Penn Medicine Name Digital Innovation Honoree

World-renowned for clinical, educational, and research excellence, Penn Medicine is one of the nation’s top academic medical centers. Our Information Services Department develops and manages technology that supports the day-to-day clinical, research, educational, financial, and management operations of five hospitals, several satellite practices, and more than 5,000 physicians. The Penn Metabolic and Bariatric Surgery Program offers complete surgical, nursing, nutrition, and psychological care for people with severe obesity.

We are trying to help patients with significant obesity lose weight through bariatric surgery, which reduces the size of the stomach and is the most effective and durable treatment for severe obesity. Today, 37.7 percent of US adults have obesity (while another one-third are overweight). Obesity is linked to heart disease, stroke, type 2 diabetes, and some types of cancer. Estimated annual obesity-related health care costs (excluding employment-related and social costs) in the US are $190.2 billion—almost 21 percent of annual medical spending. While 16 million US adults are candidates for bariatric surgery, only one percent receive the treatment—with the complexity and overwhelming nature of the preoperative process serving as the primary barrier. In addition to extensive pre-op testing, this process includes up to six months of supervised weight loss (required by most insurance companies) and certain lifelong post-op food restrictions.

Health care apps are based on the well-documented finding that patients want to be engaged in their own care. While most commercially available health apps are primarily directed at patients, Penn Life Gained, the Penn Medicine bariatric surgery app, early adoption technology launched in October of this year, is aimed at both patients and care-providers Additionally, patients use social media to share experiences with other patients, The app will generate more efficient care as a result of connecting the physician and patient to the care plan. It builds on and extends the benefits of Apple CareKit, an open-source software framework that allows developers to create apps for helping patients manage their medical conditions. Through the CareKit side of the Penn app, our patients: 1) receive pre- and post-op instructions and meal-time and supplement reminders; 2) monitor food intake, calorie count, and nutrition content; 3) set and track progress on personal goals; 4) gain access to online resources such as weight-loss support groups and recipes for healthy meals; 5) check their daily step counts and expended calories; 6) identify and report symptoms; and more, all with the goal of a better surgical outcome and sustained, life-long weight loss. In contrast to the few existing bariatric apps, our Penn-physician-designed adaptation includes a unique clinician facing app that enables doctors, nurses, and dietitians to supply targeted, individualized care, making adjustments as needed in response to real-time patient data and information. Through this clinician app, care-providers gain pre-op access to patients’ caloric intake, food choices, activity levels, and more in one convenient dashboard and communicate feedback and recommendations back to the patient—ideal for managing care and maintaining momentum between office visits. Post-op, clinicians can track patient progress, e.g., caloric and activity levels, vitamin and supplement adherence, and respond to episodes of pain, nausea, vomiting, problems at incision sites, and other symptoms reported by patients. (This information can also be incorporated into decision-support software for bariatric surgeons.) A key feature allows clinicians to customize the app, e.g., removing the post-op goal of daily weighing if a patient has a history of bulimia. Feedback from users and potential users has been positive: “I call and tell them that information all the time, so … there’s less I need to look up and tell them.” “I just like it that there’s someone else watching me.” “Knowing that Penn is behind [the app] … would make me feel comfortable using it.”

Since there are many commonalities in patients’ pre- and post-op surgical requirements, there is enormous market potential for our app, essentially encompassing every form of surgery as well as numerous long-term health care problems such as cancer, diabetes, and cardiovascular disease. Additionally, Penn has entered into a contract with Independence Blue Cross, in which Penn will not seek reimbursement for hospital readmissions within 30 days after inpatient stay or surgery. By alerting physicians to patient hurdles and complications in real time and enabling timely interventions, the app may reduce 30-day, non-reimbursable readmissions. And by actively engaging patients with their caregivers in the demanding pre-op process described above, we expect to reduce the attrition rate and more successfully lead patients to having the surgery. Finally, bariatric surgery provides overall health care cost savings within two-four years of the procedure, reducing expenses for patients, insurers, and businesses that pay for their employees’ health insurance.

This blended patient/provider app is Penn-owned and Penn-developed, compelling features in light of Penn’s international reputation for health care excellence. Penn Metabolic and Bariatric Surgery, which developed the physician-side of the app in conjunction with Penn Medicine’s Information Services Department, is the highest volume and most experienced bariatric surgery practice in the Philadelphia area.