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Digital Health Technologies for Alzheimer’s Disease

Digital Health Technologies for Alzheimer’s Disease | Healthcare and Technology news | Scoop.it

According to The Alzheimer’s Association, there are over 5 million Americans with Ad. It is the sixth leading cause of death. More than 15 million caregivers provided an estimated 18.1 billion hours of unpaid care at a value of approximately $221.3B. The impact of this disease is also well-illustrated in a recent  PBS documentary.  While it might seem incongruous on the surface to discuss digital technology and a population with significant cognitive challenges, I will illustrate how it can be beneficial at different stages of the disease’s course.

 

Cognitive Assessment Tools.  Most tools for assessing cognitive abilities have been of the traditional written form, as offered by the Alzheimer’s Association.  The ability of digital tools to detect early diagnosis of Ad is important in medical and social planning for the patient and family. Some have taken traditional diagnostic tools and transformed them into a digital platform. Such is the case with Quest Diagnostics’ CogniSense.  A more transformational approach is one seen with a utilization of the Anoto Pen which can measure the writing instrument’s position up to 80 times per second. An exciting study by the Lahey Medical Center and MIT’s Computational Science and Artificial Intelligence Laboratory looked at using the Anoto Pen versus traditional cognitive assessment tools for Ad and other diseases. This method has already shown advantages over traditional tools, described in an MIT News piece: “… while healthy adults spend more time on the dCDT [digital clock drawing test via Anoto] thinking (with the pen off the paper) than “inking,” memory-impaired subjects spend even more time than that thinking rather than inking. Parkinson’s subjects, meanwhile, took longer to draw clocks that tended to be smaller, suggesting that they are working harder, but producing less — an insight not detectable with previous analysis systems…”  A digital platform called Neurotrack claims it has the ability to detect Ad at its earliest stages by assessing recognition memory, a function specific to the brain’s hippocampal region which is affected early in the course of Ad. Digital assessment tools like these can also save clinician time and offer a better objective patient assessment.

 

Cognitive Improvement tools. A handful of small studies have shown that ‘brain exercise’ in the form of cognitive augmentation games decreases the risk in normal individuals of getting Ad. One would naturally ask if this carries over to those already diagnosed AD. Some earlier studies suggested this was the case. An older review of multiple small studies showed that while they suggest that brain exercises slowed progression of cognitive decay they did not affect mood or the ability to care for oneself.  It is worthy of noting that patients with larger baseline ‘cognitive reserve’ do better to a point then characteristically have a rapidly progressive course. In a previous post, I discussed the merits of music as an ideal digital health tool. Music should be considered as a potentially much appreciated and useful tool.  Relative to Ad specifically, I would reference the incredibly informative and moving award-winning film Alive Inside, documenting the response of patients with severe Ad to music relevant to their personal past. An intriguing interactive game/tool is Tovertafel, a Dutch technology which projects via suspended box visuals onto a table.  There are various exercises and games on the platform which are both enjoyable and mentally stimulating. Less sophisticated yet popular games are offered by the Alzheimer’s Association.

 

Tools for monitoring daily activities. Technologies have been developed to aid patients with mild to moderate disease and their caregivers to make daily activities easier and safer. SmartSole makes an innersole with a GPS locator with an associated smartphone app and call service for alerts. Silver Mother by Sen.se is a customizable digital tech platform (front door position, room temperature, and water and food containers) connecting caregivers with love ones’ activities of daily living.  For patients with early dementia or for caretakers to connect with loved ones at a distance, grandCAREis a very comprehensive platform and service.

 

While one might associate digital tools with those of us who are “connected,” their utility in the realm of Ad can be profound.  I would submit that the potential for digital tech to prolong independence and/or improve lives of caregivers in the home or at a distance must be the subject of clinical studies.  Public health policy might very well change as a result of such outcome studies.

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What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration 

What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration  | Healthcare and Technology news | Scoop.it

Participation in pay-for-performance plans like MACRA’s Quality Payment Program (QPP) poses new challenges for resource-strapped healthcare organizations. Many provider sites lack the time and technical expertise needed to retool their EHR implementation to document new metrics under value-based reimbursement models like the Merit-based Incentive Payment System (MIPS).

 

Nonetheless, that is precisely what clinicians must do to deliver on quality reporting requirements. When using EHR documentation tools, many factors must be considered for a provider to get credit on having met clinical quality measures (CQMs). How that information gets stored in the EHR directly affects reporting. Many healthcare organizations are finding that customizing an EHR to recognize when a measure has been met—preferably in a manner that poses as few interruptions to patient engagement as possible—is easier said than done.

Overcoming EHR Limitations

Many outpatient and inpatient settings still struggle with common EHR data management headaches. As clinicians bring new quality measures into the EHR, those underlying data management issues can foil even the best-laid reporting plans.

Discrete Data Capture

The push to better document clinical quality is causing a transition in EHRs to focus more on structured or discrete data that is easier to trend over time. Unfortunately, many healthcare providers still receive patient data from healthcare affiliates via fax. Those faxed documents show up as attachments in the patient chart and are not fully integrated into the patient data file. If that information was sent via HL7 interface instead, details on the care rendered by that hospital or other healthcare entity would flow into the EHR as discreet data variables. For many providers today, capturing that information in a manner that makes it usable in reporting and analytics still requires timely, manual data entry.

Documentation and Data Consistency

Provider sites with multiple clinicians may also encounter issues related to the slightly different way that each EHR user documents care. MIPS and other quality programs require consistency and a high degree of specificity in clinical documentation. If a clinician does not get diagnosis specifics into the patient chart, that patient may not be included in the CQM calculation they need to be included in. Many clinicians are having to modify their documentation process during patient encounters so they and the staff can capture all the necessary information in the EHR.

Clinical documentation will have even bigger repercussions under the Cost component of MIPS, which is slated to be factored into performance scores in coming years. Take, for example, a patient that is in for the flu. That patient has a certain anticipated cost impact (the average Medicare spending per beneficiary), calculated based on past medical history and services rendered. If a patient goes to a physician and has the flu but also has diabetes, heart failure, and asthma, that flu patient is probably going to cost more to care for. If the physician only submits the flu diagnosis and fails to document patient co-morbidities then the healthcare organization will not get the same allowance under the MIPS Cost category and could be labeled as “higher cost” than a comparable provider encounter for a patient that required fewer resources to care for.

Clinicians, coders, and staff need to make a mental transition away from “we’re submitting claims” to “we’re submitting data” to better serve clinical reporting initiatives and patient care analysis.

Making Informed CQM Selections

Beyond adapting to new data management processes, clinicians reporting under value-based programs also have a great deal to learn as they layer in additional quality measures under MACRA. One of the biggest challenges clinicians and administrators face is selecting the best measures for their specific healthcare organization. With limited spare time on their hands, many healthcare teams are leaning on outside expertise to help them evaluate the implications of various measure selections.

Measures Without Benchmarks

Many quality measures under MACRA are carry-overs or “relics” from other reporting programs. For these CQMs, providers can look to prior performance averages to evaluate the likelihood of success should the healthcare organization elect to report on those measures. That data does not exist for some CQMs, which are referred to as “measures without benchmarks.” On measures that have no benchmark data available, providers will be limited to a maximum of three reporting points instead of the ten points available on measures with benchmarks established.

To further complicate things, details on the availability of some benchmark data will not be calculated until after the March 2018 QPP reporting deadline. Providers may wish to further diversify or report on additional measures that could help offset low point earnings on measures without benchmarks.

Topped Out Measures

Another CQM caveat that providers should be aware of relates to “topped out” measures. These relic measures from other reporting programs are very engrained in many healthcare settings. Medication reconciliation, for example, was a requirement under Meaningful Use. Widespread adoption and universally high compliance rates on that measure makes it more difficult for clinicians to out-perform peers. Achieving maximum points on such measures requires a perfect or near-perfect score.

Keep average performance thresholds in mind when evaluating CQM selections, not just the healthcare entity’s individual performance track record. Look at a broader set of measures to maximize MIPS score potential. Clinicians could earn more points by scoring 70 percent on a non-topped out measure than they would earn scoring 95 percent on a topped out measure. Some topped out measures will likely be eliminated in future years to help diversify CQMs, as was the case under Meaningful Use.

Understanding the intricacies of CQM selection and EHR data management will be vital to success under value-based payment programs. Healthcare administrators and clinicians who proactively work to better understand the impact of various measures and streamline EHR processes will be best positioned to maximize program incentives.

 

Does your organization have the resources it needs to successfully navigate MIPS

Technical Dr. Inc.'s insight:
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inquiry@technicaldr.com or 877-910-0004
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