How are healthcare providers accustomed to delivering care in-person redesigning their practices and garnering the requisite skills to integrate and implement digital therapeutics?
Healthcare systems and care delivery are changing in rapid-fire fashion. Factors are converging to speed these changes, particularly in chronic disease care. An increasing number digital health therapeutics have demonstrated their clinical and cost effectiveness and they’re being integrated into an array of healthcare systems and value-based care models to transform healthcare delivery.
The delivery of diabetes care offers a valuable model to explore this question.
Diabetes care requires day to day self-care on the part of the person with diabetes or their caregivers and regular follow up with healthcare providers on their understanding and application of self-care behaviors. Management calls for frequent follow up to assess glycemic management, manage co-morbid conditions, detect and treat complications and titrate medications to optimize treatment.
Standards Suggest Optimal Care Delivery Can be Technology-Enabled
Over the last several years increasing evidence demonstrates the effectiveness of digital therapeutics in diabetes care. A systematic review of technology-enabled Diabetes Self-Management Education and Support (DSMES) concluded that these solutions improve people’s A1c levels and most effectively do so when they:
- Include two-way communication between the patient and the care team
- Offer individualized feedback
- Utilize the Patient-Generated Health Data (PGHD)
- Provide tailored education.1
Findings from this systematic review led to the publication of the new, stronger statement cited below about the role of technology-enabled DSMES in the 2018 ADA Standards of Medical Care.2
“Emerging evidence demonstrates the benefit of Internet-based DSMES services for diabetes prevention and the management of type 2 diabetes. Technology-enabled diabetes self-management solutions improve A1C most effectively when there is two-way communication between the patient and the health care team, individualized feedback, use of patient-generated health data, and education.”2
Based on other research these 2018 ADA standards also promote the value of technology-assisted tools in the prevention or delay type 2 diabetes as cited below.3
“Technology-assisted tools including Internet-based social networks, distance learning, and mobile applications that incorporate bidirectional communication may be useful elements of effective lifestyle modification to prevent diabetes.”
Remodeling HCP Roles Calls for Digital Champions
Technology-enabled diabetes care and education can be coordinated by various members of the healthcare team. But today’s clinicians having, for the most part, practiced in face-to-face delivery environments, will require new skills and knowledge to deliver care in this connected care world. An editorial in JAMA posed this question: Is It Time for a New Medical Specialty? – The Medical Virtualist, referring to the current demands by consumers for convenience-based healthcare delivery and our growing capabilities to deliver technology-based solutions.4
Considering these need, let’s again use the example of diabetes.
Diabetes educators, with their expertise in diabetes, team-based care and the use of PGHD to optimize care plans, have the opportunity to become virtualists. But they, like all healthcare providers, need training and a supportive learning environment.
At WellDoc, we’ve been involved in championing this role among diabetes educators. Rather than using the term virtualists, we call them Digital Champions. We’ve embarked on a collaboration to develop a Diabetes Digital Health Learning Network (DDHLN) with the American Association of Diabetes Educators (AADE), the membership organization for diabetes educators. I’ve been privileged to co-lead this learning network with my WellDoc colleague Malinda Peeples.
Our Digital Health Learning Network with AADE
Our goal has been to offer our colleagues’ access to use BlueStar, WellDoc’s digital health therapeutic cleared by FDA as a mobile medical app, with their patients in a supportive network for sharing and learning. We’ve called this the Diabetes Digital Health Learning Network (DDHLN). Through weekly webinars, this network of colleagues explored strategies to bring innovative tools to the practice of diabetes care and education. Though we continue to keep the DDHLN small AADE members from across the United States who practice in a variety of settings are participating.
By offering this learning network we’re helping diabetes educators gain skills and competencies to integrate digital therapeutics into their armamentarium and jointly identifying best practices. To date we’ve identified two best practices as:
- Determining the workflow of the practice environment
- Measuring patient engagement
Over time we believe arming diabetes educators with these new skills can elevate the roles of the diabetes educator in the variety of evolving healthcare delivery models in which they practice, increase their utilization and help them become leaders in practice redesign for value-based services. And lastly, but most importantly, improve the care of people with diabetes, which is a significant healthcare need today.
The development of the DDHLN was a natural extension of the licensing agreement that WellDoc entered into with AADE to digitally deliver the AADE7 Self-care behaviors curriculum in patient-friendly tailored small “doses” over a 12-week journey in.
Taking our collaboration to promote the concept of digital champions among diabetes educators with AADE one step further, Peeples and I co-authored the article, Are You Ready to Be an eEducator? in AADE In Practice.5
The concepts discussed here can be applied by any healthcare providers who want to integrate digital health tools into their practices. The ever-advancing capabilities of technology mixed with consumer demands and coverage for these services will only increase over time. Healthcare providers will need to be ready to practice in this technology-enabled world.
1. Greenwood DA, Gee M, Fatkin FJ, Peeples MA. Systematic Review of Reviews. Evaluating Technology-Enabled Diabetes Self-Management Education and Support. Journal of Diabetes Science and Technology. 2017. DOI: 10.1177/1932296817713506. 1–13
2. American Diabetes Association. Standards of Medical Care in Diabetes – 2018. 4. Lifestyle Management. Diabetes Care. 2018;41(Suppl. 1):S38-S50.
3. American Diabetes Association. Standards of Medical Care in Diabetes – 2018. 5. Prevention of Delay of Type 2 Diabetes. Diabetes Care. 2018;41(Suppl. 1):S51-S54.
4. Nochomovitz M, Sharma R: Is It Time for a New Medical Specialty? – The Medical Virtualisthttps://jamanetwork.com/journals/jama/article-abstract/2664528?utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=112717&redirect=true (Accessed February 16, 2018.)
5. MacLeod J, Peeples M. Are You Ready to Be an eEducator? AADE In Practice. 2017; 5:30-35.