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Quantified Self: Helping Physicians Empower Their PatientsBest Practices And Technologies For Doctors And Patients Monitoring Chronic Diseases

About the Moderator

Brian McGowan, Ph.D., Moderator, @BrianSMcGowan

Brian S. McGowan, PhD is your host for this series. Dr McGowan is the Co-Founder and Chief Learning Officer at ArcheMedX a healthcare informatics and e-learning technology company. He is the author of '#socialQI: Simple Solutions for Improving Your Healthcare'. He has lectured both nationally and internationally on the need to drive innovation in healthcare. He is currently consulting with start-up companies, medical societies, patient advocacy groups, and academic medical centers committed to accelerate quality improvement through innovative technology and frictionless information flow.

About The Panel

Sarah Krug, CEO, Cancer 101, @SarahKrug1Sarah Krüg is CEO of CANCER101, a patient advocacy organization and President of the Society for Participatory Medicine, a patient/provider member driven organization whose mission is to enable collaborative partnerships between patients and healthcare professionals.

Kathleen Starr, Ph.D., SVP, Behavioral Insights & Strategy, Inventiv Health, @DrHealthPsychKathleen holds a doctorate in Clinical Health Psychology from the University of Miami and completed a post-doctorate fellowship at Duke University Medical Center. She has over 15 years of experience in the life science industry translating behavioral insight into commercial strategy.

Robert Stern, CEO, Projects in Knowledge, @RSSternRobert Stern is the founder, president and chief executive officer of Projects In Knowledge, an ACCME-accredited developer of continuing medical education programs for physicians and other healthcare professionals. Stern is also the founder and past president and chief executive officer of MedPage Today, an award-winning medical news website.

Dr. Jennifer Dyer, Pediatric Endorinologist, @EndoGoddess Dr. Jennifer Shine Dyer is a pediatric endocrinologist in private practice in Columbus Ohio, an accomplished behavioral researcher with a MPH in health behavior studies. She created the award-winning EndoGoal Diabetes Rewards App. Dr. Dyer began developing apps to automate her successful weekly SMS texting protocol that she used with her teen diabetic patients to improve their insulin adherence.

How to Participate

• Submit your questions in the GoToWebinar presentation window

• Follow along and share your thoughts on Twitter at #HWClive

• This webinar will be recorded and available for download a few days after the webinar

The Psychology of Self-Monitoring Technology

Kathleen Starr, Ph.D.

6

• Observing and Recording

› Target thoughts, feelings, and behaviors

› Real time

• Natural Environment Assessment & Therapeutic Tool

› Track patterns

› Assess progress

› Reinforcement or punishment

What is Self-Monitoring?

7

Self-monitoring is a powerful change agent

Essential ingredient of self-regulation

Internal feedback loops that regulate behavior

CognitiveAffective

Physiological

Current Situation Desired State (Goal)

digitalart at www.freedigitalphotos.net

8

Is self-monitoring technology key to motivating people towards healthier behavior?

tungphoto on www.freedigitalphotos.net

9

No perfect linkage between motivation and behavior

Adoption

I’m going to give this a try.

•Behavioral consistency

•Goal setting

•Self-evaluation reaction

•Expectations for goal-related performance

•Privacy expectations

Sustained engagement

I’m going to keep it up!

•Memory & attention› Information overload

•Effortful self-awareness

•Information accuracy› What am I learning?

• Causation versus correlation

•False sense of responsibility

Is lack of motivation the only problem?

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• Feedback Loops

• Reinforcement

• Social encouragement

• Cues

• Goal planning

• Incentives

How to super charge behavior change

Breaking habits

Starting new behavior

Maintaining behavior

11

How to identify mechanisms underlying behavior change in robust yet scalable ways

Future Directions

How technology itself impacts/changes models of health behavior change

How to leverage technology to promote behavioral maintenance

The Patient & Self-TrackingSarah Krüg

CEO, CANCER101President, Society for Participatory Medicine

sarahkrug@cancer101.org

The FACTS

Pew Research Center/CHCF Health Survey, September 2012

The FACTS

What are patients using to track health indicators?

34% of individuals who track use non-technological methods such as notebooks or journals.

21% of individuals who track use at least one form of technology such as apps or devices.

Who are patients sharing their data with?

34% of trackers share their data or notes with someone else

52% share with a health professional

22% share with a spouse/partner

What is impact of self tracking and how are patients using their data?

46% of trackers say that this activity has changed their overall approach to maintaining their health or the health of someone for whom they provide care.

40% of trackers say it has led them to ask a doctor new questions or to get a second opinion from another doctor.

34% of trackers say it has affected a decision about how to treat an illness or condition.

Integrating Data into Daily & Clinical Care

Self-tracking experimentation: Patients needs to be able to figure out if their self-monitoring is working (e.g. Diabetics who use glucose monitor to track blood sugar levels in correlation to food intake)

Clinical Care: Clinicians want to know how their patients are doing on a new treatment without having to wait months or may want to provide encouragement or modify dosages (e.g. Tracking symptoms & Medications)

Research: Data can act as research evidence to generate knowledge about what works, in which context and for which patients

Technology & the Elderly

90% of the elderly have at least one chronic disease and 77% have two or more chronic conditions

In a recent study of patients between the ages of 65-100:

• 41% owned a PC, 61% owned a cell phone but adoption of other technologies lagging with 3% who owned a smart phone, 3% a tablet, and 8% a laptop

• Of those in study none were currently using health monitoring devices that transmit health data to their clinicians

• 40% who are thinking about using a self tracking device said they would prefer a clinician teach them how to use the technology

Issues• Clinician Coaching: #1 person elderly people want to train them on technology is the doctor—the

least likely person to train them

• Literacy: Screen sizes, fonts, menus, audio volume

• Costs: 71% had an annual income of $25K or less and unwilling to pay for technology

Krug, Sarah. “Bridging the HCP-Patient Gap.” Pharmaceutical Executive. April 2011.

Patient EmpowermentPatient Profile

Participatory Medicine

Participatory Medicine aligns the HCP and patient on a common pathway

SHARED DECISIONSSHARED DECISIONS

“Participatory Medicine is a model of cooperative healthcare that seeks to achieve active involvement by patients, professionals, caregivers, and others across the continuum of care on all issues related to an individual's health. Participatory medicine is an ethical approach to care that also holds promise to improve outcomes, reduce medical errors, increase patient satisfaction and

improve the cost of care.”—Society for Participatory Medicine

ALIGNED GOALSALIGNED GOALS

http://participatorymedicine.org/

CANCER101

Overview

CANCER101 Today

Navigator Distribution Cancer101’s Navigator guides patients through the cancer journey by:‒ Providing information to understand treatment options‒ Deploying tools to track and manage symptoms and medications‒ Arming patients with a platform to keep it all organized‒ Facilitating coordinated cancer management between patients, caregivers

and the medical community

‒ Enabling patients to document experiences in a way that complements objective healthcare data gathered during the care process

Thousands of cancer centers and community practices pre-order navigators and provide them to patients at the point of care. Patients and caregivers can also order directly through our website.

Navigator Sections

•Tumor Specific Information (22 different Cancer Types)•myMedical History •Questions to Ask Doctor•Symptom Tracker•Medication Tracker•Medical Bills & Insurance Tracker•10 Year Calendar & Appointment Tracker•What is a Clinical Trial?•Caregiver Support•Medical Dictionary•National Resources

We distribute approximately 100,000 requests per year and receive over 300,000 requests for navigators.

We partner with over 1200 cancer centers and community oncology practices to disseminate our materials in all 50

states & Canada. We have also received requests from over 40 countries.

Our Reach

http://cancer101.org/

Patient communities are emerging as key influencers and disrupting the healthcare landscape. They are impacting strategies, policies, and setting the stage for new patient-centric innovations. Patients

are now sought after thought leaders influencing the way healthcare systems think about and interact with patients and prodding them to improve the patient experience.

 

The Patient Shark Tank™: If you build it, they will come?

The Patient

Goal: To incorporate the voice of patient into the design, development or enhancement of

technology being developed by the healthcare community and move away from the notion: "If

you build it they will come".

Jennifer Shine Dyer, M.D., M.P.H.Physician, Mobile Health Entrepreneur

Duet Health, LLC

EndoGoddess, LLC

Columbus, Ohio

June 19th, 2013

Quantified Self: Pediatric Diabetes Case Study

Problem: Adherence

Endocrinologist

1. Support glucose checking

Patient Engagement: Physician Role

2. Support glucose logging

Patient Engagement: Physician Role

3. Support meal (bolus) insulin dosing

Patient Engagement: Physician Role

BasalBasal InsulinInsulin

Prandial Boluses

Insu

lin

0hr 24hr

BG

mg

/dl

Intensive Basal Bolus TherapyIntensive Basal Bolus Therapy

Meal BolusMeal Bolus

Pump download, missed meal bolusesPump download, missed meal boluses

Barriers to Bolus Adherence:Barriers to Bolus Adherence:

• No insurance• Low socioeconomic

status• Reduced health

literacy• Lack of frequent office

contact• Over/under

involvement of family• Family conflict

• Depression• Adjustment disorder

with chronic disease• Eating disorder

(diabulimia)• Forgetfulness • Fear of low blood

glucose reaction• Peer pressure

This is Paige.

Paige has insulin-dependent diabetes.

…and loves her smart phone.

A SMS texting pilot study that Paige wasa part of helped her to remember to check her blood sugars and to take her insulin.

However, texting stopped helping Paige after3 months…

Weekly Prepaid Visa Card

BRIDGING THE GAP

@ehrandhit : Some day someone is going to ask me for the data (an ACO or someone else). Are you ready for others to see your metrics?

-John Lynn, Founder EHRandHIT

@ Point of Care360TM

BRIDGING THE GAP

@ Point of Care360TM

Real Time Clinician

Knowledge

Real Time Patient Data

BRIDGING THE GAP: FULL 360°

@ Point of Care360TM

Clinicians Self reported real-time data

HIPAA compliant messaging

PatientsClinician knowledge support Health care organizations

CLINICIAN PERFORMANCE IMPROVEMENT

MEASURING PATIENT OUTCOMES

BRIDGING THE GAP: FULL 360°

@POINT OF CARE360™ WITH MY360™ PATIENT COMPANION APP

@ Point of Care360TM

@Point of Care360™

My360™

PatientsClinicians Data

SYNCING CLINICIAN WITH PATIENT DATA

@ Point of Care360TM

ENGAGING CLINICIANS

• Patient driven learning• Integrate patient reported data

in context with @Point of Care360™ clinician platform

• Allows clinicians to track patients between visits

• Reports Level 7 patient-centered outcomes• HIPAA-compliant

ENGAGEMENT DRIVES ADHERENCE

@ Point of Care360TM

•ACCOUNTABILITY FOR CLINICIANS

•ACCOUNTABILITY FOR PATIENTS

•ACCESS TO RELEVANT INFORMATION

SYNCING CLINICIAN WITH PATIENT DATA

@ Point of Care360TM

PATIENT GRAPHS: SHARED DATA

Shared Graph Component

MY360™ Patient App @Point of Care360™ Clinician App

On demand Sync Component

On demand Sync Component

BRIDGING THE GAP: FULL 360°

@ Point of Care360TM

Maximizing reimbursement through

data

@Point of Care360™

My360™

PatientsClinicians

Analytical Health360™

HealthcareOrganization

Core relationship

Empowering clinician & patient engagement

Championing MU 2 & 3 in the industry

Outcomes

How to Participate

• Submit your questions in the GoToWebinar presentation window

• Follow along and share your thoughts on Twitter at #HWClive

• This webinar will be recorded and available for download a few days after the webinar

About The Panel

Sarah Krug, CEO, Cancer 101, @SarahKrug1Sarah Krüg is CEO of CANCER101, a patient advocacy organization and President of the Society for Participatory Medicine, a patient/provider member driven organization whose mission is to enable collaborative partnerships between patients and healthcare professionals.

Kathleen Starr, Ph.D., SVP, Behavioral Insights & Strategy, Inventiv Health, @DrHealthPsychKathleen holds a doctorate in Clinical Health Psychology from the University of Miami and completed a post-doctorate fellowship at Duke University Medical Center. She has over 15 years of experience in the life science industry translating behavioral insight into commercial strategy.

Robert Stern, CEO, Projects in Knowledge, @RSSternRobert Stern is the founder, president and chief executive officer of Projects In Knowledge, an ACCME-accredited developer of continuing medical education programs for physicians and other healthcare professionals. Stern is also the founder and past president and chief executive officer of MedPage Today, an award-winning medical news website.

Dr. Jennifer Dyer, Pediatric Endorinologist, @EndoGoddess Dr. Jennifer Shine Dyer is a pediatric endocrinologist in private practice in Columbus Ohio, an accomplished behavioral researcher with a MPH in health behavior studies. She created the award-winning EndoGoal Diabetes Rewards App. Dr. Dyer began developing apps to automate her successful weekly SMS texting protocol that she used with her teen diabetic patients to improve their insulin adherence.

Thanks for Joining Us

• This webinar will be available on-demand at www.HealthWorksCollective.com.

• Stop by to learn more and share your comments.