The Future of Asthma Management with Geisinger

In an effort aimed at improving asthma care, AstraZeneca and Geisinger have partnered to create an app suite that helps asthma patients and physicians stay connected between office visits, engaging them in co-managing a disease with symptoms that are often underreported. The suite includes a mobile app that allows patients to track and log symptoms and triggers as they occur, and a web-based application that combines this patient-reported data with the electronic health records seen by physicians. Through the mobile app, patients also have the ability to reach out to a team of respiratory therapists if they have questions or concerns.   

Paul Simonelli, M.D., Ph.D., the Chair of Pulmonary and Critical Care Medicine at Geisinger, has been closely involved in this joint initiative and serves as a principal investigator. Below, he provides some insight into the collaborative effort between AstraZeneca and Geisinger and its impact on asthma care.

How was the need for this technology discovered?

Dr. Simonelli: I recently saw a patient who had asthma for many years. For a long time, she didn’t need any care. However, last year she got sick and started suffering from shortness of breath, chest symptoms, and coughing. She was receiving treatments that weren’t working and came to the pulmonary clinic. We prescribed the appropriate medications and told her to come back for follow-up in a month. When she came back I asked her how she felt. For the first two weeks with the medications she felt great, but then she caught a viral infection that triggered her asthma and sent her to the emergency room, which I was not aware of until her next appointment.

Then, between her next two appointments, she had another less severe exacerbation. This led me to three questions:

  1. Why did it take so long for her to get the right help for a condition she was already known to have?
  2. When was the right time for her to see me when she felt sick?
  3. And when is the right time for a follow-up?

As I was discussing all of this with the patient, I noticed she had a cell phone next to her. I wondered whether there was a possibility she could’ve just reached out and saved herself the suffering in between scheduled visits. If she had been tracking her symptoms, I could’ve looked at them and told her to come in.

What excites you most about implementing this technology at Geisinger?

Dr. Simonelli: I think the answer is two-fold – there is the patient side and the provider side. As a patient, knowing the right time to see a doctor is important. The patient needs to be seen when it is right for them; therefore, the idea of an automatic follow-up appointment when a patient is feeling well doesn’t make sense. The idea that somebody can’t get in contact with their doctor in between visits when they are sick makes even less sense. With this app suite, the patient can reach out to a team of respiratory therapists if they have questions or concerns about their symptoms as they happen, and get guidance as to whether an office visit might be warranted.

Then there is the provider side. As a doctor, with this technology, I can see all the data the patients have been recording themselves, in addition to information coming in from the electronic health record. There is a wealth of data at my fingertips. If I can see a patient is having exacerbations, I can reach out to him or her and ask how they are doing or if they need to come in. This allows for co-management of the condition between the providers and the patients.

What makes this technology beneficial for asthma patients?

Dr. Simonelli: We know that asthma patients are frequently misdiagnosed – some research shows that in almost 30 percent of cases other conditions are masquerading as asthma. This is in part because, to complete the diagnosis, a doctor needs a longitudinal view. There are many data points you need to put together, over time, to make that diagnosis. When patients record their symptoms, they are providing the data necessary for that viewpoint. They are helping show their disease’s variability, which is key for the doctor.

Secondly, adjustments in treatment aren’t made in a timely fashion. Patients are waiting too long to escalate or deescalate their care. This technology is a tool that could help this process.

Thirdly, it is difficult to know who should receive high level care. Should it take you a couple years to get there? The answer is unequivocally no – this should be a quick process over the course of weeks to months, not years. With this app, you are getting a longitudinal view of symptom data in a more timely way, which can expedite that judgment.

This technology has the potential for use in other patient populations with chronic airways disease, like chronic obstructive pulmonary disease (COPD). Eventually we could even see its use expand to chronic diseases beyond respiratory, such as diabetes. We’re excited to see where it goes.

The app suite is currently in beta and will be available for Geisinger asthma patients on both iOS and Android. To find out more about Geisinger, visit www.geisinger.org or connect with them on FacebookInstagramLinkedIn and Twitter.