Quest Chronic Care
Pair “human touch” with technology for patient care
In April 2018, the American Medical Association (AMA)1 announced a Google-sponsored challenge to health data management organizations to come up with a better way for patients to remotely monitor and manage their healthcare.
The Health Care Interoperability and Innovation Challenge will examine how mobile technologies can leverage “patient-generated health data in meaningful ways to have maximum impact on improving physician workflow, improving clinical outcomes, or reducing cost in the healthcare system.”
This AMA-Google effort is just one of a series of initiatives announced in recent years that aim to harness data and technology to improve care and outcomes. While advances in remote monitoring, big data, genomics, and AI are causing seismic shifts in how care is delivered, it is vital that healthcare providers maintain their moorings in human connection. In few areas of healthcare is the value of human interaction more evident than it is in chronic care.
Chronic care refers to care provided to patients with chronic health conditions, such as diabetes, hypertension, arthritis, and cancer, to name a few. Today, three in four patients in Medicare have multiple chronic conditions. Since chronic conditions are more likely to occur with age, we can expect the rates of chronic conditions, and the costs to treat them, to skyrocket as the population in the U.S. (and many other countries) ages over the coming decades.
According to research from AARP patients with chronic conditions are generally sicker, more likely to use hospitals and emergency rooms, have greater social isolation, and experience accelerated decline in their quality of life.2 Yet, most of these patients are only eligible for reimbursement from Centers for Medicare & Medicai
d Services (CMS) for one annual wellness visit with their primary doctor. And when they are with their physician, the 10-20 minutes of time for a typical consult may be inadequate to deal with the complex behavioral, social, and other issues that can complicate care decisions.
A recent survey by Quest Diagnostics3 brings to life just how challenging it is for physicians to meet the care needs of patients with chronic conditions. Almost all primary care physicians (95%) surveyed say they became a doctor to treat the whole patient, not just the different conditions they have. But 3 in 10 (29%) physicians say they are overwhelmed and overworked, while half (49%) say they are very busy but try to make time to support patients’ needs. As a result, only 9% said they felt very satisfied that their patients in Medicare with multiple chronic conditions were receiving all the care they need.
In 2015, CMS began to reimburse for Chronic Care Management (CCM) services to help physicians address care gaps such those highlighted in the Quest survey. CCM services are non-face-to-face, such as phone consultations, provided to Medicare beneficiaries who have multiple chronic conditions. These services help the physician monitor patients with chronic conditions such as arthritis, asthma, diabetes, hypertension, heart disease, and osteoporosis, so issues are surfaced, and addressed, before they become major health challenges.
While physicians may be inclined to use CCM services, barriers to adoption exist. The Quest survey found that four in five (82%) primary care physicians say patients would benefit from a CCM service, about 23% of PCPs surveyed said that administrative complexity, such as billing codes, have limited their adoption of CCM.
But CCM does something that an app or remote device can’t do. CCM services are typically phone based. They are powered as much by the human voice, and human connection, as by technology. And this human connection can make all the difference.
A case in point happened not long ago with a patient who, with her physician, was a CCM client of Quest’s. The patient was suffering from depression, a condition that was only revealed as a consequence of the compassionate, patient dialogue she had with one of our nurses. The nurse was then able to discuss care options for the patient.
The need for closer care and connection was also highlighted by the Quest survey. It found that while 48% of patients will discuss their medical conditions with their primary physician; most will not discuss social and behavioral issues, such as loneliness and transportation concerns. As many as 32% fear being a burden on loved ones.
And CCM provides a recurring point of contact with a patient. In addition to seeing a physician as part of the annual consult, the patient can also connect monthly with another human being who is concerned about their welfare. Perhaps not surprisingly, the Quest survey found that most physicians and patients believe 1-2 physician visits is wholly inadequate. CCM is one way to help close these disconnects.
Technology can never solve what ails healthcare, but technology that enables human connection can. The difference is knowing when and how to use it to serve each unique human being in our care.
- Mills, Robert J. “AMA, Google Launch Health Care Interoperability & Innovation Challenge.” American Medical Association. April 9, 2018. Accessed May 23, 2018.
- Flowers, Lynda. et al. “Medicare Spends More on Socially Isolated Older Adults.” Insight on the Issues.” AARP Public Policy Institute. November 2017. Accessed May 23, 2018.
- Gorode, Kim. “Physicians Lack the Time and Tools to Discover Hidden Risks in Patients with Chronic Conditions, Finds Study from Quest Diagnostics.” Quest Diagnostics. May 23, 2018. Accessed May 23, 2018.
UNMC solves big data problem in EHRs
A modern genetic test for a cancer patient contains more information than ever before: Too much, in fact, for modern digital medical records.
That’s a problem. A big, big data problem. But it’s a problem with a solution at the University of Nebraska Medical Center.
New tests, particularly those genetic cancer tests, hold critical clues about the nature and ferocity of a tumor. They help doctors and patients plan treatments, and adjust for new mutations in the tumor.
But those tests don’t neatly fit into modern health records. In fact, those test results don’t fit at all. Physicians must wade through multiple file attachments, or scroll through an apparently never-ending “notes” section for the important details.
It’s like looking for a specific movie scene among a stack of old VHS tapes. That’s great for 1995, but not in today’s digital age that moves at warp speed.
The problem is that electronic health records—EHR for short—were originally created to help the billing process.
“EHRs were not built for clinical teams to use as searchable databases,” said Kelly Choi, M.D., GenomOncology’s Chief Commercial Officer. GenomOncology is a Cleveland-based firm focused specifically on all that biomedical data, or informatics that comes out of cancer gene testing and research.
GenomOncology builds powerful engines that doctors and researchers use to tease important information from things like complex genetic tests. After signing an exclusive agreement with UNMC, GenomOncology now has a way to transmit those results to a patient’s EHR, arming their doctors and care-providers with a clearer picture of their patient’s health and history.
The deal began with UNMC researchers Scott Campbell, Ph.D., and Jim Campbell, M.D., who managed to simplify the complex. They developed a way to codify and name the multitude of facts that come from cancer gene testing. It needed to be something that a doctor could quickly and easily understand.
UNMC’s technology transfer and commercialization office, UNeMed, negotiated the licensing agreement that pairs GenomOncology’s powerful engine with the Campbells’ elegant system. The system is called the Nebraska Lexicon Synoptic Pathology Reporting Module, and functions as an add-on to the most widely-used EHR terminology in the world, SNOMED CT.
GenomOncology’s platform, now armed with the UNMC module, will do more than just help with diagnoses treatment plans. The system could make a dramatic impact in research, helping filter and enroll patients for clinical trials.
By making the EHR a more useful database, researchers and clinicians can find potential patients or trial programs. They will no longer need to spend countless hours poring through attachment files. PR Newswire
Microsoft patents glasses that measure blood pressure
Whether they are smart or traditional, BPMs typically come in one two forms—those for the upper arm, and those for the wrist. Both employ inflatable cuff technology, although blood pressure measurements taken at the wrist may be less accurate. That is because the wrist arteries are narrower and not as deep under your skin as those on the forearm.
But a number of companies are experimenting with moving away from these locations.
Apple has recently patented a self-inflating blood pressure monitoring watch. It comes with a cuff equipped with sensors integrated into a collection of tiny airbags. Then there is Samsung’s upcoming Galaxy Watch. It is rumored to be able to keep tabs on your readings by shining polarized light and then sensing the intensity of the scattered light.
But Microsoft might have taken the strangest route of all in coming up with a blood pressure monitoring device. The prototype was revealed in a report by Christian Holz and Edward Wang of Microsoft Research.
Dubbed Glabella, the glasses come with optical sensors concealed inside the frame. From there, they continually measure pulse waves at three different locations on the user’s face, and then calculate the time and rate between these areas and the heart to calculate blood pressure. The glasses also collect data on physical activity so can function as a 24/7 activity tracker.
Interestingly, the sensors have only been shown to be accurate for taking systolic pressure. This is the top number or highest blood pressure when the heart is pushing the blood round the body. While it is generally considered to be more important than diastolic pressure, both readings have their use. Systolic pressure is better for determining your risk of having a stroke or heart attack. A high diastolic pressure, on the other hand, is bad for the heart because it shows the heart is not relaxing enough which can lead to other cardiovascular problems.
The report says it conducted a real-world trial which showed the technology to be accurate. Whether we’ll actually see a commercial version of this product is not entirely clear. Manufacturers often patent technology that never progresses past the planning stage. Patents make it more difficult for others to move in and poach ideas. Gadgets & Wearables