A guide to embedding automated patient adherence journeys in your EHR platform

For modern Electronic Health Record (EHR) platforms, evolving from a simple system of record to a proactive engine of patient care is paramount. A critical component of this evolution is solving poor patient adherence, which leads to diminished health outcomes and costly readmissions. This guide explores how embedding automated, interactive patient adherence journeys directly into your EHR can transform post-treatment care, improve outcomes, and increase clinical efficiency.

Examples of automated patient adherence journeys in action

Post-operative recovery journeys

This journey is for end-users who have been discharged after knee replacement surgery and are segmented based on whether they have a designated carer in their file.

• A welcome SMS is sent to the patient upon discharge. "Hi [Patient First Name]. Welcome to your personalised recovery journey from [Clinic Name]. We'll send helpful reminders and check-ins over the next 2 weeks. Reply HELP for support at any time."
• One day post-discharge, an email is sent containing a video link on "Proper Icing and Elevation Techniques" and a PDF guide to their medication schedule.
• At 9:00 AM daily for the first 7 days, an SMS medication reminder is sent. "Good morning. This is your reminder to take [Medication Name]."
• At 3:00 PM daily, an interactive SMS is sent to check on their progress. "On a scale of 1-10, how is your pain level? Please reply with only a number."
• If the patient's response is between 1 and 6, an automated message replies, "Thank you for the update. That's a good level for this stage. Keep up with your care plan." This response is logged in their patient record within your platform.
• If the patient's response is between 7 and 10, the path branches. They receive an SMS stating, "We've noted your high pain level. A care coordinator will call you within the next hour to discuss." Simultaneously, a high-priority task is created and assigned to the patient's care team in your platform.
• If no reply to the pain check-in is received within two hours, and the patient has a designated carer on file, an automated SMS is sent to the carer. "Hi [Carer Name]. We haven't heard from [Patient Name] for their daily pain check-in. Please check on them and ensure they are following their recovery plan."

Chronic disease management

This journey is designed for end-users newly diagnosed with Type 2 Diabetes.

• The journey begins with an SMS in the end user's preferred language. "Hello [Patient Name]. Your care team at [Clinic Name] has enrolled you in a program to help manage your diabetes. You'll receive tips and reminders to support you."
• Every morning at 8:00 AM, a WhatsApp message reminds them, "Good morning. It's time to check your blood glucose. Please reply with your reading (e.g., 120)."
• If the glucose reading is within the target range set by their provider, they receive an encouraging message. "Great, that's a healthy number! Remember to take your medication with breakfast." The reading is automatically synced to a data field in their patient record.
• If the reading is above the pre-defined high threshold, a different message is sent. "Your reading is higher than your target. Please make sure you have taken your medication and avoid sugary foods today. Would you like us to send you a link to our 'Healthy Eating' guide? Reply YES or NO."
• If the end user replies YES to the guide offer, an email is triggered, containing a link to the relevant resources in their preferred language.
• Every Friday, an email is sent with a "Weekly Wellness Tip" and a link to a healthy, diabetes-friendly recipe.
• Thirty days into the journey, an interactive SMS is sent to gauge their confidence. "You're one month in! How confident are you feeling about managing your diabetes? Reply A for Very Confident, B for Somewhat Confident, or C for Not Confident." The response updates a 'Patient Confidence' field in their record, allowing your users to run reports on patient sentiment.

Complex medication adherence

This critical journey is for end-users discharged after a transplant, segmented by the specific immunosuppressant drug they have been prescribed.

• The journey starts with an SMS and an Email sent simultaneously upon discharge to ensure the message is received. The email contains a detailed, printable PDF of their full medication schedule.
• At 8:00 AM daily, an SMS is sent. "Hi [Patient Name]. This is your reminder to take your morning dose of [Immunosuppressant Drug Name]. Please reply 'DONE' once completed."
• If a "DONE" reply is not received within one hour, a follow-up SMS is sent.
• If there is still no reply one hour after the second message, an automated voice call is placed to the end user with a recorded reminder message.
• If the voice call is not answered, a high-priority alert is flagged on the care coordinator’s dashboard within your platform, and an SMS is sent to the patient's registered emergency contact.
• Twice a week, an interactive SMS checks for side effects. "This is your health check-in. Have you experienced any of the following symptoms in the last 3 days? A) Fever B) Nausea C) Unusual Swelling D) None of these. Please reply with the letter of your answer."
• If the reply is A, B, or C, the journey triggers an immediate update to your client's EHR via a web request, creating a task for the transplant nurse to review the specific symptom. The end user receives a confirmation SMS: "Thank you for the information. Your care team has been notified and may contact you for more details."
• If the reply is D, the system logs the "no symptoms" response and the journey continues without escalation.

Antidepressant medication adherence & well-being journey

This journey is for end-users starting a new antidepressant prescription for Major Depressive Disorder, as recorded in your clients' EMR. It uses data points like age, appointment schedules, and prescription history for segmentation and branching logic.

• Three days after the prescription is recorded, a secure message is sent via your patient portal. "We're here to support you as you begin your new medication. It's common to have questions. Here is some information about what to expect: [Link to common side effects page]. You can report any concerns here: [Link to secure form]."
• If the patient's age is under 25, the initial message also includes an additional link to youth-specific mental health support resources.
• Weekly for the first six weeks, an SMS is sent to the end-user. "This is your weekly check-in. On a scale of 1 (low) to 5 (good), please rate your average mood for the past week. Reply with just a number."
• After they reply with their mood rating, a second SMS is sent. "Thank you. In the last 7 days, have you missed more than 2 doses of your medication? Please reply YES or NO."
• If the mood is reported as 1 or 2 for two consecutive weeks, OR if the end-user replies YES to missing more than 2 doses, the journey checks if there is an upcoming appointment scheduled in your platform within the next 7 days.
• If both conditions are met (low mood/missed doses AND no upcoming appointment), a notification is automatically sent to the prescribing physician's dashboard within your platform, flagging the patient for a proactive check-in.
• In week five, if prescription data from your clients' EMR shows the end-user is on a 30-day prescription and a refill has not yet been processed, an email reminder is sent.

Benefits of adding automated patient adherence journeys to your EHR platform

By automating the patient adherence experience, EHR platforms can drive real value for healthcare practices:

Improve clinical outcomes: By proactively sending medication reminders and educational content, and recording patient wellbeing, healthcare practices can ensure they are guiding patients through every step of their adherence pathway.

Increase care team efficiency: Free up valuable clinical staff from manual, repetitive follow-up calls, by automating routine check-ins and data collection, allowing care teams to manage by exception and focus their expertise on patients who require direct intervention.

Reduce readmission costs: By providing continuous support and enabling early intervention through proactive monitoring, automated adherence journeys help prevent complications that lead to expensive hospital readmissions, protecting revenue under value-based care models

How to embed automated patient adherence journeys in your EHR

So, you're convinced of the value. How do you actually embed automated patient adherence journeys in your EHR platform? Several approaches exist, each with implications for development resources, time-to-market, and ongoing maintenance:

Custom development: This offers maximum customisation. However, it requires significant research and development, dedicated expertise, substantial upfront investment, and continuous ongoing maintenance to adapt to new needs. Time-to-market can be very long.

White-labeling a specialised solution: For many EHR providers, the most efficient, scalable, and feature-rich path is through white-labeling. This approach allows you to embed patient engagement capabilities quickly and seamlessly.

White-labeling software lets you integrate pre-built patient journey automation features or entire modules from a third-party provider directly into your own EHR platform. These features are presented seamlessly to your users under your brand and user interface. This dramatically accelerates your product roadmap by allowing you to instantly offer sophisticated, new capabilities without dedicating internal resources to build and maintain them from scratch.

Benefits of white label

Save time. Integrate powerful new functionality into your platform in a fraction of the time it would take for an internal build, dramatically accelerating your product roadmap and speed to market.

Focus your resources. A white label solution lets your development team concentrate on enhancing your core EHR features and unique value, rather than diverting resources to build adjacent capabilities.

Fully built solution. Immediately leverage a mature and scalable engine built and refined over years, offering proven capabilities to your users from day one.

Eliminate tech debt. The white label provider manages the technical upkeep, keeping your team agile.

Introducing Aperture by Pendula: A white label solution

Aperture by Pendula is a white label solution that powers some of the world's leading B2B SaaS platforms. We combine a visual workflow builder with native communication channels and powerful data integrations, allowing you to embed a complete patient engagement engine into your EHR in just weeks.

Key Capabilities:

Visual workflow & journey design: At the heart of Aperture is a powerful visual builder. It enables users to design sophisticated communication journeys with features like smart decisioning and flexible automation. You can choose to embed the full builder for maximum user flexibility, or offer pre-defined workflows for standardised use cases.

Data integration & triggers: Layer powerful data connectivity onto your workflows. Aperture's integration capabilities allow you to trigger journeys from user behaviour in your platform or data changes in other systems. This also enables rich audience segmentation based on real-time, unified data.

Omnichannel communication channels: Complete the journey with reliable communication. Aperture features native, scalable channels—including Email, SMS, RCS, and WhatsApp—that can be orchestrated by your workflows to deliver the right message on the right channel at the right time.

HIPAA-compliant by design: Built with the security and privacy requirements of healthcare in mind, ensuring all patient data and communications are handled in a compliant manner.

Recipe: 

• Webhook Trigger
  
  • Action: This node will initiate the flow when a patient is discharged. An external system (e.g., your EHR platform) will send a POST request to the webhook URL.
  • Configuration: The payload should contain patient and carer data such as patientFirstName, patientMobile,clinicName, medicationName, carerName, and carerMobile. 
• Outbound SMS
  
  • Action: Immediately send a welcome SMS to the patient.
  • Configuration:
    
    • Recipient: Use the merge field for the patient's mobile number from the webhook trigger (e.g., {{patientMobile}}).
    • Message Body: "Hi {{patientFirstName}}. Welcome to your personalised recovery journey from {{clinicName}}. We'll send helpful reminders and check-ins over the next 2 weeks. Reply HELP for support at any time."
• (Workflow Node - Delay/Wait)
  
  • Action: Pause the flow for one day.
  • Configuration: Set the delay duration to 1 day.
• Outbound Email
  
  • Action: Send an email with recovery resources.
  • Configuration:
    
    • Recipient: Use the merge field for the patient's email address from the webhook trigger.
    • Subject: "Your Post-Surgery Recovery Guide"
    • Email Body: Use the email builder to embed a video link for "Proper Icing and Elevation Techniques".
    • Attachments: Upload the PDF guide for their medication schedule directly in the 'Attachments' tab.
• (Workflow Node - Delay/Wait)
  
  • Action: Pause the flow until 9:00 AM the following morning to start the daily reminders.
  • Configuration: Set a specific date/time for the flow to resume.
• Outbound SMS
  
  • Action: Send the daily medication reminder. This node (and the subsequent delay and pain check-in nodes) would be duplicated in the flow for each of the 7 days.
  • Configuration:
    
    • Recipient: {{patientMobile}}
    • Message Body: "Good morning. This is your reminder to take {{medicationName}}."
• (Workflow Node - Delay/Wait)
  
  • Action: Pause the flow until 3:00 PM on the same day.
  • Configuration: Set the delay duration to 6 hours.
• Conversation
  
  • Action: Send an interactive SMS to check on the patient's pain level.
  • Configuration:
    
    • Recipient: {{patientMobile}}
    • Message Body: "On a scale of 1-10, how is your pain level? Please reply with only a number."
    • Replies Tab: Configure paths for expected replies. Use the 'Number' recipe to capture numeric responses.
    • Outcomes Tab: Set the 'No reply' expiry to 2 hours and ensure the 'No reply' path is toggled on.

Branch

• Criteria Split
  
  • Action: This node follows the 'Replies' path from the Conversation node. It directs the flow based on the numeric value of the patient's reply.
  • Configuration: Create two paths.
    
    • Path 1 (Low-Medium Pain):
      
      • Rule: {{messageBody}} less than or equal to 6.
      • Action:
        
        • Outbound SMS: Send a reassurance message: "Thank you for the update. That's a good level for this stage. Keep up with your care plan."
        • Make a web request: Send the pain level response back to your platform to be logged in the patient's record. This would be a POST or PATCH request.
    • Path 2 (High Pain):
      
      • Rule: {{messageBody}} greater than or equal to 7.
      • Action:
        
        • Outbound SMS: Send an alert message: "We've noted your high pain level. A care coordinator will call you within the next hour to discuss."
        • Make a web request: Send a POST request to your platform's API to create a high-priority task for the care team.

Branch

• This branch follows the 'No Reply' outcome from the Conversation node.
• Criteria Filter
  
  • Action: Checks if the patient has a designated carer on file.
  • Configuration:
    
    • Rule: Check if the carerName field from the webhook trigger is not null.
    • Success Path:
      
      • Outbound SMS: Send an SMS to the carer's mobile number.
        
        • Recipient: {{carerMobile}}
        • Message Body: "Hi {{carerName}}. We haven't heard from {{patientFirstName}} for their daily pain check-in. Please check on them and ensure they are following their recovery plan."
    • Fail Path:
      
      • The experience ends, or you could add a step to create a low-priority task for staff to follow up with the patient directly.

As you can see, Aperture by Pendula is a powerful solution for seamlessly embedding automated patient adherence journeys in your EHR platform.

Take the next step with Aperture by Pendula

Interested in white-labelling Aperture by Pendula to quickly and easily embed patient engagement capabilities in your EHR platform?