Beacon IC3 Communities Project From Theory to Practice

Association of Utah Diabetes EducatorsNovember 4th, 2011

Korey Capozza, M.P.H. andSarah Woolsey, M.D.

Learning Objectives

• Describe the Utah Beacon Communities project

• Review highlights of the Utah Diabetes Practice Recommendations 2011

• Introduce Utah Healthscape • Introduce mobile health tools being

used in the Beacon Communities project

• Demonstrate the benefits of the Utah Clinical Health Information Exchange for care providers and patients

Utah Beacon IC3

Improving Care through Connectivity and Collaboration

• 1/17 in the U.S.• Project Dates: May 2010 –Mar 2013• GOALS: Utilizing technology, improve

health care delivery outcomes while reducing costs

• Targets: Patients with Diabetes Type II in the Salt Lake MSA, Communicable Disease Reporting, End of Life issues

Partners

• UDOH; Public Health, Epidemiology, Diabetes Program, Vital Records

• University of Utah Community Clinics• Utah Health Information Network• Intermountain Healthcare• Utah Medical Association• Commission on Aging in Utah• Community Healthcare Providers

More visits needed

Colwill J M et al. Health Aff 27:w232 (2008)

©2008 by Project HOPE - The People-to-People Health Foundation, Inc.

What is it like in the trenches?

• More visits/Less Time for visits• More diagnoses per patient• More medications prescribed• More preventive services required• More transitions• New Technology does not always “fit”• Patient outcomes not satisfactory

Not just about the technology-Ideal

Trained People, Efficient

Processes and Easy Tools

Data Systems, Structure

d Data

Health Information Exchange

Quality Analysis,

Interventions

Understand

Outcomes, Reassess

$

Not just about the technology-Current State

Informal process, Poor

Training, Digitized

Paper

Paper Based

Systems, Non-

structured Data

Fragmented Health

Information Exchange

Labor Intensive Quality

Analysis, Interventions

Limited Understanding of Outcomes, Labor

Intense Reassessment

Not just about the technology-Ideal

Trained People, Efficient

Processes and Easy Tools

Data Systems, Structure

d Data

Health Information Exchange

Quality Analysis,

Interventions

Understand

Outcomes, Reassess

IC3

Beacon Utah-who we are

Commission on Aging• Using web-based technology to connect patients’

end of life wishes to EMTs, ERs, and hospitalsUtah Health Information Exchange

• With UDOH making easier to report communicable diseases through our electronic records

• Connecting health information for all Utahns and health providers

Intermountain Healthcare• Making the Patient Worksheet available through

Health Information Exchange for DM patientsUniversity of Utah

• Studying effects of patient portal connections and care mangers to improving patient engagement and health

Beacon Utah-who we areClinical Interventions Team

• 62 Primary Care clinics• 330 providers• Potential to impact 50,000

patients with Diabetes• Eye care specialists-in

recruitment• YOU

Aims of the IC3 Beacon Community

• To demonstrate that health IT-enabled quality, cost/efficiency, and population health improvements are possible in diverse communities by 2013.

• To support lasting innovation networks in our community through which a wide range of stakeholders can continue to collaborate, design, and implement new technology-enabled ideas that improve health care beyond 2013.

• To provide lessons, implementation insights, and best practices for other communities eager to improve health, health care, and cost-efficiency in their communities.

Beacon Clinic Intervention QI Process

Select Clinic

Provider Champion

Designate the

clinic QI team

Feedback session,

review clinical data, Set

SMART QI aim

Begin PDSA

cycle with HI support

DATA

IC3 Beacon Community

cHIE

UCIT LearningSessions

Public Health registry

HealthScapewebsite

Other BeaconSites

State, national political arena

Complete assessment with HI

coach

Population Health Improvement Interventions

• Performance feedback to providers• Provider Reminders• Clinical Guideline Use/Dissemination• Patient Reminders• Care Managers• Depression Screening and Treatment• Provider Communication Skill Improvement• Low cost medications/diabetes products• Tailoring care to specific demographics of populations• Patient self-management support

• Diabetes Educator Availability

• Authored by a multidisciplinary panel • Resources for providers and patients• http://

health.utah.gov/diabetes/diabetespracticerecommendations/udpr.htm

Utah Diabetes Practice Recommendations

Diabetes Management for Adults 2011

What’s New in 2011• Diabetes screening protocol

– Clarifies the role of A1C in diagnosis

• Cardiovascular disease– Addresses the controversy concerning ASA

• New insulin protocols for type 2 diabetes• Updated medication summary• New sections

– Depression and vaccinations

• New tools– Active links, referral forms, CKD management,

updated protocols for lipids, extensive references and blood pressure management

Key Treatment Targets

UDPRs, 2011

Initiating a Basal Insulin

Page 12, UDPR for Adults 2011

UDPR Appendices

• Comprehensive foot examination form

• Foot care information for patients

• Medication summaries

• CKD management• Referral form for eye

examination• Tobacco quit line

information

• Healthy eating tips for patients

• Glucose monitoring• State certified self

management programs, topics covered and when to refer patients

• Vaccination guidelines• Diabetes and

depression

Intermountain Diabetes Worksheet

Utah Beacon Consumer Engagement

In the Clinic Outside the Clinic

• A ratio problem: 1% to 99%• How can we support patients beyond the

physician office to improve self care and diabetes management?

“Look, it’s very simple: Lose weight, take your meds, stop smoking, eat right…and try not to be so depressed about it.” Easy, right? Great, see you in six months!

?

Behavior Change: The $3 Trillion Dollar Question

• How can we leverage technology to help patients change behaviors?

• How can we improve health care decision making – from choice of a health plan to daily self-care practices?

Beacon Patient Engagement Tools

• Performance reporting Web site

• Support patient healthcare decision making

• Diabetes tracking Web tools

• Organize, simplify care regimens

• Provide ongoing, data-driven feedback to pt

• Improve self-tracking and focus on improvement

• Smartphone innovations

• Can we make tracking and self management fun???

• Mobile Health

• “Care Manager-lite”• Cost-effective• Address health

disparities

Utah HealthScape

• Patient decisions about health plans and providers impact the care they receive and the system they receive it in

• Goal: To develop a consumer-directed website• Educates consumers about quality variation; Helps

consumers find and demand high quality care• Increases competition, accountability to consumers of

healthcare, and lowers costs• Motivates consumers to advocate for public reporting on

nationally-recognized indicators of quality care

“I need to find a Spanish-speaking doctor in my area.”

“My husband and I work full time. We need an eye clinic with

extended hours.”

Multi-Channel Health Tracker

• A Beacon primary care clinic requested our help in designing an online patient tool to help with self-management

• Health 2.0 invitation to meet with health care technology start-ups

• We met “The Carrot”

Health Tracking Support

EMR Integration

Social Media Component

Integrated “App”

Mobile Phone Tools

• Utah Department of Health Program, co-branded with Utah Beacon

• Studies: Text messaging support can double the quit rate.

• Free and available now to any patient in Utah.

Free C, Knight R, Robertson S, et al. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomized trial.

Lancet 2011;378(9785):49-55.

Text to Quit• Smoking increases the risk for Type 2

diabetes and makes it harder to manage

• Text to Quit = text messaging service that offers patients daily tips to help get through the quitting process

• Used in Utah since 2009• Content developed by New Zealand

government

Text to Quit (cont’d)• Messages both encourage and educate

participants how to manage day-to-day stresses associated with quitting and offers useful tips for avoiding triggers and controlling cravings

• Free and available across cellular networks

• 2 messages per day x 21 days (one way)

• For Beacon partnership, tracking reported outcomes at exit

Your Turn

hLog For Diabetes

hLog For Diabetes

Confidential

How is it Different?• Users cannot track all

metrics from day one

• They have to achieve mastery of simple tracking

• Unlock higher levels to track multiple metrics

• Compete with other diabetics to be on time in tracking and medication

Confidential

Features• Users start with

blood sugar tracking to earn yellow belt

• Consistently track once a day to earn green stripe

• Goal is to reach black belt where they track blood sugar, insulin, carbs and exercise

Confidential

Badges and Milestones• Users earn

badges for continuous tracking

• They can share these on Facebook and Twitter for motivation

• Signing up beta testers: See me if you are interested

Confidential

Rationale

• Diabetes education and care management have been shown to improve patient engagement and self-care activities

• mHealth may be able serve this function at much lower cost, thus increasing access to care management services

• Cluster-Randomized Trial, Mobile Coaching– University of MD, 163 patients, 1 year– Showed 1.9% HbA1c reduction vs 0.7%

in usual control (p>0.001)

C. C. Quinn, M. D. Shardell, M. L. Terrin, E. A. Barr, S. H. Ballew, A. L. Gruber-Baldini. Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control. Diabetes Care, 2011

Care4Life

• Adapted from 2 systems deployed in Mexico

• Interaction is customized and two-way. “Pocket care manager”.

• Developed with content from the National Institutes of Health and the Centers for Disease Control and Prevention

• Testing in 66 Beacon clinics• Implementation and Evaluation Sept.

2011-Dec. 2012• Received IRB approval October 2011• Preparing to sign up clinics in November

2011

Tailored to Individual

Targeted Messages

Targeted Med and App. Reminders

Personal Health Portal

Key Features

Personal Web Portal

Manage Subscriptions

Exercise Progress

Weight Loss Progress

Medication Adherence

Glucose Readings

Medication Reminders

Appointment Reminders

68

a) User can set glucose reminders according to their doctor’s recommendations (i.e. before breakfast daily)

b) System sends glucose reminders & provides immediate feedbackc) User can track all glucose recordings on web portald) System sends education messages & tips

Care4Life | Increase Blood Glucose Monitoring

Care4Life. Reminder: Time to check your BEFORE meal glucose. Reply with your BEFORE meal glucose reading (e.g. 125).

Care4Life. Before meal readings under 70 can be dangerous. Do you know what to do when readings fall below your target? Text LOW for more info

Glucose recordings graph on web portal

Glucose reminder System feedback

Things you can do now

1. Tell your patients about Text to Quit2. Check out www.UtahHealthscape.org3. Tell me if you or someone you know

would like to be a beta tester for hLog4. kcapozza@healthinsight.org5. Attend our Learning Session,

November 10th

Clinical Health Information Exchange (CHIE)

PROVIDERS

• E-prescribe• E-referrals to any other

participating cHIE clinician• Electronically order and

deliver reports• Share with other cHIE

clinicians through the Virtual Health Record (VHR)• Hospital reports• Lab results• Medication histories• Allergies• Clinician documents• Patient Worksheet

PATIENTS• Patient consent required• All or Emergency options• Free• Recommended for

• Chronic Conditions• Multiple medications• Children (vaccination

records)• Anyone

Clinical Health Information Exchange (CHIE)

Data Source(s) General Lab

Micro Reports

Radiology Reports

Transcription Reports

Medication History

Brigham City Community Hospital 10/2010 8/2010 6/2010

Central Utah Clinic 1/2010

Lakeview Hospital 8/2011 2/2011 2/2011

Medicaid 1/2010

Moab Regional Hospital 8/2009

Mountain View Hospital 3/2011 2/2011 2/2011

Ogden Regional Hospital 8/2011 2/2011 2/2011

PAML 5/2011 5/2011

St. Marks Hospital 8/2011 2/2011 2/2011

Timpanogos Hospital 3/2011 2/2011 2/2011

Not just about the technology-Ideal

Trained People, Efficient

Processes and Easy Tools

Data Systems, Structure

d Data

Health Information Exchange

Quality Analysis,

Interventions

Understand

Outcomes, Reassess

Better care for Patients

June 22, 2011