mHealth has potential to enhance role of diabetes educators, continuum of care
INDIANAPOLIS — Through the evolution of technology and connectivity, patients with chronic diseases such as diabetes are benefiting from improved access to care, enhanced communication and peer support. However, concerns about privacy and liability have some clinicians backing away from the transition into mobile health technology. At the American Association of Diabetes Educators annual meeting, diabetes educators discussed the potential of mobile health technology, or mHealth, to enhance their roles in the ever-changing landscape of health care.
Donna Rice, MBA, BSN, RN, CDE, president of Big Picture Health, LLC, past-president of the American Association of Diabetes Educators (AADE) and Endocrine Today Editorial Board member, said there is an imbalance between the growing needs and available resources of diabetes care.
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Donna Rice
“There’s a growing demand for services coupled with fewer resources to provide the service and pay for it,” Rice said during a presentation. “We know that health care transformation is here with further change coming, yet we’re still stuck in an acute care delivery model. We have to be open to new ways of doing business; we have to realign our mission and our goals of services.”
Rice said that utilizing mHealth will allow for several benefits to providers and patients, including improved access to care, as well as the ability to monitor critical measures by supporting independence in care and supporting and/or monitoring behavioral changes. It also has the potential to enhance communication and provide decision support; with the capability to link resources; create peer support and implement data acquisition, tracking and reporting.
Rice also said that mHealth can benefit health systems through enhanced communication in marketing efforts through information-sharing as well as tracking data on clinical outcomes, innovative financial and billing strategies, while creating accountable or integrated care.
From a business perspective, Rice said mHealth will increase proactive care vs. reactive care, decreasing readmission rates, providing real-time data, and creating “big picture thinking” on outcomes and quality vs. reimbursements. Utilizing mHealth also gives providers a chance to handle a greater volume of patients effectively, she said. Self-management support will also be enhanced by mHealth. However, Rice said these things will only happen with initiative and a push for change.
‘Turning data into action’
Malinda Peeples, MS, RN, CDE, vice president of clinical advocacy at WellDoc Inc. and past president of the American Association of Diabetes Educators (AADE), said educators and clinicians must first identify the problem.
“(Diabetes is) not just a problem here in the US, but globally; particularly with China and India pushing the numbers into astronomical figures. Diabetes globally is a significant health problem. We’re all faced with the question: How are we going to deal with such a number of people with diabetes?” Peeples said during a presentation.
One way is by turning data into action. Peeples said 43% of patients with diabetes have HbA1c levels that are out of control, and that just 12% meet glucose, lipid and BP targets.
“There is a gap in meeting the standards of care. mHealth can fill the gap,” she said.
mHealth is a rapidly evolving domain within health care. With the proliferation of mobile phones and other wireless devices, health has become a focus for these communication technologies.
“What is both interesting and powerful is that we can now use the devices that we are all familiar with to support healthy activities like monitoring our exercise or weight, sending text messages that include health education tips, or remotely monitoring chronic diseases such as hypertension and diabetes. Our personal devices are now not just our phones but can be our health buddies,” Peeples told Endocrine Today.
“We expect to see more clarity around the types of mHealth applications in the market. There will continue to be those health and wellness applications, but we see an evolution toward more integrated solutions that will be linked with the provider to form a new type of treatment or therapy.”
Peeples said this mobile integrated therapy will offer three key benefits to the patient and providers:
- Translate the treatment and education plan into daily self-management support.
- Integrate clinical, behavioral and educational messaging to provide both real-time and trending support.
- Turn data into actionable information that can help providers respond in a more timely and effective manner.
During the presentation, Peeples said the technology behind WellDoc is the key to patient-centered care because of its simple accessibility. It is designed to provide self-management coaching to the patient and deliver information that reflect the patient’s condition directly to the provider.
“And, it’s adaptable and dynamic to meet a person’s daily life,” she said.
Founded in 2005, WellDoc was initially focused on developing diabetes management solutions. Peeples presented a case study using the WellDoc Mobile Integrated Therapy platform, a software solution for mobile devices that links providers to patients to coordinate diabetes care and encourage self-management and long-term adherence.
The WellDoc product has undergone two randomized control studies. In a recent study by Charlene C. Quinn, RN, PhD, of the University of Maryland School of Medicine, and colleagues, published in September 2011 in Diabetes Care, data demonstrated that HbA1c levels decreased by 1.9% in a maximal treatment group compared with 0.7% in a control group; a difference of 1.2% (P<.001) over 12 months. The analysis included 163 patients.
Quinn and colleagues suggested that when individually analyzed and presented to providers, a combination of patient behavioral mobile coaching with blood glucose data, lifestyle behaviors, and patient self-management data significantly reduced HbA1c levels during a 1-year period.
“I would challenge you to understand what it means for you and your patients. I believe that mobile health provides for diabetes educators an opportunity probably parallel, or more significant than the introduction of blood glucose meters,” Peeples said, noting that the technology provides a new opportunity to connect patients and clinicians through ongoing support for their mutual goal — good diabetes care.
WellDoc’s first commercial product, DiabetesManager, was cleared by the FDA as a Class II medical device in 2010 and is now being marketed to disease management companies.
A parent’s perspective
Pam Henry, MEd, founder of MyCareConnect, an Internet tool for parents, schools and health professionals to share diabetes information via email and text message, spoke candidly about the inspiration behind her creation at Rice and Peeples’ presentation.
When Henry’s daughter, Sarah, was diagnosed with type 1 diabetes in 2003 at age 6, she said she felt overwhelmed with information, or a lack thereof.
“I created this for my own use, for better communication with my school nurse. Other school nurses in the district found out about it and asked if they could use it, too. So I had no intention of this becoming a product, I really didn’t; I just needed a solution,” Henry told Endocrine Today.
MyCareConnect and BlueLoop are both HIPAA compliant applications that log and track blood glucose trends and document dosages, and electronically notify parents, schools or health professionals of the daily progress.
“It’s more proactive care. It’s catching trends before they become a problem, and ultimately, our goal is to have healthier children and adults,” Henry said. – by Samantha Costa
For more information:
Rice D. #WKSHP05. Presented at: The American Association of Diabetes Educators 2012 Annual Meeting & Exhibition; Aug. 1-4 2012; Indianapolis.
Disclosure: Ms. Rice is on advisory boards for Novo Nordisk and Sanofi-Aventis. Ms. Peeples is a WellDoc employee. Ms. Henry reports MyCareConnect has a partnership with Sanofi-Aventis.