USING TECHNOLOGY TO ENGAGE PATIENTS AND ADVANCE … · USING TECHNOLOGY TO ENGAGE PATIENTS AND...

USING TECHNOLOGY TO ENGAGE PATIENTS AND ADVANCE NUTRITION PRACTICE

MARGARET  K.  DITTLOFF,  MS  RDN  

DISCLOSURES AND ACKNOWLEDGEMENTS

Sponsored  by:  

Special  thanks  to  Academy  of  NutriFon  and  DieteFcs    for  providing  informaFon  and  images  of  ANDHII  

LEARNING OBJECTIVES ▪ Define  paFent-­‐generated  heath  data  and  explain  the  challenges  and  barriers  associated  with  integraFng  it  with  tradiFonal  provider  data    

▪ Describe  how  structured  nutriFon  data  may  be  leveraged  to  support  clinical  decision  support  as  well  as  quality  and  outcomes  research    

▪ List  examples  of  how  to  leverage  nutriFon-­‐related  technology  to  encourage  and  empower  paFents  in  the  hospital  and  beyond  

▪ Discuss  which  digital  health  devices  currently  on  the  market  could  be  useful  to  dieFFans  

LESSONS FROM “POKEMON GO”

“One  thing  is  certain:  Nian0c,  in  partnership  with  Nintendo  and  Google,  has  found  a  new  and  

revolu0onary  way  to  get  people  to  engage  with  apps.”  

Source:  Kantar  hOp://us.kantar.com/tech/mobile/2016/overnight-­‐success-­‐of-­‐pok%C3%A9mon-­‐go/  

PATIENT ENGAGEMENT: WHAT DOES IT REALLY MEAN?

Passive:  

Receives  care  

Ac+ve:  

PaFent-­‐-­‐Provider  share    health  data  

Connected  care  communicaFon  

Partner:  

ParFcipate  in  care  &  treatment  decisions  

Tracks  treatment  &  wellness  acFviFes  

Sharing  Health  InformaFon  with  PaFents  

MEASURING PATIENT ENGAGEMENT IN THE U.S.

NEW AGENCY TO ADVANCE DIGITAL HEALTH IN AUSTRALIA

KEY TRENDS DRIVING DIGITAL HEALTH ▪  “Consumerism”  

▪  Self-­‐care  

▪  Social  care  

▪  Telecare  

▪  Technology  maturity  

▪  Interoperability  

▪  ArFficial  intelligence  &  analyFcs  

▪  Precision  medicine  

DIGITAL HEALTH IS CONNECTED HEALTH

Benefits  may  include:  

•  Reduce  inefficiencies  

•  Improve  access  

•  Reduce  costs  

•  Increase  quality  

•  Make  medicine  more  personalised  

Smart  Phones  

Compu+ng  

Analy+cs  

Wireless  devices  

Social  Networks  

Internet  

Mobile  apps  

Body  sensors  

Gene+cs  Microchip    processors  

CONNECTED HEALTH TECHNOLOGIES ▪ Apps  for  educaFon  or  engagement  

▪ Mobile-­‐friendly  paFent  portals  

▪ PaFent  generated  health  data  (from  consumer  devices)  

▪ Remote  paFent  monitoring  (from  medical  devices)  

▪ Secure  messaging  /  SMS  texFng  

▪ Telehealth  (audio-­‐visual  fee  for  service)  

▪ Telehealth  (concierge  service)  Source:  HIMSS  2016  Connected  Health  Survey    

of  hospitals  use  3  or  more  connected  health  technologies  

52%  

Expect  to  add  to  their  plaborm  47%  

hOps://www.digitalhealth.gov.au/assets/cdaExamples/CDASharedHealthSummary.html  

MY HEALTH RECORD EXAMPLE: SHARED HEALTH SUMMARY DOCUMENT Electronically  share  data  between  healthcare  providers,  and  with  paFents  to:  

•  Support  conFnuity  of  care    

•  Improve  the  interacFons  between  providers  and  paFents  

What  about  NutriFon  Data?            Future>>  HL7  CDA  Nutri0on  Templates  

PATIENT-GENERATED HEALTH DATA (PGHD) Health-­‐related  data  created,  recorded  or  gathered  by  or  from  paFents  (or  family  members  or  caregivers)  to  help  address  a  health  concern.  

•  PaFents  are  responsible  for  capturing  and  recording  these  data  

•  PaFents  decide  how  to  share  these  data  with  providers  and  others  

Examples:  

▪  diet  &  exercise  trackers  

▪  sleep  trackers  

▪  monitoring  devices  (BP,  glucose,  vital  signs,  O2  etc.)  

Source:  PaFent-­‐Generated  Heath  Data  Fact  Sheet  hOps://www.healthit.gov/sites/default/files/

paFent_generated_data_factsheet.pdf  

CHALLENGES & BARRIERS WITH USING PGHD ▪  Clinical  IntegraFon  into  health  systems    ▪  Interoperability  ▪  Data  aggregaFon  ▪  AnalyFcs/clinical  decision  support  rules  

▪  Ahtude  of  clinical  providers  (doctors,  nurses,  dieFFans)  

▪  Time  and  workload  

▪  Professional  lack  of  “trust”    

▪  Age  and  technology  level  of  parFcipants  ▪  E.g.,  Smart  phone  –  4th  generaFon  or  later  

Source:  Personal  Connected  Health  Alliance  of  HIMSS  

For  all  of  the  promises  of  mobile  heath,  we  are  unlikely  to  realize  the  poten0al  un0l  pa0ent-­‐generated  data  becomes  more  intertwined  with  the  health  care  system.  

—Russell  Branzell  President  &  CEO,  College  of  Healthcare  InformaFon  Management  ExecuFves  

REMOTE MONITORING: SUTTER PILOT STUDY

hOp://www.healthleadersmedia.com/technology/hacking-­‐healthcare-­‐device-­‐interoperability#  

“.  .  .    (SuQer)  hypertension  pa0ent  care  team  to  no0ce  14-­‐day  trends  and  reach  out  to  pa0ents  who  needed  aQen0on,  advising  them  to  increase  or  reduce  medicine  dosages,  increase  exercise  levels,  or  have  a  die0cian  give  advice  on  changing  ea0ng  habits.”  

-­‐-­‐Albert  Chan,  Vice  President  and  Chief  of  PaFent  Experience  at  SuOer  

•  Six  month  pilot  study  of  149  paFents  with  high  blood  pressure  (not  randomized,  controlled  study)  

•  Integrated  realFme  BP,  exercise  and  diet  tracking  data  using  Validic  technology  into  paFent  portal  

•  Mobilised  a  hypertension  care  team  to  review  14-­‐day  trends  and  engage  paFents  

NUTRITION TECHNOLOGY TO ENCOURAGE AND EMPOWER HOSPITALISED PATIENTS

Add  clinical  dieFFan-­‐looking  picture  here  

ENGAGING PATIENTS USING FOOD & NUTRITION TECHNOLOGY

Serve  Nourish  

Engage  

Educate  

Communicate  

INTERACTIVE MEAL ORDERING

©2016  -­‐  Screenshots  provided  courtesy  of  Peter  MacCallum  Cancer  Centre  and  CBORD  

DIET EDUCATION WITH NUTRIENT INFO

©2016  -­‐  Screenshots  provided  courtesy  of  Peter  MacCallum  Cancer  Centre  and  CBORD  

MENU DISPLAYS TO EDUCATE PATIENTS & STAFF ▪  Promote  healthy  menu  choices  

▪  Provide  nutrient  and  allergen  informaFon  

▪  Monitoring  intake  provides  encouragement  

©2016  -­‐  Screenshots  provided  courtesy  of  CBORD  

TECHNOLOGY FOR CLINICAL PRACTICE AND RESEARCH

TO BE, OR NOT TO BE . . . STRUCTURED

STRUCTURED DATA

NARRATIVE / FREE TEXT

▪ Machine-­‐processable  data  

▪ Uses  healthcare  standards  and  terminology,  clinical  facts  (medicaFons,  diet)  are  encoded    

▪ Human  readable  

▪ Has  “no  meaning”  -­‐  must  be  tagged  to  assign  meaning  

▪ Ambiguous  terms  and  context  

8/6/16  

ANDHII IS EFFICIENCY

24  

•  NCPT  Term  Instant  Search  •  NutriFon  Diagnosis  SuggesFons  

•  Remember  preferred  units,  frequent  intervenFons,  and  desired  monitors  

•  Translate  data  into  narraFve  note  

Puhng  NCP  into  AcFon  a  Clinical  Data  Warehouse  

ANDHII REPORTING

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NutriFon  IntervenFon   Lifestyle  changes   Outcomes  

APPLICATIONS USING INTEROPERABLE TECHNOLOGY (HL7 FHIR© SPECIFICATION) ▪  Get  Feedback    ▪  EvaluaFon  and  PaFent  monitoring  

▪  FHIR  ObservaFon  Resource  ▪  InpaFent  monitoring  (e.g.,  feeding  pump  data)  

▪  PaFent  monitoring  –  mobile  devices  (Fitbit®,  etc.)  

▪  Use  Feedback  ▪  ModificaFon  CarePlan  or  Goal  Resources    

▪  HIT  Goals  to  improve  care  coordina+on  and  pa+ent  safety    

DEMONSTRATION OF ENTERAL FEEDING ORDER AND OBSERVATIONS •  Create  and  store  NutriFonOrder  Resources  in  “FHIR  server”  

DEMONSTRATION OF ENTERAL FEEDING NUTRITION ORDER AND OBSERVATIONS

Scenario:  

▪  Using  the  tube  feeding  example  above  

▪  Create  and  store  NutriFonOrder  Resources  in  “FHIR  server”  ▪  Volume  delivered  to  the  PaFent  recorded  and  stored  as  ObservaFon  Resources  

▪  Get  Resources  and  Generate  a  quick  graph  of  the  actual  delivered  volume/energy  vs.  what  was  ordered.  

Developed  by:  Eric  Haas,  DVM  HL7  FHIR  NutriFonOrder  Resource  Editor  

QUESTIONS?

THANK  YOU!  

MKDITTLOFF@YAHOO.COM  

@MKDITTLOFF