Table 3. Lessons Learned from soft launch.

Issues identified	Reason for change	Changes for pilot	Evaluation source	Category of change
Patient in the top 20% of CAPE readmission risk model has complicated conditions and poor prognosis.	Barriers and difficulty with recruitment due to patient condition and prognosis preventing patients from wanting to participate in the study.	Patient in the top 50% of CAPE readmission risk model	Study meetings	Process
Insufficient characterization of HF symptoms from custom built survey	Existing HF validated symptom tool with better characterization	Two question symptom survey adapted from the HF management zone tool.	Study meetings Patient interviews	Process
Tailored interventions created only for MCI alert and limited intervention pathways for other non-MCI alerts.	Feedback from HF team and significance of other alerts during soft launch.	Standardized intervention pathways for tachypnea, tachycardia, Afib w/ RVR alerts.	Study meetings Soft launch experience with patients	Process
MCI generated 1 day early for subject 102 and 1 day after readmission for subject 103	MCI alerts are not HF specific	PhysIQ updated the MCI alerting algorithm which will increase MCI sensitivity	Soft launch experience with patients	Process
Diuretic escalation after MCI alert	MCI is a non-specific decompensation alert	MCI alerts result in assessment and laboratory draw	Study meetings Soft launch experience with patients	Process
All patients should discharge with intravenous diuretic rescue dose	Identified barriers related to insurance approval and financial risks.	HF team to prescribe intravenous diuretic rescue dose for select high-risk patients after discharge through pharmacy.	Study meetings Provider interviews Soft launch experience with patients	Process
HHN communicate with HF RN on subject cases	RN not equipped for patient management	HHN communicates with HF NPs and MDs	Study meetings Soft launch experience with patients	Process autonomy
No standardized workflow for HF clinical team	Unclear process for HF RNs and NPs	Standardized workflows and training for HF team	Study meetings Provider interviews	Process autonomy education
HHN contacts individual HF team members	HHN unclear which clinical provider to contact	Created a single centralized pager for the HF team	Study meetings	Process autonomy
Low engagement during weekly all team meeting	Need for HHN and HF team to communicate	Utilize existing HF weekly meeting	Study meetings	Process autonomy
No case review meetings	Need to gain a deeper understanding of data	Recurring case review meetings with all team	Study meetings	Education
Subject 105 unable to comply with research activities	Unclear if the reason that subject 105 could not comply with research activities is due to lack of stable social support.	Added in the ENRICHD survey tool to investigate if social support is associated with patient compliance.	Soft launch experience with patients	Process

Abbreviations: Afib with RVR, atrial fibrillation with rapid ventricular response; CAPE, clinical analytics prediction engine; ENRICHD, enhancing recovery in coronary heart disease; HF, heart failure; HHN, home health nurse; IV, intravenous; MCI, multivariate change index; NP, nurse practitioner; RN, registered nurse.