Creating Seamless Chronic Condition Support

Michelle Cartier: Thirty-seven percent of US adults 20 and older have type-2 pre-diabetes. That is an insane number.

Host: You're hearing from Michelle Cartier, a director of product strategy at MEDHOST. She's outlining some of the major considerations that patients face today and the tools we have available to measure their impact.

Michelle: Five out of every six healthcare dollars goes to chronic condition management.

Host: This is Health IT on the Record, presented by MEDHOST, a show that dives into how health information technology innovations impact every aspect of a health system from multi-hospital networks down to individual patients.

In this episode, we're discussing the new beta of YourCareEverywhere Condition Management, a program developed to provide patients and their health coaches with a tool that encourages seamless communication and support that helps patients with chronic conditions better manage their disease in between office visits. It allows health coaches to set specific care goals for patients and connects patients with accessible resources like registered dietitians and nurses to provide digitized support and structured coaching sessions.

Along the way, we'll also take a look at how health information technology specialists are using interconnected data and devices to help those managing chronic conditions. We're going to zoom in on one of the program's participants, and for the purpose of this interview, we're calling this participant Jane. Enjoy the conversation.

Michelle: So we conducted our first beta with a primary practice in Charlotte, and there were three coaches at the facility, and they went and recruited ten patients who wanted to participate in our study and were willing to use the application for a period of time. And then, not surprisingly because the demographic can skew a little bit older for diabetes and some of those folks don't have smartphones, they recruited the caregiver in the case of three patients who didn't have smartphones or just sort of said, "I'm not going to track this with any regularity, but I really want to do better and I have a caregiver that helps me." That was a spouse or a daughter. So we have 13 total patient/caregiver participants.

Host: Right. And is there one, I know we can't use names, but let's just call her Jane. So tell me about Jane and we'll kind of follow her along here.

Michelle: Okay. So Jane participated in our program for two weeks and logged her data with regularity. She and her husband drive a FedEx truck.

Host: That sounds kind of fun.

Michelle: It could be. I mean, you definitely get to see a lot of the United States. A lot of people.

Host: Especially if you're going all over the region. Cool.

Host: So it was Jane's husband who was?

Michelle: Jane was actually the type-2 diabetic. And so imagine how difficult it is to live with this lifestyle generally, and then imagine yourself being on the road constantly with poor food choices, an erratic schedule, disrupted sleep. I mean, how difficult might it be to manage this condition if that were your occupation? And so at the conclusion of the beta, Jane couldn't come to the in-person focus group, obviously.

Host: She's on the road.

Michelle: Yeah. She's on the road. So we spoke and she said, "I had never had this sort of structure and the ability to just track this and see it trended over time with any regularity."

Host: When you're talking about the tracking part, what are people normally doing? What's the traditional method to monitor, manage, a chronic condition like diabetes? What are people normally doing?

Michelle: Yeah. I mean, there are two different paths, I think. One, and we saw this with another one of our patient participants who came into the focus group and brought his notebook, and you can just track back over the pages and over the years. And he has four columns of data where he tracked his weight and his blood glucose and his pulse, and something else I can't remember, in columns day after day, year after year, with very little ability to understand contextually how he slept or how what he ate might have impacted his blood glucose for the day. Or whether it was trending high or low, or better.

Host: There's no graph or anything.

Michelle: There's nothing.

Host: It's just a bunch of information.

Michelle: It's just columns. Yeah. Very hard to sort of synthesize that information, right?

Host: Definitely makes sense.

Michelle: And then I would say the other sort of method is really just managing this on your own. Maybe not writing anything down. Maybe not complying at all.

Host: It's all in your head.

Michelle: Just being completely over –

Host: Just trying your best.

Michelle: Trying your best.

Host: Sort of.

Michelle: Yeah. Doing your best. Doing it when you can. Trying to read what you can, when you can. Maybe if you have a hyperglycemic or hypoglycemic episode just out there sort of on your own trying to navigate this world.

Host: So before, we've got Jane. She's traveling. She's doing a lot of work. So, I mean, you were saying just a moment ago what she was doing. How does it affect someone who doesn't keep track of this? I know that sounds like an obvious question but really how does that affect them?

Michelle: Well, I mean. So they could have hyperglycemic or hypoglycemic episodes where their blood sugar is too high or too low. That can cause all kinds of serious complications if that is not brought under control eventually over time. Diabetes can be a devastating disease. Folks can suffer from kidney disease. There's a preponderance of heart disease that correlates. They could have neuropathy or nerve pain. Glaucoma. There's just a variety of things that have to be managed and have to be improved in terms of lifestyle so that the complications are not created and the symptoms don't worsen.

Host: So I know we've talked just now about some of the different numbers. Some of the different trends of how this is affecting so many people. But there are other trends that can play a role in this to hopefully combat this. And so one of those – I know it's a big buzzword just generally in the whole world, but Internet of Things is a real thing.

Michelle: It is a thing.

Host: It's a thing that's in our lives now and it impacts a lot of us. So off the top of your head, I know I putting you on the spot here, but any idea on just kind of high-level numbers of some data on what this looks like today? And then from what we have today, maybe we can talk more about how this fits into YourCareEverywhere Condition Management, and what you all have made and the results from this beta test.

Michelle: Yeah, sure. Well, in terms of Internet of Things, I think the number is upward of 75% of Americans have a smartphone. I think the number's close to 40 million Americans have a connected device that they will wear at least once a month, and that number has grown substantially in the last five years.

Host: Hockey stick.

Michelle: Oh yeah.

Host: And that's just at least once a month. I mean, we've got, I mean, people every day, whether it's an Apple Watch or a Fitbit. I mean, that's what this is including. It's just any kind of wearable device that's tracking you, your movements, all this stuff.

Michelle: That's right. Right. Vital signs or activity or whatever it might be. And so, if you put those two things together, right, that can be a very powerful platform for applications that enable you to trend and make sense of that data over time.

Host: Health IT on the Record is brought to you by MEDHOST. With over 30 years of experience partnering with provider nationwide, MEDHOST is helping evolve better solutions for healthcare management through innovative workflows and technologies. For more information, visit medhost.com. Let's jump back in.

Host: So tell me about what you built, what your team has built, and then let's talk a little about kind of what your assumptions were going into this beta and then what actually happened. So what is it that you built and kind of how has it been playing out so far?

Michelle: Yeah. We built a platform, condition management platform, that enables coaches and their patients to interact with each other continuously in real time for a structured coaching program. So the coaches can deliver educational content to type-2 diabetics or those at risk of type-2 diabetes. The can prescribe certain tasks like check your blood glucose after meals or exercise 30 to 45 minutes, three times a week. And they can communicate with their patients through the application. They can even reach their patients when the patients aren't in the app, which is really important because a lot of folks start out strong and then maybe taper off over time.

And the patients, for their part, use the YourCareEverywhere smartphone application. And they log in and they see a task list for the day, so it has everything that their coach has recommended they do at the time at which they recommended that they do it. And the patient can then log that information or can sync one of their wellness devices to the application that will track their exercise, for example, for them. And those readings are rendered real time back to the coach through the coaching platform. And the patient can interact with their coach as well, securely, via that application, and can see their data trended over time and start to make sense of this condition that they have.

Host: So they can see it in real time. They can see the data.

Michelle: That's right.

Host: And so can their actual doctor.

Michelle: That's right.

Host: And this isn't just some random person somewhere out in the world. This is actually – this is their doctor.

Michelle: That's right. This is their health coach.

Host: That's an important part of this.

Michelle: I think it is. I think so.

Host: They can trust them. And you say you get feedback. Are they able to – I mean, in my mind, I'm thinking like, "Are they sending a thumbs-up emoji?" Or is it – what does that look like?

Michelle: I mean, they could send a thumbs-up emoji. They're sending a secure message, so. That's popular in the healthcare space, so they can send sort of protected healthcare information that way.

Host: Protected emojis.

Michelle: Yeah. Protected emojis. Or they can nudge the patient, which would be more of what you're talking about.

Host: That's with the poke emoji.

Michelle: Almost like a poke. Yeah. And so the patient, whether they're in the application or not, can receive a smartphone notification saying, "You have a new nudge from your coach."

Host: That's like a pat on the back. It's like, "Hey, let's keep going. Let's keep walking together."

Michelle: Yeah. That's right. And that could be in the text, in fact, that's in the application once they log in.

Host: You say it could be the text?

Michelle: Yeah. The nudges – the actual content of the nudge, for privacy reasons, is actually in the application in sort of a text format, but the notification that you've received a nudge from your coach might remind you to log in to the app to retrieve that.

Host: So you built the software solution here, so YourCareEverywhere Condition Management – all right, we have a sample size of both sides of it, being patients and the coaches, so what were your assumptions? You're the Director of Product Strategy. I mean, you've, I'm sure, had some things on your mind of how you thought it would go. What was the assumption, and then let's talk about what was the outcome?

Michelle: Yeah. So I was very optimistic during the beta. I definitely feel like we have a very strong product that can add a lot of value to – can complement what the coaches and the healthcare providers are already doing for their patients, but I didn't know what was going to be most useful or what might be missing. You never really do until you put it in folks' hands and they have to use it day-in and day-out. And so I think for me, the biggest learning was the simplest things were the most effective, the most powerful, things.

Host: The simplest things.

Michelle: The simplest things.

Host: So is there one – what is a simple thing that might have seemed like it could've been easy to overlook in an assumption?

Michelle: Yeah. I mean, I think one was – one woman told me, "This is the first time I've ever seen my data." Right?

Host: Did she have a notebook before?

Michelle: No, she didn't have a notebook.

Host: But even if she did have a notebook, you would still want to be able to see it.

Michelle: Right. And some of the glucometers that people are using will record their historical readings for maybe two weeks historically, or write the last five readings or something. So they had seen some, potentially, but they had not seen it trended in graphical format over time. To me that would be obvious, to put a chart in the application. But I didn't think it was going to be that powerful, right?

Host: Wow. That's got to be really empowering, to see your own data that could help you fight something. Fight a chronic disease.

Michelle: I think so. I think so. Yeah.

Host: Tell me more about people who are making the leap to digital. Having something like your smartphone that – in this midst of a world of Internet of Things, what's it like for someone who might not be as comfortable?

Michelle: That's a great question. Actually I was worried about this, because you can read the statistics about the demographics of folks in the 65-plus cohort and how they don't necessarily adapt to technology, and we've been talking to folks that might be beta sites for us who said, "I just don't know if these folks are going to have smartphones." And everybody did great. I mean, they recruited patients ranging in age from 30 to 80 years old. The 80-year-old gentleman rolled into the focus group at the conclusion of the beta with a smartwatch –

Host: What?

Michelle: Yeah. He has a smartwatch. He has his iPhone. I mean, he was a super-user.

Host: Did he already have that gear?

Michelle: He already did. But he's 80 years old. I mean, I do not think we should count these folks out. And I think what we've found is that most people that expressed some difficulty in adapting this technology or using it on a recurring basis did a great job after they initially got set up, right? I mean they all were able to log their data throughout the beta period.

Host: I like how you said how this 80-year-old gentleman just rolls up. I'm just imagining a really hip, cool grandpa. But you're right. I mean, when you said earlier like 64% of people have a smartphone and that's just smartphones, that's not counting ...

Michelle: That's smartphones. Yeah.

Host: What's layered on top of that with smart devices.

Michelle: That's right.

Host: Good point. So overall, do you have just like a final outcome thought of what – any other insights before we kind of move on to think about what this first study means for the future of condition management?

Michelle: Yeah. I think we definitely understand that there's value here. We have to make some modifications just in terms of more customization and flexibility for some of these folks that would better fit their lifestyle.

I think probably the biggest, most valuable takeaway for me was the fact that there are applications now that allow people to manage their conditions digitally, but none of the people that participated in our beta – and this wasn't a requirement, this just happened to be true. None of them were using anything before they were invited to participate in this. And all of them – well, not using anything digital, I should say. All of them said, "I trust this one because my healthcare provider recommended this application."

Host: They're on the other side of this.

Michelle: That's right. They're on the other side of this. So their healthcare provider recommended it, and that's the application they're going to use.

Host: So when you now start to think about the future, what do you think this means for condition management? What's next after diabetes? What are you and your team wanting to do next?

Michelle: Yeah. I think this means that there's a broad applicability for this type of content. Lifestyle content, exercise, and eating well, and sleeping well, are just things all of us should be doing, right? Not just folks with type-2 diabetes. And so those tend to be the things that everyone needs to do, whether or not it's diabetes that they're struggling with, or heart disease, or obesity. And so I think those will be the sort of natural extension of this application.

Host: It's just the beginning, right?

Michelle: Just the beginning.

Host: So probably my final question is now when you're thinking about how this could fit into the larger EHO workflow, do you just have one or two things that you're excited about?

Michelle: Yeah. I'm excited about how this application will help facilities meet their patient-generated health data measure, which is the impetus for collecting information from patients outside the clinical setting of care and incorporating that into their chart and the HR. And so we're doing a lot of exploration around the workflows that are appropriate for that right now.

Host: I'm really looking forward to see what's happening next, and I know this is just the beginning, building on top of something that's already great. So, Michelle, I guess that's a good place to probably wrap up this conversation. So I'm not sure if you have any final thought or anything, but do you have any final thoughts? Anything that we've not touched yet that is just on your mind, on your heart, just about the work that's happening?

Michelle: I'm just really excited about the work that's happening. I would say I think this is just the beginning, like you said, and I think we have a really awesome team that has been working really hard on this for a couple of years, and the reception we've been getting as we have been demoing this has been really exciting. And it was very rewarding to put this in patients' hands and see it positively impact their life, and have some of them ask me if they could continue to use it.

Host: That's got to be the best feeling ever.

Michelle: It is.

Host: Well, it's well deserved and this is just the start. So thank you so much, and yeah. I appreciate your time.

Michelle: Thank you, Clark.

Host: Thanks for listening to Health IT on the Record, presented by MEDHOST. For more stories and content like this, be sure to visit medhost.com/resources. Thanks.