Patient Mobile Self-Care App Drives Better Outcomes

Anthony Macaluso Jr., MD Texas Colon & Rectal Specialists
Patient Mobile Self-Care
App Drives Better Outcomes

BY RANDOLPH FILLMORE

Texas Colon & Rectal Specialists, serving the Dallas-Fort Worth metroplex area, is the largest practice of its kind in the United States, with 17 specialists in 18 locations. TCRS colorectal specialists perform more than 2,000 surgeries and 8,000 colonoscopies every year using minimally-invasive, leading-edge technology and cancer screening protocols. TCRS doctors also treat a variety of other colorectal conditions, such as Crohn’s disease, ulcerative colitis and diverticular disease, among other conditions.

According to Nancy Bowman, TCRS executive director, as leaders in measuring and benchmarking their performance against industry standards – even with outcomes exceeding national benchmarks – the group wanted to continuously “raise the bar” and seek opportunities to improve their performance.

“It is part of our DNA to continuously seek improvements – both clinically and operationally – and to achieve better outcomes for our patients, while optimizing costs and utilization,” adds Bowman.

Bowman credits their 2010 conversion to electronic medical records (EMR) as being a big step toward greater “front end” efficiency. That conversion helped by doing away with the burden and shortcomings associated with working in a paper environment. But that didn’t go far enough.

“We wanted more,” Bowman says.

TCRS also wanted to improve their ability to measure performance based on patient-reported outcomes.

“We didn’t want multiple technology solutions,” she explains. “We wanted one solution that could electronically engage patients from the moment the first appointment is scheduled and throughout the entire treatment and recovery period. Most importantly, we wanted to optimize patient experiences, minimize or prevent post-procedure unplanned events, in-crease efficiency for the practice, and ultimately, collect data to document each patient’s outcome.”

To get them where they wanted to be, Bowman was looking for a single patient-facing solution to optimize patient flow, help patients prepare for procedures, and communicate any issues or problems post-procedure and/or post-surgery. One that included tools for securely collecting data directly from patients. They also wanted to be able to collect data from their patients’ responses, to see how they could improve, mitigate or prevent unplanned events. They wanted to see and understand “the big picture” about their patients’ outcomes. But, where to find what she needed was another question. No one vendor seemed to provide an integrated solution, and existing disparate platforms could not cross-communicate without significant development. In addition, the costs of implementation would be prohibitive.

Fortunately, with the help of their EMR provider, Athena health, Bowman found Qure4u, a mobile phone-based application designed for medical practices that can optimize patient-flow practices, help patients prep for procedures, provide tools for collecting data directly from patients and allow for post-procedure communications and monitoring.

“When that connection was made, the stars lined up,” says Bowman. “By tailoring the Qure4u app to our protocols, we’ve all but eliminated paper-based manual registration and check-in process, and dependence on phone call follow-ups. TCRS is now up to 88%patient engagement/patient usage with one affordable digital solution, not several. This is a very impressive number, because most practices using some form of digital patient engagement technology are only at 30-40% patient usage.”

Optimizing Patient Flow Saves Time and Money

“Qure4u has really improved patient flow,” says Bowman. “The patients like it because of the convenience factor, and we like it because when we used the paper check-in and history forms, patients would often skip over some important areas of their demographics or medical history. But the digital check-in prompts them to fully complete the forms on the tablet.” The Qure4u app not only optimizes patient flow as patients can check in to the doctor’s office before they visit, it also helps patients:

  • Pay copays
  • Sign documents
  • Upload their insurance cards
  • Update demographics
  • Fill out health history forms and clinical questionnaires
  • Report symptoms

“With Qure4u, everything is digital, we have no paper and no manual data entry. Everything is automatically pushed in the patient’s chart. That means patients can be seen by the clinical staff more quickly and office throughput is improved,” she explains.

“The Qure4u app,” Bowman elaborates, “provides a monitoring system for their care team, one that can not only help with ‘front desk’ tasks, but also help patients with pre-procedure preparation.”


Like other medical practices, before using Qure4u, TCRS was handing out paper-based instructions to their patients instructing them how to prepare for procedures. There were drawbacks to this process. It was not always easy for patients to understand. Important prep tasks were often missed, resulting in patients arriving for procedures poorly prepared, leading to cancellations and rescheduling.

Using the Qure4u app instead of paper, the patient receives step-by-step instructions for what they need to do at home and when. The app even shows the staff which patients have followed all the instructions at the correct time and order, and which have not.

That feature makes it easy for staff to reach out to patients who may need help preparing prior to the day of their procedure.

“Bob,” a 53-year old Dallas business executive who works in the healthcare industry, recently underwent a colonoscopy at a TCRS clinic.

“I’m 53 years old and I had never had a colonoscopy,” he explains. “My doctor had been after me for several years to have it done. I finally said ‘yes.’ By a coincidence, several weeks before, my wife had a colonoscopy at another medical practice, and she really struggled with the paper-work and sorting out the printed and poorly photocopied prepping instructions.”

The procedure handout had been photocopied many times over, so the words were a little faded and the prepping directions were written in a hard to follow, awkward way. It made her prep difficult, he recalls.

Bob admits that, like many his age, he is not an “app wizard.” But he found that the TCRS/Qure4u app he downloaded to his mobile phone made his prepping experience much easier than what his wife had encountered.

“I was emailed a user name and password,” he says. “I had no problem logging into the app right away. The prep information came in ‘chunks’ that were easy to follow. I was not barraged with information. I really had peace of mind, and I felt that I was doing everything correctly in getting ready for the procedure.”

Once patients leave the clinic, it has always been difficult for care providers to track their health between visits or do post-procedure follow-up to make sure their patients are recovering well and quickly. Bolbjerg’s vision and Bowman’s quest was to improve patient tracking using the Qure4u HIPAA-compliant communication tool, the “MyCarePlan” app. The Qure4u “MyCarePlan” app provides patients access to both video and text messaging, and it allows them to access their care plans, appointment scheduling and vitals. Using this app, patients can get help at home and at their fingertips, because it connects them with healthcare providers through telehealth and messaging, while ensuring the security of sensitive information.

Now, TCRS staff constantly monitors incoming patient communications for questions and problems. When necessary, follow-ups with patients are carried out using the Qure4u integrated Telehealth and messaging tools for:

  • Automatic & uniform data collection
  • Compliance with specific protocols
  • Reporting vitals and adverse events
  • Flagging at-risk patients
  • Integration of data to registries

Patients who may be having post-procedure adverse events, such as bleeding or fevers, can message TCRS through the app.

“After a procedure, a patient is prompted to complete a questionnaire that has been designed for that procedure,” explains Bowman. “We have a number of staff who monitor messages coming in from patients, whether administrative issues or post-procedure problems. We immediately report medical issues to our clinical staff.”

According to Bowman, TCRS adds anonymous patient data gathered by the Qure4u apps to a larger database support-ed by the Texas Medical Association. The database can be used for potentially benchmarking and comparing results against other participating providers throughout the state, and even the country.

The app can also be used to help implement specific clinical pathways and protocols.

“We are about to launch our customized Enhanced Recovery After Surgery (ERAS) protocol, that will facilitate and provide the data to measure patient compliance with a clinical pathway designed to yield faster recovery after surgery. It helps patients get ready for surgery by sending tasks and reminders to optimize their health and complete necessary pre-surgical tests and or tasks.

“Once they are out of the hospital, the tool will provide the practice the ability to monitor the patient’s recovery and quickly respond to any alerts or reported issues,” Bowman explains.

She adds that patient outcomes and compliance with the specific clinical pathways will be measured and analyzed from data collected through the Qure4u app. “We envisioned the utility in the Qure4u app would be adaptable to a practice developing a new protocol or be able to gather data that was unique to a study’s parameters,” confirms Bolbjerg

“Increasingly, practices are reaching out to us to get help collecting Patient Reported Outcomes Measures [PROMs],” says Dr. Monica Bolbjerg, who developed the Qure4u app. “A benefit to having solid data is that care providers can better document the quality of their care. By including data from patients, providers can also demonstrate their value to payers and to referring physicians. However, collect-ing such data is almost impossible if you don’t have an automated means, such as a mobile app, through which your patients can report.” Post-procedure monitoring and patient-reported outcome data can be collected through the Qure4u app’s ability to seamlessly link to the patient’s EMR, explains Bolbjerg.

The data is stored in the Qure4u database and can be exported for reporting. Previously, collecting this kind of data meant healthcare providers and their care teams had to spend time at the office or on the phone interviewing and informing patients about their health, then manually enter data into the patients’ records – a time-consuming and costly process.


Qure4u solves time and staff problems by implementing digital care plans for the patient using technology that can both drive care plan compliance and collect data directly from the patient. That feature also enables practices using Qure4u to:

  • Design procedure-specific protocols
  • Tailor procedure preparation
  • Enroll patients automatically
  • Monitor compliance

“The platform has bi-directional EMR integration, so whenever providers change the patient’s diagnoses or add orders into the EMR, the platform automatically updates the patient care plan,” explains Bolbjerg. “The app also empowers patients through guided self-care, as caregivers capture specific and relevant patient-generated data through patient questionnaires, automated messaging, and integrated home-monitoring devices and apps.”

Eager for Change,
a Young Doctor Becomes a Healthcare Innovator


In the year 2000, in her native Denmark, Monica Bolbjerg, MD, was just starting her medical career when she saw serious administrative inefficiencies hindering the effective-ness of the doctor-patient encounter.

“The patient’s journey was bogged down in paperwork,” she recalls. “When I realized that we were treating paper instead of patients, I saw opportunities to not only include patients in their own healthcare, but also improve the efficiency of healthcare providers.”

In 2001, while still practicing medicine, she developed the world’s first “patient portal,” which set her on the path to becoming a leading, international healthcare innovator building new, mobile-and web-based patient engagement tools.

Focused on building ever-better and more efficient tools to enhance the doctor-patient relationship, Bolbjerg developed the Qure4u app and has since traveled the world advocating new technologies aimed at benefiting both the practice of medicine and the patient journey with tools that, to date, have been used internationally by more than two million patients “online.”

After Bolbjerg, her husband, Torsten, and their four children relocated to the United States, they founded Qure4u in 2015 and have continued promoting medical practice efficiency and improving the patient journey. Her efforts have won her multiple innovation prizes and put her in the spotlight as a speaker at The Healthcare Think Tank.

“As a young doctor, I saw the problem clearly – patients left their brief, face-to-face doctor encounters lacking sufficient tools or knowledge to understand their health problems and without a link to connect them with their healthcare providers,” Bolbjerg told her international audience at a 2016 McKinsey & Company Healthcare Conference in Dubai.

“Our quest has been not only to optimize medical office patient flow but also to make patient communication with their healthcare providers easier and more efficient by developing a patient-centric platform using a mobile ‘app’ by which the patient has online communication with their healthcare providers at all times.”

Today, Bolbjerg is continuing to expand the ways in which the patient-centric Qure4u app can be used in medical practices to improve their efficiency, benefit patients, improve outcomes, and serve as a useful tool in data collection and research.

“As a young doctor, I saw the problem clearly – patients left their brief, face-to-face doctor encounters lacking sufficient tools or knowledge to understand their health problems and without a link to connect them with their healthcare providers.”

Monica Bolbjerg, MD
Co-founder
Qure4u

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