The AMDIS Connection: Effective Disease Management Combines the Best of High & Low Tech

At the University of Michigan, with allergist Mark Morris, MD, we converted regular clinics for severe asthmatics into a disease management program. Caring for patients went from frustration with the amount of time it took to do all of the processes—patients waiting in the lobby for long periods of time, then being routed all over the hospital to get lab work—to creating a much more compact, home-like setting that allowed us a lot more time to talk with the patient.

It still amazes me that, after 30-plus years in medicine, the most satisfying things we do are still the most low-tech.

However, new technologies in the form of numerous applications now available on a variety of platforms, can enhance this paradigm. Effective disease management combines these new tools with very low tech doctor-patient communication. It deliberately endeavors to engage patients in their care in a way that’s not token or nominal, but requires that patients understand how to read their bodies and how to adjust treatments. For example, there are many different levels of asthma severity, and a level can either over-treat a patient or under-treat him or her at different times of the day, month or year.

Patients can now use applications to record a variety of information and store it on devices, in a personal health record (PHR) or on a variety of platforms, on a thumb drive or other storage mechanism. There, it’s accessible to their physician or care team. Patients are actually engaged with their health data and with the adjustment and modulation of their treatment in prescribed ways. Having a new generation of devices, which provide a means of measuring how you’re doing as well as documenting what you decided to do as a result: that is where the real power lies.

Patients love the flexibility of saying, “I’m feeling pretty good today, and the protocol that I’ve got right here on the screen tells me I can use this medication instead of that one, or use a little less. Or if I’m not feeling so hot, before I call in, I can take the following steps.”

That’s exactly what we did in the asthma disease management program at Michigan. Not only did patient satisfaction go up, but there was a decrease in ER visits (which is a major issue for asthma) and patient-perceived health levels increased.

So if you’re not looking at the whole patient, the reason why he or she is still suffering and not able to enjoy life is because the clinician hasn’t opened his or her eyes enough. In this program, that’s what we gave ourselves, both doctors and patients: the time and freedom to reflect on disease management. It’s not just a couple of brochures.

It’s very important that in this era of trying to improve overall outcomes, that disease management doesn’t cost as much. Surely, it’s a lot cheaper than ER visit after ER visit. In the final analysis, a patient’s living environment—and all the way toward the end of that discussion, one’s medications—matters immensely. It’s more important that physicians and patients conquer fear, poor communication, poor information and powerlessness. Conquering all of these things is what the new generation of tools can do for us.