Selected Podcast
Integrating Patient Data into Practice
Nikke Kaemmerer, Registered Nurse and Project Specialist, discusses the use of patient-generated health data and her personal experience collecting and using this kind of information.
Featuring:
Prior to her work at MetaStar, she has worked most of her nursing career in specialty areas of neuroscience and neuro intensive care, including stroke care and endovascular procedural care. Nikke has been involved with quality improvement for her entire nursing career. She was involved in many quality improvement initiatives as a staff nurse in the ICU. She also worked as a Quality Improvement Coordinator for a large healthcare system in Milwaukee, WI.
Nikke graduated from Alverno College in 2003 with her Bachelor’s Degree in Nursing and a support degree in Computer Studies and Science. Nikke brings years of expertise as a registered nurse and healthcare quality improvement professional. She is also a patient and consumer of a large healthcare system. Nikke is a person with diabetes (PWD) specifically Type 1 Diabetes. 2020 marks her 30th year since diagnosis. She shares both patient and provider experience as we discuss the use and management of patient generated data in healthcare by providing her experiences.
Nikke Kaemmerer, BSN, RN
Nikke Kaemmerer has been with MetaStar for 4 years. She is working currently as a Stroke Systems of Care Project Specialist with the WI Coverdell Stroke Program and a Quality Improvement Advisor on a Community Coalition Team. These roles focus on enhancing care coordination, improving transitions of care after acute hospitalization and reducing hospital readmissions.Prior to her work at MetaStar, she has worked most of her nursing career in specialty areas of neuroscience and neuro intensive care, including stroke care and endovascular procedural care. Nikke has been involved with quality improvement for her entire nursing career. She was involved in many quality improvement initiatives as a staff nurse in the ICU. She also worked as a Quality Improvement Coordinator for a large healthcare system in Milwaukee, WI.
Nikke graduated from Alverno College in 2003 with her Bachelor’s Degree in Nursing and a support degree in Computer Studies and Science. Nikke brings years of expertise as a registered nurse and healthcare quality improvement professional. She is also a patient and consumer of a large healthcare system. Nikke is a person with diabetes (PWD) specifically Type 1 Diabetes. 2020 marks her 30th year since diagnosis. She shares both patient and provider experience as we discuss the use and management of patient generated data in healthcare by providing her experiences.
Transcription:
Nikke Kaemmerer, BSN, RN (Guest): 2020 marks the 30th year of managing type 1 diabetes for me. This has been an exceptional journey which has also shaped me as a person, my career and my life.
Scott Webb (Host): That's MetaStar registered nurse Nikke Kaemmerer, and on this episode of MetaStar Health's IT Radio, w're going to learn about Nikke's dual role as a provider and diabetes patient. Nikke is a Project Specialist with MetaStar. In that role she focuses on enhancing care coordination, improving transitions of care after acute hospitalization and reducing hospital readmissions. Her work also encourages healthcare providers to assist patients in navigating the complex healthcare system, monitoring their personal risk factors, and reporting the results to their healthcare providers. Nikke and her teammates work to provide technical assistance to the Wisconsin Medicaid Electronic Record Incentive Program promoting interoperability. Let's hear from Nikke about the value of patient-generated health data.
Nikke: When we think about patient generated health data, we’re thinking about the information patients collect. So, for example, somebody who has say high blood pressure or diabetes. They keep records of their own blood pressure management. They also keep records of their blood glucose logs. And this is very important for them as well as their providers. They utilize this information when they go to the doctor to help inform the physician how these numbers fluctuate over time. They use the information to make valuable healthcare decisions and improve their disease management. This might be lifestyle changes, medication adjustments, activity level adjustments and diet management.
There’s a number of patient generated health data tools that patients use on a daily basis. Such as, the glucose monitors, or the blood pressure cuffs, activity trackers, heart monitor trackers. There’s a number of different things and then there’s also some things that patients use to keep notes such as a dietary log.
Host: And now, let's hear about Nikke's experience as a registered nurse with patient-generated data.
Nikke: I used to work in an endocrinology clinic, and we would have patients who come in with so many different pieces of information for us. They would come in with their blood glucose meters which we would download. We would also get paper logs it patients preferred to keep track of their numbers that way. We also received dietary logs, activity monitoring, blood pressure monitoring and these were very important pieces of information for making those decisions and helping the providers understand how the patients are living outside of the doctor’s office.
Host: And now, let's hear from Nikke about her experiences as a diabetes patient.
Nikke: My 15 years plus working in healthcare as a Registered Nurse does make some of the aspects easier to navigate the system. As a patient, perhaps my expectations are raised, and I tend to notice the small glitches that another patient may not notice. Because I know how the system should flow. To illustrate this, I can share my story with you regarding my diabetes journey.
Over the years, diabetes technology has come a really long way. When I was first diagnosed in 1990, my parents had to help me manage my condition. I was 12 years old at the time. I remember my mom and my dad checking my blood sugars and they utilized these test strips with a big pad on it and it felt like you had to put so much blood on that test strip to get the pad saturated enough so that it would read your glucose levels. And my mom would sit there for two minutes with a timer, waiting and waiting and waiting and then she would match the test strip to the bottle. There was a color ratio, the strip would change color, so if it was low the color would be a blue or a green, if it was higher, it would be closer to a brown.
So, as she sat there waiting and waiting, which seemed like forever; and then trying to figure out and quickly. She always laughed and said I swear every time I do this, it’s brown. At that time too, I was regulated with insulin injections and I remember my parents giving me injections three to five times a day depending on what I was eating, what I was doing and what my blood sugars were.
When I was 17, my parents decided to move me to an insulin infusion pump. An insulin pump is a medical device which is programmed in partnership with my healthcare providers and it also delivers insulin continuously. I currently continue to use that insulin pump and the continuous glucose meter as well which is a newer phase of diabetes technology over the last few years. These diabetes devices track and store information every few seconds and they are capable of being downloaded on the manufacturer’s website. I’m able to review reports and graphs to assist me in analyzing my blood glucose trends. These reports are helpful for me and my provider as we collaborate to make those decisions on my lifestyle and my medication dosages to improve my overall glucose management.
Host: Patient portals can be a significant component of the patient-generated data. As to whether Nikke sees her patient-generated health data, yes and no.
Nikke: The patient portal gives me information that my providers or my healthcare system enter into my electronic record. Typically what happens with my patient-generated data... For my insulin pump, when I said I download it into the manufacturer's server, I can then go and print probably about 30 pages of information that I take to my doctor's office when I go for my appointments or if she wants to do a spot check. This 30-page report includes things like your blood glucose logs. It includes your averages, some little pie charts to see how your trends of where your glucose management is going over time. It also includes what settings you have set up in your pump and insulin delivery information and anytime you change over what I call my hardware– my tubing or refill my pump and such. The doctor then gets this report ten minutes before I go in for my appointment, which can pose some frustrations. It's hard for her to kind of analyze everything in ten minutes, and the patient portal doesn't allow me– unfortunately at this point, I'm hoping that it will someday– to upload a PDF because it's a PDF file, and it doesn't upload a PDF file and attach it to a message. Unfortunately, the long answer and the short answer is no with regards to being able to see that information in the portals.
Host: Patient-generated health data has the power to improve patient care, not by completing EHR data but by empowering the patient to engage in their own health. Here's Nikke with her recommendations on how to improve the information exchange process.
Nikke: As a patient, you don’t know what you don’t know. And when you are diagnosed with such a big disease process that is life changing; which diabetes in general and type 1 definitely are. You need to advocate for yourself. You need to take control of your disease management. Your doctor is there to help you do that. I always say I make a PAC with my doctors and what PAC means is P-A-C. I partner with my doctors. the A in PAC stand for accountability and knowing who is accountable for what tasks. So, I’m accountable as a patient to monitor my blood sugars all the time, constantly. That’s what I’m accountable for. My doctor is accountable for helping me whether they have new information on new technology that might be available or new medications. Helping me make sure that I’m on the best possible tract so that I can live my life the way I want to. And the C in PAC stands for communication. This is pretty simple. It’s keeping those lines of communication open. I know my doctor is not a mind reader. So, I have to tell her, and I have to communicate with her when things aren’t going right and when things are going great.
Being a patient is tough and confusing. Again, especially when you are first diagnosed with a new condition. Be patient with your patients as a provider. I always tell my doctor, be patient with me. But showing us how to fully live the life we want to live and analyze our data, also giving patients freedom and flexibility in their treatment plan to make simple adjustments so we can maintain control.
Host: MetaStar hopes you enjoyed Registered Nurse Nikke Kaemmerer’s inspirational story. Patient-generated healthcare data is necessary to provide a complete picture of the patient's well-being. Patient-focused healthcare technology has grown in many ways over the years, such as the use of insulin infusion pumps and glucose monitoring devices described by Nikke. It's important to healthcare teams that they take this into consideration when making further enhancements to patient portals. This will allow patients and providers to share information in more meaningful and collaborative ways. For more information, visit www.metastar.com.
Nikke Kaemmerer, BSN, RN (Guest): 2020 marks the 30th year of managing type 1 diabetes for me. This has been an exceptional journey which has also shaped me as a person, my career and my life.
Scott Webb (Host): That's MetaStar registered nurse Nikke Kaemmerer, and on this episode of MetaStar Health's IT Radio, w're going to learn about Nikke's dual role as a provider and diabetes patient. Nikke is a Project Specialist with MetaStar. In that role she focuses on enhancing care coordination, improving transitions of care after acute hospitalization and reducing hospital readmissions. Her work also encourages healthcare providers to assist patients in navigating the complex healthcare system, monitoring their personal risk factors, and reporting the results to their healthcare providers. Nikke and her teammates work to provide technical assistance to the Wisconsin Medicaid Electronic Record Incentive Program promoting interoperability. Let's hear from Nikke about the value of patient-generated health data.
Nikke: When we think about patient generated health data, we’re thinking about the information patients collect. So, for example, somebody who has say high blood pressure or diabetes. They keep records of their own blood pressure management. They also keep records of their blood glucose logs. And this is very important for them as well as their providers. They utilize this information when they go to the doctor to help inform the physician how these numbers fluctuate over time. They use the information to make valuable healthcare decisions and improve their disease management. This might be lifestyle changes, medication adjustments, activity level adjustments and diet management.
There’s a number of patient generated health data tools that patients use on a daily basis. Such as, the glucose monitors, or the blood pressure cuffs, activity trackers, heart monitor trackers. There’s a number of different things and then there’s also some things that patients use to keep notes such as a dietary log.
Host: And now, let's hear about Nikke's experience as a registered nurse with patient-generated data.
Nikke: I used to work in an endocrinology clinic, and we would have patients who come in with so many different pieces of information for us. They would come in with their blood glucose meters which we would download. We would also get paper logs it patients preferred to keep track of their numbers that way. We also received dietary logs, activity monitoring, blood pressure monitoring and these were very important pieces of information for making those decisions and helping the providers understand how the patients are living outside of the doctor’s office.
Host: And now, let's hear from Nikke about her experiences as a diabetes patient.
Nikke: My 15 years plus working in healthcare as a Registered Nurse does make some of the aspects easier to navigate the system. As a patient, perhaps my expectations are raised, and I tend to notice the small glitches that another patient may not notice. Because I know how the system should flow. To illustrate this, I can share my story with you regarding my diabetes journey.
Over the years, diabetes technology has come a really long way. When I was first diagnosed in 1990, my parents had to help me manage my condition. I was 12 years old at the time. I remember my mom and my dad checking my blood sugars and they utilized these test strips with a big pad on it and it felt like you had to put so much blood on that test strip to get the pad saturated enough so that it would read your glucose levels. And my mom would sit there for two minutes with a timer, waiting and waiting and waiting and then she would match the test strip to the bottle. There was a color ratio, the strip would change color, so if it was low the color would be a blue or a green, if it was higher, it would be closer to a brown.
So, as she sat there waiting and waiting, which seemed like forever; and then trying to figure out and quickly. She always laughed and said I swear every time I do this, it’s brown. At that time too, I was regulated with insulin injections and I remember my parents giving me injections three to five times a day depending on what I was eating, what I was doing and what my blood sugars were.
When I was 17, my parents decided to move me to an insulin infusion pump. An insulin pump is a medical device which is programmed in partnership with my healthcare providers and it also delivers insulin continuously. I currently continue to use that insulin pump and the continuous glucose meter as well which is a newer phase of diabetes technology over the last few years. These diabetes devices track and store information every few seconds and they are capable of being downloaded on the manufacturer’s website. I’m able to review reports and graphs to assist me in analyzing my blood glucose trends. These reports are helpful for me and my provider as we collaborate to make those decisions on my lifestyle and my medication dosages to improve my overall glucose management.
Host: Patient portals can be a significant component of the patient-generated data. As to whether Nikke sees her patient-generated health data, yes and no.
Nikke: The patient portal gives me information that my providers or my healthcare system enter into my electronic record. Typically what happens with my patient-generated data... For my insulin pump, when I said I download it into the manufacturer's server, I can then go and print probably about 30 pages of information that I take to my doctor's office when I go for my appointments or if she wants to do a spot check. This 30-page report includes things like your blood glucose logs. It includes your averages, some little pie charts to see how your trends of where your glucose management is going over time. It also includes what settings you have set up in your pump and insulin delivery information and anytime you change over what I call my hardware– my tubing or refill my pump and such. The doctor then gets this report ten minutes before I go in for my appointment, which can pose some frustrations. It's hard for her to kind of analyze everything in ten minutes, and the patient portal doesn't allow me– unfortunately at this point, I'm hoping that it will someday– to upload a PDF because it's a PDF file, and it doesn't upload a PDF file and attach it to a message. Unfortunately, the long answer and the short answer is no with regards to being able to see that information in the portals.
Host: Patient-generated health data has the power to improve patient care, not by completing EHR data but by empowering the patient to engage in their own health. Here's Nikke with her recommendations on how to improve the information exchange process.
Nikke: As a patient, you don’t know what you don’t know. And when you are diagnosed with such a big disease process that is life changing; which diabetes in general and type 1 definitely are. You need to advocate for yourself. You need to take control of your disease management. Your doctor is there to help you do that. I always say I make a PAC with my doctors and what PAC means is P-A-C. I partner with my doctors. the A in PAC stand for accountability and knowing who is accountable for what tasks. So, I’m accountable as a patient to monitor my blood sugars all the time, constantly. That’s what I’m accountable for. My doctor is accountable for helping me whether they have new information on new technology that might be available or new medications. Helping me make sure that I’m on the best possible tract so that I can live my life the way I want to. And the C in PAC stands for communication. This is pretty simple. It’s keeping those lines of communication open. I know my doctor is not a mind reader. So, I have to tell her, and I have to communicate with her when things aren’t going right and when things are going great.
Being a patient is tough and confusing. Again, especially when you are first diagnosed with a new condition. Be patient with your patients as a provider. I always tell my doctor, be patient with me. But showing us how to fully live the life we want to live and analyze our data, also giving patients freedom and flexibility in their treatment plan to make simple adjustments so we can maintain control.
Host: MetaStar hopes you enjoyed Registered Nurse Nikke Kaemmerer’s inspirational story. Patient-generated healthcare data is necessary to provide a complete picture of the patient's well-being. Patient-focused healthcare technology has grown in many ways over the years, such as the use of insulin infusion pumps and glucose monitoring devices described by Nikke. It's important to healthcare teams that they take this into consideration when making further enhancements to patient portals. This will allow patients and providers to share information in more meaningful and collaborative ways. For more information, visit www.metastar.com.