The Effect of an Integrated Mobile Smart app on the Reduction of Patient Readmission Rate

Submitted by Gabriel Rousseau PMHNP, MSN, RN

Tags: digital assitants health care systems healthcare organization hospital innovation training program

The Effect of an Integrated Mobile Smart app on the Reduction of Patient Readmission Rate

Objective

The purpose of this proposed study is to demonstrate that managing patient’s health by integrating a smart mobile app with an existing electronic health records system can reduce incidents of disease recurrence or relapse among discharged patients.

Research Design

The study will be implemented using a mixed-research design where qualitative survey will be used to obtain crucial information from existing studies in forms of interviews while a quantitative survey will be administered in form of a questionnaire.

Sample

A sample of 50 patients that are using the application and 50 patients will be evaluated among patients that have previously been diagnosed and treated in the selected healthcare facility. Some of the target respondents will respond to a questionnaire while others will be interviewed in a face-to-face engagement.

Theory

Fundamentally, with the advancement of technology, it is prudent that healthcare providers utilize this underlying concept to provide real-time healthcare to patients by monitoring their health and core symptoms such as blood pressure and temperature. Based on previous studies and an understanding of how smart technology works, it is apparent that integrating a mobile app with existing EHR systems can reduce incidents of disease recurrence or relapse among discharged patients.

Analysis

Information will be analyzed using advanced analytical approaches such as SPSS, which will allow the researcher to make the necessary inferences regarding the information provided.

Implications

Based on the proposed study, it is apparent that technology is crucial in every aspect of human life. In this case, the study demonstrates that smart app technology can be used to manage patient conditions, which can make it possible for healthcare providers to respond to disease escalations just in time to prevent them against critical disease advancements. Consequently, this can be paramount in the prevention of relapses among patients with chronic illnesses such as diabetes and blood pressure.

Key Words: Electronic Health Records (EHR), Smart Technology, Patient Readmission

Problem Statement

Technology has been advanced in almost every aspect of healthcare; however, besides consolidating information from patients for future reference and consistency, the adoption has not contributed much in the manner follow-up is carried out in most hospitals. Integrating the existing health records with a mobile phone app that enhances real-time follow-up and monitoring of treated patients can reduce cases of relapse. A study conducted by Shilpa, Naik, Shewade, and Sudarshan (2020) demonstrated the importance of integrating a smart app in EHR systems to understand the progress of certain illnesses after diagnosis and treatments have been undertaken on a patient. The study demonstrated that it is easier to identify patients that were misdiagnosed or developed secondary symptoms after the treatment (Shilpa et al., 2020). The proposed app should allow patients to update the manner their bodies respond to treatment after being discharged from hospital. Meanwhile, the app should generate notifications to the nurses or other practitioners that were involved in the diagnosis and treatment of the patient.

Purpose of the Study

QN: The purpose of this study is to determine the effect of an integrated mobile smart app on the reduction of patient readmission rate

QL: The purpose of this study is to determine the effect of an integrated smart mobile app on the efficiency of patient follow-up after discharge

Research Questions

Does using an integrated mobile smart app reduce patient readmission rate?
Does the use of an integrated mobile app enhance the efficiency of patient follow-up after discharge from hospital?

Proposed Research Methodology

Conducting a primary study could significantly facilitate a viable understanding and potential solution to the research problem in question. A mixed method approach is crucial in obtaining information and opinions from all persons of interest (Spoorenberg, Uittenbroek, Kremer, Reijneveld, & Wynia, 2016). A qualitative study using interviews will allow respondents to provide detailed views regarding EHR and ways it could be made more useful. A quantitative survey, on the other hand, will allow a large number of respondents to provide statistical information for statistical analysis.

Significance of the Study

Undertaking this study could essentially transform the manner electronic health records are utilized in the advancement of quality healthcare. The study is relevant to the current desire to make HER efficient and usable to the current and emerging issues in healthcare. Ultimately, it provides an opportunity within which smart devices can be utilized to provide personalized follow-up among patients. Considering that the number of patients has increased significantly over the past decade according to a study conducted by van der Poll, van de Veerdonk, Scicluna, & Netea (2017), it is only logical that patients are given the capacity to monitor their health and general wellbeing. In this regard, therefore, the study provides adequate justification upon which smart technology can be utilized in allowing patients to access and make proper use of the existing EHR systems.

Literature Review

The literature selected for this study seek to demonstrate that improved communication through the use of mobile smart applications has an impact on the reduction of readmission cases among critical or chronic diseases. Notably, the studies assume that reduced readmission cases is associated with recovery from illness and the ultimate quality of healthcare. Apparently, few studies have been conducted on the direct effect of smart apps on the reduction of readmission cases in hospitals; however, the studies selected point to the importance of proper communication on the reduction of readmission and the reduction of readmission in hospitals.

The Current Integration of Smart Apps in Healthcare

Various medical centers are gradually recognizing the importance of integrating their health records with a system that makes such information more usable. In 2016, a team in Duke Health developed the Substitutable Medical Apps and Reusable Technologies (SMART), an Epic-based electronic health record, which would be compatible with the children’s project that was being established in Boston (Bloomfield Jr., et al., 2017). The system was designed to utilize the Health Level Seven International’s (HL7) Fast Healthcare Interoperability Resources (FHIR), which would be referred as SMART on FHIR.

A compatible server infrastructure written in Mode.js was custom-programmed to serve two primary functions. The code was used to manage API activities such as rate-limiting, authorization, logging, auditing, and analytics. Additionally, it retrieved HER data and converted it into a FHIR-compatible format. Subsequently, coding was done on the user interface to allow end-users to integrate as many apps as possible. The results of this development showed that integrating SMART on FHIR allowed the incorporation of several apps, into an existing EHR. From this study, it is apparent that a series of apps can be successfully integrated in EHR, allowing various users to access information or even interact with the information.

A similar developmental study was conducted by Harvard Medical School and Boston Children’s Hospital through an interoperability project that allowed users to run medical applications across multiple healthcare IT systems (Mandel, Kreda, Mandl, Kohane, & Ramoni, 2016). The application was embedded on contemporary web standards that allowed programmers to customize interfaces, authorize functions, and modify programming terminologies into medical contexts that users could understand easily.

SMART technology has been widely utilized in most global systems. A recent study conducted by Karhade, Schwab, Del Fiol, and Kawamoto (2020) proposed the use of ‘SMART on FHIR’ interoperability standard to provide an efficient utilization of EHR data by a variety of different-level users. The findings we consolidated from secondary sources that provided crucial information on the topic. According to this study, this form of technology can be utilized on sensitive cases such as spine surgeries and chronic illnesses to predict existing and emerging risks. Fundamentally, ‘SMART on FHIR’ can be integrated with or as an EHR add-on application to assist medical practitioners and patients to monitor their health statuses and initiate the appropriate response towards such illnesses.

Importance of Integrating the Smart-App Technology

With the increased number of heart failure patients in the U.S., Park et al. (2019) found out that the adoption of remote monitoring technology has enhanced disease management especially for patients with chronic diseases. After studying a sample of 58 patients, which represents 10%. Based on the selected sample, it is apparent that smart applications are undoubtedly useful, which mostly depends on the design of the given application.

Integrating mobile apps into health records has been applied widely following the emergence of personal electronic health records especially by patients suffering from chronic diseases. Giordanengo et al., (2016) conducted a study on the current attempts of integrating data from apps, wearables, and personal electronic health record (pEHR) systems with the EHR systems from health facilities. The current challenge, however, is that most systems have not yet been synchronized with most personal electronic health systems, which means healthcare practitioners in most institutions cannot monitor patients automatically even in cases where the process is considerably necessary. The study aimed to create a framework within which data could be transferred and shared with the relevant stakeholders to improve health outcomes among patients. The study proposed the development of a system that allowed patients to access and analyze data about their health state in real-time.

By monitoring and understanding their health status, patients are able to control the evolution of the disease by altering their habits that correlate with the advancement of the disease. Ultimately patients enjoying the system could choose an equipment that could aid the management of their disease. Arguably, this emanates from the fact that most sicknesses escalate due to the fact that most patients never understand or track the progress of potential diseases unless they become symptomatic. The study pointed out to the missing technological bridge that could enable medical practitioners participate in the conversations and decisions relating to patients’ health.

Subsequently, the study proposed interoperability as a bridge illustrated by the use of open EHR where different systems could be interlinked to utilize common data banks. In so doing, the systems could interpret information differently depending on the specifications of apps as designed to suit different user needs. For instance, while the practitioners’ apps give insights on the best course of action and trends regarding certain illnesses, the patients’ apps allow the users to understand their statuses and the points at which they can seek further medical attention from their designated healthcare provider.

Can Smart Mobile Apps Reduce Readmission Rates

Shameer et al. (2017) established that predictive modelling of hospital readmission records using machine learning can significantly reduce the rate of readmission in most hospitals. The case study, which was conducted on Mount Sinai Heart Failure Hospital, showed that readmissions of most patients emanate from chronic or acute conditions like stroke, myocardial infarction, and pneumonia. Mainly, this occurs due to the high degree of sensitivity of these illnesses and the difficulty associated with monitoring and comprehending their progress in the human body. Predictive modelling using machine learning entails integrating smart applications that use previous data to determine the likelihood of the recurrence of certain illnesses.

Predictive modelling does not necessarily have to be undertaken using mobile applications; data-driven electronic medical record-wide (EMR-wide) has been successfully tested based on its ability to predict the probability of a given readmission. Using a considerably huge repertoire of EMR variables from the center highlighted, where a sample of 1068 patients was selected, it was observed that 16.66% of the sample, representing 178 patients were readmitted. (Shameer et al. 2017) The Naïve Bayes Algorithm, was used to classify readmitted cases to enhance multistep modelling.

With the cases readmitted being contrasted against non-readmitted cases, the factors contributing to the risks of readmission were assessed and analyzed based on the correlation-based feature selection (CFS) method. The model demonstrated that machine learning was essential in understanding the factors that contributed to readmission cases and triggered proper response approaches against contributing incidents. Ultimately, integrating EMR or EHR systems provided an efficient approach within which the model could be tamed to predict and initiate mitigation processes against readmission cases among patients with highly critical or chronic illnesses. Presumably, the completion of this study obviously neglected the effect of readmission cases that occurred as a result of scheduled appointments and had nothing to do with escalation of the symptoms.

Importance of Smart App on Quality of Service Delivery

Quality service delivery in healthcare is mostly dependent on the prevalence of information that aids the resolution of problems while improving patient outcomes. Yang, Fang, and Horn (2018) demonstrated that quality exchange of information had a direct influence on the relationship between patients and the hospitals they visited regularly. Information exchange was observed to be mostly exchanged through smart social media applications such as WhatsApp and Telegram. According to the study, since the improvement of communication over time, communication between practitioners and patients has improved significantly. The study also demonstrates that insufficient communication between hospitals and patients jeopardizes the relationship between such hospitals and their patients. Meanwhile, proper communication occurs in cases where practitioners can communicate with their patients efficiently especially through simplified charts or customized smart apps.

Besides using smart apps, facilities and researchers are constantly establishing models to predict and understand the likelihood of patient readmission, especially on illnesses whose relapse could lead to the death or paralysis of a patient. Flaks-Manov et al. (2020) observed that readmission of patients demonstrates a reduced quality of healthcare such that if healthcare facilities could predict the possibility of a readmission, it is possible to initiate the appropriate mitigation strategies. The study was conducted using a multisource mixed-method design that used EHR data and feedback from health practitioners.

Role of Integrated Smart Apps on Quality Communication

Information exchange, skills, and general practitioner experience has a direct correlation with the rate of readmission in most hospitals. Cross, McCullough, Banaszak‐Holl, and Adler‐Milstein (2019) established that the readmission of patients emanated from the skills and experience of practitioners. The study was conducted by evaluating secondary data from a large academic medical center dating between July 2013 to March 2017. Purposely, the study sought whether the differences in portal implementation reduced the likelihood of readmission of patients between facilities with enabled interfaces and those without portal enhancements.

Besides interface enhancements on the utilization of EHR, the study demonstrated that the efficient exchange of information among practitioners in nursing facilities was associated with reduced readmission rates. Arguably, sharing of information emanates from proper utilization of smart technology such as through mobile apps, which are the most efficient tools of information exchange. It is thus apparent that through properly integrated smart apps, medical practitioners can easily exchange information leading to an improved delivery of healthcare services.

Wani and Malhotra (2018) initiated a study to show that the quality of healthcare depended on the manner experts utilized EHR records. The study focused an approach on the exploitation of electronic health records based on the confines of HITECH (Health Information Technology for Economic and Clinical Health) Act. The study demonstrated that proper utilization of EHR allowed healthcare practitioners to predict and understand illnesses and establish appropriate mitigation approaches.

Alienating with the current trends is crucial in understand appropriate approaches that can be utilized to improve the quality of healthcare. According to the study by Dauwed, Yahaya, Mansor, Hamdan, and Meri (2019), there is vast information and data especially in EHR systems, which if used appropriately can transform the quality of healthcare especially on chronic illnesses. Implicitly, smart mobile technology is arguably one of the current trends that could allow practitioners to make proper use of vast data, experience, and expertise of most practitioners around the world.

The studies highlighted represent a few of the studies that are crucial for this study. Currently, only a few studies have been conducted on the implications of integrating smart apps with EHR systems; however, the studies highlighted provide an implicit understanding on the justification for conducting a study about the effects of smart apps on the reduction of patient readmission. So based upon the review of literature, this proposed study is important because it integrates crucial ideologies on the most viable approach of utilizing EHR systems.

Conceptual Framework

The study will be completed based on a conceptual framework in which case, the researcher undertakes a comprehensive assessment of the existing studies and use them to establish a solution to the underlying problem. The research framework highlighted in this case seeks to provide the researcher with a proper understanding of the problem. Upon this understanding, the researcher can demonstrate a viable solution to the underlying research problem. Furthermore, the researcher uses a series of existing studies to illustrate how EHR systems can be linked with mobile apps and utilized to facilitate the monitoring of patients once they have been discharged from hospitals to mitigate escalation of their ailments, reduce readmission and prevent chances of mortality.

Key Concepts

Readmission Rates: Readmission occurs when a patient has been treated but the symptoms recur, further threatening the wellbeing of the patient. Readmission is a desirable; however, it needs to be undertaken before the patient achieves life threatening symptoms. Automated patient monitoring will allow patients to be checked and readmitted while still medically stable.

Smart Mobile App: Smart mobile applications allow users to access, process, and send information from their smart mobile device. The app can also be programmed to undertake these roles automatically and systematically. The proposed app will fetch essential information from the patient of an individual and will send triggers if symptoms escalate beyond normal. The patient will be able to report symptoms, which will be processed and designated health practitioners.

Patient Follow-up: Patient follow-up is crucial especially in cases where patients are recovering from critical or chronic illnesses. Mostly, patients are given appointments; however, patients can develop complications prompting an immediate checkup. If left unaddressed, such cases will escalate into untreatable limits, paralysis, and death.

A Recap of the Study Problem

The studies provide information regarding the manner EHR systems have been utilized previously to enhance the quality of healthcare. For instance, Curtis et al. (2018) provided a detailed analysis of how EHR systems have allowed health caregivers to track the progress of patients whenever patients visit for further consultation. Currently, most medical centers have comprehensive databases containing information of their patients. As a result, these healthcare centers can successfully track the wellbeing of patients, which allows for the discovery, diagnosis, and treatment of persistent illnesses. Ultimately, with this kind of tracking, healthcare centers have successfully improved healthcare outcomes. Practically, this has been evidenced by the reduced degree of readmissions, mortality, and medical complications in hospitals. Subsequently, doctors are keen to enhance complete recoveries of their patients.

Evidence indicates that healthcare is expensive for patients, insurance companies, and all stakeholders involved. According to Fox and Felkey (2013), hospitalizations account for 30% of all the expenses involved in healthcare. The study further shows that in Medicare, hospitalizations are even more expensive, accounting for 37%. Mostly, these expenses escalate considerably when patients are forced to go back to hospital shortly after being discharged. The study indicates that 18-20% of Medicare patients return to hospital within 30 days after being discharged. In 2010, the readmissions cost Medicare $17 billion, which arguably makes them considerably undesirable.

In most cases, the most critical questions asked are whether readmissions are unavoidable under all circumstances. As the study by Fox and Felkey (2013) shows, although it is impossible to reduce readmissions of patients by 100%, certain measures can be initiated to avoid unnecessary readmissions such as those emanating from misdiagnosis or incomplete treatments. The current study does not necessarily eliminate readmissions, but allows medical practitioners to monitor the statuses of patients based on the progress of their symptoms. An app that taps into the real-time health information of an individual such as heartbeat and sugar levels can allow healthcare practitioners to understand if a patient requires further check-up or a change of prescription.

Existing Gaps in the Study

Mobile Apps have already been initiated in certain hospitals to enhance healthcare outcomes and reduce readmissions. Currently, most hospitals are undertaking a generic approach of utilizing electronic health records; however, this study proposes a case where medical practitioners can monitor all forms of information of discharged patients in real-time. Currently, no study provides a situation where comprehensive smart apps have been incorporated to monitor the health situation of patients after they have been discharged from hospitals. To initiate this study successfully, exploring related studies allows the researcher to understand the loopholes with respect to the manner they can be accomplished successfully.

It is to the interest of the researcher to make the study process as cost-effective and economically viable as possible. Establishing a balance between the cost of conducting the research and building a research that fully addresses the objectives of the research comprehensively remains a legitimate concern in this study. Additionally, it is important to make the implementation of the proposed system convenient and cost-effective. Arguably, the implementation process can be made cost-effective by using bots to interpret and raise issues regarding discharged patients. Mainly, this is practically viable, considering advancement in machine learning has already been initiated in a wide range of cases. It means a machine learning model may be developed to make it easy, cost-effective, and possible to monitor cases of individuals being discharged from these hospitals. Clearly, this poses a huge limitation to the scope of the proposed study, which only focuses on an app that will allow medical practitioners to monitor the underlying cases automatically without having to initiate a secondary monitoring system. Such a system would require a different study to evaluate the viability and practicality with respect to the current needs in the healthcare sector.

Another study gap is that researchers have not yet identified a situation where they can undertake a successful implementation of the system due to the liability of the current burden. As such, it is the responsibility of the patient to undertake due diligence regarding their health status and return to hospital if they realize their prescription is not working according to the initial agreement with the doctor. Currently, doctors are under no obligation to monitor or follow up with the problems affecting patients unless it is overly necessary or they have a special case, whose program and outcome contributes in the development of a given case study.

Does the Studies aid in Answering the Research Question?

In summary, the studies highlighted provide an implicit illustration that integrating a smart app with EHR systems can improve patient outcomes by allowing medical practitioners to observe the progress of patients even after they have been discharged from hospital. Using a collection of various studies, the researcher demonstrates the essence of undertaking the current study to ascertain the implication of building a system that allows patients and doctors to monitor their progress post diagnosis and treatment. Arguably, the studies can be said to have answered the inherent research questions of the current study.

It is prudent to undertake further research on the effects of integrating smart-app technology with EHR systems on the rate of readmission in selected hospitals to understand the connection. It is apparent that the studies highlighted for the purpose of this study do not point to a direct correlation; therefore, initiating a study to understand whether there is a direct connection makes this study necessary. In this case, this would require undertaking a primary survey on the degree of assimilation of smart-app technology in various hospitals and the manner it has facilitated the reduction of readmissions or escalation of medical cases.

Predictions, Outcomes, and Variables

The intended outcome of this research is to establish that integrating EHR systems with the current mobile apps has a direct impact on the number of readmissions in hospitals. First, the researcher seeks to evaluate existing studies and case studies to determine the progress in the utilization of EHR systems using modern technology. Demonstrating how the integration could improve the quality of healthcare may require an assessment of an actual app that is linked with an EHR systems, the process within which patients, medical practitioners, and other end-users can use the app efficiently and the impact it would have in monitoring their healthcare statuses. Furthermore, this may require a study of extreme medical cases and how failure to monitor them has led to relapse or worsening of their conditions.

Dependent Variable

A reduction in the readmission of chronically ill patients is the dependent variable, which majorly depends on a high-quality tracking smart application. The variable is directly linked to the overall improvement of the quality of healthcare. For the purpose of this study, the control experiment will be achieved by observing the wellbeing, recovery and overall progress of patients using the app can be compared with patients in similar scenarios but not using the app.

Independent Variable

Integrating mobile smart apps with EHR systems is the independent variable, which dictates the process and outcome of the study. The app will be linked through commands that will allow for retrieval, update, and comparison of data that is already existing in the EHR database. Modification of data in the database will be accomplished upon approval of the supervisor in charge. Majorly, the project is designed to reduce fatalities among critical recoveries in hospitals by allowing integrated apps to monitor the progress of the patients in real-time. Subsequently, this project will lead to a reduction in the cost of healthcare following the fact that readmissions are commonly associated with huge costs and sometimes death. The app will further enable medical practitioners to become better and more efficient in their work. They will be able to release patients without the doubt of losing them immediately they are discharged from hospital.

Goals and Objectives Measurable

The ultimate goal of this study is to develop an app that can source crucial information from EHR and use it to monitor the health of discharged patients. Interestingly, the objective is measurable such that a reduction in the number of hospital readmissions can be evaluated among patients using the app and compared with patients that are not using the given app. It is expected that the rate of readmission among patients with critical illnesses will reduce considerably in the event that they smart apps can monitor their health consistently. Based on the information collected from these patients, the app can trigger a timely recall of a patient or recommend a checkup with their medical officer.

Gathering Data

Implementing this study will be undertaken by studying existing case studies, hypothesizing, and recommending future studies that could assist in the verification of the given study. The app will be used to gather data about the subscribed patients from the EHR systems. End-users of the app will be the patients and attending doctors; however, they will be accessing the system from different interfaces. The patient will only view information or receive notifications on their information; however, the doctors will be able to view notifications or view information about all patients they are assigned to monitor.

Cost of Using the App

Using this app will undoubtedly be associated with transmission and maintenance costs. A smart wrist device will constantly collect and update data to the control server for processing, which means it will only operate by being connected to the internet. If established to be highly efficient, customers will be given the choice of either using it, seeking constant hospital appointments, or abandoning the monitoring process all the same. The patients must be made aware of the cost implications as well as the advantages of using the app.

RESEARCH METHODOLOGY

Statement of Purpose

The study was intended to explore the utilization of patients’ records using a smart mobile app. This app was designed to allow patients and health caregivers to monitor the health status of the chronically ill patients to prevent escalation of the disease, relapse, or readmission. The research targeted patients from a single facility where the given app could allow patients to interact with the main servers by providing their symptoms and recovery progress. Meanwhile, the attending physicians could monitor the wellbeing of the patient using the notifications generated based on the updates given by the patient and the devices attached to the patient.

Description of the Methodology

The research will be conducted based on a mixed methodology approach to address the loopholes identified in the literature analysis. Currently, the utilization of smart applications to monitor human health is ongoing albeit slowly. It is therefore apparent that under the right circumstances and with the utilization of quality models, smart app technology can be utilized actively to monitor the health of patients after they have been discharged from hospital. The app allows patients to track their health while maintaining a personalized assessment of their progress once they have been treated and discharged from hospital.

Quantitative Survey

The quantitative analysis will be descriptive and correlational due to the nature of research. HealthVault is an application that patients are already using to utilize electronic health records. The study will allow the researcher to assess the efficiency of the application and its relevance to the current study. In this case, the research will be conducted to demonstrate that proper utilization of the application can be used to improve the overall health status of discharged patients. Ultimately, the assessment will be used to build an understanding of the impact of the app in reducing death rate, mainly due to delayed response to an escalation of the disease.

Correlational Analysis

A correlational analysis allows the researcher to evaluate the strength of the relationship between two quantitative variables. In this case, the study seeks to establish the relationship between use of a smart app to monitor health and a reduction in the rate of mortality among subscribed patients. It will target a sample of 50 patients, who are using the app versus 50 previously treated patients who are not using the app. According to Javali, Gudaganavar, and Raj (2011) 50 participants are sufficient for internal consistency and reliability. Majorly, the study assumes that after visiting the facility the patient is registered into the hospital EHR system from where information about their health will be kept and utilized for reference upon demand. With the assistance of the smart app, accessing information from the system will be made easier. Additionally, the patient will be able to update the information automatically or by inputting their systems whenever heart rate, temperature, blood sugar, and blood pressure decreases or increases.

Irregular body symptoms will trigger an alert in the system and the patient may be required to visit the hospital or have the physician visit them at their homes. Uniquely, the study will seek to demonstrate that monitoring the wellbeing of patients remotely and in real-time is important in the preservation of their health. An application that communicates with the EHR in real-time will allow patients to live safely if when they are experiencing life-threatening and chronic illnesses.

Data Collection

Data is crucial in building a comprehensive assessment of any given research question. It allows the researcher to make a strong conclusion based on statistical facts that can be proved beyond a reasonable doubt. Information will be obtained from a selected EHR system, upon which information regarding the users will be analyzed based on the current wellbeing of the patients. The record will show the time each patient was enrolled into the system, their record of diagnosis and treatment, and their current health and mortality status. The current status will be recovered, recovering, under diagnosis, or undergoing treatment. Presumably, this information exists in the database records of each patient. Data on patients with similar conditions who are not using an integrated app will also be obtained from the system and compared with the data of patients who are not using the app. The challenge of fetching information about the current health or mortality status from the system may be difficult for patients who are not using the app. It may require the researcher to obtain such information from other relevant registries.

Data about the cause of death may need to be assessed comprehensively to ensure that death emanated from a delayed response. Other factors such as successful diagnostic and treatment incidents will be assessed to establish whether their progress is as a result of the quality of treatment they received or as a result of the monitoring using the aforementioned app. Understanding the criticality of the app will allow the researcher to build on the recommendations and determine whether the patient needs to track their data using an integrated system or the problem can be addressed by having the doctors treat the patient with thoroughness to avoid cases of relapse or death.

Data collection instruments in this study will be a wrist smart watch, which will fetch data on temperature and heart rate. The watch will communicate with the mobile device, where the patient will be able to provide further information such as how they are feeling through their user interface. The information will be temporarily updated in the database from the patient’s device; however, once the attending physician approves, it will be recorded permanently as an update from the patient for subsequent references. The physician attending to the given patient may respond to the patient’s post and any actions undertaken during the subsequent appointments and other follow-up procedures. Therefore, the researcher will only be required to obtain information from the hospital database under the underlying terms and conditions.

The information collected is connected to the research questions in the sense that the research question highlights the correlation between the use of the app and the prevention of death following a delayed response. The data obtained allows the researcher to determine whether mortality, relapse of recovered patients, and escalation of previously treated illnesses can be prevented by utilizing the smart app – EHR integration. Cross-examination of the health workers may be a viable approach of determining whether the app makes the diagnostic and treatment procedures more efficient or not.

Upon collection, the data will be analyzed by comparing individual cases and their recovery trend based on whether they have used the app or not. Understanding the cases will allow the researcher to demonstrate whether the app is important in preventing patients against escalation of the diseases or mortality just by understanding the progress of their health in real-time.

Qualitative Analysis

Qualitative analysis will also be undertaken by conducting interviews among the medical staff in the selected healthcare facility. Majorly, this approach will be undertaken to understand the importance of the given application in managing patients that have been diagnosed, treated, and discharged. The researcher will book appointments with as many physicians as possible to obtain a viable opportunity to ask all questions that are relevant to the given study. Confessions and testimonies about their experiences will allow the researcher to determine the viability of the given smart app in managing critical patients after they have been discharged from the hospital.

Consistency of the information obtained will be evaluated based on the similarity in the responses from the patients. On the other hand, the accuracy of the information will be obtained by make comparisons with the statistical records obtained from the EHR files. Essentially, the responses obtained in this study will allow the researcher to understand the process within which the app can be utilized to optimize performance yield a desirable degree of efficiency. The data will be recorded in form of narrations from the respondents. It may be recorded for future references; besides, it will allow the researcher to highlight all the issues mentioned and discussed by the respondents.

Trustworthiness of the Study

Trustworthiness of any research is crucial in upholding the integrity and reliability of the research in its long run utility. Additionally, the information provided is expected to allow readers to adopt the recommended solution with the assurance that it will work. To ensure that the information collected will be trustworthy, the researcher will need to undertake extensive measures towards obtaining as many cases as possible from a healthcare facility that allows patients and physicians to interact with the EHR. The information collected must be truthful and a declaration form signed by the health administrator may be required to ensure the truthfulness of the information used in the research. Trustworthiness in this case will be ascertained by assessing the validity, reliability, and objectivity of the findings upon conducting the research.

Validity

Mostly, validity tests the accuracy of measure in assessing the correlation between the underlying variables. In this regard, it is fundamental that the results measure the attributes they are designed to measure in a concise and clear manner. Additionally, the measure must align with the underlying research theories, which implies that the research must be conducted based on viable models that allow the researcher and the reader to ascertain the suitability of the results in the given research. Hamad, Savundranayagam, Holmes, Kinsella, and Johnson (2016) observed that tests in a valid measurement are characterized by being reproducible such that if the survey was to be conducted repeatedly under similar circumstances, similar results would be achieved. Based on this concept, the validity of the study can be achieved by comparing and analyzing similar cases in the EHR database of the selected hospital.

The study will be conducted on a health facility that already has a reliable and properly integrated EHR system. In this case, it will be possible to undertaken a comprehensive analysis on the manner patients have been subscribing to the smart app in question. In essence, the existing system will facilitate an easy evaluation of the system while maintaining the privacy of the patients. However, conducting an extensive assessment will be necessary to provide a proof that there is indeed a correlation between using the app and reducing the possibility of a relapse or escalation of the disease. To establish the validity of this data, therefore, the researchers will be required to undertake an in-depth assessment of patients that are already using the app.

Viable Tests for Validity

Validity in this survey will be tested by comparing results of various patients. Clearly, the integrity of the results will be identified from the records of patients that are already using the app compared to the results of the individuals not using the app. regardless of the opinions of the respondents, EHR records will be used to demonstrate the viability of the application. Due to the nature of the research, conventional tests may not be viable; therefore, the validity of the data will be ascertained by the judgment of the researcher.

Trustworthiness of QL method

Trustworthiness of the qualitative survey will be assessed depending on the consistency that will be highlighted in the overall responses. Obviously, the respondents will be requested to sign at the end of their interview declaring that the responses they give are true to the best of their ability. Assessing responses on initial responses may provide the researcher the opportunity to identify loopholes that may be used by the researcher to improve on their subsequent interviews. Ultimately, the researcher exhibits the advantage of ascertaining the truthfulness of the responses during the proceedings of the interview.

Privacy Concerns

Privacy is an important aspect in addressing the issues affecting most patients in hospitals. Moreover, conducting research among patients is highly sensitive, which shows the importance of taking precautionary measures to ensure privacy among patients is respected accordingly. In this case, it means that accessing and assessing the records of target group will need to be undertaken in a highly confidential approach to avoid interfering with their confidentiality. All patients selected for the assessment will need to be notified and their consent sought before any assessment can be undertaken on their records. As such, comprehensive paper work and consultations with the hospital’s management will allow the right patients to be outlined for the survey.

Probable Difficulties in Executing the Study

Inasmuch as the study in question is highly critical in determine whether the wellbeing of patients can be improved by integrating smart technology into monitoring their health, establishing its viability remains a highly legitimate challenge. Mainly, this can be attributed to the prevalence of the multiple factors that influence the wellbeing and quality of healthcare. For instance, while some patients need an automated system to monitor the quality of their health, some can depend on their individual discipline and an alteration in their lifestyle to ensure their illnesses do not return once they have been successfully diagnosed and treated.

The role of the app in this case remains an issue of concern due to the dynamic nature of illnesses. Considering that most of these diseases are currently being managed by consistent consultations with the doctors, the role of the smart app in managing them can arguably be placed in legitimate criticism. Essentially, addressing this issue would require a prolonged period of studying a certain set of patients to determine the long-term effect of utilizing the given app to manage certain illnesses in real-time. Obviously, this would require an assessment of common issues affecting modern health such as strict routines that make it difficult for certain individuals to monitor the wellbeing of their bodies.

To understand whether using an app is essential and viable, the study will only be limited among patients experiencing chronic illnesses such as diabetes, high blood pressure, and cancer. It means the researcher may be required to evaluate the records of such patients, who are already using the application to ascertain whether using the app has made it possible and easier to manage their sicknesses and improve the quality of their health. Cross-examining willing individuals may be necessary; however, undertaking a comprehensive survey of the challenges affecting them and leading to the underlying predicament they are in may be necessary to determine whether an app may be necessary.

Failure to prove that an app may be necessary is highly probable due to the nature of the research. Obtaining consent is; for instance, a single attribute to determining the quality of this survey. Getting the patients and having them cooperate is another aspect, which would need more time and resources. Limiting the scope of the research remains a viable option where the researcher obtains information from healthcare facilities that have already integrated their EHR systems with smart apps to monitor the health wellbeing of their patients. Assuming that no hospital has already embraced this system, it would require the researcher to demonstrate the importance of such a system by building an app and using a set of 100 patients to determine its viability beyond a reasonable doubt.

Major Populations in the Study

The target population for this study will be healthcare providers from the target hospital of choice. Primarily, these will be patients who have been using the app versus those that have not been using the app. Interviewing these respondents will be subject to approval by the hospital administrators. For the interview to happen, administrators will need to make contact to the patients requesting them to participate in the given study under a set of terms of conditions. Essentially, this participation will be entirely voluntary, but the researcher will need to make viable efforts to ensure the target research subjects understand the significance of the study and that the researchers will respect their confidentiality. Meanwhile, the terms and conditions will be observed unconditionally during the process of the study.

Ethical Considerations in Regard to the Recruitment of the Participants

Prior to implementation of the study, this proposal will be submitted to the Institutional Review Board for approval or study procedures and consent procedures. Particularly, these considerations will be subjected to the underlying ethical principles of beneficence, autonomy, and justice. Conceptually, beneficence entails that the actions of the researcher are intended for the ultimate good. Respect for autonomy among the participants will also be upheld. As such, only adults of sound mind will be allowed to participate in the study. Subsequently, the ethical principle of justice will be applied to apply fairness in the manner information collected will be used in the decision-making process.

Confidentiality in handling of information collected will remain an important aspect in the entire research. According to Bowser, Shilton, Preece, and Warrick (2017), ethical attributes such as confidentiality, openness, and legality build a sense of good faith and encourage participation of relevant target participants. Explaining the details of the research and the implications of participation in research will enable the participants to be more open, which will make their responses more viable to the research.

Plans of Addressing the Participants

The major plan of addressing the target participants will involve making initial contacts to request the participants to respond to a set of questions that will assist the completion of the underlying research. Another plan will entail booking appointments to ensure participants undertake the study while they are available and comfortable to participate in the study.

Ethical Concerns with Respect to Data Collection/Intervention Activities

Ethical concerns and values are not only important in handling participants; they are critical in the handling of data collected in the course of the research. All data collected, therefore, will need to be handled with absolute confidentiality. Additionally, the information collected will be utilized only for the purposes highlighted in the disclaimer such that the participant will understand the purpose of undertaking the given study.

Participants Refusing Participation

It is possible that the target participants may refuse to participate in the study. In this case the researcher will need to respect their decision. Considering that participating in the research is not compulsory, agreeing with the participant’s resolve is prudent; however, convincing the participant to take part in the research is viable especially because the number of target participants is small and each input is paramount in enhancing the quality of the research.

Early Withdrawal from the Study

Besides refusing to participate in the research, certain participants may refuse to proceed with the research even after agreeing to participate. Under such circumstances, asking the reason for withdrawing from the study will enable the researcher to get closure. The researcher may seek to understand if there is anything they can do to make the researcher to change their mind.
Response to any Predictable Adverse Events
Besides withdrawal from the study, adverse or undesirable events are likely to occur, which may interfere with the collection of data for the given research. Mostly, some of these events are inevitable, however, the researcher must establish contingency measures to ensure they obtain the appropriate responses from the right respondents. Setting aside resources, working on the right strategies, and anticipating all probable drawbacks could protect the researcher against undesirable consequences such as failing to conduct the research exhaustively and conclusively.

Handling of Data

All data collected needs to be utilized appropriately to ensure a successful generation of the research inferences. Besides, it is prudent to safeguard the data collected for future reference. Treating the data with confidentiality and caution also ensures such data remains in the right hands. Ultimately, it is critical that the researcher and relevant data handlers uphold the terms and conditions that were utilized during the process of collecting data. Access Privileges to collected data must as well be limited to the designated handlers such as the researcher and the research supervisor. Subsequently, protection of confidential material must be done with absolute caution to prevent accidental or coincidental infringement of the underlying confidentiality agreement. Data collected will be maintained in a safe and secure area, with the access only limited to authorized personnel. Any electronic data will need to be protected through use of passwords, biometrics, and encryption.

Ultimately, while conflicts of Interest are likely, managing such conflicts facilitates a viable collection of data and a conclusive completion of the research. In this study, the probable conflicts of the study could emanate from conducting research on patients whose conditions are already apparent or visible through external symptoms. Disclosure of probable sources of the conflict of interest by the researcher to the participant plays a fundamental role in the avoidance of such conflicts. The research anticipates that they will not receive any financial or promotional benefits from implementation of this study. Disclosure forms will be used to enable the respondents to understand which data they will be required to provide to facilitate the completion of the study.

Summary of the Proposal

Various studies have previously indicated the importance electronic health records in the storage and retrieval of patients’ records in healthcare facilities. Besides using these records for reference, however, most healthcare facilities have not utilized these records to address medical problems proactively. In that regard, this proposal demonstrates that these records can be utilized for proactive management and mitigation of undesirable ailments by linking EHR systems with mobile smart apps. The proposed smart apps would allow both healthcare providers and the patients to communicate with the system in real-time. Particularly, if these records can be utilized in real-time, the study seeks to demonstrate that they can be utilized to manage patients with chronic diseases by raising response alerts. Subsequently, this can reduce incidents of relapses and life-threatening readmissions.

Tracking the wellbeing of patients after they are diagnosed, treated, and discharged remains a significant challenge even in modern clinical medicine. Arguably, the current healthcare model assumes that patients will always go back to hospital whenever they develop symptoms requiring medical attention. The major question regarding this issue is, what if these patients can be tracked using the modern technology of smart applications and devices that support such applications. Since electronic health records (EHR) systems have been introduced in the modern healthcare system, it is prudent to utilize them appropriately using smart-app technology. Current studies demonstrate that following up on the wellbeing of patients is mostly difficult or impossible. Using a systematic technological model, it could be possible to monitor the health progress of patients after their time in hospital. The study demonstrates that integrating a mobile app with existing EHR systems can reduce incidents of disease recurrence or relapse among discharged patients.

Significance of the Research

The study is highly relevant in the management of chronic diseases in modern medicine. It is also in line with the advancement of smart technology that allows devices to sense body symptoms and communicate with other interlinked systems through the Internet of Things (IOT). The study allows the researcher to assimilate a series of concepts on the importance of an interlinked system between EHR and a mobile device. Fundamentally, the study demonstrates how patients can be allowed to take charge over their health with the assistance of autonomous systems that facilitate the deliverance of quality healthcare.

Potential Challenges and Limitations of the Study

The drawback of the highlighted studies is that they fail to provide a direct connection between the availability of doctors to monitor the health situation of their patients. According to Kawatsu et al. (2018), most doctors are mostly too busy dealing with new cases to monitor discharged cases. In this case, the proper utilization of the proposed mobile app may not be implemented successfully to address the needs of the patients. Nonetheless, it is possible to initiate a framework where separate monitoring departments to monitor the wellbeing of the patients. Obviously, this would translate into additional costs of operation within hospitals; yet, there lacks a viable approach within which the doctors monitoring these cases can achieve financial gains from such patients.

The study is also limited by the prevalence of too many cases of patients and illnesses. It means that managing the inherent cases associated with most people could become unpractical for most patients. Consequently, it is prudent to reduce the number of cases to a limited number of patients, which would mean the system would have to narrow down the monitoring process to patients suffering from chronic or highly sensitive diseases. Understanding the overall process within which the monitoring process operates may be important for healthcare providers, which means that doctors within the hospitals building and testing such systems may need to undertake training on the most viable approaches of managing these cases.

Recommendations on Future Research

Numerous attributes remain unaddressed in this research; therefore, further and advanced research may be necessary may be necessary to facilitate efficient application of the proposed technology. Of concern in the implementation of this technology is the fact that most healthcare providers are overwhelmed by the prevalence of numerous diseases and health complications among most people. Building an autonomous system to counteract the challenges of implementing this system is thus necessary and fundamental in the ultimate utilization of the system that will enable all individuals to use smart technology to monitor their health and mitigate undesirable or life-threatening symptoms.

It is apparent that all healthcare facilities need to monitor the health of their patients even after they have been treated and discharged to ensure they live healthy lives while the technology monitors and manages their body health and performances. In this regard, the highlighted studies ascertain the importance of proper communication between hospitals and their patients. In essence, this mode of communication can be enhanced efficiently and conveniently using smart app technology and the rich information that exists in EHR databases. Interestingly, the proposed technology provides the backbone upon which customized applications can be developed for healthcare organizations to facilitate effortless and real-time communication among practitioners and their patients. From the studies highlighted in this proposal, smart apps can be used to enhance proper communication, which can undoubtedly reduce readmission of patients once they have been treated and discharged from hospitals.

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