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Using Consumer Technology to IntegratePatient Generated Health Data in the EHR
Christopher Longhurst, MD, MSChief Information Officer, UC San Diego Health SciencesClinical Professor of Medicine and Pediatrics, UC San Diego
@calonghurst
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• Review current practice of managing diabetes data• Share approach and benefits of EHR integration of home data• Discuss future opportunities
Goals
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Diabetes is “big data”
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Primary goal: balance home blood glucose trends
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Quarterly visits with the specialist are insufficient
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• Only active delivery of CGM data between visits
• Provider workflow outside of EHR
• Disparate outcomes data• Workflow demand = increased
activation energy
Current clinical practice
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I have no real or apparent conflicts of interestrelevant to this presentation
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Passive data communication
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• Mobile phones are increasingly ubiquitous among teens and healthcare proxies for young children and older adults
• Adolescents are adept with electronic media and this technology has been implemented in care models1,2
• Youth from low-income families are more likely to access the internetfrom their phone than a computer3
Mobile enables healthcare consumerism
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• CGM data within the EHR allows custom reporting to triage care for a large number of patients
• Auto-report generation every 2 weeks, or sooner on-demand• Patients triaged by episodic nocturnal hypoglycemia, percent
overall hypoglycemia, and estimated HgbA1c
Diabetes triage report in the EHR
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Population health within the EHR
Outcome data in a unified database
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Improved workflow, care, and reimbursement!
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Evolving care model
In support of At-Risk and Telehealth models providing convenience and enhanced access to multi-disciplinary teams, particularly in locations without pediatric endocrinologists
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• Goal of enhanced self-management skills and improved provider interpretation of data4
• Patient portal facilitates bidirectional asynchronous communication about data
• Adolescents need to be involved in their care and have special needs for security/privacy5,6
Ask the patients about their data
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• Passive data communication
• Population health within the EHR
• Outcomes data unified• Improved workflow, care,
and reimbursement
• Only active delivery of CGM data between visits
• Provider workflow outside of EHR
• Disparate outcomes data• Workflow demand = increased
activation energy
Current clinical practice
and
Less documentation + no device downloads in clinic = more time to interact with patients at visits!
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24
Journal of American Medical Informatics Association, April 2016
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• Currently we set patient/proxy expectation that we do not have the people-power to monitor all patient data in real-time
• Implications disrupt the current care model to facilitate stronger (real-time) support for our patients, and to optimize our understanding of their disease at individual and population levels
• Broad applicability to all age groups and disease
On the horizon
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• Technology-enabled care models improve value for patients• Updated reimbursement strategies incentivize adoption
Conclusions
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1. Hassan A, Fleegler EW. Using technology to improve adolescent healthcare. CurrOpin Pediatr 2010;22(4):412-17.
2. Wu YP, Hommel KA. Using technology to assess and promote adherence to medical regimens in pediatric chronic illness. J Pediatr 2014;164(4):922-27.
3. Johnson SL, Tandon SD, Trent M, et al. Use of technology with health care providers: perspectives from urban youth. J Pediatr 2012;160(6):997-1002.
4. American Diabetes Association. Children and Adolescents. Diabetes Care2015;38(Suppl 1):S70-6.
5. Anoshiravani A, Gaskin GL, Groshek MR, et al. Special requirements for electronic medical records in adolescent medicine. J Adolesc Health 2012;51(5):409-14.
6. Gray SH, Pasternak RH, Gooding HC, et al. Recommendations for electronic health record use for delivery of adolescent health care. J Adolesc Health 2014;54(4):487-90.
References