Quantified Self: Helping Physicians Empower Their Patients

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

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  • Diabetes is hard because the treatments that are expected are demanding and hard to stick to: multiple daily injections or continuous insulin pump infusions and a minimum of 4 blood sugar checks per day. But none of this works unless people take it. Quantified self plus gaming and social motivation tactics can be combined to help.
  • I am Dr. Jennifer Dyer, an endocrinologist…and an entrepreneur. An endocrinologist takes care of people with diabetes. This is me with PJ who I diagnosed with diabetes at 15 months old while I was at Children ’s Hospital. He is a now thriving 6 year old in the first grade who is extremely healthy. But…he and his family have to work very hard to achieve this.
  • Frequent contact (intensive) as evidenced by DCCT trial and more physiologic basal bolus therapy.
  • I have long been concerned about how I can better motivate my patients. Fear doesn’t always work. But thinking like a teen does work. To motivate teens, I began texting them weekly. It worked to improve their diabetes care but solution not scalable and effect wore off…they needed more, they needed actual rewards. So I left medical practice to build the solution.
  • Real rewards. Not only do you feed yourself but you feed Cooper too. Cooper is along for the journey. Your diabetes dog. Everytime you take of yourself you take care of Cooper. Engagement.
  • Quantified Self: Helping Physicians Empower Their Patients

    1. 1. Brought to you byQuantified Self: Helping PhysiciansEmpower Their PatientsBest Practices And Technologies For Doctors AndPatients Monitoring Chronic Diseases
    2. 2. About the ModeratorBrian McGowan, Ph.D., Moderator, @BrianSMcGowanBrian S. McGowan, PhD is your host for this series. DrMcGowan is the Co-Founder and Chief Learning Officer atArcheMedX a healthcare informatics and e-learningtechnology company. He is the author of #socialQI: SimpleSolutions for Improving Your Healthcare. He has lecturedboth nationally and internationally on the need to driveinnovation in healthcare. He is currently consulting withstart-up companies, medical societies, patient advocacygroups, and academic medical centers committed toaccelerate quality improvement through innovativetechnology and frictionless information flow.
    3. 3. About The PanelSarah Krug, CEO, Cancer 101, @SarahKrug1Sarah Krüg is CEO of CANCER101, a patient advocacy organization and President of theSociety for Participatory Medicine, a patient/provider member driven organization whosemission 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 andcompleted a post-doctorate fellowship at Duke University Medical Center. She has over 15years of experience in the life science industry translating behavioral insight into commercialstrategy.Robert Stern, CEO, Projects in Knowledge, @RSSternRobert Stern is the founder, president and chief executive officer of Projects In Knowledge, anACCME-accredited developer of continuing medical education programs for physicians andother healthcare professionals. Stern is also the founder and past president and chief executiveofficer of MedPage Today, an award-winning medical news website.Dr. Jennifer Dyer, Pediatric Endorinologist, @EndoGoddessDr. Jennifer Shine Dyer is a pediatric endocrinologist in private practice in Columbus Ohio, anaccomplished behavioral researcher with a MPH in health behavior studies. She created theaward-winning EndoGoal Diabetes Rewards App. Dr. Dyer began developing apps to automateher successful weekly SMS texting protocol that she used with her teen diabetic patients toimprove their insulin adherence.
    4. 4. How to Participate• Submit your questions in the GoToWebinar presentationwindow• Follow along and share your thoughts on Twitter at#HWClive• This webinar will be recorded and available fordownload a few days after the webinar
    5. 5. The Psychology ofSelf-Monitoring TechnologyKathleen Starr, Ph.D.
    6. 6. 6• Observing and Recording› Target thoughts, feelings, and behaviors› Real time• Natural Environment Assessment & Therapeutic Tool› Track patterns› Assess progress› Reinforcement or punishmentWhat is Self-Monitoring?
    7. 7. 7Self-monitoring is a powerful change agentEssential ingredient of self-regulationInternal feedback loops thatregulate behaviorCognitiveAffectivePhysiologicalCurrent Situation Desired State (Goal)digitalart at www.freedigitalphotos.net
    8. 8. 8Is self-monitoring technology key to motivating peopletowards healthier behavior?tungphoto on www.freedigitalphotos.net
    9. 9. 9No perfect linkage between motivation and behaviorAdoptionI’m going to give this a try.•Behavioral consistency•Goal setting•Self-evaluation reaction•Expectations for goal-relatedperformance•Privacy expectationsSustained engagementI’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 responsibilityIs lack of motivation the only problem?
    10. 10. 10• Feedback Loops• Reinforcement• Social encouragement• Cues• Goal planning• IncentivesHow to super charge behavior changeBreaking habitsStarting new behaviorMaintaining behavior
    11. 11. 11How to identify mechanisms underlying behaviorchange in robust yet scalable waysFuture DirectionsHow technology itself impacts/changes modelsof health behavior changeHow to leverage technology to promote behavioralmaintenance
    12. 12. The Patient & Self-TrackingSarah KrügCEO, CANCER101President, Society for Participatory Medicinesarahkrug@cancer101.org
    13. 13. The FACTSPew Research Center/CHCF Health Survey, September 2012
    14. 14. The FACTSWhat 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/partnerWhat 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 thehealth 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 fromanother doctor.34% of trackers say it has affected a decision about how to treat an illness or condition.
    15. 15. Integrating Data into Daily & Clinical CareSelf-tracking experimentation: Patients needs to be able to figure out if their self-monitoring isworking (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 havingto 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 whichcontext and for which patients
    16. 16. Technology & the Elderly90% 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% whoowned 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 totheir clinicians• 40% who are thinking about using a self tracking device said they would prefer a clinician teachthem how to use the technologyIssues• Clinician Coaching: #1 person elderly people want to train them on technology is the doctor—theleast 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
    17. 17. Krug, Sarah. “Bridging the HCP-Patient Gap.” PharmaceuticalExecutive. April 2011.Patient EmpowermentPatient Profile
    18. 18. Participatory MedicineParticipatory Medicine aligns the HCP and patient on a common pathwaySHARED DECISIONSSHARED DECISIONS“Participatory Medicine is a model of cooperative healthcare that seeks to achieve activeinvolvement by patients, professionals, caregivers, and others across the continuum of care on allissues related to an individuals health. Participatory medicine is an ethical approach to care thatalso holds promise to improve outcomes, reduce medical errors, increase patient satisfaction andimprove the cost of care.”—Society for Participatory MedicineALIGNED GOALSALIGNED GOALShttp://participatorymedicine.org/
    19. 19. CANCER101OverviewCANCER101 TodayNavigator 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, caregiversand the medical community‒ Enabling patients to document experiences in a way that complementsobjective healthcare data gathered during the care process Thousands of cancer centers and community practices pre-order navigators andprovide them to patients at the point of care. Patients and caregivers can alsoorder 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 ResourcesWe distribute approximately 100,000 requests per year andreceive over 300,000 requests for navigators.We partner with over 1200 cancer centers and communityoncology practices to disseminate our materials in all 50states & Canada. We have also received requests from over40 countries.Our Reachhttp://cancer101.org/
    20. 20. Patient communities are emerging as key influencers and disrupting the healthcare landscape. Theyare impacting strategies, policies, and setting the stage for new patient-centric innovations. Patientsare now sought after thought leaders influencing the way healthcare systems think about and interactwith patients and prodding them to improve the patient experience.The Patient Shark Tank™: If you build it, they will come?The PatientGoal: To incorporate the voice of patient into thedesign, development or enhancement oftechnology being developed by the healthcarecommunity and move away from the notion: "Ifyou build it they will come".
    21. 21. Jennifer Shine Dyer, M.D., M.P.H.Physician, Mobile Health EntrepreneurDuet Health, LLCEndoGoddess, LLCColumbus, OhioJune 19th, 2013Quantified Self: PediatricDiabetes Case Study
    22. 22. Problem: Adherence
    23. 23. Endocrinologist
    24. 24. 1. Support glucosecheckingPatient Engagement: Physician Role
    25. 25. 2. Support glucose loggingPatient Engagement: Physician Role
    26. 26. 3. Support meal (bolus) insulin dosingPatient Engagement: Physician Role
    27. 27. BasalBasal InsulinInsulinPrandial BolusesInsulin0hr 24hrBGmg/dlIntensive Basal Bolus TherapyIntensive Basal Bolus Therapy
    28. 28. Meal BolusMeal Bolus
    29. 29. Pump download, missed meal bolusesPump download, missed meal boluses
    30. 30. Barriers to Bolus Adherence:Barriers to Bolus Adherence:• No insurance• Low socioeconomicstatus• Reduced healthliteracy• Lack of frequent officecontact• Over/underinvolvement of family• Family conflict• Depression• Adjustment disorderwith chronic disease• Eating disorder(diabulimia)• Forgetfulness• Fear of low bloodglucose reaction• Peer pressure
    31. 31. This is Paige.
    32. 32. Paige has insulin-dependent diabetes.
    33. 33. …and loves her smart phone.A SMS texting pilot study that Paige wasa part of helped her to remember tocheck her blood sugars and to take herinsulin.
    34. 34. However, texting stopped helping Paige after3 months…
    35. 35. Weekly Prepaid Visa Card
    36. 36. BRIDGING THE GAP@ehrandhit : Some day someone isgoing to ask me for the data (an ACOor someone else). Are you ready forothers to see your metrics?-John Lynn, Founder EHRandHIT@ Point of Care360TM
    37. 37. BRIDGING THE GAP@ Point of Care360TMReal Time ClinicianKnowledgeReal Time PatientData
    38. 38. BRIDGING THE GAP: FULL 360°@ Point of Care360TMClinicians Self reported real-time dataHIPAA compliant messagingPatientsClinician knowledge support Health care organizationsCLINICIAN PERFORMANCE IMPROVEMENTMEASURING PATIENT OUTCOMES
    39. 39. BRIDGING THE GAP: FULL 360°@POINT OF CARE360™ WITH MY360™ PATIENT COMPANION APP@ Point of Care360TM@PointofCare360™My360™PatientsClinicians Data
    40. 40. SYNCING CLINICIAN WITH PATIENT DATA@ Point of Care360TMENGAGING CLINICIANS• Patient driven learning• Integrate patient reported datain context with @Point of Care360™ clinicianplatform• Allows clinicians to track patients between visits• Reports Level 7 patient-centered outcomes• HIPAA-compliant
    41. 41. ENGAGEMENT DRIVES ADHERENCE@ Point of Care360TM•ACCOUNTABILITY FOR CLINICIANS•ACCOUNTABILITY FOR PATIENTS•ACCESS TO RELEVANT INFORMATION
    42. 42. SYNCING CLINICIAN WITH PATIENT DATA@ Point of Care360TMPATIENT GRAPHS: SHARED DATAShared Graph ComponentMY360™ Patient App @Point of Care360™ Clinician AppOn demand SyncComponentOn demand SyncComponent
    43. 43. BRIDGING THE GAP: FULL 360°@ Point of Care360TMMaximizing reimbursementthrough data@PointofCare360™My360™PatientsCliniciansAnalyticalHealth360™HealthcareOrganizationCore relationshipEmpowering clinician &patient engagementChampioning MU 2 & 3 inthe industryOutcomes
    44. 44. How to Participate• Submit your questions in the GoToWebinar presentationwindow• Follow along and share your thoughts on Twitter at #HWClive• This webinar will be recorded and available for download afew days after the webinar
    45. 45. About The PanelSarah Krug, CEO, Cancer 101, @SarahKrug1Sarah Krüg is CEO of CANCER101, a patient advocacy organization and President of theSociety for Participatory Medicine, a patient/provider member driven organization whosemission 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 andcompleted a post-doctorate fellowship at Duke University Medical Center. She has over 15years of experience in the life science industry translating behavioral insight into commercialstrategy.Robert Stern, CEO, Projects in Knowledge, @RSSternRobert Stern is the founder, president and chief executive officer of Projects In Knowledge, anACCME-accredited developer of continuing medical education programs for physicians andother healthcare professionals. Stern is also the founder and past president and chief executiveofficer of MedPage Today, an award-winning medical news website.Dr. Jennifer Dyer, Pediatric Endorinologist, @EndoGoddessDr. Jennifer Shine Dyer is a pediatric endocrinologist in private practice in Columbus Ohio, anaccomplished behavioral researcher with a MPH in health behavior studies. She created theaward-winning EndoGoal Diabetes Rewards App. Dr. Dyer began developing apps to automateher successful weekly SMS texting protocol that she used with her teen diabetic patients toimprove their insulin adherence.
    46. 46. Thanks for Joining Us• This webinar will be available on-demand atwww.HealthWorksCollective.com.• Stop by to learn more and share your comments.

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