Overview

The University of Texas System implemented Project Diabetes Obesity Control (Project DOC), a virtual ecosystem with public and private organizations connected by a core digital health platform, to manage chronic disease.

Organization Name

University of Texas System

Organization Type

• Academic Medical Center

National/Policy Context

In 2015, an estimated 11.4% of adults in Texas had diabetes, with an even higher disease burden in the underserved lower Rio Grande Valley region in South Texas, where Project DOC was piloted.

Local/Organizational Context

• The University of Texas System is a state university system including six health institutions: the University of Texas Southwestern Medical Center, the University of Texas Medical Branch at Galveston, the University of Texas Health Science Center at Houston, the University of Texas Health Science Center at San Antonio, the University of Texas MD Anderson Cancer Center, and the University of Texas Health Science Center at Tyler. The system is also affiliated with other teaching hospitals and community clinic networks.
• Together, these hospitals and clinics see over 6.78 million outpatient visits and 1.38 million hospital days annually.

Leadership

The University of Texas System convened public and private stakeholders to develop this ecosystem.

Participants included:

• PricewaterhouseCooper customized its cloud-based information interchange to create a custom cloud-based digital health platform, DoubleJump Interchange, that permits data aggregation and sharing across participants in the ecosystem. For more information, see: https://www.pwc.com/us/en/health-industries/assets/DJH-Interchange-Tech-Sheet-Nov-2016.pdf
• AT&T provided an end-to-end secure communication network with IoT (Internet of Things) capabilities, as well as an IoT service for remote patient monitoring. For more information, see: https://about.att.com/innovationblog/doctor_connected
• IBM collaborated with the UT System to create 360HealthProfile, an application with patients’ EHR and remote patient monitoring data.
• University of Texas Health School of Public Health in Brownsville served as the local shared-service office to engage with community partners.Various other care delivery organizations, retail partners, and community groups, such as:
  • Su Clinica Familiar, a federally qualified health center
  • US Wellness, nutrition counseling and health screening services company
  • Pursuant Health, providing health kiosks in Walmart stores
  • Surescripts, which provided prescription fulfillment
  • Walmart, whose stores were used as initial sites for health screenings

Funding

• The project received $3 million in 2016 from the Valley Baptist Legacy Foundation to expand its program.

Tools or Products Developed

• Under Project DOC, two REDI (Real-world Education Detection and Intervention) programs were developed.
  • REDI Prevention
    • Free health screening and education is offered at retail stores, churches, and other community programs to identify patients.
    • These patients are risk-stratified and connected to additional services, such as nutrition counseling, community cooking classes, self-monitoring at health kiosks, and medication counseling by pharmacists.
  • REDI Remote Monitoring Program
    • Patients with poorly-controlled diabetes are provided with remote monitoring to collect data between clinic visits. EHR and remote patient monitoring data are combined into a profile on the digital health platform. Data collected helps to target patient education and medication management as well as clinical care.

Tech Involved

• AT&T remote patient monitoring
• Digital health platform
• Electronic medical record
• Fitbit Tracker

Where We Are

• Project DOC is a pilot project that was started in 2015.

Outcomes

• Disease-Oriented Outcomes:
  • Among the 226 patients for whom remote patient monitoring was prescribed, 111 patients with pre-monitoring and post-monitoring HbA1C measurements (as of February 2018) showed an average reduction of 1.17 points (from 10.08 to 8.91). The 30-day readmission rate was 7.2% for patients who received remote monitoring, compared with 18.2% for those who did not.

• Patient Outcomes:
  • 1,334 individuals participated in health screenings at local Walmart stores and were surveyed after screening
    • Patients’ desire to receive health checkup at Walmart: 69% indicated that they only went to Walmart to shop and would not have gone for a health checkup.
  • Utility of and need for screening service as educational tool: once enrolled, 94% indicated that they found the screening service to be educational and 98% indicated that they would recommend it to family and friends. Only 22% knew their own disease risks.
  • Patients’ desire to change health behaviors: 76% indicated that they would want to change their behaviors on the basis of the screening results; however, they needed help to do so.
  • Patient satisfaction with screenings: Patients found the community-based health screenings to be helpful and were interested in receiving help to make changes to their health.

Benefits

• The program is able to engage patients in care at a community level and involve many local community stakeholders.
• The digital health platform allows for a global view of the population’s health and compiles patient data from different sources.
• Novel public-private collaborations are creating a whole continuum of care and improving patients’ health at a population level

Unique Challenges

• There is a complex level of interactions between participants that needs to be managed by the central convener, and these partners are very disparate. These programs need to match the needs of the target population.
• There is a constant evolution of technology and potential change in technical partners over time.
• There is a need for participants to cooperate with each other in the event of issues arising in the ecosystem.
• Protection of patient data and compliance of various partners is key to sustaining the ecosystem.

Sources

1. University of Texas Health Affairs. https://www.utsystem.edu/offices/health-affairs
2. Convening a Digitally Enabled Ecosystem to Address the Chronic Disease Burden of an Underserved Community. NEJM Catalyst. https://catalyst.nejm.org/digital-health-platform-ecosystem-chronic-disease/