About the Challenge
Congratulations to the Winners of AHRQ's Digital Solutions to Support Care Transitions Challenge!
AHRQ is awarding $50,000 for first place and $25,000 for second place to two challenge winners for prototype development.
CareLoop's Safe Discharge Communication Pathway, empowered by the interoperable CareLoop® platform, ensures safe transitions in care for patients and care team members. The team applied an agile approach to person-centered design, rapid prototyping, and advanced informatics methods, HL7/SMART on FHIR and only HIPAA-compliant tools and services, with a modern asynchronous interoperable communication platform. The innovative solution provides closed-loop and context-specific communication between the patient and family caregivers and hospital, primary care, and community partner care teams throughout the hospital discharge to home transition in care. In this Challenge, design partners addressed the information-sharing needs, burdens, and gaps for patients with three emblematic chronic conditions (congestive heart failure, hypertension, and depression) and showed a clear commitment to diverse audiences, especially those with low health literacy and low English-language proficiency. The team specifically accounted for the COVID-19 public health emergency and the consequences of social isolation on care transitions, switching from in-person to virtual design sessions to recruit representative focus group participants.
CareLoop will continue to enhance the Discharge Pathway with user-centric modifications to address users who are patients or family caregivers with low health literacy or limited English proficiency. The team prioritized five design ideas that they will continue to build out: 1) testing data-driven personalization triggers, 2) creating an educational resource library for patients and family caregivers, 3) creating an assessment library for clinical teams, 4) improving processes for collecting and analyzing co-design feedback, and 5) gaining feedback on perceptions of intelligent virtual assistants.
WeWa.life is a personal health navigator platform designed to address underserved individua and virtual health community needs. An intuitive phone app enables health consumers to be in control, informed, entertained, engaged, and activated around the most important thing in their life--their health. The WeWa.life Cloud platform provides a single point of integration with existing health consumer systems using open APIs and an interoperable system architecture. Our WeWa.life developed a user-centered design solution incorporating behavioral science and interoperable digital health technology to provide a hyperpersonalized approach to managing health and improving medical outcomes along six Health Goal pathways. The solution is well-grounded in existing literature regarding healthcare costs, adherence and medication safety, and health information technology policy and focus on three key aspects of care transitions that are similarly well-grounded in existing evidence: discharge instructions, medication management, and followup care.
WeWa.life will continue their progress to finalize the commercial version of their app, develop a Spanish-language interface for WeWa.life, expand the web interface and backend portal, add additional health pathways (goals), continue developing the digital voice assistant, and develop large-scale real-world trials.
Congratulations to Our Phase 1 Semifinalists!
AHRQ has selected 5 semifinalists from Phase 1 of the AHRQ Digital Solutions to Support Care Transitions Challenge.
Each Phase 1 semifinalist was awarded $20,000 and will move on to Phase 2 to develop their prototype. After the five organizations build out their solutions, a first and second place winner will be awarded.
University of Texas Health Science Center at Houston
With significant advances in prenatal and postnatal care, an increasing number of premature infants and infants with complex medical problems survive to be discharged from the neonatal intensive care unit (NICU). The immediate period after leaving the NICU is critical for parents as they move from the hospital environment to the home setting and is the period in which parental knowledge, skills, and resources can have tremendous impact on an infant's outcome. In a collaboration of UTHealth's McGovern School of Medicine together with the School of Biomedical Informatics (SBMI), we will develop a telehealth application, MyInfantCare, that will provide tailored and adaptive content in an accessible and engaging format to support families and clinicians during the period leading up to NICU discharge through their initial visits with outpatient healthcare providers. Utilizing SBMI's existing digital health framework, Digilegos, we will incorporate customizeable digital modules spanning the evolving needs of infants, parents, and healthcare providers in a tool that will grow with the requirements of care coordination for high-risk infants in their transition from the NICU to home.
CareLoop's Safe Discharge Communication Pathyway, empowered by the interoperable CareLoop® platform, ensures safe transitions in care for patients and care team members. Applying an agile approach to person-centered design, rapid prototyping, and advanced informatics methods, HL7/SMART on FHIR, with a modern asynchronous interoperable communication platform, the innovative solution provides closed-loop and context-specific communication between the patient and family caregivers and hospital, primary care, and community partner care teams throughout the hospital discharge to home transition in care. In this Challenge, design partners will address the information-sharing needs, burdens, and gaps for patients with three emblematic chronic conditions (congestive heart failure, hypertension, and depression) with low health literacy and low English-language proficiency. The team will consider the COVID-19 public health emergency and the consequences of social isolation on care transitions and alter as needed the approach to the solution design.
University of Utah
Our objective is to better support the needs of patients returning home after hospitalization by engaging them in anticipatory planning and connecting them and those in their support network—family, friends, neighbors, outpatient providers—to community-based resources. The Going Home Toolkit electronic resource planner will utilize connections to the United Way 211 referral service and the patient's personal health record to enable efficient communication of post-discharge needs, referrals to supportive services, and systematic capture of patients' supportive resource information to better understand care transition needs. The Going Home Toolkit is organized around common needs after hospital discharge, such as transportation, medication, errands, meals, housework, personal care, billing and insurance, ongoing information, and support.
Target User: patients, caregivers, clinicians involved in discharge planning and education.
Nationwide Children's Hospital
Communication and comprehension of medical information is a known barrier in health communication and equity, especially for non-English-speaking caregivers of children with special healthcare needs. We employed user-centered design in understanding the problems identified by our complex care team members. After exploring the use of medical interpreters, the lack of interpreter service accessibility and translation technology maturity, our team at Nationwide Children's Hospital proposed to develop an EHR-integrated, multimodal (voice-interactive and text-based) communication and translation app, called Caawin, to enable non-English-speaking caregivers and providers to communicate with each other using their preferred languages. Caawin is initially intended to support Spanish-speaking families.
WeWa.life is a personal health navigator platform designed to address underserved individual and virtual health community needs. An intuitive phone app enables health consumers to be in control, informed, entertained, engaged, and activated around the most important thing in their life—their health. The WeWa.life Cloud platform provides a single point of integration with existing health consumer systems using open APIs and an interoperable system architecture. Our WeWa.life is developing a user-centered design solution incorporating behavioral science and interoperable digital health technology to provide a hyperpersonalized approach to managing health and improving medical outcomes. The platform has six Health Goal pathways. for the AHRQ Challenge, we are focusing on the Conditions and Medication pathway, which will address medication reconciliation, adherence, and care transition.
Challenge Overview Webinar
About AHRQ's Digital Solutions to Support Care Transitions Challenge
The AHRQ Digital Solutions to Support Care Transitions Challenge team held a webinar on March 5, 2020, to share information and answer questions about the challenge's purpose, themes, timeline/prize structure/submission requirements, evaluation criteria, submission process, and questions and answers. A closed-captioned version is available. (1 hour, 15 minutes, 32 seconds)
- Slide Presentation: AHRQ’s Digital Solutions to Support Care Transitions Challenge (PDF, 2.6 MB)
- Frequently Asked Questions and Answers About AHRQ's Digital Solutions to Support Care Transitions Challenge
- Announcing the Challenge
Care Transitions Challenge Video (1 minute, 41 seconds)
Alternative Audio-Described Version (1 minute, 41 seconds)
The Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services (HHS), is announcing a Challenge competition to develop interoperable health information technology (IT) solutions that engage patients and family caregivers during care transitions from inpatient hospital care to home (community living). AHRQ is using the America Creating Opportunities to Meaningfully Promote Excellence in Technology, Education, and Science (COMPETES) Reauthorization Act of 2010 to support this Challenge. 15 U.S.C. § 3719 (as amended).
To achieve the goal of improving care transitions, AHRQ is interested in receiving applications that propose technological solutions that ease administrative and information management burdens, and support patient activation and engagement, especially among Americans that may have low health literacy or limited English language proficiency. These technical solutions should leverage evidence-based standards.
Specifically, we seek solvers that will create interoperable digital health solutions that are developed with user-centered design. Solutions in this Challenge will improve care communications during transitions, develop and use standardized processes for leveraging and transferring data from electronic health records.
Fast Healthcare Interoperability Resources (FHIR) serves as a standalone data exchange standard, but can be used in partnership with existing widely used standards, accelerating the develop process for digital solutions. FHIR is used to address the people, processes, and technology needed to send, receive, and use digital care plans and optimize medication reconciliation. Winning solutions that use FHIR in this Challenge would enable patients, families, and caregivers to receive and understand hospital discharge instructions and care plans while easing administrative burden on physicians, nurses, and staff at discharging hospitals.
FHIR Standards are valuable to AHRQ as design and architectural components of solutions submitted to this Challenge. Solvers will clearly demonstrate in their submissions how their solution uses standards and will be built to incorporate updates.
AHRQ is looking for innovative digital solutions that:
- Serve people with multiple chronic conditions by reducing the burden of care transitions between hospital and home.
- Are created with user-centered design methods to address the needs of healthcare providers and patients, families, and caregivers.
- Include individuals from the multiple chronic conditions (MCC) community throughout the development and testing of prototypes.
- Account for diverse levels of health literacy, cultural and linguistic diversity, and ease of provider, patient, and caregiver use.
This Challenge incentivizes development of technological solutions; researchers wishing to conduct original investigations testing the implementation or effectiveness of technological innovations, should consider AHRQ's funding opportunity announcement, "Improving Quality of Care and Patient Outcomes During Care Transitions."
For Further Information Contact
Name: Priscilla Novak, Ph.D., M.P.H., PMP