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Q&A with Melissa Williams
Respiratory Rescue
Propeller Health: App vs. Asthma

My name is Melissa Williams. I’m a respiratory therapist and Director of Clinical Innovation for Propeller Health.

How did you get involved in Propeller Health?

I’ve been a respiratory therapist for over 20 years. Anybody that comes in with any breathing problems at all is usually seen by someone like me. What Propeller offers to me as a respiratory therapist is a very easy and simple way to monitor patients in real time. We've never really had that luxury before. Patients would come into the office, and you would ask them how they have done the past month. They may or may not have a diary that they've written on to keep track of their inhaler usage. Now, we have a system that we can look at every single day and see the patients in real time. It makes my job easier on so many different levels. It really is a dream come true for a respiratory therapist. You don't have to go fishing for information. It's all right there. With one click, you can see how your patients are doing, who's doing well, and who's not doing well, very simple.

Tell us a little bit about the study in Louisville?

Currently, the sensors are getting into the hands of patients through the AIR Louisville Program. It’s a self enrollment program. As long as you're a Jefferson County, Kentucky resident and have asthma, you can enroll in the program and the sensors are free. It's a grant-funded program. We have money allocated for up to 1,100 sensors. Currently, there's about 700 patients enrolled. (C&C: since these interviews happened earlier in 2015 and 2016, the numbers cited will have changed by now.)

How do patients benefit from being involved with Propeller Health?

It's so simple for patients to be able to see how they're doing. It's amazing how many patients feel like they're doing well, but we try to get them to see a new normal. What they're feeling now is not necessarily normal. They can look at the information and see how they're doing. They can see how their children are doing, which is really important for parents to monitor their kids. They can give them some freedom yet have that luxury and comfort of knowing how they're doing.

Unfortunately, for doctors, you can't necessarily rely on anybody to recall information. It's hard, when you go in, to remember what you've done over the past month. You may say, "I think I used it a couple of times," when, in reality, you've used your rescue inhaler 20 times in the last month. When a patient goes in, they could pull the app up on their phone. They could show the physician right there what their usage has looked like in the past 7 days, 30 days, 60 days, whatever they choose to show them. They can also print out a report for the physicians to have in hand. They can put it in their chart, as well, just a very detailed report of how they're doing.

What defines a patient who is not doing well?

A patient is defined as not doing well based on their rescue inhaler usage. Technically, according to Asthma Guidelines, more than two rescue inhaler usages a week categorizes you as not doing well, so anything above that. It doesn't seem like very much, so patients are surprised to hear that. There’s a difference between a daily inhaler and a rescue inhaler. A daily inhaler is something that's prescribed to you to use on a regular basis. Usually, they're prescribed either once a day or twice a day. You take it at specific times throughout the day. Propeller can remind people to take their medications. If you forget, you're going to get a notification on your phone saying, "Hey, did you forget to take your controller medication today?" It's just a reminder, which is great for busy people like most of us to be able to say, "Oh, I did forget to take that." We can improve what's called "Adherence Scores," and that is how well you're sticking to taking your daily medications.

How does a device like the Propeller sensor prevent Emergency Room visits?

The sensor lets you see a trend of how the patient is doing. A patient's trend may show that it’s typical to use their inhaler prior to exercise, and we know that. But then, all of a sudden you see a couple of days where that rescue inhaler usage climbs. Now they've used it two or three times in the last couple of days with no sign of exercise. It allows us to reach out to the patient to see what is going on. Is there an issue that we can catch prior to them getting to that point and making it to the ER?

What does the future of Propeller look like, after the grant period?

Hopefully, the future for Propeller with Air Louisville is that it becomes a self sustaining program. Hopefully, with the employers that have signed on with Air Louisville, they'll see that it is a program that pays for itself. That we can look at claims data and show you that you're going to have much lower costs. Patients aren't going to be going to the ER. We're going to save you money, by simply letting your employees use the system. The way we talk to employers about saving money through the program is we say, "Let us see your claims data from the past year." We can look at all the patients, employees that have claims associated with asthma. We can look at that total cost, and say, "Right now, the program is free. Let us sign those employees up. Then, at the end of the program, a year later, we'll do that same claims data, and we'll show you how much we can make a difference."

What has the data from the study shown you?

What we noticed from the 2012 data, was that the hot spots were not where we thought they were going to be. City officials thought that the hot spots were going to be in the really low income areas or around a lot of chemical plants or things like that, but they weren't. They were around places that had a lot of idling cars. For example, the YMCAs tend to be hot spots. We were looking at schools and the busing system to see what that made a difference. I think there was a lot of people opening their eyes to the fact that it really wasn't what they thought it was going to be.

What are some of the main factors driving asthma in Louisville?

This is a difficult place to live with asthma. We can't change the terrain here. We live in the Ohio valley. It is what it is. It makes it tough. Allergies here are terrible. So, we're just doing what we can to prevent what's possible. Some things we can't change, and some things we can. I think allergies in Louisville are better in the fall than they are in the spring, but they still exist unfortunately. When it gets colder, then you have more of the respiratory diseases. You kill off a lot of the allergens, but then one of the biggest triggers for asthma is cold air.

How does Propeller ensure patients that their privacy is protected?

One of the ways we ensure that privacy is protected is that, first of all, employers have no access to patient data whatsoever. They can't see the dashboard. They have no idea who's enrolled in the program. It's all anonymous information at the end: we just give them the forms of claim data.

So they have no idea who's involved, it's all extremely private. The patient can choose to share this information with their physician or not. It's really up to them. They can add their physician as a “follower” to them in the program, but if they just want to use it as a self management tool, they can do that as well. The sensor will record date, time, and location, if you choose to have your location settings on on your phone. It will give you weather information for that day and air quality.

What's been some of the most impactful feedback that you've received from patients?

I think probably the most impactful feedback is that patients just didn't realize what it meant to be healthy. They were so used to the lifestyle that they had been living. They didn't realize that wasn't healthy. We have patients that would say, "Goodness, it's so great when I can look at this, and I get a little smiley face to know that I've been well." I know that's something really small, but it means a lot to know that they're having a good day. They can see that on there, and it really boosts their confidence. They have a chance to be a part of the first ever citizen-driven health way to change a city. I find it fascinating. I think it's awesome that Louisville has opened themselves up to this information, and they get to be part of such a big thing.