Before and after surgery, most patients must serve as the ‘general contractors’ of their own care: Managing appointments, following directions, remembering instructions and more.


Even when everything goes well, it can be a stressful experience. When things do not go well, patients may arrive unprepared for surgery, be readmitted after improper post-care or experience any number of other complications.

“For caregivers, managing patient documents is equally time-consuming and stressful,” said Matthew Cohlmia, director of digital strategy at Providence St. Joseph Health. “Some caregivers even resort to building silos as they feel inundated with the repetitive processes involved in patient care. The result is frustration and deterioration of communication and customer and caregiver satisfaction.”

Providence St. Joseph needed to eliminate barriers to a better experience by simplifying its approach. Instead of allocating resources to manually calling and e-mailing patients and performing other repetitive administrative duties, the health system wanted its caregivers to be free to focus on innovation, improving patient satisfaction and reducing costs. It also wanted to reduce no-shows and minimize confusion in care coordination.


“The best solution we selected after a thorough process of assessing a variety of options and then piloting the top two solutions was Twistle, an automated patient engagement platform that helps guide patients through their episodes of care,” Cohlmia said.

Patients download the app, through which they receive educational materials, reminders, checklists, surveys, communication tools and more, all customized by their Providence St. Joseph Health care team. The intent is to make their care management simple and care plans accessible, providing the right information at the right time.

“Care teams use a simple interface to track patients and get appropriate alerts if a patient requires their attention,” Cohlmia explained. “The pathways are designed to match the caregiver’s desired workflows. And information is documented in the EHR, so there is no confusion as to what was relayed to patients. Also, if a patient forgets what was transmitted, the information can easily be re-sent.”


There are many vendors of care management and patient engagement technology on the market today, including Athenahealth, CipherHealth, Epic, Health Catalyst, LexisNexis Health Care, Medfusion and Solutionreach.


Twistle has undergone a rigorous testing period at Providence St. Joseph. The product was selected to pilot after a vender evaluation of more than 50 systems.

For the pilot, several Providence St. Joseph Health hospitals used Twistle for planned surgical episodes with exceptional results. Initial cases included patients undergoing joint replacement, spine surgery, colorectal surgery, cardiovascular surgery and bariatric surgery. For these cases, the clinical care teams used Twistle to communicate with the patients throughout the entire episode of care.

“Information is documented in the EHR, so there is no confusion as to what was relayed to patients. Also, if a patient forgets what was transmitted, the information can easily be re-sent.”

Matthew Cohlmia, Providence St. Joseph Health

The app also was where patients received information about how to prepare for surgery and what to do afterward. The app provided one place to keep all the exchanges and information together so that the care team and patient had access and a record.

Since completing the pilot phase, the health system now has 14 hospitals signing up to use Twistle for surgical episodes of care – plus new pilots are being tested involving longer term, chronic care management.


The impact of the app on the Providence St. Joseph Health care delivery experience is reflected in the fact that 94 percent of the patients who used it found it to be helpful. The app also encourages patients to rate and review at the end of their care pathway. The health system saw online ratings for physicians improve by an average of 0.9 stars.

Some other key metrics include:

  • Within the first 614 surgeries across four Providence St. Joseph hospitals, patient adoption was 95 percent.
  • Patients using Twistle had a 16.5 percent lower occurrence of overall complications from spinal surgery.
  • Patients went home sooner, with a reduction of 5 percent in the average length of stay. For colorectal surgery, patients on the app went home an average of two days earlier than non-app users.
  • Twistle patients had a 22.8 percent lower cancellation rate for appointments and satisfaction ratings were 7.2 percent higher than for those not on the app.
  • Patient calls dropped by 26 percent when the app was used in a clinic.
  • No-show and cancellation rates for colonoscopy procedures fell by 29 percent at clinics that used the app to engage with patients before their procedures.
  • In one test, colorectal surgery patients also had a 20 percent reduction in readmissions.


“It made sense to pilot with surgery patients as surgery is anxiety-provoking, and it’s complicated to navigate all the things you need to do and know through the entire episode of care,” said Dr. Amy Compton-Phillips, executive vice president and chief clinical officer at Providence St. Joseph Health. “The pilots showed us that managing the flow of information and communication between care teams and patients in a single place made surgery a much better experience.”

The app not only helped streamline interactions between patients and caregivers, it also built longer lasting and stronger relationships and trust, added Aaron Martin, chief digital officer at Providence St. Joseph Health.

Twitter: @SiwickiHealthIT
Email the writer: [email protected]

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