The COVID-19 pandemic has generated unprecedented and sustained health management challenges worldwide. Health care systems continue to struggle to support the needs of the majority of infected individuals that are either asymptomatic or have mild symptoms. In addition, long-term effects in the form of long-lasting COVID-19 symptoms or widespread mental health issues aggravated by the pandemic pose a burden on health care systems worldwide. This viewpoint article considers aspects of digital health care solutions and how they can play an ongoing role in safely addressing gaps in the health care support available from initially and repeatedly overwhelmed providers and systems. Digital solutions can be readily designed to address this need and can be flexible enough to adapt to the evolving management requirements of various stakeholders to reduce COVID-19 infection rates, acute hospitalizations, and mortality. Multiplatform solutions provide a hybrid model of care, which can include mobile and online platforms accompanied by direct clinician input and feedback. Desirable components to be included are discussed, including symptom tracking, patient education, well-being support, and bidirectional communication between patients and clinicians. Customizable and scalable digital health platforms not only can be readily adapted to further meet the needs of employers and public health stakeholders during the ongoing pandemic, but also hold relevance for flexibly meeting broader care management needs into the future.

Introduction: The transition from hospital to home disrupts the continuum of patient care, adversely impacting readmissions and patient engagement. Our study objective is to develop and assess a Digital Health Ecosystem (DHE) intervention to mitigate CABG and PTCA readmissions and improve patient satisfaction with minimal clinician burden. Methods We developed and assessed a DHE combining evidence-based personalized content; web-based clinician dashboards; patient caregiver mobile apps; and nurse care plans and escalation protocols (figure). A tertiary-care hospital in Bangalore, India deployed the DHE to address post-discharge challenges of CABG and PTCA. India is attractive for testing digital health due to its large population, large mobile phone penetration, large out of pocket healthcare costs and positive telehealth attitudes. In an IRB-approved retrospective study, Jan-Dec 2019, we assessed patient outcomes and satisfaction for 799 patients (CABG=325; PTCA=474). We used an all-comers real-world approach without exclusions to assess feasibility. Results Escalations of care (n=7665), were greater in CABG (n=4772; 15 per patient) compared with PTCA (n=2893; 6 per patient). The figure shows 101 higher level escalations from 82 patients (48 CABG, 34 PTCA) with 41 resolved via virtual care and 60 resulting in 35 ED visits and 17 hospitalizations. Net Promoter Score (NPS) indicated patients were loyal and likely to recommend the DHE. The hospital NPS increased by 60%, from hospital reported baseline of 47 to 75. Conclusions Only 10.3% of patients after discharge had serious complaints. There were relatively few ED visits (4.4% of patients) and even fewer readmissions (1.9%). This contrasts with Indian studies showing 10-20% readmission after CABG. We demonstrated a DHE that provides improved post-discharge patient care and satisfaction and can be implemented alongside traditional healthcare. Moreover, this DHE may significantly reduce readmissions.

BACKGROUND Among 36 million hospitalizations that occur each year in the United States, >5 million return for unplanned readmission within 30 days of discharge. Although, prevention of readmission due to clinical and procedural factors are considered, there has not been a sufficient focus on improving patient engagement to reduce readmissions. Poor patient engagement by the hospital clinical team results in the lack of knowledge of the disease and treatment in patients that further lead to inadequate self-managed care for recovery during the post-discharge period. OBJECTIVE The objective of this study was to assess proof-of-concept of a digital healthcare management ecosystem that allow human and digital interactions to reduce unplanned readmissions by providing comprehensive post-discharge care to individuals discharged after major surgery. METHODS Post-discharge care was through digitized tailored care pathways provided by 19 care coaches (1 for 50 patients) supported by a digital expert medical team. We tested our digital ecosystem from January 01, 2019 to December 31, 2019 in cardiac and orthopedic surgery departments, Fortis Hospital, Bangalore, India. The first six months was the testing period where the system was deployed, tested in real-world, and refined using feedback. The testing period was followed by six months of evaluation period. RESULTS A total of 152 patients were provided digital care during testing and 648 patients during the evaluation period. During a 30-day follow up after discharge, 80/800 (10%) communicated clinical complaints, and 39 were readmitted (4.9%). CONCLUSIONS Our results demonstrate feasibility and proof-of-concept of a comprehensive digital post-discharge care ecosystem, a unique innovative solution to reduce unplanned readmission rates and subsequently reduce healthcare costs. However, an important part of effectiveness of post-discharge care remains in testing our solution in large clinical studies

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BACKGROUND The coronavirus disease (COVID-19) pandemic has generated unprecedented and sustained health management challenges worldwide. Healthcare systems continue to struggle to support the needs of the majority of infected individuals that are either asymptomatic or have mild symptoms. OBJECTIVE To rapidly and safely address gaps in the healthcare support available from initially, and repeatedly, overwhelmed providers and systems. We sought to create a digital healthcare solution that could appropriately monitor and manage needs of individuals requiring self-isolation due to suspected or diagnosed COVID-19 with mild to moderate symptoms. METHODS A theoretically grounded multiplatform digital healthcare application was created to safely monitor and support this group of affected individuals based on rapidly emerging scientific guidance. The solution – COVIDCare – was designed to address this need and to be flexible enough to adapt to the evolving management requirements of various stakeholders to reduce COVID-19 infection rates, acute hospitalizations and mortality. RESULTS The COVIDCare multiplatform solution provides a hybrid model of care that includes mobile and online platforms, paired with direct clinician input. The patient mobile application includes four program components: 1) symptom management, 2) patient education, 3) wellbeing support, and 4) communication with healthcare providers. The clinician web-based portal includes secure, bi-directional, chat communication between the patient and clinician. CONCLUSIONS COVIDCare can flexibly address strategic needs of strained healthcare systems and is customizable to meet the needs of employers and public health stakeholders who continue to manage the lasting impact of the COVID-19 pandemic.