While most people with diabetes are well informed about their disease and have good access to health care, this knowledge has not generally led to healthy behavior for those with type 2 diabetes¹, according to a study undertaken to better understand diabetes and the disease burden. Findings were presented at the American Diabetes Association’s 71^st Annual Scientific Sessions.

SHIELD (The Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes) is the largest nongovernmental study of its kind.² AstraZeneca sponsored the study.

“The American Diabetes Association and National Diabetes Education Programs have resulted in a significant increase in awareness - a big change over the past decade,” said Dr James R Gavin III, MD, PhD, Emory University School of Medicine and SHIELD investigator. However, Dr Gavin added, “SHIELD confirmed it is time we move well beyond awareness. We need patients who are informed and take the next step in behavior modification.”

According to SHIELD authors, 87% of 3,867 type 2 diabetes respondents in the baseline survey said they knew that obesity can aggravate or contribute to the onset of chronic disease.

Yet, while 70% of type 2 diabetes respondents said they had tried to lose weight over the previous 12 months, only 34% said they had maintained the desired weight for more than six months. As for exercise, 63% of 3,897 type 2 diabetes patients reported their health professional had recommended an increase in physical activity in the last 12 months, yet 87% reported they were inactive within the last seven days.  Nearly one in five individuals with type 2 diabetes (17%) reported they’d rather take medicine for their health problems rather than changing their lifestyle, and 5% reported they didn’t even bother to try and stay healthy.³  

The presence of a comorbid condition was not enough to motivate healthy behavior. SHIELD results indicated respondents who reported comorbid cardiovascular disease or moderate coronary heart disease risk had negative health attitudes and were not employing healthy behaviors: 74% of 1,150 very high risk individuals (those with diabetes and cardiovascular disease) reported they did not exercise regularly and 67% of very high risk patients had tried to lose weight in the past 12 months.⁴  

“It is clear we have done a good job at building awareness,” said Dr Gavin. “With over two-thirds of US adults overweight or obese,⁵ more than 70% of adult Americans engaged in minimal physical activity,⁶ and diabetes, particularly type 2, growing at epidemic rates,⁷ we need a different approach that is more intervention-based, and SHIELD data can inform the direction.” said Dr Gavin.

¹ Green et al.  Health Related Behaviors of People with Diabetes and Those with Cardiometabolic Risk Factors: Results from SHIELD.  International Journal of Clinical Practice. 2007. 61:7:1794-1796
² Bays et al.  Prevalence of self-reported diagnosis of diabetes mellitus and associated risk factors in a national survey in a US population: SHIELD (Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes). BMC Public Health. 2007. 7:2-7
³ Bazata et al. Affecting Behavior Change in Individuals with Diabetes.  Findings from SHIELD (Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes). Diabetes Educator. 2008; 34:1028;Table 2
⁴ Robinson et al. Preventive Cardiology.  2009;12:4;Table 3
⁵ NIDDK.  Statistics Related to Weight and Obesity. http://win.niddk.nih.gov/statistics/index.htm.  Accessed June 10, 2011.  
⁶ http://www.mayoclinic.org/medicalprofs/treating-managing-obesity.html, Accessed June 10, 2011.
⁷ International Diabetes Federation. IDF Diabetes Atlas, 4th Ed. Brussels, Belgium: International Diabetes Federation, 2009.

An Overview of Principles and Strategies for Engaging Patients in New Delivery Models Using Health IT

OptumInsight’s LifeCode^® Natural Language Processing Technology Receives U.S. Patent

“We wanted to make sure that we had sufficient resources to accommodate the additional time required to use ICD-10 accurately. We knew OptumInsight’s CAC solution had the capability to do what we needed today, and will enable us to work more rapidly within the coming ICD-10 environment.”

LifeCode bridges the natural way physicians communicate about patient care and the data required in hospital information systems to help provide consistent and accurate diagnoses and procedure codes for proper reimbursement and metrics for quality reporting.

The newest LifeCode NLP engine patent recognizes OptumInsight’s innovative “mere-parsing” methodology, which not only identifies and interprets words and phrases, but enables the technology to understand their contextual use to make coding decisions and track clinical documentation practices.

For example, a patient record may include the phrase “breast cancer.” Other computer-assisted coding (CAC) tools are often unable to determine whether this is a current or past diagnosis, or whether it pertains to the patient or the patient’s family history.

Because LifeCode understands the words around such phrases, the software can make these distinctions, which results in more accurate coding recommendations and clinical analytics. These capabilities help increase the accuracy of the information to the insurer, increase the productivity of medical claims coding staff, decrease claims rejected by health plans or missed charges and speed time to payment. NLP can also be used to improve the meaningful use of EHRs by identifying holes in current documentation practices and specific clinicians who may need additional support with regards to best practices.

“OptumInsight’s patented NLP technology is helping hospitals increase coder accuracy and productivity today. It will help support the transition to the more complex ICD-10 code system, and information used for measuring quality, best practice adherence and documentation improvement,” said Mark Morsch, vice president of technology, OptumInsight.

Ohio Health, a network of not-for-profit hospitals in Central Ohio, made significant gains in coding efficiency when five of its hospitals implemented OptumInsight’s CAC solution. OptumInsight’s CAC solution helped Ohio Health realize a 106-percent increase in productivity among diagnostic coders and a 60-percent increase in emergency department coding within months of using the technology. Ohio Health hopes to realize an improved case mix for inpatient services over the longer term, a critical measurement for ensuring accurate Medicare and Medicaid reimbursement rates.

Implementing OptumInsight’s CAC is also foundational to Ohio Health’s ICD-10 readiness efforts. By October 2013, the Centers for Medicare & Medicaid Services requires all health care providers to code medical claims using the ICD-10 classification system, a 155,000-line index of medical diagnoses and procedures that replaces the 17,000-line ICD-9 system. As a result, hospitals and physicians offices face an increased demand for coding resources and are at greater risk of lost revenue and productivity from bottlenecks, inaccuracies, denials and delays in the coding process.

“ICD-10 requires a lot more data knowledge and will take more time to code correctly,” Diane Setty, Ohio Health’s corporate director for health information management. “We wanted to make sure that we had sufficient resources to accommodate the additional time required to use ICD-10 accurately. We knew OptumInsight’s CAC solution had the capability to do what we needed today, and will enable us to work more rapidly within the coming ICD-10 environment.”

LifeCode Technology
OptumInsight’s NLP system received its first patent in 2005 for its architecture and sophisticated method of interpreting the context of words used in clinical documentation and assigning meaning. It has continually been refined for more than a decade, reading more than 300,000,000 medical documents since its creation and over 5.5 million medical documents per month.

Supporting Resources:

• Visit Optum’s CAC resource page online
• Request AHIMA’s CAC Report featuring Measuring the Performance of CAC
• Read more about Ohio Health’s success with CAC

 

Corporations, academics and private citizens responded to a national developer challenge issued this spring by researchers at Children's Hospital Boston and Harvard Medical School designed to inspire innovation in health information technology (IT) and the way in which health IT supports health care. Fifteen applications were submitted to the "SMART" Platform Apps Challenge in the less than three months since its launch, and an expert judging panel of industry leaders has selected the Meducation SMART app as the winner of the $5,000 prize. Six teams received honorable mention.

Launched in March and posted to Challenge.gov, the SMART (Substitutable Medical Applications, Reusable Technologies) Platform Apps Challenge tasked developers with creating web applications that would interface with an electronic medical record (EMR) or personally controlled health record (PCHR) and demonstrate value to patients, physicians, or public health researchers. A SMART architecture and common programming interface were created and made publicly available to entrants.

The Meducation SMART app, designed by Polyglot Systems, Inc. – a health IT company with a focus on improving care and access for underserved patient populations – provides multilingual, patient-friendly instructions for medications listed in a physician's electronic medical record or the personally controlled health record of a patient. The app uses the SMART programming interface to obtain the medication list and then links out to a drug information database, which facilitates the generation of simplified medication instructions for patients, available in a dozen languages.

"This is a production quality application that brings real value to the patient and has a clean presentation," said Kenneth Mandl, MD, MPH, of the Children's Hospital Informatics Program (CHIP), Harvard Medical School (HMS), and co-lead on the SMART project.

The SMART project stems from the work of a SHARP (Strategic Health IT Advanced Research Projects) grant from the Office of the National Coordinator for Health Information Technology (ONC). SMART promotes an "iPhone-like" approach to health IT, where EMRs and PCHRs are reimagined as platforms that run substitutable medical applications that can be rapidly created and also rapidly upgraded or replaced. A significant limitation of today's health IT environment is disparate systems that are inflexible and not able to scale or be customized to meet particular needs.

"Current-stage EMRs decide if, when, and how you will view the data trapped in their systems," continued Mandl. "The SMART Platform Apps Challenge was designed to demonstrate what can happen when electronic health information becomes liberated and can be readily consumed by computer applications. iPhone and Android app developers have been very successful because the address book and GPS data in those platforms is clearly and consistently presented by the platform. Our goal is to present health data in as useful and consistent format. Based on the submissions we received, I think we have demonstrated that this approach can be successful."  

"That we had so many excellent applicants reflects the hunger and need felt in the community to deliver innovative healthcare applications directly to doctors and patients without having to learn the details of a large, monolithic EMR," said Isaac Kohane, MD, Ph.D., also of CHIP, Harvard Medical School, director of the Countway Library of Medicine at HMS, and co-lead on the SMART project.

Six teams were also awarded honorable mention for the following apps:

• "Clinical Research" – facilitates interoperability between an EMR system and a clinical electronic data capture system;
• "DxSocial"- matches patients with doctors based on their experience treating patients similar to them;
• "Medication Risk Maps" – helps identify and compare medication side effects and risk of adverse events across drugs;
• "MyNote" – provides an intuitive, interactive timeline of patient history with disease-specific schemes, and allows patients to annotate the timeline;
• "Priority Contact™" – enhances the work process of a clinician by managing contact with patients after they have left the clinic and new information relevant to their treatment plan has been obtained;
• "rxInfo" – is a suite of SMART apps to help identify patients for clinical trials, provide drug interaction information, FDA Label information about marketed drugs, and a listing of nearby federally funded health centers.

"Through this competition we showed the real power of lowering barriers to developer engagement with health IT and have shown that the desire and ability to spark creativity and innovate is there, just waiting to take off," said Mandl. "We have a tremendous opportunity to revolutionize how health IT supports and helps manage healthcare, and through SMART, aim to give the community the encouragement and tools they need to get started."

All apps submitted in the SMART Platform Apps Challenge can be viewed on Challenge.gov. A SMART "App Store" will launch in 2012. The SMART team plans to design future challenges focused on developing specific functionality.

Special thanks to the judging panel, which included Susanna Fox, director of Health Research at the Pew Internet & American Life Project; Regina Herzlinger, the Nancy R. McPherson Professor of Business Administration at the Harvard Business School; David Kibbe, director of the Center for Health Information Technology at the American Academy of Family Physicians and principal at The Kibbe Group LLC; Ben Shneiderman, professor of Computer Science at the Human-Computer Interaction Laboratory at the University of Maryland, College Park; Edward Tufte, professor emeritus of Political Science, Statistics, and Computer Science at Yale University; and Jim Walker, chief health information officer at Geisenger Health Systems.

 

Aetna has launched a special texting program to help members who have been diagnosed with diabetes more easily and successfully control their condition and avoid complications. Members who agree to participate in the program will receive educational text messages and reminders about diabetes screenings and tests, medications, tips on healthy eating and exercising and general health information.

“Managing a chronic condition like diabetes has to fit in and keep pace with today’s increasingly busy lifestyles,” said Kyra Bobinet, M.D., MPH, medical director of health and wellness innovation for Aetna. “Statistics show that two-thirds of Americans use text messaging on a daily basis. Texting reaches people in ways that are even more convenient and easy for them. Tools and information that can help members make better informed decisions about their health care will be delivered to their fingertips anywhere they go.”

The diabetes texting program is available initially to a limited number of members who have Aetna medical, pharmacy and disease management benefits. Members who sign-up will receive short text-based messages on their mobile devices over a three-month period. Members will be evaluated on how well they follow four best-practice measures of diabetes management:

• Receive regular A1C screenings which measures blood glucose levels
• Receive an annual LDL screening which shows the level of bad cholesterol and cardiovascular risk
• Follow instructions for taking medications
• Enroll in a disease management, nurse and health coaching program

Aetna has a variety of programs in place to help people with chronic conditions, like diabetes. Aetna’s full suite of health and wellness programs as well as mobile technologies that include iPhone, Android and Blackberry apps help members make immediate, informed health care decisions.  Aetna teamed up with Silverlink Communications to launch the diabetes texting program. Aetna’s Medicaid plan in Delaware (Delaware Physicians Care) pioneered the use of health-related texting, successfully using it since 2006.  Aetna Medicaid currently offers a texting program to diabetic members that provides health information and reminds members to have routine blood testing.

Through a heartwarming story, David Agus discusses how doctors need to report the positives of new drugs and treatments to the medical community so we can help each other take steps towards curing terminal diseases.

David B. Agus is a Professor of Medicine at the USC Keck School of Medicine and heads USC’s Westside Cancer Center and the Center for Applied Molecular Medicine. His research focuses on the application of proteomics and genomics for the study of cancer and the development of new therapeutics for cancer. Dr. Agus’ clinical responsibilities include the development of clinical trials for new drugs and treatments for cancer, supported by the National Cancer Institute and other private foundations.

 

 

 

 

A couple of keystrokes and Dr. Robert Turner has what he needs to know. "I don't ever have to search through the chart looking for things," he said. That's a big deal because Richard Walton has two huge charts. "They didn't know what you had tried, what you had done before," Walton said.

Both doctors and patients at the Kelsey-Seybold Clinic like the new electronic medical record system.

"Everybody knows what my medical history is; everybody knows what medication I'm taking; everybody knows when I've seen my general practitioner or urologist or what. It's all in their system," Walton said.

Patients like it because you can get test results and other medical histories almost immediately. For example, if you took a cholesterol test you find your lipid panel results and it would not only show you your results but what the norms are. "Prior to that it was call the doctor's office, get the nurse, then take a message, then call me back," mother Cecilia Winters-Morris said. Winters-Morris now emails her questions to her seven-year-old son's doctor, and she gets the answers back on her smart phone. And her son's pediatrician likes it too. "I can take the time to think about the situation instead of trying to hurry it up and rush the job between patients," said Dr. Kelly Bruce Lobley, a pediatrician with the Kelsey-Seybold Clinic.

Last year, Kelsey-Seybold went 100 percent electronic medical records. It finished the conversion last year. Now, its 500,000 patients can email their doctor and get test results on a smart phone. And this is the future.

 

Go get your future!