BD: Couchbase Mobile and digital health: connecting patient and clinician – Couchbase Connect 2016

www.bd.com© 2016 BD. All Rights Reserved.

1

C O N D U I TC o n n e c t i n g P a t i e n t t o P r o v i d e r

C o u c h b a s e C o n n e c t 2 0 1 6


2

© 2016 BD. BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company.

We are a Fortune 500 company that is:• Reaching the corners of the world: Locations in more than 50 countries with more than 40,000 associates worldwide

• Focused on improving efficiency of healthcare delivery and patient outcomes: Understands and serves the needs of our customers, including healthcare institutions, life science researchers, clinical laboratories, pharmaceutical and biotech partners and patients

• Part of the fabric of the healthcare industry since 1897: Offers legacy of medical supplies and services, devices, laboratory equipment and diagnostic technologies

• Continually innovating practices across the healthcare continuum: Advancing cellular research capabilities and therapies, point-of-care diagnostics, medication management, infection prevention and patient safety

Who is BD?


3

© 2016 BD. BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company.

BD’s strategy is to apply technology and clinical knowledge to make healthcare more effective, efficient and safe. Our areas of focus are:• Enabling safer, simpler and more effective parenteral drug delivery

• Improving clinical outcomes through more accurate, timely and efficient diagnostics

• Providing tools and technologies to the research community that facilitate the understanding of the cell, cellular diagnostics and cell therapy

• Enhancing disease management in diabetes, women’s health and cancer, and infection control

• Improving clinical, laboratory and research practices in emerging markets

BD’s strategic focus


4

David BostickData Science

David DowneyWeb & Server

Sean UlrichMobile

Dylan WilsonSoftware Lead

The Team

Nakul Mahajan SQA

Shreesh UniyalMobile


5

Type 2 Diabetes

Adult Onset Diabetes

With type 2 diabetes, the body either doesn't produce enough insulin, or it resists insulin.

Injectable medications

Lifestyle modification

Oral medications

https://www.cdc.gov/diabetes/pubs/statsreport14/diabetes-infographic.pdf


6

Ethnographic InsightsC o n d u i t

PRIORITIESTIME DATA EDUCATION

Clinicians don’t want to muddle through logbooks or meters and patients don’t care

or don’t see any return on their effort

Type 2 is a complex disease with many clinical and lifestyle concepts, all

interconnected

Type 2 Diabetes is serious, but isn’t always a priority; short-term choices have mostly

long-term effects

Patients and Clinicians both report not having enough time to adequately discuss

the many facets of Diabetes


7

Facilitate a more meaningful patient clinician relationship.

Vision VISION

C o n d u i t


8

Comprehensive activity metrics at high resolution including METS, Steps and Sleep

ACTIVITY

Key clinical metrics

INSULIN & GLUCOSE

GPS timeline from Moves app categorized / anonymized via Foursquare

LOCATION

LoseIt + Meal Images

FOOD

We outfitted 30 Type 1 and 30 Type 2 diabetics with a host of hardware and software devices to comprehensively track “free-living” diabetics.

60 Diabetics for 21 Days

Data We’ve Previously Collected2 0 1 5 O b s e r v a t i o n a l S t u d y


9

DSL and rules engine for precision user engagement

CYRANO

Data visualization and patient management

CLINICIAN PORTAL

Patient support and cloud connectivity

CONDUIT APP

Transparently and automatically connect patient data

HARDWARE DEVICES

Scalable database + mobile synchronization

COUCHBASE + MOBILE

FHIR Based REST API for CLINICIAN PORTAL

WEB SERVER

Solution ComponentsC o n d u i t


10

Nearly all data in the system is stored in FHIR Resources. Extensions used as necessary.

C O N D U I T P L A T F O R M B A C K B O N E

FHIR (2) aims to simplify implementation without sacrificing information integrity. It leverages existing logical and theoretical models to provide a consistent, easy to implement, and rigorous mechanism for exchanging data between healthcare applications.

F A S T H E A LT H C A R E I N T E R O P E R A B I L I T Y R E S O U R C E S

Provides the API for the Clinical Web Portal. Spark (1) Server used as the base; we replaced Mongo with Couchbase

REST API

Comprehensive set of “Resources” representing a wide variety of concepts in healthcare. Built for extensibility.

JSON DATA FORMAT 21

Database Design: FHIR

(1) https://github.com/furore-fhir/spark

(2) https://www.hl7.org/fhir/overview.html


11

System Architecture

Couchbase Cluster

FHIR Server

Clinician Portal

Mobile App

Sync Gatewa

y

BGMConduit Smart Cap

MS Bot

Cyrano RX +

Scheduled

Twilio

3rd Party Auth


12

Designed for humans by humans. Messages are carefully crafted and delivered with precision.

H U M A N B E H A V I O R B U I LT I N

Tailored to the T2 Diabetes space. Non-programmers can write and rewrite rules. Over 40 rules with well over 100 individual messages covering a broad variety of situations will be in production.

D S L F O R B U S I N E S S U S E R S

Enables Scheduled Messages. Uses Couchbase Views to catch up if the RX side goes down.

CRON MODE

Uses SG Webhooks to maintain state in near-real-time. Rules are fired as events occur.

RX MODE 21

Cyrano Engagement Engine


13

MobileApp


14

Automatically collect and display blood glucose readings from off-the-shelf BG meter.

Maintain BG Record Bluetooth LE Enabled

Authored in C# for significant code reuse & long-term maintainability in a healthcare environment. Always available for offline use.

Xamarin Native + Offline

Continuously connected to the cloud for caregiver and clinician access.

Cloud Connected

Transparently collect insulin usage and display to user answering the age-old question: “Did I take my medication?”

Maintain Insulin Record

Enable user to explore the effect of food on the body. Give clinicians tangible starting point for conversations about

food.

Meal Vignette

Connects to BG and Insulin devices


15

Sample ScreensC o n d u i t M o b i l e


16

ClinicalPortal


17

All out-of-range events in one place Each Meal + Paired Test + InsulinServes as a conversation starter

MEAL VIGNETTE BROWSER

Fasting BGInsulin Adherence

Per-Meal BG Trends

DATA DASHBOARD

ALERTS

Insulin RegimenPersonal Goals

PATIENT REGISTRATION + SETTINGS

Clinical PortalC o n d u i t


18

Clinical PortalC o n d u i t


19

D E M O

BD: Couchbase Mobile and digital health: connecting patient and clinician – Couchbase Connect 2016

Technology

Transcript of BD: Couchbase Mobile and digital health: connecting patient and clinician – Couchbase Connect 2016