The brainstorming for how to deal with the impending physician shortage is happening on many different fronts. Some think cutting the length of medical school from four to three years would help. Federal legislation aimed at creating more government-backed training spots at teaching hospitals is under review. Others think more nurse practitioners will help. California is reviewing legislation to delegate more duties to nurse practitioners and pharmacists.
One concern remains: Fewer physicians mean fewer mentors to train doctors in diagnosing and treating patients with chronic conditions that could lead to costly complications.
A joint venture between a health system and simulation developer called SiMCare Health has led to the development of Web-based patient simulators tapping thousands of patient experiences. The first of these focuses on diabetes.
HealthPartners Institute for Education and Research in Minneapolis worked with VitalSims and University of Minnesota to develop the platform. The research started in 2000 and the platform has undergone three randomized control trials. Health Partners has used the system for the past several years and now it’s making it available to providers and creating a new revenue stream for the health system.
SiMCare Diabetes is designed particularly for primary care physicians to help them better diagnose and manage diabetes, and the co-morbidities that can lead to complications that drive up healthcare costs. It has 18 patient profiles, derived from thousands of case studies, with underlying conditions such as sleep apnea, hyperlipidemia and patients who are on multiple medications for other conditions.
Here’s how it works. Users get about eight different patients with type 1 or type 2 diabetes and various co-morbidities outlined in their respective electronic medical records. They have to help patients set treatment goals for managing blood pressure, cholesterol and blood glucose levels. They review patient vitals, do a physical exam, particularly a foot exam, and based on that information can request tests or diagnostics, prescribe medications and work with patients to decide when they should take their medications. Users can also review lifestyle and potential adherence issues for each patient. Based on the actions and procedures taken for each patient, users get instant feedback. Each case ends when users successfully help them manage their condition over a six-month period.
“Primary care physicians have not had a simulated environment to treat diabetes,” said Chris Duncan, SiMCare Health CEO. “To give you a little perspective when in the simulator dealing with a patient they have access to therapies such as initiating and dosing insulin, ordering diagnostics, doing a foot exam, ordering lab tests. The simulator will tell them if the therapies are good or bad, things they may need to do.”
The Web-based platform is intended to offer an option for providers not located near a simulation center likes ones at teaching hospitals such as Harvard, Johns Hopkins and Penn Medicine. Think of simulators in the healthcare space and odds are high they are for surgery. But as Duncan sees it, the primary care and chronic care market have been largely ignored. Duncan also hopes providers will see a need for the simulator for nurse practitioners and pharmacists.
“Chronic disease represents 75 percent of healthcare costs…so better provider learning will be critical,” Duncan said. “It can be extremely helpful to newer clinicians so they can learn practices and therapies, but if you look at primary care physicians today, it can be used to provide updates on practices, medications, testing recommendations.”
Simulators focused on other conditions are in the works. Duncan expects one for hypertension will be available in the third quarter of the year and a simulator for treating asthma patients will come on the market in 2014.