technologies like Epic.

The trio proceeds with two main goals: finding someone to provide continuity for the project and ensuring they build a functional app that could be used by the entire hospital system. They are actively seeking funding with the goal of building out the app for usage at Vanderbilt, perhaps extending to broader markets later. They also hope to find a leader to run the project in the long term, as all three students plan to apply for residency positions in the next year.

Applying ideas for the future

Since November 2022, Neal, Ouadah, and Thompson Orfield have participated in several pitch competitions to earn funding for app development. They earned a $5,000 microgrant from the Vanderbilt Wond’ry Ideator Program, which supports STEM ideas and innovations. In the meantime, the MIDP students hope the app may become not only a tool for care teams and patients but an app for medical student education.

A student on second-year clerkships may only carry one or two patients per day. The app would allow them to record a plan for multiple patients as they round with their supervising teams, learning from each patient they encounter and the information they record.

“I think for all three of us, we were surprised at how many more questions this process generated for us while rounding with the teams and how many gaps in our own knowledge we were able to identify,” Neal said. “I hadn’t appreciated how many learning opportunities I had missed out on whereas this provided me an opportunity to question what I needed to know and if I functionally understood the care plan, keeping in mind that very soon, we could be the residents making some of these decisions. I thought it was a really empowering way to identify gaps in my own knowledge as a student.”

Neal credited second-year clerkships director Crook with encouragement for the project and continued learning. Crook offered feedback and time, speaking with the students, residents, and others about the app’s implementation and effectiveness.

“Honestly, their project and their take on the entire health care system is both fundamental and refreshing,” Crook said. “At its core, this is about patient dignity, autonomy and respect. While we can’t control outcomes in medicine (at best, we influence them), one thing that we can control is how our patients experience their medical journeys. As health care systems have become increasingly complex to adequately deliver the personalized care that each human being deserves, it also places an ever-increasing burden upon those same patients to attempt to navigate and understand the system around them.

“This app is the direct answer to that unspoken call. It is a solution to a problem that is so foundational that it has become almost overlooked, and the patient is the one lost in the shuffle. Seeing Emma, Sarah, and Noah not only identify this issue, but then work to address it from the patient’s perspective is truly delightful. This is a solution that simultaneously empowers patients to take better ownership of their health care while also streamlining and improving communication workflows for nurses and providers. It helps to create a unity of purpose among all members of the health care team while keeping the patient at the core.”

All three students share a sense of support from each other and MIDP leadership. Each week during IDEA Lab, Buckley met with the trio to talk through what they learned during interviews and think through ideas for further development.

Thompson Orfield said Buckley gave them the freedom to design and implement the project themselves, relying on their own skills and observations to act as lead investigators and collaborators working toward a common goal of improving patient care.

“He was a great coach,” Orfield said. “He also let us run with this how we wanted to. He’s commented that we’ve done this differently than any other cohort in the past, and every other cohort did it differently than the one before them. It was so great to see Sarah and Emma’s skillsets they have developed while earning their PhDs shining during three months working with them.”

All three agree the MIDP faculty encourage students not to shy away from challenges, balancing their efforts with a dose of reality. They identified many challenges that underscore patient dignity, but their time and resources only allow them to address one, at least for now.

Yet, MIDP makes tackling difficult problems easier through connections between other student cohorts and guest speakers from industry spaces.

“Several classes above us were close to us,” Ouadah said. “Having them and knowing the experiences they went through provided examples. We could look at them, talk to them, get recommendations from them, and we did that regularly. We could say, ‘Oh, they did this, maybe the three of us could do this other thing.’ Having those people who had already experienced it so close in collaboration with us is really special.

“Another thing that MIDP does is weekly Wednesday forums where we have speakers from inside and outside of Vanderbilt talk to us about innovation, entrepreneurship, just kind of anything and everything. We ended up interviewing several of the people who had come to talk to us. Having heard their stories for a good two years at that point was kind of cool knowing what other people had done before and how they got started. We got their recommendations and suggestions like ‘Just go talk to people’ or ‘Put it up online on Twitter,’ as we looked to develop this project. We had those examples of success before we got started.”

The MIDP cohort directly ahead of them, Pulak Goswami, PhD, and Dennis Zhou, PhD, recently worked with GE HealthCare to develop an artificial intelligence algorithm aimed at improving patient care through imaging. Like Neal, Ouadah, and Thompson Orfield, they identified their idea through a patient encounter to inspire empathy-driven innovation. Innovation, activism, and altruism drive their projects forward with all people in mind.