Think You Only Have Asthma in May and October? Think Again

asthma education

Dr. Rubina Inamdar, DignityDuring National Asthma Awareness month we’re doing a deep dive with Dr. Rubina Inamdar of Dignity Health to talk asthma awareness. So far we’ve tackled big challenges and battled common misconceptions. This week we take on seasonality.

Is asthma really a problem for all people all the time? Or do you think some months, like May and October, are when most people are experiencing problems?

We hear people who say I know I’ll have problems in May and October of every year, so why do I need an inhaler all year around? While there is some disagreement among asthma doctors about what Mild Intermittent Asthma means for many patients, for majority of those patients, even when they don’t have symptoms, their lungs aren’t quite the same as people who don’t have asthma. Many of those patients may have extra inflammation, extra reactivity compared to normal people who are not asthmatics. There are also a group of patients who have learned to live with certain symptoms that they wouldn’t be living with if they didn’t have asthma. This is especially true for people who have been undertreated or haven’t had treatment for a long time – they’ve learned to just live life slowed down.

These people keep taking the elevator vs. climbing stairs. They won’t try out for the soccer team. They won’t play with their kids or grandchildren as they normally would have because know they get winded. And the answer won’t be, “I won’t do it for my asthma.” They’ll say, “I don’t feel like it” or “I wasn’t in the mood.” They’ve learned to live with a certain level of breathing problems and once they feel better, it surprises them how much they’d started to limp along vs. run through their lives. This is very apparent in student athletes who see their athletic performance improve significantly once they start treatment. So for people who think they only have asthma symptoms a couple times a year, I say perhaps we can see how different things feel once you are on the right kind of regimen.

Keep in mind too, that there are people who think using their rescue inhaler 3-4 times a day is normal. That is not normal and needs to be addressed.

And that’s where the Asthmapolis sensor has enlightened my patients, seeing that they or their children are really using their Albuterol that much. They understand that it has become normal in their life, but that it is not normal for a patient whose asthma is under control.

Finally, people can flare at any time. With climate change, we’re seeing unusual things. Sacramento had three very heavy rains in the middle of summer last year. Having been born and raised here, I’d never seen rain in July and August. It immediately led to high pollen levels and people who were usually fine in the summer where suddenly having asthma and allergy symptoms.

Sincere thanks to Dr. Inamdar for joining us in this series. Up next week: is digital health changing asthma care for the better?

Safety Net Innovation Network Conference Highlights

events, mobile health, technology

As April turned to May the Center for Care Innovations hosted on their bi-annual Safety Net Innovation Network Conference, and we were privileged to attend. The conference brought together administrators, clinicians, researchers, entrepreneurs and investors all focused on cultivating innovation within the safety net healthcare system. The safety net is considered to be the systems and providers that organize and deliver care to individuals and families who are uninsured, who are covered by federal insurance, or other vulnerable populations.

While the two days were full of great quotes, one quote seemed ubiquitous: “Necessity is the mother of invention.” The quote, generally agreed to be trite, found a renewed significance at this event, and proved to support the growing optimism in the room that those working in the safety net, those most pressed for resources and making due with so little, were poised to innovate. These constraints were, in fact, forcing the healthcare safety net to look for new and innovative ways to do things.

Here are a few of our favorite discussions from the conference:

  • The Power of the Network. There was a lot of talk about “good ideas,” but even more talk about the challenges to implementing even the best idea. Innovation most successfully put into practice by an innovative network. We discussed identifying physician champions, creating partnerships with staff and administration, and using train the trainer models to help encourage buy-in.
  • Spend a Day in Their Shoes. The social scientist in me was thrilled to hear the word ethnography being thrown around a lot during the two day conference. Chris Conley of Gravity Tank lead us through examples of observation, interviews, and video all used to take a deep dive into the day to day life of the target population of a given service or product. Understanding daily life of individuals who receive their care from safety net institution is vital to thoughtful, intentional design and development.
  • Look Outside Your Office…and Outside Healthcare. Many presenters and participants noted that they looked for innovative solutions outside of their own clinic and outside of the healthcare industry all together. When it comes to making the patient the center of care, many individuals argued that healthcare can learn a lot from retail and other consumer focused services. It’s a balance between the expertise that exists within the healthcare space, and the need for outside the box ideas – often meaning outside of healthcare.
  • Working Together. CCI did a wonderful job of structuring the conference to create meaningful dialogue between safety net institutions and healthcare business innovators. Both groups were able to express their pain points and ask questions of the other. Insights on how to best interface included: articulating expectations early, bringing the payer into discussions, and taking things slow, rather than going for the quick pitch.

We were proud to share more about our solution and learn more about pain points for safety net providers and their visions for innovation! Video, photos, and more materials from the conference will be available through CCI in the coming weeks. Check back soon!

The Biggest Asthma Misconception

asthma education

Dr. Rubina Inamdar, Dignity

During National Asthma Awareness month we’re doing a deep dive with Dr. Rubina Inamdar of Dignity Health to talk asthma awareness. First up was tackling big challenges. This week: battling misconceptions.

What’s the biggest misconception about asthma in your opinion?

Asthma is like any other chronic disease, like diabetes or high blood press or even dental cavities. It has a lot of bad side effects that can be prevented and the preventive treatment is often much milder than treating a severe problem from the asthma.

Many people, including a lot of physicians, tend to underestimate how much asthma is affecting them or their patients, how much medication and education their asthma patients need. And most people don’t think of asthma as something that needs to be cared for every day, but rather as something that affects them one or twice a year.

There are many ways to look at asthma treatment for a patient. On one hand,asthma treatment is like brushing your teeth vs. handling a cavity. Using the inhaler every day, prevents scarring in your lungs, prevent ER visits and bad symptoms. Sometimes patients understand this analogy well as a little bit of care every day vs. a lot of care for big exacerbations several times a year.

More to the point, we really need to see asthma as a chronic disease like diabetes. Patients need to understand the inhaler to take better care of their lungs and their bodies, but it is not just about the medication you take. It’s also about the food you eat, exercise you do, rest you get at night, how well you pay attention to your environment, whether you smoke. And then if you need help in those areas, getting a breathing test once a year, if you need to get a chest x-ray or other medical intervention, if you need help quitting smoking, all the similar things you might do with diabetes or hypertension and requires paying attention not just to the inhaler in your pocket, but how you manage your health in general.

Once a patient understands that, it becomes much easier to wrap your mind around managing your disease on a daily basis rather than having horrible images of not able to breathe and being in the ER all the time. It frees patients up from doomsday diagnosis to making it far easier to manage through lifestyle.

 Sincere thanks to Dr. Inamdar for joining us in this series. Up next: the seasonality of asthma.

Top Three Asthma Challenges: Finance, Literacy, Misinformation

asthma education, public health

Dr. Rubina Inamdar, Dignity

During National Asthma Awareness month we’re doing a deep dive with Dr. Rubina Inamdar of Dignity Health to talk asthma awareness. First up: tackling big challenges.

What do you think have been the top three toughest challenges facing you and your patients in terms of educating them about – or helping them manage – their disease?

Financial issues, health literacy and misinformation.

In the last few years, financial issues have become more prominent. Most people have insurance that will cover a generic medication, but may have a large deductable with non-generic medications.  Most asthma medications are not generics, so it becomes a practical matter that has nothing at all to do with how to manage asthma, and everything to do with finances getting in the way of people being able to take their medications. We work with patients and companies to get medications at a more affordable rate, but in the end, this wasn’t something that came up 15 years ago, and it reflects the changing medical and insurance landscape.

Second, health literacy. When someone comes to our allergy and asthma clinic for the first time, the visit averages 2-3 hours, of which testing is going to take maybe 45 minutes. The rest of the time is spent teaching patients about their asthma; how to use inhalers, triggers and what to do when they get really short of breath. We educate about asthma in general but also why do you need to use an inhaler and importantly, how to use an inhaler? Technique is everything. If you are not using the inhaler correctly the medicine won’t go where it needs to go. Additionally, research shows that even if we take the time to teach someone, when 90% of those people come back for a follow-up session, there’s something wrong with their technique or they’re using the wrong inhaler for controller or reliever. It’s unfortunately quite predictable that some people will have trouble remembering which one to take regularly. That means we have people return to us pretty quickly, and tell them to bring their inhalers and we go through it again.

Third, misinformation, especially when people are learning about this brand new condition they have. For example when we start someone on a controller medication –that is an inhaled steroid – many patients fear that it will have the side effects that you hear about for steroids. The truth is that those side effects only apply in large doses, which inhalers don’t deliver. Occasionally, even if we’ve tried to dispel those concerns,  a patient may not discuss their concerns with us in a meaningful way. Instead, they just won’t take the medication. Many patients will stop their controller medication when they feel better but then they will have a severe flare up and wind up on an oral steroids to manage the exacerbation. People are under the mistaken assumption that they are taking less medication when they use oral prednisone for a few days but often the dose ends up being far more medication then staying on the preventive asthma controller inhaler.

And then there is a lot of anecdotal information on blogs and websites about how asthma medication has affected one specific person. While that clinically isn’t true for the majority of people, once those ideas get into someone’s mind, it’s very difficult to take it out, and that kind of misinformation can get in the way of managing your own disease.

Sincere thanks to Dr. Inamdar for joining us in this series. Up next week: The Biggest Asthma Misconception.

Asthma Awareness from the Provider’s Perspective

asthma education, asthma management projects

Dr. Rubina Inamdar, Dignity May is National Asthma Awareness Month so I was delighted to grab some time with Dr. Rubina Inamdar of Dignity Health to talk asthma awareness.

Over the next four weeks, we’ll do a deep dive to get her first hand experiences of educating – and reeducating – patients about their disease. Plus later this month, we’ll explore how digital health solutions like Asthmapolis are changing the physician-patient conversation for the better.

First up – tackling big challenges.

Health Technology Forum was Platform for Patient and Healthcare Leaders

events, mobile health, technology

The Mission Bay campus in San Francisco was abuzz with disruptive discussion on April 19th as technologists, health care providers, and health system executives came together for the Health Technology Forum Innovation Conference: Platforms for the Underserved.

Not only did the conference center around technology platforms, but it also served as a platform for leaders, ranging from patient advocates to frustrated Chief Medical Information Officers. These luminaries included:

  • Amy Tenderich, Editor-in-Chief of DiabetesMine.com, diligently brought the patient perspective to the patient engagement panel. Amy shared her own story of diabetes diagnosis and her road to becoming a patient advocate. She was honest and direct about the fragmented healthcare system patients were still experiencing each day, and the crowd responded enthusiastically to her no-nonsense approach to discussing innovation and design. She was a refreshing reminder that it’s not about technology; it’s about people.


  • Jan Oldenburg, VP, Patient and Provider Engagement of Aetna’s Accountable Care Services, is one of the pioneers within HIMSS for patient engagement and is the author of HIMSS recent book, Engage! Transforming Healthcare Through Digital Patient Engagement. Even more impressive was Jan’s ability to translate her wide breadth of knowledge into concise, digestible guidance for those working to innovate for patients. She highlighted three key drivers of engagement: (1) convenience, (2) connection, and (3) relevant, timely data.

 

  • Yan Chow, MD, Director of Innovation and Advanced Technology at Kaiser Permanente, is one of the directors of the Garfield Innovation Center, a 37,000 sq. ft. simulated care delivery laboratory where new innovations and ideas can be tested for improved healthcare delivery. Dr. Chow has his ear to the heart of innovation and clinical testing, and was able to provide the panel with deep, well tested insights on telehealth. He stressed the importance of testing out an innovation in the clinical setting as well as the measurement complications that come along with new kinds of healthcare delivery methods. He left the audience with the questions, “Should we be measuring other outcomes of success, and, if so, what should they be?”

 

  • Gavin Newsom, Lt. Governor of the State of California, and recent author of Citizenville: How to Take the Town Square Digital and Reinvent Government, was the much anticipated afternoon keynote speaker. While the content of Gavin’s keynote focused more on government and citizenship than health care, he highlighted many of the same ideals that those in the healthcare innovation space champion: open data, grassroots action, and participatory change. He remarked openly about financial corruption in politics and spoke extensively on the de-geniusing effect of political office. He urged attendees to create change immediately, rather than waiting for some position of power, arguing that an individual’s moral power as a citizen is more powerful than the degeniused political power.

  • The final panel of the day included four Chief Medical Information Officers who presented on the extreme IT challenges that face hospitals. The group’s discussion was candid, graceful, and had a great sense of humor, while never understating the complicated challenges they face as CMIO’s each day. Interestingly, the struggle for IT change appeared to be equal parts technical, financial, and personal. The panelists talked extensively about the psychology of change and the resistance they received when transitioning healthcare providers to a new system. The panel was moderated by Justin Graham, MD, MS, CMIO North Bay Healthcare, and included Mike Aratow, MD, CMIO, San Mateo Medical Center; Rajiv Pramanik, MD, CMIO, Contra Costa County Health Services; and Jenson Wong, MD, CMIO, San Francisco General Hospital.

The Health Technology Forum embodies the ideals of the health innovation movement, not just in its work, but also in its structure. The forum began as a periodic Meetup of like-minded health technology enthusiasts in 2010, and has been rapidly growing ever since. The group, now of well over 2200 individuals, has put on two conferences and is an active player in networking and collaboration for health innovation. In true grassroots fashion, the group’s primary convenings are still the Meetup’s, which are open to the public.

Technology-driven innovation in healthcare: two takeaways from Healthcare Innovation Summit

events, mobile health, technology

Asthmapolis co-founder, David Van Sickle, had a lot to say about technology and healthcare innovation at last Wednesday’s Healthcare Innovation Summit at Stanford University, and his words seemed to resonate with the audience. He received enthusiastic applause after passionately describing his motivation to found Asthmapolis and tackle the problems he saw in asthma management.

The Summit, put on by Stanford University’s Graduate School of Business, brought together patients, providers, insurance companies, health systems managers and entrepreneurs to discuss what healthcare innovation looks like now and in the future. David was invited to talk at this Summit to help explore  the question, “how can health technology be disruptive– improving  health outcomes, reducing healthcare costs and leading to more innovation?

The Summit brought together the most respected names in healthcare innovation from across industries. Mark Bertolini, CEO of insurance giant, Aetna, talked about how insurance companies must reinvent themselves to survive in the future. Another panel explored innovative models of care delivery through examples from Molly Coye, CIO of  the UCLA Health System,  and Yan Chow of Kaiser Permanante’s Innovation and Advanced Technology Group. So what was all the buzz about? Two of the most tweeted-about themes of the day centered around defining new roles enabled by technology.


(1) The new role of patients as consumers of healthcare

Patients are increasingly becoming the CEOs of their personal health, says Vinod Khosla. When patients are recast as consumers in a  healthcare market, they are in a powerful position to demand convenience, timeliness and relevance from healthcare. In order to attract and keep patient consumers, healthcare systems will have to allow increasing customization so that any patient can access what they need, when they need it.

(2) The new role of technology-driven care

There was also talk about different types of care and the changing roles of providers. Will doctors be replaced by an ipad and a big-data-crunching-computer? Data and analytics can offer amazing insights into disease, diagnosis and interpretation, but will never replace the important ritual from a doctor-patient conversation or the comfort of a caregiver’s touch. Doctor and author, Abraham Verghese, MD, explored this dynamic through the transformation of his own doctor’s bag, and emphasized the need to not let technology be a barrier to communication, but rather a platform to support  it. This drawing from a 7-year-old patient  perfectly captures this challenge.


Watch the full panel, Revitalizing Healthcare Innovation, with David Van Sickle.

The role of technology will be to augment patient-provider relationships and support human needs throughout the healthcare journey. It must be high tech and high-touch.  And that’s what Asthmapolis is striving  to do–inform the patient-provider conversation with data in order to improve asthma management.

New Mobile Push Notifications and Better Alert Management

release

Having asthma is a pain, so we work hard to be your trusty sidekick in the battle. Our new release gives you more tools in that arsenal by alerting you – in the way you choose – when important things happen.

You tell us what’s the most effective and convenient way to reach you – and we’ll let you know with alerts for you and your family.

  • New push notifications.
    Now you can get these important messages on your mobile phone by push notification — those little boxes that pop up on your screen.
  • More notification options for what – and how – you hear from us.
    You can get notifications about more things, like when your sensor has a low battery. And you can get notifications in more ways – about you and your family – by email, text message or those new push notifications.
  • Easier setup for notifications, online and on the go.
    We made it easier to set up when you want to be notified of key events, and easier to review how each alert will be delivered. You can now make these changes online or on the go through our mobile apps. Plus it’s never been easier to tell Asthmapolis which family members you want alerts for.
  • Updates to improve automatic sensor syncing 

CBS News Features the Asthmapolis Program at Dignity Health

asthma management projects, mobile health, sensors
We’re delighted to see our friends at Dignity Health featured in this great piece by CBS News! The segment focuses on both the day to day experience of a patient, Duffy Minges, using Asthmapolis to better manage her asthma as well as the way providers, like principle investigator, Dr. Rajan Merchant integrate Asthmapolis into their clinical workflow. Watch the full video below.

“Now I can breathe, and I’m not as exhausted anymore.”

 

 

The Dignity Health trial in Woodland and Sacramento was also featured in a recent educational webinar for the members of Innovation Learning Network, a disruptive ideas sharing network for healthcare professionals and systems, founded by Chris McCarthy of Kaiser Permanente’s Innovation Consultancy. Asthmapolis CEO, David Van Sickle, and Dignity Health Woodland’s Dr. Rajan Merchant spoke to the ILN Network about the benefits and challenges of passive sensors and mHealth.