using consumer technology to integrate patient generated

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

• Review current practice of managing diabetes data• Share approach and benefits of EHR integration of home data• Discuss future opportunities

Goals

Diabetes is “big data”

Primary goal: balance home blood glucose trends

Quarterly visits with the specialist are insufficient

• Only active delivery of CGM data between visits

• Provider workflow outside of EHR

• Disparate outcomes data• Workflow demand = increased

activation energy

Current clinical practice

I have no real or apparent conflicts of interestrelevant to this presentation

Passive data communication

• 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

• 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

Population health within the EHR

Outcome data in a unified database

gluvue.stanfordchildrens.org

Improved workflow, care, and reimbursement!

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

• 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

• 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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Journal of American Medical Informatics Association, April 2016

• 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

• Technology-enabled care models improve value for patients• Updated reimbursement strategies incentivize adoption

Conclusions

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

Questions?clonghurst@ucsd.edu