1. Mobile Technology & Primary Care Getting through the noise William P. Moran, MD, MS & Patrick D. Mauldin, Ph.D. MUSC

2. Evolution of primary care

3. Care Coordination: Our Care Venues…

4. Evolution of primary care

7. 7 Wagner Chronic Care Model

8. Workflow in the real world… PATIENT

9. Workflow in the real world… PATIENT

10. Workflow in the real world… PATIENT

12. Have we made his life better?

13. What to do? A loud ‘signal’ MUST be heard amidst the clinical ‘noise.’ Technology must be targeted to the most appropriate patients: Risk stratification Decision support must be integrated into the data flow process Information must be reliably delivered to the correct team member (frequently not the primary care provider) Clinically actionable signals should be sent to the primary care team member Real time

14. Risk Stratification

15. Cluster A Cluster C Cluster B Cluster E Cluster D

16. Risk Stratification Healthy Complex, CV disease & Depressed Renal Disease, Depression, & CV risk Diabetes & CV risk Obesity & CV risk

17. Static and Dynamic Components No static and no utilization* within 365 days Static variables only (no utilization) or no Static w/Util within 365 days Static and utilization history (days 31-365) or top 20% with no utilization within 365 days Static and util.(Top 20% risk with until <365 days) Immediate utilization within 30 days (regardless of static results) Immediate Intervention The risk strat model is to reduce the number of &.

18. Obesity & CV risk Healthy Hypertension Hyperlipidemia & Hypertension

19. Complex, CV disease & Depressed Chronic lung disease, Depression & CV risk Diabetes & CV risk Renal Disease, Depression, & CV risk

20. Cueing the team 4 Total Risk Strat Color TypeAdmit/ERDate/TimePrograms Patient Name SelectDOBLast VisitDescription/CCDelete MUSCER4/19/2012HypertensionPt 14/6/522/8/12High BP MUSCAdmit 4/19/2012Diabetes, CKD, Hyperlipidemia Pt 25/12/402/6/12SOB MUSCAdmit4/19/2012 Diabetes, Hyperlipidemia Pt 310/6/422/20/12High blood sugar MUSCAdmit4/19/2012Sickle CellPt 41/2/874/17/12Sickle cell crisis Patient Data Delete 1 2 3 4

21. Patient Name Risk Strat Color Admit/ERDate/TimeClusterProgramsLast VisitNext VisitPCPDescription/CC Patient 2 Admit4/19/2012Complex Diabetes, CKD Hyperlipidemia 2/6/124/25/12 William P. Moran, MD SOB SF – 12 Domains Last Assessment 2/6/12 Physical Functioning General health Pain Mental health Energy/Fatigue Cueing the team

22. Real Time Courtesy of Dr. Frank Treiber

23. Summary Primary care environment offers opportunities for technology to improve the quality of patient care – monitoring clinical conditions – coordination and transitions of care – medication management But we have to be careful implementing technology in an occasionally chaotic environment – Primary care