How Technological Innovations Could Improve CVD Risk Factor Management

Benjamin Scirica, MD, MPH, associate professor of medicine at Harvard Medical School and director of quality initiatives at Brigham and Women’s Hospital’s Cardiovascular Division, discussed the importance of team-based care and gaps in technology to manage patients at risk of cardiovascular disease (CVD).

Transcript

How can multidisciplinary teams be effectively structured to enhance the management of cardiovascular risk factors, particularly in patients with familial hypercholesterolemia and elevated Lp(a)?

I think what we need to do in terms of familial hypercholesterolemia and Lp(a) is a combination of education, appropriate screening, and then treatment to the latest guidelines, and that's where care teams can be extremely effective. Because unfortunately, we know that the knowledge that we've learned about hypercholesterolemia and Lp(a) is still not widespread among the medical community, so there are many patients who are out there who should be screened—either because they have their own history of cardiovascular disease or they have a family history of cardiovascular disease. And even if those numbers are known, often patients aren't given the opportunity to receive the most advanced therapies or be treated to the most recent guidelines. And so, for example, we often will see young patients who have very high cholesterol and are otherwise healthy, and they may not be getting statins, whereas we would recognize that they should start statins as soon as it's identified. Similarly, patients with family histories of heart disease should be screened for Lp(a), and it's just not being done. And if we use team-based care and system-based care, we can identify those patients and deliver much more effective care.

What technological innovations do you see as having the greatest potential to improve coordination of care and patient adherence in managing CVD risk factors, and how can these be integrated into existing health care systems?

I think what we have to do is start thinking about the health care system having a technology platform that does several things that it doesn't do now.

The first is how it engages patients to be able to provide much better and multichannel communication, so that you're not reliant on just one thing, like a secure patient gateway, but you can communicate with patients in other ways.

I think a second aspect that's missing is good what could be thought of as customer relationship management tools for doctors or care team members, where they can manage tasks and workflows in a much more effective way than we can in electronic health records. There's billion-dollar companies out there that develop successful customer relationship management programs that are able to provide incredible support to many industries, but we just haven't utilized those in health care. And I think we have to think of our technology and health care being much more comprehensive and much more effective of getting the job of delivering health care done, rather than just as a billing or documentation type of technology.