This year’s ACR/ARHP Annual Meeting formally started Saturday afternoon with the traditional ACR/ARHP Opening Lecture and Awards.
ACR President Joan M. Von Feldt, MD, MSEd, opened the session with a look at what’s happening in the field and at the association. One topic she discussed was the dwindling workforce of clinical rheumatologists.
The 2015 ACR Workforce Study echoed the early 2005 study and found that supply will continue to decline through 2030 and be surpassed by a growing demand for adult and pediatric rheumatologists. Efforts to fill this gap with nurse practitioners, physician assistants, and rheumatology trainees supported by the Rheumatology Research Foundation will be insufficient, Dr. Von Feldt said.
But as keynote speaker Joseph C. Kvedar, MD, noted later in his lecture, digital and mobile health platforms have the potential to relieve some of the burden from the workforce shortage that all specialists are currently feeling.
Another trend is the wave of big data, which “has washed upon the ACR,” Dr. Von Feldt said. For the last several years, the ACR has been developing the Rheumatology Informatics System for Effectiveness (RISE) Registry, which collects and analyzes data from electronic medical records. RISE allows physicians to receive performance feedback and verify that they are providing quality care. The big data in RISE also can be mined to help inform clinicians about rare disease such as lupus. Dr. Von Feldt pointed to abstracts at the meeting that will present data on the impact of RISE on clinical practice and details about workforce studies.
“The ACR has been and will continue to be the beacon of quality and of value for rheumatologic care over the next decade and beyond,” Dr. Von Feldt said.
During his lecture, Dr. Kvedar, Vice President of Connected Health at Partners HealthCare, talked about how five years from now, it may be possible for a program on your smartphone to send you text messages and tell you about your health goals, with reminders about personal goals, ideas how to get exercise, and nudges away from unhealthy behaviors.
He shared his vision for such a program, which he calls Sam. Dr. Kvedar also talked about the not-so-distant future for apps and wearable devices that could help patients take better care of themselves.
“Sam is a drill sergeant, authoritarian coach. That is because I know that is what motivates me, that is what inspires me to change my behavior. If you find Sam too overbearing, fear not because we will be able to design this sort of program to be able to meet your inspirational and motivational needs,” Dr. Kvedar said.
The technology part of that vision exists today, Dr. Kvedar emphasized. It is being used in the apps on your smartphone that count your steps and estimate your stress levels or the GPS that tracks your location.
“But even though the pieces of the puzzle might be there, the jigsaw puzzle has not been assembled,” said Dr. Kvedar, author of the book The Internet of Healthy Things.
In his lecture, “Harnessing the Internet of Healthy Things: How Connected Health Can Advance Rheumatology,” Dr. Kvedar said that three areas must improve to help fit the puzzle together: Data normalization, analytics, and engagement.
Normalization is a key component because it takes raw data collected by apps and wearables, such as the steps walked per day, and makes sense of them for patients. Some wearables are already moving in that direction. A headband that has electroencephalography (EEG) sensors to measure brain activity relies on those signals to guide users through meditation sessions. Companies are making headway in this space, providing a large library of application program interfaces (APIs) that allow software to talk with each other.
The analytics that decide which recommendations to make for patients have to be flawless, and they are not there yet.
“We are used to Netflix recommending a movie or Amazon recommending a book, and if it is the wrong recommendation, you can laugh if off and move on. It does not matter,” Dr. Kvedar said. “But if it is a health behavior that an automated system is recommending, we will not get a second chance.”
Dr. Kvedar called engagement possibly the most important piece of the puzzle. He discussed a framework to motivate patients to use technology that includes making it personal and about their life and reinforcing social connections. In the hypothetical Sam scenario, the program reminded Dr. Kvedar that he should watch his diet so he could fit into his suit at his daughter’s upcoming wedding and told him about a gym that people in his social network might be using. These approaches can incorporate tactics such as subliminal messages and the sentient effect, in which patients will adhere more to using health technology if they know their physicians are tracking them.