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
25
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
Recommended
