In Canada, healthcare providers are challenged with the diabetes epidemic, as 3.4 million people have diabetes, close to 10 percent of the population, and close to 6 million people have pre-diabetes, according to data from the Canadian Diabetes Association.
“It's estimated that by 2020, one in three [Canadians] will have diabetes and pre-diabetes," Mark Angelo, CEO of LMC Diabetes and Endocrinology, a Toronto-based diabetes specialist care provider, says. "It’s a significant health and wellness issue in Canada, and it’s become an economic burden for the healthcare system, as we have a publicly funded healthcare system, as well as employers who cover the cost of drugs and other healthcare services not covered by the governmental plan."
LMC focuses on diabetes and endocrinology care with 35 endocrinologists and a team of certified diabetes educators, who are both registered dieticians and registered nurses, serving more than 30,000 patients with diabetes across nine sites in Canada, mostly centered around the Toronto area but with a location in Calgary, Alberta, Canada as well.
One of the most significant challenges facing physicians and clinicians when treating diabetes is educating and empowering patients to adopt healthier behaviors and improve self-management of their condition for better outcomes.
“Patients who have diabetes live with their condition 24/7 and 365 days a year. We only see them during visits when they see the endocrinologists and the diabetes educators and there can be very little interaction in between visits. During that time in between visits, the patients may not be able to implement the therapy properly, or may not have adopted the changes in behavior and haven’t made any progress,” Angelo says.
Mark Angelo
“As a diabetes educator, I want to coach my patients to lead a healthy lifestyle and improve their overall well-being,” Ashleigh Walker, registered nurse, certified diabetes educator and manager of the diabetes education program at LMC, says. “One of the biggest challenges I face is keeping up with patient communications and managing the progress of the patients under my care.”
In order to improve its diabetes education and management programs for its 30,000-plus patients and to increase patient engagement, LMC is deploying a digital health IT platform based on telehealth and remote monitoring tools. Angelo says the goal is to not only help patients improve self-management of their condition but also reduce operational costs using a more proactive care delivery approach. LMC is working with Washington, D.C.-based healthcare software solution provider ViiMed to deploy the platform, which integrates with LMC’s electronic health record (EHR).
LMC physicians, clinicians and diabetes educators will use the cloud-based digital platform to provide patients with a personalized diabetes management program. According to Angelo, patients will receive a tailored care plan and have access to their care team from any device through two-way recorded video and text communication, providing a “virtual safety net” for patients should they have questions or concerns related to their care plan. The platform also enables patients to interact with their diabetes educator and extended care team, participate in educational activities, set measurable goals, track meals and physical activity, and measure key health indicators. For clinicians and diabetes educators, the platform will provide greater insight into patients’ progress over time and allow them to intervene, when necessary, Angelo says.
According to Walker, the digital platform offers a number of ways to proactively engage and interact with patients between visits in order to provide support. “There are interactive dashboards that give me a quick glance at how each of my patients is progressing, so I can check in with those who need me most,” Walker says.
The key, says Angelo, is enabling the care team to effectively monitor patients’ progress, “so if they are not reaching their goals, we bring them in a visit and conduct an intervention.” By using remote monitoring and telehealth, LMC’s physicians and clinicians are aiming to enhance the education and coaching that happens on-site with more real-time coaching based on the patient-reported data that’s incorporated in the digital platform. And, the education protocols are tailored to each patient based on where they are in the lifecycle of their condition, whether high-risk or low-risk. “The platform is designed to triage and sort patients for the diabetes educators so they can focus on patients who are non-compliant or higher risk and need more engagement versus those who are stable,” says Phil Newman, CEO of ViiMed, says.
“It’s a web-based platform that the patient enrolls in and the patient is one actor of a number of actors on the platform. Besides the patient and the diabetes educator, there’s also a broader circle of care, including the pharmacists and the family doctor also can be on the platform,” Angelo says.
Through the digital tool, patients are assigned different activities each week, such as educational activities, or for patients who are newly diagnosed with diabetes there is an educational module on meal planning to help the patients incorporate healthier foods into their diets.
“There are a number of educational modules and activities that the patients will complete over the course of the program and the program will track their activities, including exercise and the steps they take, and all that information is loaded into the platform and recorded,” Angelo says. “For patients diagnosed with diabetes, they will be taking their blood glucose levels using a blue tooth-enabled glucometer, and for those looking to lose weight, they will use a wireless scale and it’s automatically uploaded into the platform. So, the platform is incorporating all the patient reported data in between visits to give the care team a better sense of how the patient is doing, so they can intervene sooner rather than later.”
Angelo continues, “It’s really a tool for the patient to be able to help them to get more insight into their condition and understand how certain activities can impact their condition, and also share that information with care team. The goal is to work with the patient to bring about a positive behavior change and empower the patient to develop new habits and behaviors.”
LMC also conducts diabetes clinical research and is one of the largest private diabetes research networks in North America, with more than 120,000 patients in its database and 24,000 new patients added each year. Angelo says the digital platform will support LMC’s ongoing effort, as a research network, to collect, measure and analyze outcomes data to drive clinical decision-making and future research in diabetes and endocrinology.
“By combining the EHR data with patient-reported data in between visits, we can start understanding how patient behavior can impact health outcomes and how interventions are affecting their health outcomes. By pulling all that data together, it will help data scientists analyze that data to find which interventions improve health outcomes,” Angelo says.
