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Witnessing down in the delta: update #1 a living case study of diabetes population health management.

As outlined in the Viewpoint section of the March 2014 issue of Health Management Technology, the Mississippi Diabetes Telehealth Network has launched in Sunflower County, MS.

Rather than waiting for the conclusion of the project to outline its impacts, I am creating a living case study that will describe the planning, execution and revision of the work as it occurs.

Below are excerpts of two interviews I conducted to establish the purpose and the thoughts that went into the initial planning of the project.

The first interview is with Dr. Kristie Henderson, Director of Telehealth at University of Mississippi Medical Center (UMMC). The second interview is with Sean Slovenski, CEO, Care Innovations, and Ray Solone, Executive Director of Marketing, Care Innovations. The full transcripts of each interview are posted in the "Online Only Features" section of the HMT website.

In May, I will post online a major feature updating the progress, as well as some of the initial results, of the program.

Jason Free: How did you get this off the ground? How did you get these different people to work together?

Dr. Kristie Henderson, Director of Telehealth at University of Mississippi Medical Center (UMMC)

Well, as we all know, Mississippi historically has been ranked last in terms of chronic diseases like diabetes. My career has been spent trying to find new approaches to help the patients in our state find the best possible care and information needed to get us on the right path for better health.

I am very active in the American Telemedicine Association, so I had a series of conversations with different vendors about this point. Every time I would talk to a vendor, I would say that Mississippi is where you need to test your clinical delivery models. It you can overcome the challenges Mississippi has with the worst outcomes, poverty, challenges with work force, then you can do it everywhere. This is about as bad as it gets in the Mississippi delta.

Fast forward ahead many months, and General Electric was meeting with the governor, and then subsequently with us. This partnership started aligning, and we began to make plans to go to Sunflower County Medical Center. They're very innovative in how they run their hospital, and they are trying hard to turn that community around. They have done other telehealth projects with us, and oftentimes when I have pilot projects, 1 go there. It's a great place for me to test because of the challenging circumstances you see there. So we went to them and, of course, they were on board. Over a series of many months, we created many committees, trying to decide what the program would look like and how the telehealth technology would fit in. In the end, we created our current model.

JF: Your plan is to begin in the delta to address diabetes, but you aim to go beyond the region, as well as address other diseases, correct?

KH: Yes. That plan was part of our initial discussions, and we hope to find the results we need to ramp up our efforts.

Everyone is so committed to the program, but we know if we are going to be able to scale this up and make a difference nationally, we are going to have to study it as a real research project and analyze the outcomes. All of us jumped in, threw our dollars in and threw our time and resources in. This decision to work together transpired along with a telecommunications company, C Spire Wireless, which said it will make sure that the connectivity to the homes and to the patients and to the clinic is there.

What I love about this project is that it truly shows you how, if you have the right strategic partners and alignment of all the governmental officials, public health, as well as the private and public academic medical center, you really can come up with a phenomenal project. We have always sought out new partnerships to confront diseases like diabetes, and now not only do we have a unique opportunity to do just that, but we are also in the perfect place for us to really test innovative models that can go beyond Mississippi. This project should deliver outcomes where patients are going to show improved health, and healthcare is going to come to them. We are going to be able to scale it to other diseases and other areas.

Jason Free: Let's discuss some of the technical elements of the project.

Sean Slovenski, CEO, Care Innovations

Speaking at a very high level, our cloud-based platform allows us to aggregate and integrate mounds and mounds of data collected from a whole source of devices; literally any device that someone may be using to monitor an aspect of their health in the home.

In terms of our interface, a lot of people don't have access to the Internet, or, especially in certain age groups, they're uncomfortable using computers and mobile phones and technology. So over the last seven years, Care Innovations has been working with senior citizens, and people of all ages, to figure out what's the best way and the right types of devices to use when someone doesn't have their own computer or doesn't have something they're used to interacting with. Can we give them something in their home they can interact with and that they will like to use? Is it unobtrusive and does it connect to all the peripheral devices we would need to use on a project like this?

Due to this work, our tablet integrates with all the different peripheral devices that will be measuring the different aspects of an individual's health. It gives them the opportunity to have two-way communication with their care professional via video and other means. We tie that into any interfaces that we can use to help support the family caregivers as well.

Ray Solone, Executive Director of Marketing, Care Innovations

The main thing to add here is the patients, when they log into the system and turn it on, they're presented with kind of a step-function approach to engaging with the platform. They are also presented with video training that is part of the system as well. So they have on-the-spot video training on the system. Once they've watched it, they get it.

It's a very simple and easy-to-use interface. It was designed through ethnographic research. Let's start with the blood sugar levels and get that under control. Then, let's step you into education that's delivered just in time. If your blood sugar is high, we may deliver certain content to you. If it's under control, we're going to congratulate you and reinforce that behavior through the platform, and through a series of questions that we call "Daily Health Sessions." Those daily sessions evolve over time to move the patient from first, let's get control of the physiological component, and then let's move into being able to better manage your condition. That's really the promise of the platform. We progress the patient through to self-management. That's really when you begin to see patients really engaging with the platform. They feel somebody's taking care of them, even though it's remote. Their usage of the platform and their adherence to the care plan is very high, and that's what we like to see as the patients engage through the process. The interface is super simple, so we don't have those fears of, "I can't do it." They get engaged with the platform.

JF: What sorts of benchmarks do you use internally in terms of when are you going to really start looking at results?

SS: Speaking of a follow-up schedule, to be realistic, the first opportunity to do that will probably be the tail end of May. We get things launched in March, and then we plan to get about a month of data. You need about 60 days of data to work out the kinks. We want to ask, "Okay, how much of an impact are we having on AC1 levels? How much influence are we having on weight gain and reduction in weight, adherence to glucose monitoring, self-monitoring and etc.?" It takes a couple of months, even though we're doing all of that starting in March, for the data to come out and be analyzed.

By Jason Free, Features Editor
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Title Annotation:Trending Topics
Author:Free, Jason
Publication:Health Management Technology
Article Type:Viewpoint essay
Geographic Code:1U6MS
Date:Apr 1, 2014
Words:1390
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