5 simple technologies to bridge the COPD care gap virtually
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Today, COPD care teams are effectively managing patients within each care setting. However, as value-based standards continue to rise, this is no longer enough. Teams face the vital need to drive better outcomes by integrating care between settings. Unfortunately, this extension of care will demand more resources that care teams simply don’t have. Examples of resource limitations:
But do these limitations mean that inadequate care is inevitable? Our COPD insiders say no. That’s because they’re exploring virtual technologies that extend their reach, empower patients, and increase quality without increasing resource consumption. Let’s look at some of their extraordinary ideas.
Contributors
Amy Shaheen, MD MSc
Medicine Professor, Division of General Medicine and Clinical Epidemiology, UNC Director of Population Health Services, University of North Carolina School of Medicine
M. Bradley Drummond, MD, MHS
Clinical Associate Professor
University of North Carolina School of Medicine’s Division of Pulmonary Diseases and Critical Care Medicine
Garry Kauffman, MPA, RRT, FAARC, FACHE
RT, Owner Kauffman Consulting, LLC
Bobbie V. Kumar, MD, MBA, FAAFP
Medical Director, Swedish Edmonds Urgent Care Director, Complex Care Management for Vituity
Virtual technologies that bridge the gap
Solution: Unified systems that trigger alerts for PCPs when COPD patients are admitted to the ER
Real-world example
One of the challenges that many institutions face is that the PCPs may not be affiliated with the emergency room that the patient has gone to. So, we generated an automatic messaging prompt through our electronic health record, which sends that primary care provider a message that simply says: ‘Your patient was seen and discharged from the emergency department. We know that these patients with COPD have high mortality in the next year. They should be on full maximal inhaled therapies. They should be educated about the appropriate use of their inhalers, and here is some contact and resource information if you think they need to see a pulmonologist.’ We often get replies back that the PCP, especially when they're outside of our system, had no idea the patient was even in the emergency room.”
M. Bradley Drummond, MD, MHS
Clinical Associate Professor
University of North Carolina School of Medicine’s Division of Pulmonary Diseases and Critical Care Medicine
Key benefits
Solution: E-consults between providers and patients, and between different providers on the care team
Real-world example
Let's stop rewarding touch time. Providers should be able to do e-consults with each other and say, ‘I'm worried about this patient. Can you look at their spirometry? I've got him on all this, what would you suggest?’ And we should be able to look at it and say, ‘I would try this and this and this,’ without actually seeing the patient, because there are so many barriers to coming into the clinic.”
Amy Shaheen, MD MSc
Medicine Professor, Division of General Medicine and Clinical Epidemiology, UNC Director of Population Health Services, University of North Carolina School of Medicine
Key benefits
Solution: Virtual RTs
Real-world example
One of the concepts I'm toying with now is a virtual respiratory therapist. It may not be cost-effective to have a respiratory therapist on staff, but we can engage a trained RT to virtually spend 15 minutes of time with a patient while they’re in their own home, through whatever technology makes the most sense. It might be a simple phone call, but Skype or FaceTime or another visual technology would be much better. I'd be curious if, in the pulmonary practice or family practice, there would be value for having that expert who could beam in literally only on an as-needed basis [and] at no cost to the practice?”
Garry Kauffman, MPA, RRT, FAARC, FACHE
RT, Owner Kauffman Consulting, LLC
Key benefits
Enables RTs to engage with more patients, more efficiently Helps reduce readmissions with more access to vital therapy
Note: Services like virtual RTs may not be permitted in some states. Be sure to review your state's legal considerations before implementing a program.
Solution: Centralized databases of how-to resource videos for patients
Real-world example
We've spent a lot of time developing a COPD resource website that has easy links to how-to videos, so that when you don't have the opportunity to engage a certified trainer with a patient, you can at least show the patient, in a standardized way, how that inhaler is supposed to be used. I think the wealth of patient champions moving things forward is great in some places, but in some settings, those people or resources may not be available. In those cases, we have to decentralize those resources a little bit and find new ways to educate patients.”
M. Bradley Drummond, MD, MHS
Clinical Associate Professor
University of North Carolina School of Medicine’s Division of Pulmonary Diseases and Critical Care Medicine
Key benefits
Solution: Artificial intelligence navigator tool via an app or Alexa
Real-world example
We’re currently developing an artificial intelligence navigator in the form of an app. The idea is to check in with patients and ask questions like, ‘Have you taken your medications today? Did you go to your follow-up, etc.?’ And if the patient describes that they're exhibiting symptoms, or if they are having problems with their medications, those concerns are routed to a real COPD navigator who can help answer those questions. Education can be provided and we can ensure that patients’ questions are being answered. But the tool can also take that information back to the primary care team to let them know that a question was asked, this was what was done, and this is how we should go forward.”
Bobbie V. Kumar, MD, MBA, FAAFP
Medical Director, Swedish Edmonds Urgent Care Director, Complex Care Management for Vituity
Key benefits
How to make your case for a technological investment
New technologies can help offset major costs, but they may involve upfront costs of their own. Before implementing a digital health solution, or campaigning for one, it’s important to perform due diligence to justify the time and investment. When appealing to administration or other stakeholders, consider the criteria to the right. Focus on how your idea keeps the patient at the center of care and drives better outcomes for all.
Patient
Clinical relevance
Improving care pathways and long-term health
Behavior
Influenceing behavior patients and providers
Value
Improving finqncial outcomes
Making your case: The COPD virtual technology checklist
Make sure you can answer these questions:
Clinical relevance
How does this idea:
Behavior
Value
How does this idea:
Virtual tools. Real results.
Today’s new challenges beg for new solutions. To integrate care delivery and reduce COPD readmissions, we need to embrace virtual care. Each tool mentioned above was designed to help reduce COPD readmissions by helping to manage care more efficiently and effectively. Dr. Drummond believes a highly functioning practice can reduce COPD readmission costs by 15-20%. He also believes that 30% of referrals to COPD pulmonologists can be prevented by “interventions that empower the PCP.” Ultimately, digital tools can help patients take control of their own wellness. Dr. Kumar says that with an AI navigator, “patients felt empowered, they felt like they understood their disease, they felt connected to somebody who could get them to the resources that they needed.” The payoff: “We are now seeing a significant drop in that post-acute spend that we otherwise wouldn't have seen.”
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Further reading
COPD insider
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