2021-01-18 NACHC+Agape App Demo

Welcome & Introductions

Andrea

ReAnne - Health Center, but also strong links with county health department.

Jennifer - Instructor for community health workers in eastern North Carolina. Her students work in community health settings across the state.

To help patients learn more about prevention and direct their own care and help communities Positive about the app in terms of ability to see overwhelming amount of information, be able to see stuff at home and think about it increase rates of HIV testing.  

Pedro - We could see this as part of a clinical workflow, for a provider to say "look at this app before you see me so that you can read at your pace and understand the issues we just talked about"

Demo of App and questions

Thai

Ken

Comment: One positive thing about the app is the ability of the users to be able to use this at home, and take it slowly understanding what is an overwhelming about of content; they can look at it in private and think about it.

Q: Does a person need to be connected to a health center, like a mychart situation, or can people just download the app without being affiliated?

A: The app will be in the Apple store and Google Android store; there is no requirement to be an existing patient. The app will be free and anyone can download it.

Comment: It would be helpful to include other Sexually Transmitted Infections (STI), mental health resources, and a reminder - this app is not monitored by anyone; all the information you put in the app stays on your phone and nobody can see it, not even the developers of the app.

Some suggestions:

• Have a button that says "Need to talk with someone?" a person could press 800 number to hotline to talk. Our patients have a lot going on, and few resources.
• Read aloud - closed captioning so that they can get privacy.
• Some of the terminology is technical and could be made more simple, like "post exposure."
• Have information about local resources, like where you can get medication or care on a sliding scale, transportation, other social services.

Ken - if you have support materials that you already use, these can be added into the app.  We are starting with generic information such as the CDC video, but we hope to get  locally-generated and locally-aligned material that health centers have created because they know their patients and have likely developed those in a way that will reach patients where they are.

Q: What is the name of the app? 

A: Name of the app is HealthFlow.

ReAnne - Privacy is important, the name of the app is neutral, and that's good.

Q: Is the information sold to a third party?

A: No, the information is not sold. The data is encrypted and it is only on the user's device. It does not go anywhere until/unless the user gives permission to someone else to see it.

•  The only reason we ask for location is to show you is to give the user local resources, and we can make that more clear. It does not track the user.
• The user can choose who they want to share which information with.
• Connection with Medical Care Team is coming as a future update.  HealthFlow is also adding a Personal Care Team to include family members and friends.  Users of the app will have full control over who sees what and can grant permissions depending on what they want to share and with whom.

Q: If the user puts in their zip code or allows location will it populate the information about the health center, eventually will there were options to include health centers and resources that are in driving distance?

A: Yes, information for the app will come from two places:

• Generic information, NACHC nationwide lists
• Information provided by the health centers that volunteer to use the app.

Q: If the patient puts in test results like CD4 is there a threshold or algorithm to alert the patient that they need to go to their provider?

A: HealthFlow is looking at different ways of doing this.  We can build in thresholds, starting with the recommended generic guidelines, but a provider could personalize this for a particular user.  If the user has a PCP, that provider can give the ranges, and eventually the app could send an alert to the primary care team if consent has been given.

Discussion about incentives: The way to use it is clear enough for patients; if you want buy-in the patients will need incentives, even $10. helps.

The health centers can put flyers up with a QR code and sharing on social media, emails to providers but incentives will really get patients to use the app.

Andrea: How have you, in the past, gotten meaningful feedback when you use incentives?

A: When we do on one-on-one case management, they could use the app with patients and provide feedback. If someone is already actively getting tested, there is an intrinsic incentive to use the app.  

A provider could say during an exam, "you have crossed these risk lines," here is something you can download to give you more information.  

If someone gets a positive HIV test, they might download it.

In a study in which ReAnne was enrolled, someone called, and asked questions.  Each phone call earned more funds added to the gift card. 

Text message is a way to get feedback.

In the future the feedback mechanism could be built into the app, and if you use and provide feedback it could give you the code for the gift care in the app itself. 

Agree: Feedback about the app is best done in the app.

Q: How wide is HealthFlow going for testing right now?  Jennifer has community health workers  that might be able to get patients to test this in the western part of the state.  

Thai - HealthFlow's goal for feedback is 2-4 health centers,10-20 patients each.

Andrea - We may want to start small, even getting 5 patients to test and give feedback would be a way to start.

Ken - The goal here is more HIV testing, and the messaging is important to make it relevant and useful.

Q: Where does the funding come from?

A: HRSA funds CAI Global through a grant for Technical Assistance and Training, CAI in turn contracted with NACHC to build the app specifically for the health center context.

Agape CHC just got a COVID grant from HRSA. 

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What information would Agape need in order to test the app with patients?

Ken and Agape

• Thai will be in touch to get information from ReAnne and Jennifer about resources so that they can be loaded into the app.
• Andrea will check in a few days to see if there are any questions.
• Andrea will check into the level at which NACHC can provide incentives to patients.
• Carol and Jennifer will think about how they might test with patients, and see if the community health workers in the western part of the state might be interested in a demo and piloting this with patients.