7/18/2017. Malinda Peeples MS, RN, CDE VP Clinical Advocacy WellDoc Columbia, MD. Disclosure to Participants

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Malinda Peeples MS, RN, CDE VP Clinical Advocacy WellDoc Columbia, MD Janice MacLeod MA, RDN, LDN, CDE Director Clinical Innovation WellDoc Columbia, MD Disclosure to

order to claim continuing education credit/hours Conflict of Interest (COI) and Financial Relationship Disclosures: Presenter: Malinda Peeples, MS, RN, CDE Employee @ WellDoc

displayed in conjunction with this educational activity Off-Label Use: Participants will be notified by speakers to any product used for a purpose other than for which it was

Objectives Introduce population health diabetes education and a new framework for educators Describe patient-generated health data (PGHD) sources, connected health devices, and

1 Malinda Peeples MS, RN, CDE VP Clinical Advocacy WellDoc Columbia, MD Janice MacLeod MA, RDN, LDN, CDE Director Clinical Innovation WellDoc Columbia, MD Disclosure to Participants Notice of Requirements For Successful Completion Please refer to learning goals and objectives Learners must attend the full activity and complete the evaluation in order to claim continuing education credit/hours Conflict of Interest (COI) and Financial Relationship Disclosures: Presenter: Malinda Peeples, MS, RN, CDE WellDoc Janice MacLeod, MA, RDN, CDE WellDoc Non-Endorsement of Products: Accredited status does not imply endorsement by AADE, ANCC, ACPE or CDR of any commercial products displayed in conjunction with this educational activity Off-Label Use: Participants will be notified by speakers to any product used for a purpose other than for which it was approved by the Food and Drug Administration. Objectives Introduce population health diabetes education and a new framework for educators Describe patient-generated health data (PGHD) sources, connected health devices, and the complete feedback loop for linking the patient and the health care team Explore the power of PGHD to build diabetes selfmanagement skills and facilitate shared decision making to improve patient quality of life and timely medication management A new framework for diabetes educators POPULATION HEALTH DIABETES EDUCATION 1

Diabetes Education: Current State diabetes education occurring at POC: Primary care, retail clinic, work place, community Virtual diabetes education expanding Virtual health care teams developing

2 Diabetes Education: Current State diabetes education occurring at POC: Primary care, retail clinic, work place, community Virtual diabetes education expanding Virtual health care teams developing (telehealth) Participatory medicine (health care consumerism) the epatient Evolving Care Models PCMH ACO Comprehensive Primary Care Initiative (CMS) Transform primary care Care coordination Communication physicians and hospitals accept joint responsibility for the quality and cost of care delivered to a population of patients (1) Risk-stratified Care Management (2) Access and Continuity (3) Planned Care for Chronic Conditions (4) Patient and Team Engagement; (5) Coordination of Care across the Medical Neighborhood The Medical Neighborhood a clinical-community partnership that includes the medical and social supports necessary to enhance health, with the PCMH serving as the patient s primary hub and coordinator of health care delivery. A definition Population Health Diabetes Education (PHDE): Using technology and the appropriate level of human touchpoints to deliver contextualized, individualized diabetes self-management care, education, and ongoing support to defined populations to build self-care knowledge, skills, and behavior PHDE links patients to their own health care team, supports timely treatment optimization, and creates practice improvement opportunities An engaged patient partnering with their informed, engaged health care team improved outcomes PHDE Framework Educator is lead for team R/R defined for various LI s facilitating practicing at top of license (efficient access, practice efficiencies) Capability to identify population of interest (data available and expertise for data retrieval and interpretation) SMS supported through technology delivered solutions supplemented by right level of human touchpoint Process for viewing, evaluating and communicating PGHD for appropriate decision-making (timely treatment decisions, material resource support, psychosocial support) Population reporting and QI initiatives Technology Enabled dsmes Hallmarks of technology integration into clinical practice The health care team surrounding the patient: Consistently identifies patients who would benefit from evidence based digital health tools as a standard of care Engages identified patients in the use of the digital therapeutic configured for their treatment plans Uses the resulting patient generated health data in a complete feedback loop to inform timely treatment and care plan optimization through shared decision making to achieve improved metabolic outcomes Diabetes Education & Support Services Who (expanding access) (AIM1) Learned intermediaries (L.I.) - non-prescribing members of the healthcare team-across the healthcare system, community, and workplace Potential for educators to lead these teams What (integrating silos) (AIM2) Includes DSME/S Psychosocial support (DAWN) Treatment optimization (medication management & shared decision-making) How (using technology to scale diabetes care) (AIM 3,4,5) Digital platform w appropriate connectivity L.I. playbook specific to role and scope of practice Where & when (enabling extension of services to maximize consumer/patient engagement & outcomes) (AIM 6,7,8) Informed by the healthcare enterprise and/or the payer objectives & guidelines Facilitate access to appropriate digital tools that meet the user s technology preferences 2

PATIENT-GENERATED HEALTH DATA AND THE COMPLETE FEEDBACK LOOP Diabetes ehealth Ecosystem Personal health devices

Mobile apps / Digital Therapeutics (clinically validated apps) Social media (DOC) What is ehealth To promote

technologies in the presence of a complete feedback loop that enables the use of data and information, to

Based on Architecture for Integrated Mobility Framework (AIM) Engaged, empowered, educated activated & informed

knowledge A New Model: The e-patient Engaged, empowered, educated activated & informed knowledge A New Model:

3 PATIENT-GENERATED HEALTH DATA AND THE COMPLETE FEEDBACK LOOP Diabetes ehealth Ecosystem Personal health devices Cloud connected monitoring systems & Data management platforms Telehealth services Digital pre-/dm education Mobile apps / Digital Therapeutics (clinically validated apps) Social media (DOC) What is ehealth To promote positive health outcomes by using a new frame of mind that incorporates information and communication technologies in the presence of a complete feedback loop that enables the use of data and information, to generate health management knowledge and wisdom. AADE 2016 Technology Workgroup. Based on Architecture for Integrated Mobility Framework (AIM) Engaged, empowered, educated activated & informed Connecting with health care team, communities and social networks (the e-community) Generates collective knowledge A New Model: The e-patient Engaged, empowered, educated activated & informed Connecting with health care team, communities and social networks (the e-community) Generates collective knowledge A New Model: The e-patient Gee, et al, JMIR 2015;17(4)e86 Gee, et al, JMIR 2015;17(4)e

Greenwood, Gee, Fatkin, Peeples Journal of Science & Technology 2017 7/18/2017 Patient-centered..connected care.

4 Greenwood, Gee, Fatkin, Peeples Journal of Science & Technology /18/2017 Patient-centered..connected care.the vision The ehealth Enhanced Chronic Care Model (eccm) Community Health Systems ecommunity ehealth PCP Delivery System Design Clinical Decision Support Clinical Information Systems Value- (Care Coordination, based Care) Information Knowledge (HER, PHR, Internet, mhealth, wearables, telehealth, etc.) Specialist Diabetes Educator Self-Management Support Data Informe d, Activate d Patient Complete Feedback Loop Productive Interactions (Action) Insight Prepare d, Proactiv e Practice Team ehealth Education Health Coach Care Coordinator Leveraging patient-generated data to inform care decisions 19 Gee, et al, JMIR 2015;17(4)e86 Improved Outcomes 20 Technology-Enabled Self-Management Feedback Loop Evaluating ehealth tools Has the tool been designed to be user friendly and engaging? Is the analysis and feedback evidence and theory based? Does the platform connect the patient with their own health care team? Has the tool demonstrated improvement in clinical outcomes and patient engagement? Does it ensured the safety and security of the patient-generated health data? Is it FDA-Cleared? 22 Are you ready to be an e-educator? Actively recommends evidence-based e-health tools and integrates into practice - Builds patient self-management skills and provides ongoing support - Partners with the e-patient in leveraging the resulting Patient-Generated Health Data (PGHD) to negotiate and drive timely therapy optimization in a COMPLETE FEEDBACK LOOP Improved outcomes e-educator becomes indispensable team member in value-based care Educator Empowerment through Digital Health USING PATIENT-GENERATED HEALTH DATA TO IMPACT PRACTICE 23 4

5 Leveraging the power of mobile health Digital Therapeutic for Type 2 Diabetes A C L I N I CA L A N D B E H AV I O R A L I N T E R V E NT I O N T O D E L I V E R O U T C O M ES First Digital Health company built on a life sciences model 24/7 individualized coaching and self management support Contextualized, individualized, ondemand diabetes education AADE 7 Connection to the care team enabling more timely care plan changes The next block buster drug: Engaged patients partnering with their informed, engaged health care team improved outcomes Extensible and secure system architecture to scale to support multiple chronic diseases Published, peer-reviewed clinical outcomes in randomized control studies and real-world programs Technology-Enabled Self-Management Feedback Loop Insert TEXT From Article Digital Therapeutic for Type 2 Diabetes A C L I N I CA L A N D B E H AV I O R A L I N T E R V E NT I O N T O D E L I V E R O U T C O M ES First Digital Health company built on a life sciences model Extensible and secure system architecture to scale to support multiple chronic diseases Published, peer-reviewed clinical outcomes in randomized control studies and real-world programs Insert Ref Demonstrated Clinical Outcomes The BlueStar Platform: How it Works Patient Coaching App: Clinical Decision Support: Mobile and Web-based Multi-device, SmartVisit Report multi-os, on- or off-line, clinical and Population Reports consumer Via fax, object in EMR or raw data via API Improved Clinical Outcomes Clinical Outcomes 58% Cost Savings (ER & Hospital visits) 58% Hospital & ER FDA cleared the BlueStar platform Visits in 2010 ADA recognized as the first digital therapeutic 2X Medication Changes (Influencing Physician Behavior) AADE curriculum integrated into BlueStar platform Real World Data Clinical Outcomes & Practice Models References: Quinn CC, et al. Diabetes Technol Ther. 2008;10(3): Quinn CC, et al. Diabetes Care. 2011:34(9): Richard Katz, MD; George Washington University Medical Center; Journal of Health Communication, December Quinn, CC, et al. Glycemic Control: Impact on Physician Prescribing Behavior, Presentation ADA 72 nd Scientific Sessions, Tang PY, et al. ehealth-assisted Lay Health Coaching for Diabetes Self-Management Support American Diabetes Association 76 th Scientific Sessions Poster Presentation AADE 2016 Oral Presentation. NACO/VFX/0217/0108 ID: 759, V1 Care Management & Administration Portal Implementation and Configuration Management Automated Decision Support System Cloud-based analytics Evidence-based guidelines Multivariate inputs Correlative and predictive modeling 5

7/18/2017 Digital Health Supports: Cause and effect analysis of dependent variables and interventional insights Summary and Insights for: BG Meds Digital Data Supports Focused Conversations w Team

6 7/18/2017 Digital Health Supports: Cause and effect analysis of dependent variables and interventional insights Summary and Insights for: BG Meds Digital Data Supports Focused Conversations w Team Example Activity Sleep Carb Summary & 1 Insight Place holder for case study 2 Smart Visit Summary Report (John) 3 4 Connecting to team sharing Smart Visit Report Hari notices a pattern of high fasting BGs and sends his team a report between visits Susan has a regularly scheduled appointment with her team today -her report was sent automatically to her team this morning Proven Clinical Outcomes Clinical 58% Cost Savings Improved Clinical Outcomes Outcomes (ER & Hospital visits) Susan also decides to send her report to her daughter Real World Data 2X Medication Changes Clinical Outcomes & Practice Models (Influencing Physician Behavior) 58% Hospital & ER Maria s care coordinator receives her report automatically each month as scheduled FDA cleared the BlueStar platformvisits in 2010 ADA recognized as the first digital therapeutic AADE curriculum integrated into BlueStar platform 2017 References: Quinn CC, et al. Diabetes Technol Ther. 2008;10(3): Quinn CC, et al. Diabetes Care. 2011:34(9): Richard Katz, MD; George Washington University Medical Center; Journal of Health Communication, December Quinn, CC, et al. Glycemic Control: Impact on Physician Prescribing Behavior, Presentation ADA 72nd Scientific Sessions, Tang PY, et al. ehealth-assisted Lay Health Coaching for Diabetes Self-Management Support American Diabetes Association 76th Scientific Sessions Poster Presentation AADE 2016 Oral Presentation. NACO/VFX/0217/0108 ID: 759, V1 The BlueStar Platform: How it Works Patient Coaching App: Mobile and Web-based Multi-device, multi-os, on- or off-line, clinical and consumer Clinical Decision Support: SmartVisit Report Population Reports Via fax, object in EMR or raw data via API Digital Health Supports: Cause and effect analysis of dependent variables and interventional insights Example Summary and Insights for: BG Meds Activity Sleep Carb Summary & Insight Automated Decision Support System Care Management & Administration Portal Implementation and Configuration Management Cloud-based analytics Evidence-based guidelines Multivariate inputs Correlative and predictive modeling 6

Digital Data Supports Focused Conversations w Team 1 Place holder for case study Smart Visit Summary 2 Report (John) 3 4 Connecting to team sharing Smart Visit Report Hari notices a pattern of high

to send her report to her daughter Maria s care coordinator receives her report automatically each month as scheduled Opportunities with PGHD Challenges with PGHD Initiatives Empower patients to

costly episode Enable clinicians and care teams to make timelier, better informed decisions Improve collaboration with patients to create personalized treatment plans Redistribute workload and

7 Digital Data Supports Focused Conversations w Team 1 Place holder for case study Smart Visit Summary 2 Report (John) 3 4 Connecting to team sharing Smart Visit Report Hari notices a pattern of high fasting BGs and sends his team a report between visits Susan has a regularly scheduled appointment with her team today -her report was sent automatically to her team this morning Susan also decides to send her report to her daughter Maria s care coordinator receives her report automatically each month as scheduled Opportunities with PGHD Challenges with PGHD Initiatives Empower patients to better manage their health and participate in their health care Provide a more holistic view of a patient s health over time Increase adherence to a treatment plan Enable timely intervention before a costly episode Enable clinicians and care teams to make timelier, better informed decisions Improve collaboration with patients to create personalized treatment plans Redistribute workload and increase efficiency Reduce health care costs Better attract and retain patients Lack of access to internet or smart phone Device abandonment of consumer health technologies Device abandonment of consumer health technologies Patients are not encouraged to capture or share their PGHD with their health care team Concerns about data privacy and security Concerns about accuracy and validity of PGHD Ability to draw actionable insights from the large volume of data Lack of best practices for incorporating PGHD into clinical workflow Data and device interoperability AADE 2012 Ms. Malinda Peeples (WellDoc, Baltimore, MD) was even more visionary in her presentation, asserting that mobile technology provides a more significant opportunity for the diabetes community than the introduction of blood glucose monitoring. We think the jury is still out on this one, especially because the burden is still on patients to manually enter data, on providers to painstakingly interpret it, and on companies and FDA to bring to market in a big way a technology that strikingly improves clinical outcomes. But the whole field sure is exciting! (Closer Look Report on AADE 2012, Indianapolis) Opportunities for Educators Not incremental but transformative Diabetes Educator Workforce: Become clinical leaders in Digital Health Chronic Disease Management Technology & care practices are demanding a whole patient view and that translates into me and all my chronic diseases. How do we take a leadership in this?... Virtual care teams are growing (Telemedicine, digital health, & more) Technology platforms are developing rapidly Explore partnerships to provide subject matter expertise Capability to address fragmentation in care - technology + educator expertise= connecting patient & care Define the roles and responsibilities for a digital health champion at each practice level. Provide guideline, educational, and certification leadership for this.! 7

8 Opportunities for Educators Not incremental but transformative Diabetes Education Services & Delivery: Connected Self-Management and Treatment Optimization moving beyond behavior change Population Health Support develop data driven education & care algorithms to expand the care team efforts to produce clinical and cost outcomes (the Joint Position Statement describes the when not the how ) How can self-management education/support & treatment optimization be provided in a way that meets the triple aim and allows for clinicians and their support staff to practice at the top of their license? self-management support not DSME/S is being highlighted as essential primary care functions Have conversations with CMS and other payer groups regarding primary care redesign Partner with PCMH and ACO organizations to provide diabetes self-management & care leadership and demonstration projects (diabetes is the use case for chronic disease) Expand the DSME/S Program structure to exist outside the bricks and mortar world and embrace virtual programs...it s less about the program structure and more about the outcomes! Opportunities for AADE Not incremental but transformative Patients: Integrate the Consumer Technology Movement with CAN Self-Management AADE BE Education THE & INTEGRATOR* Ongoing Support? Embrace the consumer movement & become the translator for connecting evidence-based self-management interventions into digital The Integrator is a single organization (not just a tools market dynamic) that induces cooperative Explore opportunities to engage with the on-line communities behavior among health service suppliers to work Lead the efforts in using patient-generated data to optimize education and as a care system delivery connecting for the defined data population? with intent to support the real-time, daily-decision making that drives outcomes *Berwick, Health Affairs 2008 PCP Specialist Diabetes Educator Thanks! mpeeples@welldoc.com jmacleod@welldoc.com Health Coach Care Coordinator 8

7/13/2017. Overview. Evolving Healthcare State. What do these have to do with Nursing Informatics & Chronic Disease & Digital Health?

7/13/2017. Overview. Evolving Healthcare State. What do these have to do with Nursing Informatics & Chronic Disease & Digital Health? Digital Health: Leveraging the Power for Chronic Disease Malinda Peeples MS, RN, CDE Vice President, Clinical Advocacy WellDoc mpeeples@welldoc.com Overview Current Health Care Challenges Digital Health