Kevin J. Campbell, MD, chief executive officer and cofounder of StreaMD, was presented the 2017 Orthopaedic Innovator Award at the AAOS/ORS Translating Orthopaedic Technologies into Clinical Practice: Pathways from Novel Idea to Improvements in Standard of Care Research Symposium. Erin Lynn Ransford connected with Dr. Campbell to discuss his product. The questions and his responses follow.

Ms. Ransford: What is StreaMD?

Dr. Campbell: StreaMD is a health-tech company based in Chicago. We design customized physician "bots" to coach patients through their entire episode of surgery. Each physician bot sends automated, preprogrammed text messages and videos directly to the patient's mobile phone(s), delivering the right information at the right time. The message content is based on a surgeon's customized perioperative instructions and care culture, making the product easy and quick to implement.

For patients, StreaMD provides an entirely new level of support, motivation, and care. That results in more engaged patients, fewer calls to the office, and higher patient satisfaction with positive physician online reviews.

Ms. Ransford: How is a bot different from a traditional mobile app?

Dr. Campbell: A bot is a software application that users interact with through conversation. Usually, a bot is designed to automate human-like tasks (such as booking a flight, scheduling a meeting, or depositing money into a bank account). Many bots function within messaging platforms to make conversation easy. It is unlike a traditional mobile app that must be downloaded, opened, signed-in, and periodically updated. For example, StreaMD bots send messages directly to an interface that patients already know and love: their phone's text message inbox.

As a result, StreaMD, a text message–based service, is easy for patients to use and results in a streamlined experience. We're very proud of creating a patient engagement product that doesn't feel like a "product." StreaMD serves as a personal connection between patients and their physicians, and patients have responded very well to this.

Physicians and clinic staff also respond well to StreaMD, because it is practical and easy to integrate within the clinical setting. Too many patient engagement apps require the clinical staff to devote additional time and resources to implement and monitor them, thus creating another 'clinician inbox.' We can create a physician bot in a matter of hours—and it can be implemented just as fast. Plus, there's nothing for clinic staff to monitor.

Ms. Ransford: How does it work?

Dr. Campbell: We provide physician-specific enrollment cards to clinic staff, who distribute them to patients with the rest of their surgical paperwork. That's all the work that's ever required from the physician's team. Patients enroll themselves through a text message. No downloads, log-ins, or passwords are required.

The messages address the most common questions patients have before and after surgery, in a conversational, supportive tone. The motivational component increases the success of this patient-engagement program. For example, a 1-year pilot test with 550 patients undergoing total joint replacement demonstrated improvement in patient satisfaction and personal connections with surgeons, reduced patient calls to the office, and generated positive reviews on physician ratings websites. StreaMD is also available for other orthopaedic specialties including sports medicine, spine, foot and ankle, and hand surgery.

Ms. Ransford: What problem are you trying to solve?

Dr. Campbell: We are working to prevent financial penalties for readmissions by improving patient health literacy and engagement, while also improving the doctor-patient relationship. Although many physicians offer some sort of engagement product, few patients actually use them. When patients do engage, it's often for something like checking lab results or confirming the time of an upcoming appointment. It's not for meaningful involvement in their day-to-day health and well-being.

We are currently conducting a prospective and randomized controlled clinical trial on patient engagement. Preliminary findings show arthroplasty patients who enrolled in StreaMD spent more time on their home exercises, had better clarity of surgical instructions, and higher patient satisfaction compared with study patients who were not enrolled in StreaMD.

Similarly, patients enrolled in StreaMD placed fewer calls to their physician's office, decreased their narcotic use, and had fewer emergency room visits.

These findings, while preliminary, show great encouragement in the power of having a tool that truly engages patients. We expect the study to be completed this fall and look forward to publishing our findings.