Development of a Smartphone App for Regional Care Coordination among High-Risk, Low-Income Patients

David T. Liss*, Tiffany Brown, Julie Wakeman, Shira Dunn, Ana Cesan, Adriana Guzman, Amish Desai, David Buchanan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Despite widespread adoption of health information technology, U.S. providers face persistent barriers to coordination of care. We sought to develop and implement a patient-centered smartphone app that facilitates care coordination when patients receive care at any hospital in a region. Materials and Methods: Partnering with patients and primary care teams at a federally qualified health center (FQHC), we developed an app that (1) used real-time location data to identify encounters at 41 regional hospitals; (2) sent notifications to users' phones, asking them to confirm hospital arrival/discharge, and; (3) sent automated messages to primary care teams about confirmed hospital encounters. App design included multiple, successive rounds of active patient participation. In a small beta test of the initial version of the app, high-risk, low-income FQHC patients ran the app on their phone for 3 months. A formative mixed methods evaluation examined the app's technical performance and user experience. Results: Twelve patients enrolled in the beta test and provided follow-up data; 11 (92%) were racial/ethnic minorities. Participants obtained emergency or inpatient care at four regional hospitals. The app had 75% sensitivity to detect events when notifications should have fired, and 90% positive predictive value (PPV) of events when notifications fired. Barriers to implementation related to the app's user interface and the performance of its location tracking algorithm. Conclusions: We partnered with patients from a traditionally underserved population to develop a new smartphone-based approach to regional care coordination. The app had moderate sensitivity and high PPV for identifying regional hospital visits.

Original languageEnglish (US)
Pages (from-to)1391-1399
Number of pages9
JournalTelemedicine and e-Health
Issue number11
StatePublished - Nov 1 2020


  • M-health
  • sensor technology
  • smartphone
  • telemedicine

ASJC Scopus subject areas

  • Health Informatics
  • Health Information Management


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