The Los Angeles-based health system is using a $7 million federal grant to expand a digital health program that will develop AI tools to help providers analyze a patient's risk of heart attack and other cardiac concerns.
Cedars-Sinai researchers have received a federal grant to study how AI can be used to help predict heart attacks and other cardiac concerns.
A team from the Los Angeles health system's Smidt Heart Institute and Division of Artificial Intelligence in Medicine is using a $7 million grant from the National Institutes of Health's National Heart, Lung and Blood Institute to set up the new program, which will use data from positron emission tomography and CT scans to analyze a patient's risk of cardiac issues.
“Advanced imaging data could help predict patients’ risk of serious cardiac events, but is so complex that clinicians aren’t always able to use it,” Piotr Slomka, PhD, director of Innovation in Imaging and professor of Cardiology and Medicine in the Division of Artificial Intelligence in Medicine at Cedars-Sinai and the lead researcher in the project, said in a press release. “This grant will allow us to create artificial intelligence tools that help physicians everywhere identify high-risk patients who would benefit from targeted therapy.”
According to the American Heart Association, more than 18 million people died of cardiovascular disease in 2019. Many healthcare organizations are looking to digital health to develop new ways to detect cardiac problems early enough for care providers to intervene before they become serious, even deadly.
Cedars-Sinai has long been at the forefront of digital health innovation, working with tools like virtual reality, wearables and AI to improve treatments and clinical outcomes. This past March, researchers in the quantitative image analysis lab at the Biomedical Research Institute announced the development of an AI tool that analyzes the amount and composition of plaque in arteries that supply blood to the heart to determine heart attack risk within five years.
“A deep learning system that rapidly and accurately quantifies coronary artery stenosis has the potential for integration into routine CCTA (coronary CT angiography) workflow, where it could function as a second reader and clinical decision support tool,” the research team reported in a study published in The Lancet. “By providing automated and objective results, deep learning could reduce interobserver variability and interpretative error among physicians. Deep learning-based plaque volume measurements have independent prognostic value for future cardiac events, and could enhance risk stratification in patients with stable chest pain who are undergoing CCTA.”
With this latest program, Slomka and his team plan on expanding the platform.
“This particular grant allows us to build a program—not just a project—which will expedite our innovative plans,” he said in the press release. “In AI, things are changing all the time, and sometimes we find that we could make much more impact if we change direction. The beauty of this grant is that it makes that easy to do.”
Nanotechnology is moving from fiction to reality, with at least two universities studying the use of miniature robots inside the body to treat diseases and address other health concerns.
Fans of Fantastic Voyage take heart: The innovative nanotechnology featured in the 1966 movie about miniaturized doctors entering a human body may actually be coming true—sort of.
Researchers at both Stanford University and Purdue University have recently published studies on the use of miniaturized robots inserted into the body to treat certain health concerns. The robots could be used to delivered timed doses of medicine, chart the course of a tumor or disease, or even remove obstructions such as blood clots.
While nanotechnology has long been a popular topic in fiction, from Michael Crichton's 2003 novel Prey to the most recent James Bond movie No Time to Die, it's starting to show up in the real world. Several programs over the past few years have focused on the development of pills fitted with digital health sensors that are ingested and used to deliver timed doses of medicine and/or track vital signs and medication results, though the digital health company best known for developing that technology, Proteus, filed for bankruptcy in 2020.
Now some researchers are trying a new delivery method.
At Purdue, "microbots" developed by Hyowon "Hugh" Lee, an associate professor from the Weldon School of Biomedical Engineering, have been used to remove blood accumulating around the brain after a stroke. Working with neurosurgeons Timothy Bentley, MD, of Purdue's College of Veterinary Medicine, and Albert Lee, MD, from Goodman Campbell Brain and Spine in Carmel, Indiana, he successfully removed pooled blood in six of seven animals.
"This innovation is a real advance in the care of strokes, which are notoriously difficult to treat," Lee, whose work was recently profiled in Nature Communications, said in a press release. "Patients with brain hemorrhages have a mortality rate of up to 50%. Currently there is no great therapeutic solution for intraventricular hemorrhage. The only other option is blood clot-dissolving drugs that have undesirable risks."
At Stanford, meanwhile, Renee Zhao, an assistant professor of mechanical engineering, is working on "millirobots," or fingertip-sized biomedical robots that move through the body on magnetic fields. As noted in a study in Science Advances, her "spinning-enabled wireless amphibious origami millibot" is designed to "crawl, spin or swim" through the body until it reaches its target, then release a high-concentration drug.
In a news story issued by Stanford, Zhao and her team say the technology "won’t just provide a handy way to effectively dispense medicine but could also be used to carry instruments or cameras into the body, changing how doctors examine patients."
"While we won’t see millirobots like Zhao’s in real healthcare settings until more is known about optimal design and imaging best practices, the lab’s first-of-its-kind swimmer … is among their robots that are furthest along," the press release continues. "It’s currently in the trial stages that come before any live animal testing that proceeds human clinical trials."
Boise State University and the University of Utah are collaborating on a new program that will use virtual reality to help medical students identify and address social determinants of health.
A new project being launched at Boise State University and the University of Utah aims to use virtual reality to train medical students how to talk to their patients about social determinants of health.
Boise State School of Nursing Associate Professor Kate Doyon and co-investigators Nancy Allen and Julie Gee, associate professors at the University of Utah’s College of Nursing, will be working with the Spencer S. Eccles Health Sciences Library and Therapeutic Games & Applications Lab to create VR platforms that will teach future doctors, nurses, dentists and social workers how to talk to patients about non-clinical barriers that may affect their ability to access care or follow care plans.
“As providers, we have to know what the barriers and facilitators are to get [patients] on a plan of care,” Doyon said in a press release issued by Boise State. “It should be routine to ask the patient about their world.”
“At the end of the day a plan must be patient-centered,” she said, she added.
Social determinants of health can have a profound effect on clinical outcomes by hindering or even preventing consumers from getting the healthcare services they need. These barriers include family and job support, socio-economic and cultural norms, language issues, physical and geographical obstacles and digital literacy.
Supported by a $100,000 grant from the University of Utah's VR4 Health Sciences Education program, the project will create VR scenarios that allow students to see how these barriers, such as lack of access to a pharmacy or a home life that isn't conducive to post-discharge recovery, affect care management and coordination.
“The more realistic we can make the [virtual reality simulation], the more of an impact we can have,” said Doyon, who plans on seeking funding from the National Institutes of Health.
Healthcare experts say that by identifying the social determinants of health, providers can develop more comprehensive care coordination and management plans that overcome those barriers to care and boost health and wellness. That might include helping consumers understand how to use telehealth and digital health, arranging transportation to and from medical appointments or offering resources to address food insecurity, exercise, legal and family issues, even budgeting and housing concerns.
The Health and Human Services Department's Office for Civil Rights has released guidelines on how healthcare providers can use audio-only telehealth platforms, including the phone, that meet requirements set forth by the Health Insurance Portability and Accountability Act.
Federal officials are cracking down on healthcare organizations using audio-only telehealth platforms – such as the telephone – to deliver healthcare services.
The Health and Human Services Department's Office for Civil Rights (OCR) has released guidance on how providers can use "remote communication technologies to provide audio-only telehealth services" without running afoul of the Health Insurance Portability and Accountability Act (HIPAA), which focuses on how sensitive health information is disclosed over various communications channels.
“Audio telehealth is an important tool to reach patients in rural communities, individuals with disabilities, and others seeking the convenience of remote options," OCR Director Lisa J. Pino said in a press release. "This guidance explains how the HIPAA Rules permit health care providers and plans to offer audio telehealth while protecting the privacy and security of individuals’ health information.”
Audio-only telehealth platforms have been heavily regulated in the past, and in many cases healthcare providers aren't permitted to conduct healthcare via that technology. But during the pandemic, which forced providers to move away from in-person services and conduct more business via telehealth, the federal government issued a series of waivers, including one on HIPAA enforcement, aimed at expanding telehealth use and coverage.
Telehealth advocates have noted that the pandemic has proven the value of audio-only telehealth, particularly in rural and remote areas and for people who don't have access to audio-visual telemedicine platforms or rely on the telephone as their only means of communication. While the federal waivers are scheduled to end with the public health emergency (PHE), some states have already taken action to permit the use of audio-only telehealth for certain services, and several bills before Congress aim to make those freedoms permanent and nationwide.
The OCR guidance serves to remind healthcare organizations that they need to be careful how they use audio-only telehealth during the public health emergency, and that those rules will tighten when the PHE ends.
The executive vice president and chief innovation officer for the Pennsylvania-based health system is helping to create new programs and pathways, all while focusing on the path to value-based care.
Innovation in healthcare doesn't just mean finding a new way to do something. It's a "fundamentally different approach to solving a problem that has quantifiable outcomes."
That's the mantra for Karen Murphy, MD, executive vice president and chief innovation officer for Geisinger and founding director of the Pennsylvania-based healthcare organization's four-year-old Steele Institute for Health Innovation. As such, she's leading the way in one of the most competitive healthcare markets in the country to research and develop new technologies and strategies to take healthcare into the value-based care era.
She has her hands full. The pandemic may have propelled telehealth and digital health innovation forward by roughly a decade, but it has also exposed barriers in using technology to connect with underserved populations, as well as causing a surge in stress, depression and anxiety, and exacerbating the burnout rate and workforce shortages in healthcare. While giving Murphy and her colleagues good targets at which to direct innovation, these barriers can also be landmines, capable of derailing an innovative platform or concept if not addressed.
Karen Murphy, executive vice president and chief innovation officer at Geisinger. Photo courtesy Geisinger.
One more caveat: healthcare innovation isn't occurring in a vacuum. Healthcare organizations are expected to simultaneously evolve and continue to deliver healthcare.
"We are caring for patients each and every day, and it's very, very difficult to innovate and operate at the same time," Murphy says. "We are not a healthcare store. We need to integrate innovation" into the ongoing care platform.
That's why innovation needs to show value, and have measurable results that can be used to prove sustainability, especially on a timeline.
The idea that innovation is meaningful' "is really hard," she adds. "We constantly expect short-term results from long-term strategies."
One strong example is the Fresh Food Farmacy, a program developed out of the Steele Institute that addresses a key challenge to care management for people living with diabetes: diet. People living with diabetes need to carefully manage what foods they eat, including when and how much they eat. This is a social determinant of health, a factor not usually included in clinical care, but which affects a patient's health and wellness as dramatically as medication.
Through the program, patients are screened in a primary care setting for food insecurity, and if they have those concerns and an A1C level of greater than 8.0 (an indicator that the patient isn't managing his or her diabetes well), they're given a "prescription" or a referral for the Fresh Food Farmacy, which gives them and their household the ingredients for 10 nutritious meals a week.
To date, the program, which also operates in satellite locations in Kingston and on the Jersey Shore, has provided almost 2 million pounds of food, or roughly 1.5 million meals, to about 1,500 patients. Internal data suggests that has helped patients reduce their A1C levels as much as 2.4 points. Geisinger is now looking to expand the program and is partnering with digital health company Season Health to integrate the program later this year into the Geisinger Health Plan.
Murphy says the program demonstrates two key facets of innovation:
It rethinks how care providers collaborate with patients to improve clinical outcomes
It's not all about the technology.
"Digital allows us to communicate with patients more effectively," she says. "And it allows us to intervene for [preventive health and wellness] in a much more cost-effective way than in the past. It gives us the tools we need to engage with patients … but we still need to learn how to engage."
"I'm thrilled for the disruption that we're seeing in healthcare," Murphy adds. "It's forcing us to rethink how we engage with patients. It's not the same as 20 years ago."
In this case, Geisinger can use technology—e-mails, text messages, and virtual care—to connect with patients at the time and place of their choosing, and through these connections the health system can collaborate to improve not only care, but health and wellness. This shifts from the philosophy that delivers healthcare in episodes, to address immediate needs to a continuous model that manages care over the long term. With chronic care patients, such as those living with diabetes, that would include not only access to food but also meetings with dietitians to help manage diet and lifestyle.
"With value-based care, providers are reimbursed based on outcomes, rather than volume," Murphy says. "And we are gathering evidence, over the past 10 years, that we've [created] positive outcomes with quality measurements."
Murphy says those measurements and that data are also needed to attract payers and to reconfigure payment methodologies that, as of now, aren't in sync with value-based care. If innovation can be proven to transform care, payers and providers will need to agree on how these programs are covered and sustained, so that the incentives will be there to continue them.
That's where innovation is headed, into platforms and programs that enhance the connection between patient (or consumer) and care provider (or team), particularly outside the hospital, doctor's office or clinic, and in-between the scheduled appointments and treatments.
Murphy sees several areas in which innovation will play a part in the healthcare ecosystem. She sees AI and machine learning playing a part in the back end, automating processes, analyzing data, and reducing workflow stresses that plague today's doctors and nurses. Those concepts will also be brought to bear on the front end, helping to manage chronic care and other treatments while giving providers more face-to-face time with their patients.
She's also bullish on remote patient monitoring, a fast-growing and evolving strategy that took off during the pandemic. She sees traditional care pathways enhanced with RPM platforms that use sensors and AI to monitor and manage care at home through wearables, smart technology, and other tools.
"There will be other factors that we don't even know about today," she says. "That's what's exciting."
Advocate Aurora Enterprises, the innovation subsidiary of Milwaukee-based Advocate Aurora Health, is building a portfolio of companies and programs aimed at helping seniors live longer, healthier lives at home.
The fastest-growing population in the US are seniors, and they're very much interested in staying healthy longer and staying at home. With that in mind, healthcare organizations are developing care management programs that allow seniors to age independently, and they're researching and investing in programs that improve home-based care, including telehealth and digital health.
As vice president of strategy and analytics, Sheetal Sobti leads the aging independently category for Advocate Aurora Enterprises, a subsidiary of Milwaukee-based Advocate Aurora Health that advances innovative solutions to address people’s broader health needs. In her role, she is responsible for building a portfolio of health and wellness companies that enables seniors to thrive independently, comfortably and affordably in their homes.
She recently sat down with HealthLeaders to talk about how Advocate Aurora Enterprises selects companies to add to its portfolio, and how those companies complement a strategy of helping older adults age independently.
HealthLeaders: How can innovative new technology or services be used to help seniors stay at home, rather than moving into a senior living facility?
Sheetal Sobti: We’ve found that most seniors want to stay in a familiar environment—oftentimes it’s where they raised their families, and where they have friends and family in the community. For many older adults, having the comforts of home prevents social isolation, which can negatively impact physical and mental health. There’s also a financial benefit to aging in place, since senior living facilities can be expensive.
However, many older adults end up having to live with family or move into a senior living facility because an adverse event happens in the home—they fall, or they just can’t get their needs met. If we can help keep them safe, that ensures they can stay home longer and be more comfortable.
Sheetal Sobti, vice president of strategy and analytics, Advocate Aurora Enterprises. Photo courtesy Advocate Aurora Enterprises.
That’s why Advocate Aurora Enterprises invested in Senior Helpers, which connects seniors to caregivers who help with activities of daily living like getting in and out of the shower or up and down the stairs. Now, with the addition of MobileHelp, we’re infusing our service portfolio with technology to provide an additional layer of safety and security to offer seniors and their family members greater peace of mind.
Q: How does Advocate Aurora Enterprises evaluate technology or services to support? What do you look for and, perhaps, what do you look to avoid?
Sobti: Our goal is to continue assembling a portfolio of innovative health and wellness solutions that help people live well at every stage of life, while also diversifying our revenue. When it comes to the aging independently [landscape], we look at the types of solutions that seniors and their family caregivers are purchasing. We ask, how can we make their lives easier?
Then we leverage our clinical expertise, which includes connecting such solutions to the broader continuum of care. We look at what’s happening when seniors are sick, in addition to what’s happening when they’re well. We complete the picture by connecting traditional home healthcare offerings, as well as our expertise in managing utilization and risk, with technology and services that compliment clinical care.
As far as what we would avoid, that might include anything that falls within Advocate Aurora Health’s core clinical purview.
Q.How are healthcare providers addressed with these products or companies? Do you look for technology or services that integrate with the primary care provider or the local health system?
Sobti: We really like the idea of using technology to connect medical professionals with services that could benefit their patients.
Last year we invested in Xealth, a platform that connects providers with an array of solutions to help patients reach their health and wellness goals. In a way, Xealth is a key enabler of our portfolio, helping achieve synergies between solutions and providers. For example, in the future if a clinician is discharging a patient who says they don’t have someone at home to help with their medication or prepare meals, that clinician could use a platform like Xealth to identify a temporary need for caregiving services like those provided by Senior Helpers.
Q.What are the challenges or barriers to adopting innovative new technology or strategies?
Sobti: It’s a big change—not just for consumers but also for health systems. But there’s a greater readiness in the post-COVID world.
Health systems today are competing in the same space as fast-moving technology companies that have far more capital, wider consumer bases and, frankly, more in-depth knowledge of consumers and their purchasing power. On the flip side, health systems have clinical expertise and trusting relationships with consumers. Things are constantly evolving and there’s a need to meet consumers where they’re at.
Q.How does Advocate Aurora Enterprises help the Advocate Aurora health system? Does the health system identify healthcare trends to pursue or test out promising new technologies or services?
Sobti: We’ve done a lot of research on market trends and solutions that complement clinical care to advance whole person health. That’s how Advocate Aurora Enterprises identified its three key areas of focus: aging independently, family development and support, and personal wellness.
Part of the reason we exist is to help broaden Advocate Aurora Health’s business portfolio at a time when health systems across the country are navigating broad industry challenges, from stagnant reimbursement rates to increased competition. And we share a purpose of helping people live well. So there likely will be times when the health system chooses to offer the proven solutions that Advocate Aurora Enterprises invests in or acquires.
Q. What new technologies or strategies are you looking at now? What’s on the horizon for healthcare innovation?
Sobti: On the heels of our MobileHelp acquisition, our focus is on integration and identifying synergies that make it even easier for seniors to age in place. We’re excited about the opportunity to bundle Senior Helpers’ in-home personal care services with MobileHelp’s personal emergency response systems and remote patient monitoring capabilities.
We’ll continue looking at solutions that keep people safely in their homes, while also alleviating the burden on family caregivers. And we’ll stay focused on broadening the continuum of care to help people live well at every stage of life.
The Digital Twin Consortium has created a framework for the use of digital twin technology, which is just now being adopted in healthcare to help providers improve care management.
The Digital Twin Consortium has unveiled a document designed to help healthcare organizations using the innovative digital health platform to improve clinical care.
Reality Capture: A Digital Twin Foundation lays out the groundwork for using the technology, which essentially uses sensors and AI to create a digital twin of an object, room, building or landscape, for use in planning and design. In healthcare, the strategy focuses on developing a digital twin of a patient, which can then be used to test the effectiveness of treatments before they're tried on the patient.
“Reality capture technologies play an important role in providing context and, depending on the scenario, delivering real, on-time decision support for situational awareness," Dan Isaacs, chief technical officer of the Boston-based organization, said in a press release. "This in turn enriches digital twin predictive accuracy and outcomes. Situational awareness serves to augment event intelligence for timely, high confidence, data driven, and evidence-based decision making."
While other industries have used digital twin technology for close to two decades, only recently has it been adapted to healthcare.
This past February, the University of Miami Miller School of Medicine announced a partnership with Amazon Web Services and the Open Health Network to create the MLBox, which would use digital health tools, including wearables and smart devices, to collect biological, clinical, behavioral, and environment data on a patient to create a digital twin. The project is supported by the National Institutes of Health.
“We want to demonstrate that this kind of individualized data capture can spur a new line of research and personalization in healthcare,” Azizi Seixas, PhD, founding director of TheMI, an associate director for the Translational Sleep and Circadian Sciences Program at the Miller School of Medicine, and one of the nation’s leading experts on sleep health, said in a press release. “With the capacity to discover everything we can about the individual, we can change the relationship between people and their health.”
“Eventually, such digital twins could comprise sufficient detail about an individual so that a computer could test different treatment or wellness options against that model to predict which are most likely to produce the best outcomes for that person,” officials said in a press release. “Instead of prescribing treatments based on a statistical model of outcomes across a large population, this new approach would provide each patient with a personalized recommendation calculated to produce the best outcome for them.”
With its new document, the Digital Twin Consortium aims to lay the foundation for guidelines and standards of digital twin technology.
“For digital twins to play a growing role in the industry for simulations, remote control or metaverse experiences, they must accurately reflect built reality,” Dominique Pouliquen, CEO of Cintoo, which has been using the technology in construction projects, said in the press release. “Various technologies are available to capture these conditions, ranging from passive cameras to active laser scanners, but navigating the reality-capture landscape is not easy. There isn’t a single scanning device that meets the criteria for all possible use cases and workflows. Today’s white paper provides information organizations can use to make the right investment decisions.”
Roughly 30 community pharmacies across the country will have access to a digital health platform that enables patrons to take a 10-minute, self-administered cognitive performance screening to detect early signs of Alzheimer's disease.
As many as 30 pharmacies across the country will soon have access to a digital health platform that will allow patrons to test themselves for early signs of Alzheimer's disease.
The Community Pharmacy Enhanced Services Network (CPESN) will select the pharmacies to receive Cognivue Clarity, a self-administered, 10-minute cognitive performance screening tool developed by digital health company Cognivue. The project will include training and onboarding services to help pharmacy employees use the tool to screen patrons and evaluate the results.
“The pandemic highlighted the need for trusted and accessible testing, screening, and referrals for large swaths of the population, but in particular for those living in underserved neighborhoods or with cognitive limitations," CPESN USA Executive Director Troy Trygstad, PharmD, MBA, PhD, said in a press release. "Community pharmacies are likely to play an essential role in early identification, education, and warm handoffs for those at risk or in cognitive decline.”
More than 6 million people in the US currently live with Alzheimer's, according to the Alzheimer's Association, with that number projected to triple by 2060. While there is no known cure, early detection of symptoms can help healthcare providers develop care management plans for brain health that could delay the progression of the disease and improve quality of life.
The program is coordinated by the Avant Institute, a Charlotte, NC-based organization that offers training for pharmacists, pharmacy technicians and pharmacy students on the knowledge and practical application of clinical pharmacy services. It's being funded by a grant from the Switzerland-based Davos Alzheimer's Collaborative, which recently issued $4.5 million in grants to organizations in eight countries to "advance how healthcare systems worldwide detect, diagnose, treat, and care for people with or at risk for Alzheimer’s."
The global project aims to improve healthcare access by connecting with people outside the hospital, clinic or doctor's office and meeting them where they are. Retail sites like pharmacies have often been seen as ideal locations to connect with people, especially underserved populations who can't or won’t see primary care providers on a regular basis.
"This grant provides an opportunity to address a significant need to fill the gaps in conducting standardized cognitive assessments for patients, and pharmacies provide an access point to reach underserved and rural communities," Amina Abubakar, PharmD, president of the Avant Institute and CEO of the Avant Pharmacy and Wellness Center, said in the press release.
Research by the University of North Carolina finds that patient-reported outcomes collected through a digital health platform can help healthcare providers monitor their patients living with cancer at home, improving engagement, quality of life and outcomes.
A new study finds that patient-reported outcomes (PROs) delivered by phone as well as online helped health systems improve care management for people living with advanced cancer.
The study, conducted by the University of North Carolina and recently published in the Journal of the American Medical Association (JAMA), sheds light on the value of an automated survey platform that allows care providers to track patient symptoms at home. The platform reduces stressful travel to and from a doctor's office or clinic and allows providers to monitor patients weekly and intervene when they detect a health concern.
“We had very high engagement with patients and their care teams in this study, with patients completing more than 90% of their symptom surveys, and nurses frequently reaching out to patients when severe or worsening symptoms were electronically reported,” Ethan Basch, MD, MSc, a researcher at UNC's Lineberger Comprehensive Cancer Center and the paper’s lead author, said in a press release. “This likely reflects how accustomed many patients and providers have become to telehealth and electronic communications.”
Supported by the Patient Centered Outcomes Research Institute (PCORI), the PRO-TECT (Patient Reported Outcomes To Enhance Cancer Treatment) trial tracked 1,191 patients receiving care at 52 community cancer clinics between October 2017 and March 2020. Roughly half of the patients were asked to complete a weekly survey, offered online as well as by phone, for as long as a year, while the rest received traditional care, often in he form of scheduled visits to the clinic or doctor's office.
The project enabled participants to report typical symptoms of cancer treatment, including fatigue, nausea, insomnia, appetite loss, diarrhea, pain, difficulty breathing, and constipation. If those symptoms appeared to be worsening or increasing, the digital health platform sent an alert to the patient's care team to follow up immediately.
According to the study, those using the online or phone survey platform experienced roughly 35% better physical function that their counterparts who reported their symptoms during office visits, and they also reported more than 16% better control over their symptoms and more than 40% better health-related quality of life.
The research adds to a growing library of data that virtual care can stand in for in-person care in certain circumstances, and can even help providers improve clinical outcomes. The platform saw increased use during the pandemic, when many health systems turned to telehealth to substitute for in-person care at a time when the risk of infection was high.
The platform also offers crucial value to people living with cancer, with studies suggesting half of cancer-related symptoms are undetected and unreported. Healthcare providers fear that people are skipping appointments or check-ups, in part because of COVID-19 fears, so they aren't keeping their doctors up to date on symptoms.
"Symptom monitoring using electronic systems that facilitate patient-reported outcome (PRO) surveys via the internet, mobile applications, or automated telephone interfaces have been shown to be feasible for identifying symptoms that can be treated by clinicians," Basch and his colleagues wrote in the study. "Prior studies have reported improved outcomes for physical function, symptom control, health-related quality of life (HRQOL), hospitalizations, and survival when such electronic systems are used by patients receiving cancer treatment. Integrating symptom monitoring into routine treatment of cancer may improve outcomes with an opportunity for reimbursement by payers."
The study also proves the value of offering multiple ways of accessing the survey, to take into account barriers that some patients may face in accessing the Internet. Roughly one-third of the participants in the study reported their symptoms via telephone.
It also points out that launching a digital health program comes with challenges.
"Despite prior evidence of the benefits and feasibility of electronic symptom monitoring with PROs, there has not been widespread adoption in treatment for cancer," the study noted. "Implementation requires technology, patient engagement, staff effort, and modification of information flow. A prior analysis of user feedback from this trial found high levels of enthusiasm from patients and clinicians. However, nurses reported that alerts could be burdensome unless there is dedicated time to address the alerts. Despite cost savings associated with PRO monitoring for insurance companies, currently funding is not available to sustain additional costs to clinics of technology and staffing in the US."
"The Centers for Medicare & Medicaid Services has suggested including PROs in a proposed oncology payment model," Basch and his colleagues wrote. "Expansion of current billing codes for remote monitoring to include PROs in oncology would facilitate greater use of the intervention. Future work could delineate the relationship of PRO monitoring with patient navigation. Work is needed to refine algorithms for communicating alerts to assess whether the number of notifications can be safely reduced."
Basch says the project now needs to be expanded, to improve efficiency and determine the best models for widespread use.
“PRO-TECT is a way to bring patients together with their care team and aids in identifying those who are at greatest risk,” he said in the press release. “And because we had equal success at all 52 practices in 25 states, it shows that there’s a wide acceptance for this kind of intervention.”
PedsGuide, an mHealth app developed by Children's Mercy Kansas City, is an on-demand clinical decision support platform designed to assist rural and remote healthcare providers who are treating children.
One of the benefits of digital health is that it allows healthcare providers to collaborate and share their expertise with others who don't have that background. Children's Mercy Kansas City is following that path with a new mHealth app designed to give providers a clinical decision support tool for pediatric care.
"Many ERs see children because they have to," says Brandan Kennedy, MD, a pediatric hospitalist and clinical informaticist and associate director of inpatient health informatics at the Kansas City, Missouri-based hospital. "Less than 10% of their ER traffic is kids, so it's not their comfort zone … but that doesn't mean they can’t treat them."
To address that concern, Kennedy and his colleagues created PedsGuide, an app that gives users on-demand clinical decision support (CDS) resources for a wide range (and growing) of pediatric care concerns, from burn treatment to diabetic ketoacidosis. The free app can be accessed via desktop, laptop or mobile device, and even includes a quick-call feature to connect with emergency medicine physicians or the Children's Mercy medical transport team.
"We wanted to create something that can help physicians make decisions at the front line of care," he says.
Brandan Kennedy, MD, associate director of inpatient health informatics, Children's Mercy Kansas City. Photo courtesy Children's Mercy Kansas City.
CDS tools for frontline healthcare providers have evolved significantly during the past few decades, thanks in large part to the advent of online resources and mobile devices. What once had to be looked up in a reference book, dictionary or magazine can now be accessed via computer or smartphone.
The challenge, as always, is in finding the right resource, an effort made all the more difficult by the growing numbers of CDS providers.
At Children's Mercy Kansas City, the belief is that healthcare providers treating children should be getting their guidance from pediatric specialists.
Sallie Guezuraga, who manages the Innovations Center at Children's Mercy's Center for Pediatric Innovation, says ER physicians first came up with the idea to develop a resource that would help frontline care works in emergency situations. They soon realized the information they wanted to include was changing often, thanks to new research and innovations. The onset of the pandemic added to the volumes of information—and the urgency to get that information out there.
"We couldn't update it quickly enough," she says. "We had to digitize it."
Armed with a research grant, the Innovations Center team created a simple mHealth app designed to help clinicians in treating children under 3 years old who presented with a fever. From there, they created new modules for infant care, then asthma treatment, then resuscitation workflows. The topics and ideas just kept coming in.
"The build became very ambitious," says Kennedy, who joined Children's Mercy several months into the program.
The current app platform has seen roughly 70,000 uploads, and Kennedy and Guezuraga say they're nowhere close to being done mapping out the infrastructure.
Sallie Guezuraga, Innovations Center manager, Children's Mercy Kansas City Center for Pediatric Innovation. Photo courtesy Children's Mercy Kansas City.
As part of the process, he says, the research team studied human factors engineering, including concepts like usability testing and think-aloud feedback, to understand how people interact in these situations with others and with technology. They wanted to know how clinicians might need and access information in different situations, such as an emergency or operating room or clinic. They also travelled with EMS responders in ambulance to see how an app might be used in an emergency situation in a rural location.
"In our current state in medicine, we have information overload," says Kennedy, noting there are more than 33 million articles of clinical literature in PubMed alone. "We have to make sure that we are translating that research into practice … in such a way that it can be used" by healthcare providers needing quick and accurate answers to their questions.
"We want to understand how and when people are using [PedsGuide] and what they are using it for," he adds.
To get a module ready for use could take as little as 18 months, says Guezuraga, or it could take a few years. And the infrastructure has to be in place so that Children's Mercy can research and update that information often.
To keep that information relevant, Children's Mercy Kansas City allows the research team the time they need to update the platform. And Guezuraga says the team is working with other organizations, such as the American Academy of Pediatrics, to make sure the information is reliable and valid.
They also want to keep the app free of charge. The idea is that healthcare providers need a resource that they can trust.
"This is an app developed by those who are in the field," Guezuraga says. "We have the experience, and we can say, 'Yes, this is what the protocol might say, but this is what actually happens.' We've been there and we know."
Kennedy points out that the app platform isn't seen as a marketable product or competitive advantage, but a tool that healthcare providers should be able to access freely and on demand. It affects all downhill care, he says, because children treated in a rural ambulance, doctor's office, clinic, ER or OR will be treated better and more effectively if the provider has access to the right information, and that in turn helps organizations like Children's Mercy Kansas City to focus on patients who need specialized care.
"We are leveraging the entire health system" to help frontline and primary care physicians improve their actions, Guezuraga says. "This ultimately helps the kids, which is our goal."
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