Using Consumer Technology to Integrate Patient Generated Health Data in the EHR

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1 Using Consumer Technology to Integrate Patient Generated Health Data in the EHR Christopher Longhurst, MD, MS Chief Information Officer, UC San Diego Health Sciences Clinical Professor of Medicine and Pediatrics, UC San

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

3 Diabetes is big data

4 Primary goal: balance home blood glucose trends

5 Quarterly visits with the specialist are insufficient

6 Current clinical practice Only active delivery of CGM data between visits Provider workflow outside of EHR Disparate outcomes data Workflow demand = increased activation energy

7 I have no real or apparent conflicts of interest relevant to this presentation

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9 Passive data communication

10 Mobile enables healthcare consumerism 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 models 1,2 Youth from low-income families are more likely to access the internet from their phone than a computer 3

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14 Diabetes triage report in the EHR 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

15 Population health within the EHR Outcome data in a unified database

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18 gluvue.stanfordchildrens.org

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20 Improved workflow, care, and reimbursement!

21 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

22 Ask the patients about their data Goal of enhanced self-management skills and improved provider interpretation of data 4 Patient portal facilitates bidirectional asynchronous communication about data Adolescents need to be involved in their care and have special needs for security/privacy 5,6

23 Current clinical practice Only active delivery of CGM data between visits Provider workflow outside of EHR Disparate outcomes data Workflow demand = increased activation energy Passive data communication Population health within the EHR Outcomes data unified Improved workflow, care, and reimbursement and Less documentation + no device downloads in clinic = more time to interact with patients at visits!

24 Journal of American Medical Informatics Association, April

25 On the horizon 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

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

28 References 1. Hassan A, Fleegler EW. Using technology to improve adolescent healthcare. Curr Opin Pediatr 2010;22(4): Wu YP, Hommel KA. Using technology to assess and promote adherence to medical regimens in pediatric chronic illness. J Pediatr 2014;164(4): Johnson SL, Tandon SD, Trent M, et al. Use of technology with health care providers: perspectives from urban youth. J Pediatr 2012;160(6): American Diabetes Association. Children and Adolescents. Diabetes Care 2015;38(Suppl 1):S Anoshiravani A, Gaskin GL, Groshek MR, et al. Special requirements for electronic medical records in adolescent medicine. J Adolesc Health 2012;51(5): 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):

29 Questions?