We are now at the last panel of the day before we have our breakout sessions, and I feel like we're coming to a topic that is both near and dear to my heart and really represents sort of the future conversation and effort that we need to be working on as a community. Which is patient generated health data. And integrating patient generated health data into the health records and into the health dialogue.We've talked a lot about access to information, and how blue button can help support access to patient information by patients and their caregivers. We've also talked just now about making sure that access is available through infrastructure and broadband.And what really I think is the next step is moving from health care system where communicating where we're communicating to patients, to a one where a health care system where we're communicating with patients and where patients are part of the conversation. And this is a dialogue, a bidirectional communication of information, between patients. Their care givers and their physicians, the entire team.So with that, I'm going to introduce Claudia Williams, who I've been working with for many years, even before she was at ONC. Claudia is now a senior adviser on health innovation and technology at the White House Office of Science and technology policy.
Before that, she led ONC state health information exchange strategy and came to ONC before that from the Markle Foundation where she was the director of health policy and public affairs at that, she helped the connecting to health effort. Join me in welcoming Claudia Williams.[Applause]>> Claudia Williams: Hey, everyone. I know we have limited time but I'm actually going to ask to you stand up for two seconds and stretch, because it's been a long haul. And while I do that, could my amazing panelist please come up to the stage, and take a seat.
I'm going to take the chair right here. But anyway, stretch a little, and sit down because this is going to be awesome.So we have come a long way to now be in this beautiful amazing room. I do love the great hall at HHS. But this is a little more gildy and fancy than in the past.
This is amazing. So I did the math last night. And double checked it because it seems quite amazing. So the average American has three visits a year with a doctor.
Each of which lasting doesn't feel like, 20 minutes, feels like less. That's 60 minutes a year.So 99.99% Of the average American's time, you are keeping healthy, staying healthy, you're taking care of yourself, outside of the office of the most of life and most of health happens outside the doctor's office.Yet for too long we've treated the office as the place where decisions get made, where information is gathered and where stuff happens.But stuff is happening else. Where.So what we really want to talk about here today is how do we bring that rich experience, the observations, the data, the insights, the decisions that are happening in life, into the conversation with the clinician. How do we put control and decision making more patient hands through the data they're tracking and interactions with clinicians in life? 99.99% Of the time.So this going to be a great panel.
I want to introduce them. All the way to the left. We have I'm going to use first names, quick introduction. Janet who is cardiologist and also the director of the million heart initiative at HHS.Next, we have Ariel, U.S.A.
Marketing manager for I never know if it's wippings or whippings (ph). Next is NOLANDO, the mother of 2 and pediatrician of the children's hospital and Mike Evans, the director of the ambulatory clinical pharmacy programs at Geisinger. Join me in wishing them a warm welcome. And then I'm going to go on over here.>> Hi, everyone.
So I just want to talk it's a fabulous to have all of you here. NOLANDO, I want to start with you. You're here really to talk about your experience as a mom. And the mom of a child who needed you very much.
Who was born it two months early. Can you talk a little bit about the experience you had tracking her growth after she was born? And what worked and didn't work about that? Talk little about that whole kind of innovation experience you got to participate in.>> I'm WANDO, as you mention, I'm a pediatrician at chock childrens and I'm also a perinatal fellow at UCLA. As you mention I had a daughter who was born two and a half months early. So she was neonatal ICU, for two and a half months.
Toward the end of my time there, I was approached by a team who was working on a study comparing patients that had access to an app that would allow them to enter data about their babies as they had been discharged that could be made available to the pediatricians. After discharged and random eyed to parents who didn't have the app and then parents who were given a Smartphone and had the app. They tracked the baby's weight, mood. And diapers, all of the stuff that is very important to us as pediatricians.
Especially as doctors who receive these we call them NICU graduates. The neonatal ICU, and come out with a lot of chronic diseases, and being able to manage them in outpatient setting can be very daunting. To pediatricians who sometimes have to see 30 to 40 patients a day. And get this NICU graduate with not a lot of data.
And so I was randomized with a group who got Smartphone, data about how much they give us a scale, weigh her every day and enter the data, and there were different components of the app. I'll talk about what was helpful and I. Thought what could have been changed. What's helpful was the weight because not just as a pediatrician, I know that's important to babies that are growing but just as a mom who has lived in the NICU two and a half months.
I knew if your baby was growing in the NICU, that was the most important thing without any other problems, that's the most important thing. So the weight being able to be convey that, was very helpful. And also, a lot of different appointments the baby had to go to. My daughter had a moderately complex course in the NICU.
So she had at least 4 or 5 follow up appointments she had to attend to. And in addition to her pediatrician appointments. So being able to record, those appointments and what was cuss discussed there in the app, and being able to convey to my pediatrician, was very helpful. Even for me, as a medical professional, you would imagine, oh, she's a doctor, she can manage all this data.
And I actually found that it can be quite complex without having all the struggles of, you know, if you have social struggles or setbacks or travel problems. Just being able to manage the different appointments and recommendations and conveying this to your primary care pediatrician who has the responsibilities of negotiating different appointments and keeping track can be daunting. So that was the most helpful part of it. And then other areas I felt like the app tried to collect data on that was so helpful, was collecting data about the babies' moods, you fussy, not.
I understand what the goal was, trying to get ahead, why is she fussy, more fussy now, because of meals and so forth. But that data translated into electronic format I don't know would be helpful to a pediatrician. Babies can be fussy for many different reasons. And so for me as a general pediatrician, the mother said my baby is not acting right.
That's a red flag. They don't have to say very much more. And so pediatrician, I don't feel like we need a computer to tell us a baby is fussy. If the mom says my baby is not acting right, we jump 'on that and go through with it, follow through.
That was my general experience, you know, with the app, from mom perspective, and you know, pediatricians perspective.>> Some of you know our friend in Moore and she describes the experience of tracking her son with cystic fibrosis and arrived at the emergency room and they said he needs IV antibiotics. She said no, this is not what an event looks like for him. He has a cold and she pulled up his data and said look at his baseline, here's the track. And no it took her 24 hours but she finally convinced them that her hunch represented by her data, was correct, and I think what we also hope that will not be a argument but a normal thing to bring the data forward even if they didn't give you a app, did you it on your own.
And that brings us to you, Janet. And I think you bring this amazing experience of sort of thinking about global change in an incredibly important area, cardiac health, and having been a clinician. And I think you have incredible insights how we actually need to change our clinical care model. What's is going to look like, what needs to happen, what needs to shift, and kind of how are we going to get there?>> Thank you for the chance to participate today.
And get to hear the other panelists. Claudia talking about something called million hearts. Initiative of the five year initiative top prevent a million heart attacks and strokes in that 5 year period. One of the key contributors to fewer heart attacks and strokes is control blood pressure.
Right now, in the country, one in three of us adults has high blood pressure. And the chances that it's controlled is about 50 50. 50 50 Chance of actually being safely controlled. And one big contributor to that poor control is that we're using a model, terrible model.
For dynamic variable like blood pressure, which varies moment to moment. We bring someone into an artificial medical setting, usually take one reading, maybe two, and then the patient and the health care professional try to make a decision about treatment based on two random not random, two data points obtained in a nonbaseline setting. Now, really, that's not very good decision making. So when I was approached about an opportunity to listen to experts and patient generated data, blood pressure control jump tops mind because the change that Claudia mentions is that the transference, of blood pressure control, from the medical person to the individual, whose blood pressure is elevated.So that they use the health care professional as a coach or consultant but they actually have the skills they need.
They have the technology they need. And most importantly, they have an active channel to and from their treating provider. So the data and the advice can flow back and forth. That has to be wrapped in a business model that supports that over time.>> Great.
And paint a picture of what that could look like for blood pressure in particular. What data obviously is blood pressure. But how does that get tracked, how does the data get snared what kind of decisions get made. How does the communication occur?>> Yeah, I listen to the previous panel, wonderful, insights there.
And one of them, kept hearing in different forms was let's make sure these data are actionable. One of my earliest thoughts is we need to have some sort of central Web site so all of us can text our blood pressures up to the place somewhere, we always think about the cloud, right? Text our blood pressure up there and then once a blood pressure to exceed the certain set of parameters but trigger goes off and the treating providers is notified. I spent more than two decades of one of those treating providers and if I started getting every blood pressure that my patients chose to send to the cloud, not only I would freak out but everyone in my office, right? Everybody would be go running out. What you want are actionable data.
So that going to the cloud business could work if we had algorithms that said X percentage of blood pressure readings falling outside these parameters, then a trigger goes off.>> Great. Wanda, I want to go back to you for a minute. As now as a physician, how does that experience affect how you doctor and whether you ask your patients to go more tracking at home. And moms I knew did tracking at home or invite that data into your practice?>> I think because I have the experience of being a general pediatrician and also being in training to be a neonatologist, I think the whole experience changed what my expectations were from parents.
I think it's easy for us to say make sure you go to this appointment and this appointment and either way, make sure you keep track of this and this and this. And sometimes he feel like we don't make sure our patients have tools they really need to be successful in taking care of themselves and their children. And so I mean, it's given me a complete 360 view of how I approach patients in terms of when I. Send them out of the NICU, I don't say make sure do you this and this and this.
I say what resources do you have? How can we help you do this. And this is why I feel that patient access to information, information technology, is incredible in terms it of being able to give patients empowerment, as you discussed earlier but also the tools to help them be more successful. And I just want to reiterate what she said, on the panel before, the information, like was said, the data is coming. And it's got to be hashed out in a way that is beneficial to the providers and the patients and their family.
And just, you know, to developers as their thinking about creating an effective ways of comparing data through mobile devices or other platforms, please keep in mind this kind of make it a collaborative effort. Good health for children is really a collaborative effort between provider and, you know, the patients and the children. And for them to really keep that in mind, because it doesn't help for the patients to have all the data and not know what to do with it. Or the provider to have all the data as well.
But not have the information, especially social information about the patient that can help them be more successful.>> Great, thanks.So Ariel, we had a prep call and she said something that was, I think, right on. Which is the observation that patients are there, right? Not every single patient. But the I had a session last week with a guy who has created something called data he's basically tracked every single possible Sensor trackable thing for his type one diabetics over the course of a year and developed hypotheses and developed them. Eating out was unhealthy.
Which is proved. Running marathon would be good. And you know, he literally had a chart with these amazing beautiful graphics. But patients are there.
So what you said in the call was we needed this yesterday. And I was interested to hear part of your business strategy isn't just putting out awesome tools and equipment into the world. But is actually trying to help us with the culture shift and the society shift we need to go through to get to the place we all want to get. Can you talk a little about that? What needs to happen and what are you guys doing to make it happen?>> Absolutely.
So for those unaware, whippings created health device and applications, so that ranges from smart sleep stomach our wireless scale, blood pressure monitor activity trackers, and all the data that the consumers use go up into the cloud and really what we're trying to do is give people these tools, as you know, you heard from previous two panelists that these are the tools that people need. And not only help them track but really improve their health. What's interesting I've observed over the years my company has come out with 6 new devices in this mobile health field, within the year, and it takes so much time for health care and med stop sign catch up. I know the model we have right now is not perfect.
The company started as an only consumer phasing product, and now that I'm out here talking to people like you, and speaking to a lot of medical professionals, to try to improve upon the current solution, we're trying to run a number of pilot programs, one with the American medical group association, where focusing on blood pressure specifically, they have a campaign called measure up pressure down, and we're working with four medical groups across the country, to address the patient physician relationship, with using these tools at home. Outside of the regular doctor's visits. And I think with this, we'll be able to come to some kind of conclusion as to where it stands with sending blood pressure measure that. Patients would take every single day with these home monitors and then the measurements that they're getting for that once a year visit with their clinician.
And you know, finding the perspective from the physician, from the physician and from the patient, as to where we can really make that care giver model work best.>> Great. Mike, you've been engaged with setting pilots at Geisinger as well and in particular focus med rec, we know how important and challenging surprising to have an accurate view of what patients are waiting until a patient in the office with the bag of meds may not be the best way to do that. Or if they don't have the bag of meds. So I've done that before.
Talk about your pilot and the what you're learning and the approach you're taking and kind of again, like this is such a big intractable problem improving blood pressure control and talk with the potential safety benefits as well as what you're doing.>> Sure. So in Geisinger, we have pharmacist based as clinical experts inside the family practice and specialty clinics, so they're not distributing pharmacists. They're clinical pharmacists in seeing patients and in population health. And an important aspect that we've noticed for quite some time is patient adherence to medications chronic medications, is about 50% of the time.
So if you can imagine, if we're trying to control a chronic disease and patient is not taking their blood pressure medicine, we're going to control their hypertension about 50% of the time. But we also noticed medication lists. So meaningful use, we're completing med rec, 99.9% Of the time in the system, but internal study of the med rec is even those completed close to 100% of the time, actually accurate, less than 50% of the time. Not a surprise to anyone in the room, I'm sure.
So our postulate was back in before 2010, was any patient can a patient accurately give us a medical reconciliation and we wanted to do this outside the office visit because as we know, and as Claudia brought up, we have 20 minutes in the office visit. We wanted to see if patients in the comfort of their own home, whatever time they wanted to take, could complete a medication reconciliation, so we com- we developed our own survey. It was a grant from ONC. Working with NORC and we used a patient portal we used a seperate software pushing a questionare that was home developed out to the patient, prior to an office visit, the idea here was to make sure the medication reconciliation was up to date prior to the office visit, that was then if the patient was coming in, we could address their chronic disease that wasn't under control, based off adherence.
One of the postulates again also was, can the elderly do this accurately. And surprisingly, very text savvy. Can and how long will they do T if they're on 25 or 30 medications and yes, these patients are on 25 and 30 medications. Will they take the time to complete the survey accurately at home? Yes, they will.
But then, what do we do with the information? So the previous panel brought up a great question. Now we're generating data. What do we do with it? So you heard me say I have pharmacists, clinical pharmacists based in specialty clinics acting, and working collaboratively with physicians and specialists. We have medications we're having issues with.
Who better of a person top take care of a so if a patient has issue with a prescribed medication, pushed to the pharmacist that are in the clinic. But they have an issue with an OTC, or herbal product, pushing to the nurses in the clinic. Again doing this outside of a office visit. That way when a patient comes, in their medication list is up to date.
The pilot occurred back in 2010. In 2011. Or pushing this across the health system now, finding out that an increase is now efficiency in the clinic. When a patient comes in for 20 minute appointment.
We've done or completed the medication reconciliation prior to. Now the nurses ruling the patient doesn't have to take 15, 20 minutes to do a med rec and also accurate. We're looking at the med rec after the appointment now saying is it complete, accurate, but most importantly back to Janet, is now the patient understand why they're taking the medication, they're going to be adhering to the medication, not going to have poly pharmacy because we're adding another medication at the offices when really it was adherence that was the issue.So it's been many contributing factors and down stream effects from the process. So I'm excited, thanks again to ONC, for inviting here and we're continuing to push forward.
We started with med rec but also looking at asthma, hypertension, Bluetooth and multiple other issues for patients, and finding out that we can actually take care of the patient better when they're at home than in the office. Thank you.>> So we talk interoperability an is a big word for today. And I. Think as we're talking about additional data streams and additional types of data, additional health IT platforms, the question becomes how does this all come together? What do these devices need to interface with the EHR, do we need a new kind of data aggregation model is what are the standards we need? And to some extent I think some of these technical problems get solved when you address the cultural problems and the business problems.
So we have to be a little careful that we don't try to drive solutions that will actually to some extent work themselves out if we can get those other things right.But also interoperability and as the Congressman said, can be both a driver right, it can also help drive forward progress if we can solve problems that allow for lots of other use cases and availability. So I just want your thoughts, each of you, from your own perspective, what is the thing we really should be focusing on from an interoperability standpoint? We don't want to the ocean. What over the next year you would love to see happen in your space, whether that simply that the data are more usable by the Doc or they're syncing up with the EHR. We'll start with Mike.>> Thanks, Claudia.
Multiple issues and I'm not sure where to start because it's an open can of worms as here we're. But I think the last we're here. Payers have to be willing to look at different ways to reimburse clinicians as we're interacting with these patients. As we develop these new delivery systems for health care, the payer system hasn't caught up.
That's the payer has to catch up. Number 2 is, where is the information going to flow back to? Ariel talked about the cloud Does it come back to the cloud depending upon the algorithm, where does it go? The last talked about it, the clinical experts, helping with the decision making. With the information experts to develop the right formula, platform.>> Great, thanks.>> I completely agree. With this on the issue as well.
And coming from the perspective of a provider, I would like to see platform that allow me to share information that I have with my patient to improve their care. And the care of their family and their children. From a parent perspective, I would like to be able to access that data, but also be in the context of being able to communicate with my division.I think I. Would hate to see as byproduct of improved access, to have there be a loss in the doctor patient relationship.
I feel like this access to data for patients and providers should accentuate that relationship. And in many cases it could even be dangerous. If a patient were to be at high risk behavior and be exposed to HIV and get a HIV test, if they have access to the results before they have time to talk to a provider, and get resources, that might not be in the best interest of the patient. And in terms of their missing that doctor patient relationship, to be able to have access to resources and information about what can help them through this process and so forth, and that's just one of many, many different examples of where I feel like it's really critical and important that there is this component of it's a team effort and all the parties need to be on the table and the stakeholders involved to make sure that there's not this unintentional byproduct that could be problematic in the future.>> Ariel?>> Yeah, I mean, that's a really good point about the (indiscernible) side.
For us it would be in an ideal world the best situation if we're able to eventually have these devices be reimbursed by insurance companies and I think the challenging piece is being able to show that what we're doing from the prevention side, actually, you know, gives a very strong ROI on the health care side. So that's something that we need to work towards getting at. And another point I just want to make is with the announcement from Apple last week, with health kit, a lot of people have been asking now to companies like similar companies, you know, what are going to be the challenges now. Is this going to be obsolete, this whole market, is Apple going to take over.
And I think for us it's making it mainstream. And we were an early adopter marketplace and mobile health and health that's all still very knew, but I think that Apple will help to make this more mainstream. That's really the goal that we're trying to get at.>> Great. I agree with all the excellent points that have been made.
And when I would only add to it, this idea of geography. And that I travel, a lot of places and most of the time thank goodness I'm not in a physician's office. And so if I'm thinking about anything, I want to register with my health professional, I want to be able to send that in from wherever I am. It's particularly dear to my heart about blood pressures, because I may have them checked at a church or I.
Might have it at a beauty shop or I might have it checked in a grocery store or pharmacy and I'd love to know those will go where I want them to go. But ideally, I want them in a pattern by the time they get here. Because I think this is about improving the quality of the decision making. This multiple data coming from patients.
It helps us as patients know whether we trust the diagnosis, I do really believe I have high blood pressure? I know because I know what brings mine up and I bring it down because I'm monitoring it. If my health care provider also has, that I think he or she will make a better decision, too.>> Okay. I want to I think Don uses effectively a way to build a movement, a way to build momentum. Which is to paint a picture in data, or paint a picture in words of the feature you want.
So I want to ask each of the panelists to write yourselves write us a postcard from two years from now. And what is it you'll be you know, having fun, at the beach. What is it you'll be with what we've accomplished together and how data are information care and I would ask you to do it in less than a minute.So what's the picture postcard you're going to write back to us in 2 years, and then it's up to all of us to make that happen.Probably Janet will start.>> It's December let's say January of 2017, million hearts curtain has fall then December 2016 and what I'm going to see is a tick downwards in heart attacks and strokes over and above the trends we've seen for 30 years. That is because the nation's blood pressure has come under control.>> Wow.[Applause]>> For me it would be about education.
And we recently just did a survey about what the American public knows about' their vital signs. And it's really low. People just don't know about what vital signs are being taken at their physician's office. And so in two years from now, it's about everyone knowing what those numbers are and income control of it.
>> For me it's I. Believe the health of a nation starts at the child level. Which is one of the reasons I'm a pediatrician. And so in two years from now, it would be heavenly if we would have some sort of a platform, whether it's the blue button or some sort of a platform that really empowers parents to empower their children, to work closely in a collaborative effort with developers and providers to have some sort of way that we can improve health care outcomes for children, with the resources that we have.
In IT.>> From a pharmacist perspective, medication adherence. If we can get patients to be adherent to medications we'll have Janet hypertension under control and the other chronic diseases under control. Using health information technology, push and pull from the patient, to increase medication adherence. By 2016, that would be fantastic.>> Let's make it happen.
And let's give a round warm round of applause to the panel. Thank you all. [Applause].
No comments:
Post a Comment