Adherence Module - Case Study

Summary

The Adherence Module is a clinician- and admin-facing platform that helps HealthOsphere monitor and improve patient adherence to prescribed therapies and home-medical regimens. Built as part of a larger home-health ecosystem, it centralizes patient profiles, task orchestration, communications, analytics, and escalation workflows so care teams can proactively close gaps in therapy, reduce readmissions, and increase patient satisfaction.

Features Built

• Patient 360 dashboard: Contact, ordering doctor, insurance, therapy history, orders.
• Task & team management: Assign, track, reassign tasks; SLA & escalation rules.
• Outreach engine: Pre-populated emails, HIPAA-eligible SMS, automated voice calls / dialer.
• Triggers & workflows: Rules that spawn tasks based on events, e.g., missed delivery, refill overdue.
• Document & note management: Patient notes, attachments, audit trail.
• Reporting & analytics: Inactive patient lists, trigger volumes, outreach effectiveness.
• User/role configuration: Region priorities, groups, admin privileges.
• Utilities: Autodialer management, contact preferences, support docs, and inline help.

User Flow: How Care Teams Use It

• Patient intake / sync: Patient records and orders are ingested from the parent system / EHR into the Adherence Module via FHIR.
• Risk/triggers evaluation: Automated rules scan records (e.g., therapy start date + supply cadence) and flag non-adherence risk or overdue actions.
• Task generation: For each trigger, the system auto-creates a task and assigns it to a team/role based on region/priorities.
• Outreach: Assigned user launches outreach from the module (phone/SMS/email templates or autodialer). Contact preferences are respected.
• Interaction & documentation: Notes, outcomes, and documents are logged to the patient’s timeline (audit trail).
• Escalation & closure: If outreach fails or needs higher-level attention, escalation rules reassign or open follow-up workflows.
• Reporting loop: Outcomes update dashboards and KPIs; managers adjust rules or training based on reports.

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Client Objective

• Raise therapy adherence to improve clinical outcomes and reduce readmissions.
• Centralize outreach and task orchestration to reduce manual work and missed follow-ups.
• Provide auditable communication channels while remaining HIPAA-compliant.
• Increase patient satisfaction and retention through timely, preference-aware communications.
• Produce actionable metrics for operational leadership to drive continuous improvement.

Problem Statement

Before the Adherence Module, patient follow-ups and outreach were fragmented across phone systems, spreadsheets, and multiple portals. That led to:

• Missed follow-ups and delayed interventions.
• Lack of a single truth for outreach attempts (no standard audit trail).
• Manual assignment of tasks causing uneven workload and slow response times.
• Difficulty proving compliance and securely handling PHI during outreach.

How We Addressed the Challenges & Solved Them

1. Single Source of Truth

Ingested patient and order data into the module and normalized it using FHIR/standard mappings. This enabled consistent trigger detection and reporting.

2. Rule-Driven Automation + Human-in-Loop

Built a rules engine to create, assign, and escalate tasks automatically while keeping clinicians in control for sensitive decisions.

3. Secure, Audited Communications

Used HIPAA-eligible messaging and telephony providers for SMS/voice with required BAAs; preserved full logging and consent status for each outreach. Twilio and similar vendors are commonly used for HIPAA-eligible messaging when configured under a BAA.

4. Smart Dialer + Contact Preferences

Integrated dialer controls and contact preference checks so patients receive communications on preferred channels only; autodialer management sits in the admin utilities.

5. Scalable Architecture and Background Processing

Offloaded scheduled jobs and heavy tasks to background workers (e.g., job schedulers, queues) to keep the UI snappy and ensure reliable retries for outreach.

6. Compliance & Cloud Data Strategy

Stored ePHI in HIPAA-aligned cloud services (managed FHIR/APIs or HIPAA-eligible cloud services) and enforced encryption at rest/in transit, role-based access, and Key Vault style secrets management. Managed FHIR platforms (e.g., Azure Health Data Services / API for FHIR) are used to securely expose standardized healthcare APIs.

7. Analytics & Leadership Reporting

Built dashboards to show trigger volumes, outreach attempts vs. successful contacts, inactive patient lists, and team performance, enabling data-driven process changes.

Discover how healthcare workflow automation can cut manual follow-ups. Learn how this architecture keeps care teams aligned.

Outcomes & Impact

• Reduced missed follow-ups: automated reminders and dialer reduced missed patient contacts (typical programs report double-digit percentage drops in no-contact rates).
• Faster task resolution: task automation cut average time-to-first-contact for high-risk triggers by a significant margin.
• Improved documentation & compliance: every outreach became auditable with consent and channel-preference tracking, simplifying audits and BAA requirements.
• Operational efficiency: centralization reduced duplicate work and improved staff utilization.
• Patient satisfaction uplift: proactive, preference-aware outreach increased reported satisfaction and retention.

APIs & Tools Used

1. Communications & Telephony

• Twilio Programmable SMS/Voice / Twilio Flex: SMS, programmable voice, IVR, and contact center. (HIPAA-eligible with BAA and correct product selection).
• Genesys / Avaya / Vonage: enterprise contact center solutions used by healthcare call centers when omnichannel routing is required.

2. Clinical Data & Interoperability

• FHIR APIs / HL7 standards: patient records and encounters exchanged using FHIR resources (Patient, Encounter, MedicationRequest, etc.). HL7 FHIR is the primary modern standard.
• Vendor EHR APIs (Epic on FHIR, Cerner, etc.): used to sync clinical and order data with the module. Epic provides FHIR endpoints and sandbox/specs for developers.

3. Cloud & Managed Health Services

• Azure Health Data Services / API for FHIR: managed FHIR service for secure PHI storage and FHIR REST access.
• AWS HealthLake / GCP Healthcare APIs: configured for HIPAA-eligible services.

4. Background Processing, Scheduling & Real-Time

• Hangfire / Azure Functions / AWS Lambda: background jobs and scheduled tasks for rule evaluation and retries.
• SignalR / WebSockets: real-time updates in the React UI for live task assignment and progress.

5. Data, Analytics & Reporting

• ElasticSearch / SQL Server / Azure Synapse / Power BI / Tableau: for search, reporting, and dashboards.
• Observability: Application Insights, Prometheus, Grafana for telemetry and uptime.

6. Security & Identity

• OAuth2 / OpenID Connect / JWT: for authentication; role-based access control for ePHI.
• KeyVault / Secrets Manager: secure secret storage.
• BAA & vendor compliance checks: essential for any third-party communication or cloud vendor.

Implement HIPAA-compliant patient communication tools to keep outreach auditable. See how we do it for leading clinics.

Security & Compliance Checklist

• Sign BAAs with all vendors handling PHI (e.g., telephony provider).
• Store PHI in HIPAA-aligned cloud services and encrypt at rest/in transit.
• Maintain full audit trails for outreach and consent status.
• Use FHIR and vendor EHR APIs for consistent patient identity and record linkage.