Clinical problems being solved by health IT

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Presented by Dr Robyn Whittaker
Waitemata District Health Board
University of Auckland

Published in: Health & Medicine
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Clinical problems being solved by health IT

  1. 1. The National Institutefor Health InnovationClinical problems being solved byhealth ITDr Robyn Whittaker• Public Health Physician Research & InnovationWaitemata District Health Board (WDHB)• Programme leader Health Informatics & TechnologyNational Institute for Health Innovation (NIHI)University of Auckland
  2. 2. • Leading NZ Institute in healthinformatics & innovation• Clinical trials to internationalstandards & ISO9001 accreditation• Evaluation of national eHealth andhealth informatics enabledinterventions• Investigator led trials of innovations& technology-based initiatives
  3. 3. Health IT:transforming healthcare deliveryFrom provider & location-centric care to:• anywhere, anytime care• community & home• consumer control of health information &shared access• patient-centred• population perspective
  4. 4. Main uses• For clinicians:clinical tools, clinical decision support &admin tools, clinicians working smarter,efficiency in health system• For consumers / patients / population:helping people to live healthier lives,reducing demand for expensive resources
  5. 5. NIHI research• Using expertise & evidence inbehaviour change techniques• Applying to unique benefits ofthe technology• Conducting high quality researchtrials
  6. 6. Waitemata DHB• Responsible for the health (and healthservices) of 560,000 people• The largest DHB in NZ• Second fastest growing DHBs• 6800 staff across 30 locations• Two large hospitals, teaching & regionalservices• Regional collaboration
  7. 7. What is the issue?• Rising prevalence of diabetes15.8% 24,000 Waitemataresidents
  8. 8. Diabetes• Costly & debilitating sequelae of poor control– Blindness, lower limb amputation, heart disease,renal failure• Significant health inequalities• DHB priority• MoH priority and required reporting asindicators of DHB/PHO performance
  9. 9. What is the problem we are tryingto address?• How to support & enhance self-management ofdiabetes to prevent/slow progression to CVD &other sequelae– Where are the gaps– What are the needs of patients– What do primary & secondary care need in order tobe able to support their patients better– How can technology & IT – based tools help– How can we integrate these into the system
  10. 10. Whittaker R, Merry S, Dorey E & Maddison R (2012): A Development and EvaluationProcess for mHealth Interventions: Examples From New Zealand, Journal of HealthCommunication: International Perspectives, 17:sup1, 11-21To link to this article: http://dx.doi.org/10.1080/10810730.2011.649103Conceptualisation- Evidence- Experts- Population
  11. 11. Self-management supportPatientWhanauCommunityPharmacyPrimarySecondaryPopulationhealthNationalRegionalDistrictLocalityPHOEvidence: intensive, integrated into health care, involvesproviders, comprehensive, holistic, practical & personal advice
  12. 12. Input• DHB Clinicians• People with diabetes• Primary Care• Maori Advisory Group
  13. 13. Potential toolsText messaging Smartphone appsPopulation based registersShared Care PlanElectronic health recordsPatient portalsTelemonitoringVideo conferencingTelehealthEducation programmesSmart glucometersPractice audit & improvementeTherapy
  14. 14. • Tools to support/motivate/advise patients andtheir caregivers– Smartphone apps, smart glucometers, SMS,websites, telemonitoring, eTherapy, PHR/portals– Structured communication between clinicians andpatients eg. text, email, phone, web-based, video• Tools about enhancing performance ofclinicians in supporting their patients– Practice-based review, specialist involvement incommunity/primary, recalls, reminders, sharedhealth information & care plans, video conferencing
  15. 15. Tools1. Virtual Diabetes Register2. Shared Care Plan3. Primary care collaboratives4. Specialist team support for primary care5. Text messaging support6. Home monitoring support7. Smartphone apps
  16. 16. Virtual DiabetesRegister• Collated by MoHfrom multipledatasets• Used for highlevel targeting &servicesplanning
  17. 17. Virtual diabetes register• De-identified• Not linked to other datasets• Cant be used for monitoring or evaluatinginterventions• Trends over time only on population basisPlan: northern region asked for linking to labs foroutcomes & monitoring performance
  18. 18. Shared Care Plan• Accessible health information to be shared bypatient, caregivers, community teams, clinicalteams• Shared decision-making about medical plan• Discussions around goal-setting• Agreed plan & tasks• Allows messaging between users• Will allow patient reported data/outcomes
  19. 19. Portal Overview
  20. 20. My Care Plan
  21. 21. My Messages
  22. 22. Primary Care Population-basedInitiatives• Northern Region Diabetes Network• Setting indicators• Linking health data for benchmarking, qualityimprovement of performance
  23. 23. Primary Care Collaboratives• Locality-based primary care project to improvediabetes care across practices• Examine practice-based data e.g. HbA1cacross the region• Small team of clinicians identify why somepractices performing better than others• Take those lessons/practices• Spend time in practices helping them toimplement the identified success factors• Try things, re-measure & review, refine,continue
  24. 24. Specialist – primary support• Provide more rapid and useful advice fromspecialists to primary care teams• Patient-specific advice that is captured as wellas more generic education• Reduce unnecessary referrals to hospital andtravel time of patients or specialists• Keep care in the community, continuity• Upskill multidisciplinary teams in community
  25. 25. Video conferencing• Evidence internationally to supporttelemedicine– Virtual clinics by specialists in primary care?– Paper rounds and advice by specialists for primarycare team?
  26. 26. Text messaging support• People with poor control who want extra(automated) support via text messaging• Some evidence of effectiveness• Based on behaviour change techniques• Particular focus on providing– Motivation for good control– Feeling supported & connected– Education/information where appropriate– Reminders about testing if desired– Self-review if desiredSMS4BG: Youneed to test yourglucose moreoften when youare unwell andwhen changingmeds/doses
  27. 27. SMS4BG• Maori/non-Maori versions• Options– Reminders for glucose monitoring• Graphed on patient portal– Insulin– Young people– Smoker– Specific goal for next 3 months:• Healthy eating• Physical activity• Stress & mood management• Between clinic visits (3 month blocks)Be prepared withplenty of healthyfood, do theshopping whenyou have plentyof time to look forhealthy options
  28. 28. Pilot study• N=40• Receive programme for 3 months• Follow-up questionnaire/interview– What was useful– What they didn’t like– Suggest improvements• Clinician interviews• Consider refining and rolling out
  29. 29. Intensive home monitoring support• Docobo hub in the home– Daily monitoring reminders & questions/responses– Structured communication with team– Issues but ¾ liked it• Need for a short-term structured programmefor starting on insulin – Tablet application– Clinical advice on titration– Motivation & support for self-mgmt– Personal communication with team
  30. 30. Smartphone apps• Plenty out there!• No evidence of effectiveness• Patient input that can be particularly usefularound carbs & cals calculations
  31. 31. FoodSwitch
  32. 32. Where to?An integrated comprehensive IT-enabled systemto support self-management & better control ofdiabetesPopulation-based dataPrimary care baseShared patient-centred plans & infoSuite of patient tools to choose from
  33. 33. Thank your.whittaker@nihi.auckland.ac.nz@rawegd

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