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

1. The National Institute
for Health Innovation
Clinical problems being solved by
health IT
Dr Robyn Whittaker
• Public Health Physician Research & Innovation
Waitemata District Health Board (WDHB)
• Programme leader Health Informatics & Technology
National Institute for Health Innovation (NIHI)
University of Auckland

2. • Leading NZ Institute in health
informatics & innovation
• Clinical trials to international
standards & ISO9001 accreditation
• Evaluation of national eHealth and
health informatics enabled
interventions
• Investigator led trials of innovations
& technology-based initiatives

3. Health IT:
transforming healthcare delivery
From provider & location-centric care to:
• anywhere, anytime care
• community & home
• consumer control of health information &
shared access
• patient-centred
• population perspective

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. NIHI research
• Using expertise & evidence in
behaviour change techniques
• Applying to unique benefits of
the technology
• Conducting high quality research
trials

6. Waitemata DHB
• Responsible for the health (and health
services) of 560,000 people
• The largest DHB in NZ
• Second fastest growing DHBs
• 6800 staff across 30 locations
• Two large hospitals, teaching & regional
services
• Regional collaboration

7. What is the issue?
• Rising prevalence of diabetes
15.8% 24,000 Waitemata
residents

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 as
indicators of DHB/PHO performance

9. What is the problem we are trying
to address?
• How to support & enhance self-management of
diabetes 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 to
be able to support their patients better
– How can technology & IT – based tools help
– How can we integrate these into the system

10. Whittaker R, Merry S, Dorey E & Maddison R (2012): A Development and Evaluation
Process for mHealth Interventions: Examples From New Zealand, Journal of Health
Communication: International Perspectives, 17:sup1, 11-21
To link to this article: http://dx.doi.org/10.1080/10810730.2011.649103
Conceptualisation
- Evidence
- Experts
- Population

11. Self-management support
Patient
Whanau
Community
Pharmacy
Primary
Secondary
Population
health
National
Regional
District
Locality
PHO
Evidence: intensive, integrated into health care, involves
providers, comprehensive, holistic, practical & personal advice

12. Input
• DHB Clinicians
• People with diabetes
• Primary Care
• Maori Advisory Group

13. Potential tools
Text messaging Smartphone apps
Population based registers
Shared Care Plan
Electronic health records
Patient portals
Telemonitoring
Video conferencing
Telehealth
Education programmes
Smart glucometersPractice audit & improvement
eTherapy

14. • Tools to support/motivate/advise patients and
their caregivers
– Smartphone apps, smart glucometers, SMS,
websites, telemonitoring, eTherapy, PHR/portals
– Structured communication between clinicians and
patients eg. text, email, phone, web-based, video
• Tools about enhancing performance of
clinicians in supporting their patients
– Practice-based review, specialist involvement in
community/primary, recalls, reminders, shared
health information & care plans, video conferencing

15. Tools
1. Virtual Diabetes Register
2. Shared Care Plan
3. Primary care collaboratives
4. Specialist team support for primary care
5. Text messaging support
6. Home monitoring support
7. Smartphone apps

16. Virtual Diabetes
Register
• Collated by MoH
from multiple
datasets
• Used for high
level targeting &
services
planning

17. Virtual diabetes register
• De-identified
• Not linked to other datasets
• Cant be used for monitoring or evaluating
interventions
• Trends over time only on population basis
Plan: northern region asked for linking to labs for
outcomes & monitoring performance

18. Shared Care Plan
• Accessible health information to be shared by
patient, caregivers, community teams, clinical
teams
• Shared decision-making about medical plan
• Discussions around goal-setting
• Agreed plan & tasks
• Allows messaging between users
• Will allow patient reported data/outcomes

19. Portal Overview

20. My Care Plan

21. My Messages

22. Primary Care Population-based
Initiatives
• Northern Region Diabetes Network
• Setting indicators
• Linking health data for benchmarking, quality
improvement of performance

23. Primary Care Collaboratives
• Locality-based primary care project to improve
diabetes care across practices
• Examine practice-based data e.g. HbA1c
across the region
• Small team of clinicians identify why some
practices performing better than others
• Take those lessons/practices
• Spend time in practices helping them to
implement the identified success factors
• Try things, re-measure & review, refine,
continue

24. Specialist – primary support
• Provide more rapid and useful advice from
specialists to primary care teams
• Patient-specific advice that is captured as well
as more generic education
• Reduce unnecessary referrals to hospital and
travel time of patients or specialists
• Keep care in the community, continuity
• Upskill multidisciplinary teams in community

25. Video conferencing
• Evidence internationally to support
telemedicine
– Virtual clinics by specialists in primary care?
– Paper rounds and advice by specialists for primary
care team?

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 desired
SMS4BG: You
need to test your
glucose more
often when you
are unwell and
when changing
meds/doses

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 with
plenty of healthy
food, do the
shopping when
you have plenty
of time to look for
healthy options

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. 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 programme
for starting on insulin – Tablet application
– Clinical advice on titration
– Motivation & support for self-mgmt
– Personal communication with team

30. Smartphone apps
• Plenty out there!
• No evidence of effectiveness
• Patient input that can be particularly useful
around carbs & cals calculations

31. FoodSwitch

32. Where to?
An integrated comprehensive IT-enabled system
to support self-management & better control of
diabetes
Population-based data
Primary care base
Shared patient-centred plans & info
Suite of patient tools to choose from

33. Thank you
r.whittaker@nihi.auckland.ac.nz
@rawegd