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“Engaging Your Patients with Mobile Health IT: A Discussion with the
Office of Consumer eHealth and Marshfield Clinic”
August 28, 2013 (60-minute)
Speakers: Ellen Makar MSN, RN-BC, CCM, CPHIMS, CENP, Senior Policy Advisor, Office
of Consumer eHealth, Jeffrey J. VanWormer, PhD, Associate Research Scientist, Marshfield
Clinic Research Foundation
Event ID: 2201922
Event Started: 8/28/2013 1:07:50 PM ET
Please stand by for realtime captions.
Good afternoon, everyone. We will go ahead and get started. My name is Ashley Green and
I’m a quality consultant at the QIO in Wisconsin, Metastar, and collaborating in this
presentation are several more QIO colleagues of ours in the upper Midwest—Stratis Health in
MN, Telligen in IA, North Dakota Healthcare Review, and the South Dakota Foundation for
Medical Care.
If you're interested in getting a certificate of completion from Metastar at the conclusion of the
webinar, you have to attend the full session and complete an online evaluation which should be
embedded in your e-mail invitation but I will send that out at the conclusion of the presentation
if you did not get that for some reason. We’d like to encourage everyone to do a survey because
it provides some valuable feedback on the sort of programming we can offer to you in the
future. Please be sure to take a moment and do that.
Learning objectives are displayed for you. We are going to have a great discussion from Ellen
Makar, who I’ll introduce in a second. Then we will move to just at the Marshfield Clinic
Research Foundation to talk about their exciting work with their Heart Health Mobile
application. A couple of other things before I present them, I would like to ask everyone to
mute your lines. And I want to encourage you to send questions to the chat function because it
is a lot easier to monitor that way. I will open up all the lines at the end if you prefer to do them
over the telecom.
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With that I am introducing our two speakers for today. First there's Ellen, and I will take a
couple of excerpts from her bio here. A director of nursing at Yale New Haven Hospital in
Connecticut, her career spans direct clinical patient care, managed care, case management,
informatics, and executive nursing practice. She's been a registered nurse since 1985 and she
teaches Masters level classes in data and project management. In 2009 she was chosen by the
alliance for nursing informatics as one of two national emerging leaders in nursing informatics
and was named one of the “20 People Who Make Healthcare Better” by HealthLeaders
magazine in 2010. Dr. Jefferey VanWorrmer is a behavioral epidemiologist with research
interests in the primary prevention of cardiovascular disease. For the past two and a half years,
he has worked at the Marshfield Clinic Research Foundation as an Associate Research Scientist
in the Epidemiology Research Center. Dr. VanWormer is also an investigator member in the
national HMO Research Network and Wisconsin’s Institute for Clinical and Translational
Research, as well as an Associate Editor for the scientific journal Diabetes Spectrum. Prior to
his work in Marshfield, Dr. VanWormer was the Director of the Heart of New Ulm Project, a
successful initiative led by the Minneapolis Heart Institute Foundation to prevent heart attacks
in rural Minnesota. Thank you and welcome to both of our presenters and Ellen, we will turn
the call to you -- Ellen
There you go, Ellen
Specifically, just a few objectives for my portion of the program, discussed specific meaningful
use objectives, the average consumer engagement, access and attitude, -- action access and
attitudes, and define blue button
To set the tone, the Department of Health and Human Services has a strategic plan, and in
patient engagement is a nationally recognized priority. So much so that it is embedded deeply
within our strategic plan. In particular, what we are talking about today, global health is so
important that it is called out in the federal strategic plan. You can see where for our rural
communities, we are really looking to mobile health as a way to engage patients. ONC has its
own strategic plan as part of a larger HHS plan and within ONC is the Office of consumer ehealth where I work.
So part of our strategy to start with is adoption. You can’t do anything else until you have
adoption of health IT and along with that very closely following is information exchange. It
hasn't been easy to get both those things up and moving, but we have gotten a lot of movement
in adoption. The information exchange part is the part we are working with now and what we
will see as these things come together and continue our forward trajectory is better technology,
better information which will transform healthcare. Our goal is really a goal for where we
empower individuals with IT to improve their health and overall, the health care system.
I wanted to call your attention to an article released this past winter. Our office put the lead in
communicating the action plan that backs our strategic priorities. The key to this article was
that patients themselves are really an underutilized resource in the health care system so there is
discussion on that as well as patients aren't the only consumers. Patients as consumers involve
others such as family members, allied health professionals, caregivers in their healthcare team,
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and -- defined as secure messaging, Internet-based resources, and increasingly mobile
applications are allowing patients to be the center of their healthcare team and are enabling
family members and caregivers to focus on care coordination as never before.
I mentioned action, access, and attitudes. This schematic really cannibalizing movement and
that is because each of these elements feed onto each other. Number one as I had said was
adoption, and very close related is access. Providers adopting health IT and then in adopting the
philosophy that patients should have access to their records is key and foundational. Once
patients have access, then they can take access to that information. They become more invested
in healthcare and they can become a partner with not only their physician but respiratory
therapists, physical therapist, care coordinator. When they start to see results from that, then
attitudes start to change. For providers as well as for patients, their attitudes begin to shift as
they see this partnership development based on shared information.
People use supports this. Meaningful use works towards getting people focused in the right
direction. Stage one was a great start, getting clinical visit summaries, discharge instructions,
educational resources, starting to involve them in care in stage II is going to take it further with
download and transmit. Patients having the ability to download their records and downloading
them to a computer at home, which records if they need to, but more importantly use them and
transmit them to those parties that they want to be involved in their care. Along with this is the
idea of how we live today which is mobile technology. When we get to stage III of meaningful
use, one of the things we're thinking about is that next logical step. Once patients have that
direction of information coming from them, we may want to communicate back and providers
will want to have that information from patients. We are starting to talk about patient-generated
information of what that looks like as well as error correction or augmentation of the record by
patient.
The focus right now is really meaningful use to -- number two -- stage II. It is a floor, not a
ceiling. Allowing patients to be able to do what they need to be associated -- that, that is an idea
to prompt people to be thinking about right direction. It is liberating the data, that is the overall
idea. Setting the stage so there will be a market for creative writers who want to assist patients
to interact with that information in the most effective and efficient way.
Sometimes there are barriers and one of the things that has been a struggle is making sure that
providers and data holders understand that privacy laws don't limit a patient in getting their
own health data. It is important to get their health data and in actuality it is their right. So our
federal partner, the office of civil rights, his office designed a campaign to clear up
misconceptions about -- the run data. There is a series of videos in a letter to patients outlining
exactly what it means to get their data and what it means for their health and partnership.
We have tools that are available for shifting attitudes. We have talked about access and
hopefully following access is action. Next in line is attitude. So making the topic approachable
and explaining the benefits. This is a video which you're free to repurpose that is kind of a
helpful way to explain to patients and caregivers how this new interconnectedness will affect
them. This fall you will be seeing a series of public service announcements that will be talking
specifically about blue button. This is a term that evokes not only the mechanism for
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downloading health records, but also a movement which is a broader meaning of increased
access for patients to their health information. If you are not familiar with blue button, you will
be soon. The pledge campaign was launched in 2011 by the ONC and it consists of a pledge for
data holders which are health plan providers and PHR's, and not data holders such as advocacy
groups and people trying to get an idea of engaging with her health information actually will
assist you in managing her health. -- Managing your health. Updated information can make a
positive difference for patients trying to manage their care. If you're diabetic and looking for
tools that will help you -- help you, you're going to be asking for applications and tools that are
going to work with the way that you live. Same thing with patients who have asthma. We are
seeing this more and more where other applications that we can wirelessly update mobile
applications with and see how are we doing today? How many calories in my eating? That kind
of thing. Health and wellness management as well as those with [ Indiscernible - low volume ]
trying to make sure that they can live the healthiest life that they can.
This gives you an idea of the breadth of this. We have a lot of interaction with professional
groups as well as data holders in designing exactly how we want to move forward with blue
button. This marketing campaign is going to be coming your way in this whole idea of both
movement and the mechanism is trying to gain traction and you will start to see this blue button
bringing symbol more and more.
Blue button. If you're a Medicare recipient or a veteran and have made my healthy that account,
you can go on the website and download data from Medicare.gov or the VA. I wanted to show
you exactly how that is on the website of federal partners. There is a Medicare blue button tab
and the logo is used on the portal.
As I mentioned, it is a movement but also a mechanism. For those were technical, feel free to
sign on and take a look at the technical specifications. Blue button plusses a way that data can
be structured so that folks who are designing applications can predict and design applications in
a way that's going to work best with data. I personally have a foot in the technical world but I
am not that technical. What this does is create an avenue for people to know what to expect. As
developers look to see who is blue button enables they will know how to use that data and be
part of an app that would be assisted to patients and providers.
The reason this is so encouraging is because there is an untapped demand to hospitals. If you
look at the upper right-hand corner, folks agree that you should be able to get your own medical
information electronically yet very through that have able to manage their health. This is an
area that is ripe for that and is an untapped market and paper is good. Having access to that data
is good that paper is flat and there's only so much you can do with that information. If you can
get an electronic download that's better because you can share that information, put it into a
spreadsheet, and create something that would be more helpful to you visually. But mobile is
how we live today. We are going to see more and more of these tools come to be.
You think about yourself as a patient or caregiver for someone else, that helps you fully
understand the frustrating world that we live in today where even if you can't get C access,
many times when you're having an episode of illness, you're not seeing one provider, you're
seeing a few providers seeing a specialist and you will have claims data. All of those data
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holders have different entryways for you to get that data and when you are getting at your
downloading separately. The idea is that you would be able to be the aggregator of your own
data so you can use it in the most helpful way for you.
The way the government has supported this thinking is through challenges. We have a
challenge going on for blue button-and able to hold in the way we looked to see the purpose is
that we crowd source the to patients. Many ideas came in, for helping me manage to my father
in a nursing home to my child's immunizations, help me manage my device data. So that is kind
of the emerging ways that ideas are coming forth in trying to use IT in were those gaps are.
Will be these initiatives ahead are probably -- meaningful use wanted to and eventually
meaningful use spray. Changing attitudes in getting folks thinking about the possibilities, and
technological changes in standards. Is important for you to know that this movement is a high
priority. The goal is to make blue button a universally recognized symbol for electronic access
to data and broaden patient engagement activities. There wasn't access some it at the White
House over we looked at ways to accelerate this movement and through that work we came up
with six work streams that we are working on right now and they included marketing,
standardizing, automating, implementing, and building on success.
-- Words of one of our regional extension centers in Delaware does patient stories. Sharing
patient and caregiver stories about how access to their data help them is one of the things we try
to do at ONC is trying to promote how other people can see using this data. In this case her
father was hospitalized and medical records contained in permission about have been on it (or - blood center. She was able to show him that it was a one-time isolated incident. It was not
something he has been on long-term and should not have been on when he was hospitalized.
She was able to clear up a misconception in the record of the hospital and prevent an error from
occurring.
Where will consumers be able to access information about who button? The foot print is big
with CMS but other than that, folks may not know where to go to get information. ONC is
constructing a website are how to where we are going to be able to have providers, data
holders, patience have a one-stop shop where we can find out who is blue button enables. To
start with right now we are saying who is getting folks access to their data? We're going to
allow graduations in that. Was getting access to their data and who is using the guidelines and
specifications for blue button funds.
The polls that are out there are the ones that are really -- and you get to envision the future of
where all of us are going to be able to take advantage of. We are at the office sponsoring a
consumer health IT Summit which will be a webcast slide and I want you to say the date for
that.
So will be tools [ Indiscernible - low volume ] to take a look. It is important that you subscribe
to our slide because there's a lot of great information that comes out and most recently we didn't
have a blog that was followed by blue button.
If you want to contact me I'd love to hear from you. With that I will turn it over to Jeff.
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Thank you so much for your presentation, I will ask you to stay on the line for some questions
at the end and I will hand it off to you.
Thanks for joining and things for the great overview that ONC is doing in this area. I am a
researcher at the Marshall clinic and in the middle of risk on some and we were involved in
global health technology development as part of these broader efforts to the Department of
Health and Human Services I wanted to tell that story today.
The strategic little bit of the information that Ellen presented, but I spent a lot of years in the
clinic environment counseling and talking to patients about doing things differently and
behavioral issues to help improve health. We did a lot of obesity counseling and diabetes and
medication and things like that. One of the things we learned is the idea behind engagement
and at the end of the day, it means keeping the dialogue open. The longer we can keep it open
with people, the more they -- the more apt they are to change in the direction we want them to.
The mobile health platform is the way that people are communicating and that stuff is in danger
species. [ Indiscernible - low volume ] in terms of access, via mobile, populations are harder to
reach through more traditional means, particularly the less educated and non-insured
population. Option the mobile devices are the only means that they have in the question is, can
we leverage that and use it to help people improve health?
This is a high priority area for Health and Human Services and they organize one of the first
contact which is called the risk check challenge. This is an effort with a lot of partners of
federal and state levels to try to reduce heart disease. The risk-checked challenge was a specific
effort that was asking folks around the country to say can you design a mobile app that can
further that end? There were a number of people that took the bait and quickly trying to
develop one of these within the specs of the contest laid out by OMC. There are 35 to 40 folks
that eventually submitted a -- and And we came up with a concept called heart health mobile so
let's talk a little bit about what it does.
We had about 30 days to do all of this which is lightspeed in the health care system and it's
actually a pretty reasonable timeframe for people who develop apps. This is a routine practice
in most care systems. Most of the mobile efforts are certainly burgeoning but they are waiting
for the provider side with sharing information. There is a lot less going on with the consumer in
mind. There is a risk check challenge all about the patient in designing and for the patient. We
put together a team of folks within writing -- wide cross-section between medicine and research
and IT and marketing and put together the specs. We cranked out a beta version of this, tested,
released that, and there are a few different bells and whistles that I will go through next.
This is the iPhone version of this but so what happens? This is basically a risk assessment tool
first and foremost so the patient enters and some basic information [ Indiscernible - low volume
] smoking history, disease history, their near-term risk for having a heart attack or a stroke and
you kind of see that on the bar here. There is an engine underneath called Archimedes which
has some fancy modeling algorithm type of work that accounts for the factors and the user is a
sense of, were derisive terms of my heart disease risk relative to other people my age? After
that it provides recommendations so there is some math behind the scenes here that you can
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actually tell the user, if you made these changes G started exercising, your risk would be
reduced by this much. If you quit smoking, you see where I'm going with this. You can go to
the yellow or green. It backs this up with some basic educational content around helping people
make some of those changes and there is also a geographic component which will actually
prefer people, if they don't know their blood pressure or cholesterol, the camera for them to the
nearest pharmacy or the nearest clinic to get some of that information and build a better mouse
trap. Get better information to get a more precise assessment of the risk.
There is also a game the final version of this that folks can walk through it and see it of a
contract -- more of a cartoony format. You can also share the results so the usual suspect -some other entities like that. At the end of the day, our version of entry of this one the contest.
It be 35 or 40 other shops which have some really good ideas, but I think we ended up with a
winner. It was developed across multiple languages and I think it was a nice platform to that
what OMC was looking for. We got a lot of buzz particularly around heart health month. Part
of the Gateway of this was the winner of this contest, there were a few cities around the country
that were organizing heart health efforts as part of heart month back in February and they were
baked into the process, they're going to be to the winner of this so Chicago, San Diego,
Adelphia in Baltimore decided to do this. There was some pretty cool stuff that the -- did in the
showcase segment is part of the national conference.
The next slide is kind of a look back around the February time frame in terms of what was
going on in some of these different cities. Chicago Cubs sort of what looked like the most
impressive effort in terms of promotion. That number of high level folks promoting this app in
Chicago was baked into Internet education and promotions going around town. They were
doing some screenings in Chicago where -- was promoted. They took the cake in terms of
getting folks to actually use it. Some of the other cities toward the bottom got kind of a late
jump on things where -- didn't coincide all that well with heart month and I think there are
some cities where these efforts continue to go on and it was presented a little bit later. We are
processing all this to figure out where it was most attractive and what segments, things like
that.
The it is a little researching. -- The next slide is a little complicated. There is a full science
behind this, this is kind of a -- in two dimensions, a reporting mechanism so you can see where
people spend most of their time on the app and the direction that they tend to go depending on
this -- thickness of the license cylinders, you can do a lot of cool user testing and make various
changes to the app in real-time and watch these lines change as people are using it. I present
this as a way to show that there is a whole science behind user and workflow behind these
applications.
Let's talk about what we learned in all of this. The biggest thing we learned is that care systems,
we can do this. You don't have to go down to Silicon Valley to build an app. There are often
people in your IT department such minimal -- with minimal consultation that you can put these
together and you can do it in a pretty quick timeframe. The app environment is a wild West
right now. There are hundreds of thousands of these. When you will start to see is able towards
-- care systems do not want to have 50 different apps to do different things, they wanted to be
like a health manager tool so it will start to ring in some of these things that they do that is a
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good thing to do for consumers. The actual use, we don't have very good information on the
types of books that into use these applications but we suspected the same people that tend to
come to the portals of the website and are tracking with this now, there is a whole environment
out there that have not done this yet and I think you can build these things but there has to be in
effort to use them.
There has to be kind of a push and promotion to generate the buzz to get things to use them.
There is a -- of who stayed with heart health mobile. From the health research site, this is a very
exciting technology because we do a lot of health records research and there's a lot of
limitations where has to be processed ago into a warehouse and we have to do that for research
purposes. Things like lifestyle issues, nutrition, exercise, -- there her to get that you can get
there a lot easier [ Indiscernible - low volume ] heart health mobile provides a platform and we
are moving into phase 2 with a lot of the meaningful use objectives. You can start to see a lot of
potential. If that connected directly to care providers, it doesn't do that today, there is
uncertainty around this but technologically that is not a huge barrier to surmount. To the extent
that we can take a lot of the burden of the users in bringing information that we already know
about, we try to direct them with more -- device that's the direction that a lot of these will go in
the future certainly for Karen opens up a lot of possibilities, and also for research.
Those are most of the points that I want to make and I will turn it over to you.
If you have a question, send them to the chat line for all participants and let's start that way and
see what kind of response we get. It is easier to keep the lines close and we can open it up in
the last couple of minutes.
Do you have patients using the heart health mobile app?
What we can do is check this by Geo segment in the there is a sizable volume of them. They
are likely to be patients but there's not a direct connection between what the users up and say
their medical record number in our system. Right of the burden is on the user to bring that into
the provider and maybe discuss some of those point. We know that happens to some degree but
right now that connection is was and we can't track that today.
Any questions for Ellen or Jeff? If I can ask to meet -- unless you specifically have a question,
that would be helpful.
It looks like you have a couple more here. Are your providers promoting health mobile app?
This is part of the dissemination grant that we are trying to put together right now so there has
not been sort of the formal launch. [ Indiscernible - low volume ] a lot of these cities where we
have -- they did another burden is coming back to us to make sure you say what you guys built
it, what are you going to do in your backyard? [ Indiscernible - low volume ]
Most of those providers tend to the cardiologist right now and we want to see [ Indiscernible low volume ] this app is sort of better suited on the primary prevention side because it has to do
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with most medical and nonmedical issues and I think the volume of patients would be more
appropriate, so that is what we are designing for some future dissemination proposal to push
that amongst our primary care providers as well as go direct to the patient and ask them to bring
this along as part of their care.
That is the idea that we are thinking is going to happen and what was so exciting about this is
we are the ground floor it now. I equate it to when I had teenagers a few years ago, my kids are
now in their 20s. Ever number one I had no use for texting to my daughter went to a concert I
was sitting outside waiting for her and I decided to text. She could hear me, because the music
was too loud but I suddenly had a use for texting. What we're seeing now is kind of the
movement were is there is more access people see the potential of action, there will be a
demand for better tools.
It looks like you have a couple of other questions that are probably going to fall to you. To use
TCMS MCR with awards positions for making info available to patient access like following
certain best practice protocols?
I think we're seeing that already. A lot of the models like accountable care organizations really
are relying on patient engagement as that blockbuster drug of the century. Patients with the
untapped resource in their care and so by partnering with patients ensuring that information and
involving them in care, they're going to be rewarded by those mechanisms.
Do you think blue buttons future?
It is widely available through CMS and through the VA but as I show that slide with all of
those makers, they're starting to put that infrastructure out there and I believe you're going to
see a big ramp up this fall of that logo becoming much more prominent and in fact we feel that
is probably going to be a differentiator. Those who offer you the ability to access your
information by have blue button and to use it on some kind of a helpful mobile application or
other health tool, that is going to make you decide that this is one want to work it -- work with.
Fellow providers, how are they feeling into doing? Power providers generally receiving the
notion that they communicate with patients Mobley or using e-mail?
This up -- they are quite supportive of the idea that there is the practice. Today there is no real
strong incentive for providers to communicate this way. As you can imagine there is a big mix.
Embraces technology and him they love it when patients want to use this and do it this way.
There are other providers that meet your to say that the majority of providers are pretty slow to
adopt this type of technology. Ellen -- the fundamental change for this comes from patients.
How can you guys are doing this? Or this is how I want to do it. I think the title switch. It is a
slow process. So it has to come from both ends. We need to make efforts of providers to
explain how this works and why it may be beneficial with them in patients. But we also
promoted pretty heavily with patients and if you ask for this, or tools will be. -- More tools will
be built.
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There really is a sense that healthcare is lagging behind other industries like banking and
commerce and the patient and consumer expectation should drive a lot of the and options.
This is back to school time so when you're getting kids ready for fall sports in back to school
trying to check immunizations and making sure all the paperwork is in, having that information
linked by the ability for you as a patient to be the conduit for that information to be transmitted
easily, when you think about things like online banking is a no-brainer. Was checking account
Ellen's? You can get that on your phone. -- What is my checking account balance? I think we
are really going to see that trajectory should way up and that is a wonderful thing. -- Shoot up
This was a great discussion today, and I want to thank you both for your insights and
experience in these areas, and I want to remind everyone to please complete an evaluation and
we will resend that link along with the materials that have been posted so you can get Ellen and
Jeff -- Ellen and Jeff in their presentations on the website. On behalf of our upper Midwest
family of QIO, it is 1:00 PM so if you have additional questions, please feel free to contact me
on the link above. We will be happy to forward any questions to our presenters.
Thank you, everyone.
[ event concluded ]
This material was prepared by Stratis Health, the Minnesota Medicare Quality Improvement
Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of
the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS
policy. 10SOW-MN-C9-13-22 091213
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