Researchers from Brigham and Women's Hospital and Massachusetts General Hospital say AI technology could be used in a hybrid platform that improves how clinicians communicate with patients and their families about serious illnesses and palliative care.
AI technology is starting to show up in care management and coordination platforms as an avenue for interpreting data and communicating with patients, usually through chatbots, but is it appropriate for dealing with patients in palliative care?
In a recent article in NPJ/Digital Medicine, researchers from Brigham and Women’s Hospital and Massachusetts General Hospital say the platform could help care providers with serious illness communication (SIC) by smoothing over what is often a difficult process. But the technology needs to be integrated carefully in a hybrid platform.
Patients with serious illness often experience delayed SIC because clinicians are poor at prognosticating life expectancy for terminally ill patients, usually erring on the side of optimism,” says the January 27 article, authored by Isaac S. Chua and David W. Bates of Brigham and Women’s and Christine S. Ritchie at Mass General. “Moreover, systematic methods to identify patients with palliative care needs are lacking.”
SIC is a both complicated and delicate process. Providers first have to determine whether a patient is in need of palliative care services, then talk to that patient and his or her family about everything from life expectancy to end-of-life care.
The traditional SIC delivery process consists of a series of conversations where gathering, interpreting, and integrating SIC data occur within a clinical encounter followed by manual clinician documentation in the electronic health record (EHR) post-visit,” Chua, Bates and Ritchie write. “This process can be broken down into the following steps: determining patient eligibility for SIC; gathering and interpreting information (e.g., eliciting and clarifying the patient’s illness understanding, hopes, and worries); conducting a therapeutic conversation (e.g., counseling and supporting the patient on coping with life-threatening illness) with the goal of shared decision-making; documenting the conversation; and making SIC documentation accessible to others in the HER. However, each step is a potential bottleneck because the ability to initiate SIC or make forward progress depends heavily on the clinician’s ability, skill, and judgement.”
The researchers point out that many clinicians lack SIC training, and there are no clear standards to document how the process should be conducted or how the EHR facilitates documentation. This might lead to inaccurate or uncertain diagnoses and timelines, awkward and infrequent conversations and more anguish for patients and their caregivers.
“In addition to training more clinicians to be competent in SIC, a novel workflow that addresses these barriers will be necessary to ensure that all seriously ill patients receive timely and effective SIC that informs their care in real time and naturally results in documentation of patients’ goals and preferences that is visible to others,” the article suggests.
That workflow, Chua and his colleagues write, should by a hybrid strategy that combines AI tools in the background with in-person services that should always be the backbone of SIC. The technology would be used to gather and interpret data to ensure and accurate diagnosis and timeline, and to give clinicians the information they need to have those conversations with patients.
“AI can also streamline the SIC documentation process and potentially improve the quality of SIC documentation via natural language processing (NLP)—a form of machine learning designed to understand, interpret, or manipulate human language,” the article continues. “Missing or incomplete documentation in the EHR regarding patient preferences for life-sustaining treatment is common and contributes to medical errors related to end-of-life care.”
“NLP also has the potential to address barriers resulting from poor EHR design that prevent or inhibit the extraction and flow of meaningful advanced care planning information across the care continuum,” Chua and his colleagues continue. “In its current state, identifying SIC documentation in the EHR typically involves a manual chart review that possibly includes a keyword search or utilization of note filters. NLP-enabled software that identifies free text SIC documentation would likely reduce the time and effort clinicians spend looking for this information and prevent inadvertent oversight of patient preferences leading to goal-discordant care. AI-assisted chart reviews have demonstrated higher accuracy and shorter time for extracting relevant patient information compared with standard chart reviews.”
Finally, the AI platform could also be helpful in giving clinicians feedback on their communication skills, a critical component of discussing SIC with distraught patients and family members.
Chua, Ritchie and Bates conclude by noting AI technology can greatly benefit SIC, but some of those benefits aren’t there quite yet. A hybrid approach that integrates data analysis and NLP with in-person services would be an ideal platform, improving accuracy and eliminating gaps in care while giving clinicians more information and guidance to handle challenging and often delicate conversations. But the technology hasn’t been tested enough or isn’t developed far enough to be put to use in clinical situations.
“This proposed paradigm still requires that clinicians undergo some SIC training to capitalize on the assistance provided by AI, as well as additional research to avoid unintended consequences of AI implementation,” they write. “That said, a semi-automated approach to SIC delivery holds tremendous promise and would likely improve current SIC workflow by optimizing clinical manpower and efficiency while increasing the likelihood that these critically important conversations will occur effectively and in a timely fashion.”
Vanderbilt University Medical Center is joining forces with Carnegie Mellon University and Cornell University on a Defense Department-funded project to create an artificial lung that can be used by patients at home.
Three universities are joining forces to develop an artificial lung platform that can be used by patients at home.
Vanderbilt University Medical Center, Carnegie Mellon University and Cornell University are sharing a four-year, $87 million grant from the Department of Defense Congressionally Directed Medical Research Program (CDMRP) to create the platform, which would allow patients with incurable lung disease who can’t wait for a lung transplant or who aren’t viable candidates.
“The need for helping people with chronic lung disease is just so apparent, because it’s literally millions,” Matthew Bacchetta, MD, MBA, MA, a professor of surgery and adjunct professor of biomedical engineering at Vanderbilt who’s leading that research team, said in a press release issued by the university. “Transplant is obviously the only outlet for those patients. If you can’t get a transplant, you are stuck living with chronic lung disease. The need is quite great, and there is little out there that addresses it.”
The portable device would take the place of ECMO (Extracorporeal Membrane Oxygenation) system, a platform housed in a hospital’s ICU that can temporarily takes over the functions of the body’s heart and lungs.
More than 12 million people suffer from chronic lung disease, often in the form of chronic obstructive pulmonary disease (COPD). The Defense Department is spearheading the research because veterans are roughly three times more likely to develop COPD.
Vanderbilt’s team will focus on designing and testing the modes of vascular access and the ergonomics of the device as well as developing the gas exchange mechanism. The Cornell team will work on coating technology to make the platform more biocompatible. The Carnegie Mellon team will work with the Vanderbilt group on the gas exchange mechanism and develop the telemedicine platform that will allow patients to use the device at home while being monitored by caregivers.
“The intent is that this could potentially be used for years,” Bacchetta said in the press release. “It’s a very different design approach from ECMO, [which] is temporary and limited to an ICU setting. That’s not our design intent. We’ve completely erased that drawing board and created a new drawing board that is focused on management of chronic lung disease in a durable and enduring fashion, really as a destination therapy.”
The Pennsylvania health system is pointing to a recent survey that shows the digital health tool, which is now marketed by a company spun out of Penn Medicine, improves real-time care coordination.
Penn Medicine is touting the results of a study showing the value of a digital workflow tool, developed at the health system, that allows providers to better coordinate care between teams.
The tool, called CareAlign, pulls data from the electronic health record and allows multiple providers to access from different locations and schedule services, such as tests and specialist consults. It’s designed to give the patient’s care team real-time access via mHealth devices to the patient’s care management plan as it’s designed and updated.
According to a study recently published in Applied Clinical Informatics, the digital health tool saw widespread use across three hospitals in 2016, and has been positively reviewed by clinicians in surveys taken in 2016 and 2018, with steady use over at least four years.
Penn Medicine has since spun the service into a digital health company called CareAlign, which markets the tool to other health systems.
“This demonstrates that there is a definite need for clinician-facing platforms that build on to the investment health systems have made in electronic health records to help clinicians be more efficient, improve communication and streamline documentation,” Subha Airan-Javia, MD, an adjunct associate professor of Medicine in Penn’s Perelman School of Medicine and a former associate chief medical information officer at Penn Medicine who launched the company and now serves as its CEO, said in a recent press release.
The project points to a growing interest among healthcare organizations to develop their own digital health solutions to address long-standing gaps in care management and coordination, particularly as the technology becomes more sophisticated. Several health systems – including Penn Medicine – have set up their own digital innovation labs, and some have launched companies out of those labs to market their products.
It also highlights the need for innovative digital health solutions that can address gaps in care, particularly in inpatient settings where a patient with complex healthcare needs is being managing by a team of care providers not always in the same room, or even the same building. Through virtual care platforms and mHealth devices, those providers now have opportunities to collaborate and coordinate online.
According to executives, CareAlign was developed in 2014 in the health system’s Center for Health Innovation after Penn Medicine Chief Medical Information Officer C. William Hanson II, MD, asked Airan-Javia to design a tool that would “make the workflows around patient care easier and more efficient to manage.” The platform was originally designed to address hand-offs, then expanded to include overall care coordination, including digital rounding.
Airan-Javia and her team then introduced the tool to clinicians in Penn Medicine’s three Philadelphia hospitals. By 2020, they said, it had been adopted by 159 out of a possible 169 primary inpatient services.
“One way to interpret this finding is that users of this system are now able to review data to satisfy clinical questions more often, whereas, before, the accessibility of data made it more challenging,” Jacqueline Soegaard Ballester, MD, a surgical resident at Penn Medicine who served as lead author for the study, said in the press release. “Another interpretation is that with increasingly accessible data, more users are learning to incorporate this information into their work more often and in new ways. Increasing access to data may, in turn, help providers make more informed decisions and progress patient care more quickly.”
“Anything we can do to reduce clerical burden in healthcare is a step in the right direction,” she added. “That frees up clinicians to dedicate more time to non-clerical tasks and/or care for more patients. This is especially important given the increasing rates of burnout in the medical profession and the challenges we are facing amid the COVID-19 pandemic.”
The Kansas City-based health system has opened an inpatient virtual nursing unit that is managed almost entirely by nurses, and is fielding calls from health systems across the country interested in the concept.
A Kansas City–based health system is putting nurses at the center of the virtual care platform and seeing positive results not only in patient and nurse satisfaction, but clinical and business outcomes as well.
Saint Luke's Health System opened its virtual nursing unit in 2018. Launched by Susie Krug, chief nursing officer at Saint Luke's East Hospital in Lee's Summit, Missouri, the unit sits on a telemedicine platform built by Teladoc Health and managed by nurses at the health system’s technology center in downtown Kansas City.
"It's a new model of care," says Jennifer Ball, the health system's director of virtual care. "It's there to [help] the nurses as well as the patients, with a focus on virtual care. Virtual everything is going to be our future."
Jennifer Ball, director of virtual care at Saint Luke's Health System. Photo courtesy Saint Luke's.
It was designed, Ball says, with the idea that nurses are often the focal point of care in the inpatient wings, handling different tasks in between and around rounds and visits made by doctors and specialists. Nurses have the most contact with patients and their families, handle the administrative and educational tasks, manage bedside devices and data-gathering, even lend a hand with everything from the meals to the TV, she says.
That kind of work is why nurses have been rated the most trusted profession for 20 straight years by Gallup, but it's also why so many are dealing with stress, anxiety and burnout—and why health systems are having a difficult time filling those positions. Add in the challenges of protecting both patients and care providers during a pandemic, and the job becomes tougher.
Due in part to the shift to virtual care caused by COVID-19, many health systems are rethinking how that strategy can be scaled and sustained beyond the pandemic—not only outside the hospital but inside as well.
Saint Luke's virtual nursing unit operates on the idea that many of the tasks performed by nurses in the inpatient setting not only are repetitive but inefficient, and that a telemedicine platform that connects every room in the unit can allow nurses to manage those tasks from one place. Nurses and staff on the unit would then be freed up to focus on patient-facing care, while those in the command center would monitor the patients and enter data in the medical record.
"They chart in the same system," Ball points out, "so everything is right in" the EMR.
Early results show positive outcomes for the virtual unit. Patient satisfaction is high, and patients are discharged within two hours of the discharge order, some 20% faster than in other units, and they're also out of the hospital before noon at a 44% faster rate. This, in turn, reduces the wait time for patients in the ED and reduces the time to treatment.
Turning those metrics around, health system officials say the unit has boosted nurse morale as well, improving workforce engagement, reducing fatigue (physical and intellectual) and even improving Saint Luke's recruitment capabilities.
Ball says the health system learned quickly that a virtual nursing unit is different from any other virtual care program. Workflows must be designed specifically with nursing in mind, and often go through a few iterations before working out.
"We've changed what the virtual nurse does several times," she says. "It was challenging at first because this is a new model, and we had to learn what works and what doesn't work. And while this is [modeled] as an observation unit, it has been anything but that over the past year. "
Ball says Saint Luke's had the advantage of launching the program in a new, specially designed unit, rather than integrating it into an existing wing. She expects to integrate virtual nursing to other wings in the future, and to deal with new challenges as they expand the footprint.
"There will be some culture change involved," she says.
For that reason, Saint Luke's launched its own virtual nurses training program about a year ago, with the idea that nurses should be trained specifically in virtual care rather than brought over from another area of the hospital and introduced to it. With virtual care the emphasis is more on technology, as well as on communication. After all, sitting in a command center surrounded by six large monitors isn't quite what nurses are taught to expect in school.
"For some of the nurses, it's a lot, but for others not so much," Ball says.
And that's why education and team-building are so important to the program. Unlike many doctors, nurses work in a team setting, with the understanding that care coordination and management are group-based rather than individual goals.
"You need buy-in from nurses at the beginning," Ball says. "You can't start too early with education … and team building. In some cases, you have to sell what a virtual nurse can do," but once they see what is possible, they're invested in the program.
That goes for the patients as well. Many might wonder whether a virtual nursing unit isolates patients too much, depriving them of the in-person care that helps them adjust to being in a hospital and puts them on the path to recovery. But Ball says patients have come to appreciate the idea that they're always being looked after, and they develop connections to their virtual nurses. They identify more closely with those nurses than with the nurse who shows up when someone pushes the help button.
Just as Saint Luke's checked in on Ochsner Health's virtual nursing model as it was developing its program, Ball says she's fielding requests from other health systems who want to adopt that strategy. And she has an eye to the future as well, including integrating the virtual nursing model into existing wings and hospitals in the system.
"There's always new technology as well," she says, eyeing the fast-developing telemedicine landscape and the emergence of digital health tools, including wearables. "This [model] is going to be used in new ways in the future," such as mentoring and precepting, and integrated with other services such as the pharmacy, social workers, dietitians, and chronic care management.
Federal officials are issuing grants of between $1.4 million and $2 million to 29 community health centers across 14 states and Puerto Rico to help them expand their virtual care and digital health footprints.
The federal government delivered a much-needed valentine to 29 health centers on Monday with the release of nearly $55 million to support virtual care services for underserved populations.
The money, announced by the Health and Human Services Department through the Health Resources and Services Administration (HRSA), supports an ongoing effort by the government to help federally qualified and community health centers and rural health clinics use innovative new technologies, such as digital health tools and telehealth and remote patient monitoring platforms, to address access issues caused in part by the pandemic.
“Virtual care has been a game-changer for patients, especially during the pandemic,” HHS Secretary Xavier Becerra said in a press release. “This funding will help health centers leverage the latest technology and innovations to expand access to quality primary care for underserved communities. Today’s announcement reflects the Biden-Harris Administration’s commitment to advancing health equity and putting essential health care within reach for all Americans.”
“Today’s awards will help ensure that new ways to deliver primary care are reaching the communities that need it most,” added HRSA Administrator Carole Johnson. “Our funding will help health centers continue to expand their virtual work while maintaining their vital in-person services in communities across the country.”
Through the American Rescue Plan and efforts like the Federal Communications Commission’s COVID-19 Telehealth Program and Connected Care Pilot Program, federal officials are looking to build momentum for virtual care services, which were mired in a low adoption rate prior to the pandemic but have seen a surge over the past two years.
Health centers have been especially busy, reported a 6,000% increase in virtual visits and a 130% percent increase in centers using digital health from 2019 to 2020. There are more than 1,400 of them scattered across the country, serving some 29 million people a year, the majority of which are living at or below 200% of the federal poverty line and faced with financial, societal and physical barriers to accessing care.
While this increase in the use of virtual care is good, it may also be unsustainable. Much of the growth is tied to emergency federal and state waivers issued during the public health emergency to expand access to and payer coverage of virtual care during the pandemic. Some states have made improved their virtual care guidelines since then, but many of those waivers will end when the PHE does, forcing care providers to drop services that are no longer sustainable.
Support has been growing to pressure Congress to make many, if not all, of those waivers permanent. In January some 336 organizations, led by the American Telemedicine Association (ATA), Healthcare Information and Management Systems Society (HIMSS), College of Healthcare Information Management Executives (CHIME), Consumer Technology Association (CTA), Alliance for Connected Care and others, sent a letter urging Congress to enact permanent telehealth reform.
Researchers at the University of Miami School of Medicine have launched an NIH-funded study to create a 'digital twin,' which would stand in for the patient on any tests or new treatments to determine whether they're effective.
Researchers at the University of Miami Miller School of Medicine are creating a “digital twin” that would replace the patient during tests and treatments.
Called the MLBox, it would use digital health wearables and smart devices in the home to collect biological, clinical, behavioral and environmental data on a patient, then create a model that could be used to test out new treatments before they’re tried on the actual patient.
The project is being spearheaded by the Miller School’s Media and Innovation Lab (TheMIL), along with Amazon Web Services and the Open Health Network, and will initially focus on treatments for sleep issues, such as sleep apnea, and their link to serious health concerns like dementia and heart disease.
“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.”
Seixas will be working on the project, which is funded by the National Institutes of Health, with Girardin Jean-Louis, PhD, director of the Translational Sleep and Circadian Sciences Program and professor of psychiatry and behavioral sciences.
Through the use of sensors and digital health devices, the MILBox will develop and analyze a patient’s sleep patterns, weight, environmental pressures and stress levels. The data will be gathered over seven consecutive days to create a biological health algorithm, which would act as a patient’s digital twin.
The idea is to create a model that will stand in for the patient, allowing care providers to study how a certain drug or treatment works without putting the patient through any stress or danger. For example, it would allow doctors to identify and design a treatment for a specific type of allergy without needing to run the patient through a battery of tests to identify to what the patient is allergic.
“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,” the press release stated. “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.”
Much of the work will be done on the PatientSphere 2.0 platform developed by the Mountain View, CA-based Open Health Network. Officials say the platform will be device-agnostic and scalable, so that more sensors and devices can be added and more data collected to address other health concerns.
“You will be able to add and subtract different devices based on the use case,” Seixas said in the press release. “We’ve designed this to be future-proof and support our larger mission of creating a new kind of personalized health care.”
The program enrolled its first participants in late 2021, and officials hope to have as many as 1,500 participants this year.
A new survey conducted by the University of Michigan and supported by the AARP finds that less than one in every three seniors is using an mHealth app, andf those numbers are even lower for seniors who should be using them.
Senior care advocates say mHealth apps could do a world of good for people over 50 who want to live healthy lives and stay in their own homes, but a new survey finds that less than a third actually use that resource.
According to an online and phone survey of some 2110 seniors ages 50-80 taken in August 2021 by the National Poll on Healthy Aging, based at the University of Michigan Institute for Healthcare Policy and Innovation and supported by the AARP, only 44% have ever used an mHealth app, and only 28% are using one now. That’s stunning news considering the emphasis being put on virtual care these past two years to deal with the pandemic.
“Now that most older adults have at least one mobile device, health-related apps can provide an opportunity to support their health-related behaviors, manage their conditions and improve health outcomes,” Pearl Lee, MD, MS, a geriatrician at Michigan Medicine who worked on the poll report, said in a press release.
Indeed, not only do most seniors either have a smartphone, laptop, tablet or computer, but there are more than 350,000 mHealth apps to choose from, offering help with and resources on chronic care management, cognitive and behavioral health, diet and exercise, even on-demand access to primary and specialty care services.
Yet 56 percent of the seniors surveyed said they’d never used an app. And those who are in poor health, or with lower levels of income or education (often part of a population that faces barriers to accessing the care they need), are far less likely to have used or be using apps.
For example, only 14% of seniors surveyed who live with diabetes are using an app to manage their medications, and just 28% are using an app to manage their blood sugar levels. When asked specifically if they used continuous glucose monitors, which are wearable and allow people to track and manage their blood glucose numbers in real time, just 11 percent said they use the devices, and yet 68 percent said they’d heard of the devices and more than half expressed an interest in trying them.
The AARP, which has long been an advocate of the use of digital health tools to help older Americans live longer and better lives, sees that interest as a good sign.
“AARP’s research has found a sharp increase in older adults purchasing and using technology during the pandemic, and many are interested in using technology to track health measures,” Indira Venkat, the organization’s vice president of consumer insights, said in the press rleease. “With more people 50+ owning and using technology, we may start to see an increase in older adults using apps to monitor their health.”
Of those seniors who are taking advantage of this resource, 34% are using apps to track exercise and 22% are monitoring nutrition. About 20% are using apps to manage their weight, 17 percent are tracking sleep, 9 percent are monitoring their blood pressure, 8 percent are using them for meditation, and just 5 percent are using apps to access mental health or stress management resources.
Among the seniors surveyed who aren’t using mHealth apps, roughly half said they aren’t interested (a better word might be ‘motivated’), 32% said hadn’t thought about using apps, 20 percent weren’t sure if they would be helpful and 14 percent said they are uncomfortable with the technology.
These results aren’t earth-shattering – many surveys have reported low adoption of mHealth resources among the senior population over the past decade. But the results once again point a finger at the healthcare industry for not emphasizing the value of mHealth apps to seniors.
Advocates say more health systems should make digital health education and access an integral part of senior care management and coordination strategies, and care providers should take the time and effort to help seniors understand where to access and how to use the technology.
Privacy and security concerns may play a part as well. According to those surveyed, just 23 percent were very confident that their personal health information is sure on mHealth apps, while 58 percent were somewhat confident and 20 percent had no confidence in mHealth app security.
That includes putting more effort into targeting mHealth resources at seniors who could really use them. Only 15 percent of seniors with annual incomes less than $30,000 use mHealth apps (compared to 43 percent of seniors with incomes greater than $100,000), and those with college degrees are more than twice as likely to use apps as are those who hadn’t completed their high school education. In addition, seniors who reported being in good, very good, or excellent health were more likely to use apps than those saying they’re in poor or fair health (29% to 21%).
“People who describe their health as fair or poor – the people who might be most in need of the kind of tracking, support and information a good health app can give – were significantly less likely to use such apps than those who say they’re in excellent, very good or good health,” Preeti Malani, MD, an infectious disease physician with training in geriatrics at Michigan Medicine who directed the poll, said in the press release. “Health providers should consider discussing the use of health apps with their patients, because one-third said they had never thought about using one.”
A new program sweeping across Canada enables healthcare providers to prescribe a year-long pass to the country's national parks for patients dealing with mental and physical health concerns.
Healthcare providers in four Canadian provinces are taking a unique approach to addressing soaring rates of depression and anxiety: they’re prescribing nature.
Doctors, nurses and other providers are prescribing year-long Parks Canada Discovery Passes, worth roughly $70, to patients struggling with mental and physical health issues through a national program called PaRx, or A Prescription for Nature. The prescription offers unlimited admission to more than 80 national parks, national historic sites and national marine conservation areas.
“I can’t think of a better way to kick off 2022 than being able to give the gift of nature to my patients,” Melissa Lem, MD, a family physician and Director of PaRx, said in a blog by the BC Parks Foundation, which launched the program in November 2020. “There's a strong body of evidence on the health benefits of nature time, from better immune function and life expectancy to reduced risk of heart disease, depression and anxiety, and I’m excited to see those benefits increase through this new collaboration.”
The program was started in British Columbia and has since been adopted in Ontario, Saskatchewan and Manitoba, with more than 1,000 healthcare providers registered. It won a prestigious Joule Innovation prize from the Canadian Medical Association and was recognized by the World Health Organization in its recent COP26 Special Report on Climate Change and Health.
Lem and other others supporting the program say it encourages people with stressful health concerns, particularly behavioral health issues like depression and anxiety, to get out and enjoy nature, and that studies have proven the beneficial effects of being outdoors.
“We see health benefits in all sorts of different spheres,” Angie Woodbury, a student at the Max Rady College of Medicine, part of the University of Manitoba, and an active participant in and researchers for the PaRx program, said in a January 2022 story published by the university. “In cardiac health, in stress and anxiety, in pain, energy and mood, things like that. We know that spending two hours … in nature reduces your levels of the stress hormone cortisol.”
“A lot of people are under the assumption [that] you’re healthy if you take your medications and exercise, or go to the doctor,” Woodbury added. “But [roughly] 80% of your health has to do more with social determinants of health, the built environment that you live in — your level of income, whether you’re able to afford medications or healthy foods. Social prescribing is trying to address those other things that impact your health.”
And they’re not stopping there. Lem recently told the Canadian news service TriCity News that the program is looking to partner with transit organizations to provide free transportation to parks for new Canadians and inner-city residents.
“We need to reduce barriers to nature,” she said, adding that she hopes the entire country will participate in the program by the end of this year. The park pass prescription “makes the message even more powerful and easier to follow. It is a big deal.”
The state of Michigan is funding a one-year study at the Children's Healing Center, which is expanding its programs to include play and recreation therapy, social and emotional support programs and caregiver resources, many of which aren't covered by Medicaid.
The state of Michigan is funding a study that will analyze how play and recreation therapy, social and emotional support programs and caregiver services can improve life for children with complex medical conditions and their families.
State officials have budgeted $900,000 for the Children’s Healing Center, which opened in Grand Rapids in 2015. The grant will support a 12-month program launched in October 2021 by the center and Priority Health, a Michigan-based health plan, to offer expanded services for 100 children and their families and study the value of caregiver-focused resources and play therapy, which are not traditionally covered by Medicaid and thus often out of reach for many families.
“This new pilot will make a huge difference to families in our community who have kids with complex medical conditions,” Children’s Healing Center CEO Amanda Barbour said in a press release. “Clinical studies consistently reinforce the healing power of play, yet access to play is not always easy for our families. By providing hospital-grade facilities that focus on cleanliness, we make play safe and fun – and that translates into fewer inpatient hospital stays and other improved outcomes.”
“We are thrilled to work alongside the team at the Children’s Healing Center to help provide critical and transformative emotional and social care to our most vulnerable populations here in West Michigan,” said Priority Health President Praveen Thadani, whose organization is helping to identify and enroll the 100 children and their families and will be responsible for data collection and identifying benchmarks. “Our goal is to help individuals live healthier lives, and that is why we work closely with our provider partners to implement value-based arrangements that result in better patient outcomes and lower overall cost of care. This pilot program is a launch pad for future innovations that rethink the way in which care is delivered.
The center will submit a report in September that will analyze the program’s value, utilization trends and health outcomes associated with isolation and loneliness, mental health concerns, emergency department visits and hospitalizations. That study will help state officials in deciding whether to support similar programs for Medicaid recipients in the future.
The 7,200-square-foot center is designed as a germ-free environment, and id divided into four zones: active fitness, art and learning, exploratory play, and technology. Programming is available for children up to age 26 and their caregivers.
The Hudson Headwaters Health Network is seeing significant interest in its new mobile health unit, a specially designed vehicle to take healthcare right to the people.
A network of community health centers in upstate New York has started using a mobile medical unit to help remote patients—including students at a small college campus—access care. And officials say the fledgling program could eventually lead to a mobile health fleet.
The Hudson Headwaters Health Network, based in Queensbury, rolled out its first van shortly before winter, with scheduled stops in three small communities (a fourth stop, at the SUNY Adirondack campus, has since been added). The 40-year-old network of 21 community health centers used a $1 million grant and added close to $2 million in fundraising to support the service.
The mobile unit addresses a growing problem in rural areas like northern New York, where healthcare providers are scarce and health insurance is often a luxury. FQHCs and rural health clinics (RHC) are often the only resource for residents' basic healthcare needs if they can the time and make the effort to travel to a clinic.
But a clinic that can travel to these small towns makes a big difference.
Jessica Rubin, vice president of philanthropy and communications at the Hudson Headwaters Health Network. Photo courtesy HHHN.
"The idea was to do what we do best," says Jessica Rubin, HHHN's vice president of philanthropy and communications. "We provide primary care, and when you can't build any more brick-and-mortar [locations], mobile is the best way to reach people."
The idea of putting healthcare on wheels isn't necessarily new, dating back to the first house call. But the advent of digital health technology and an emphasis on taking healthcare to people who normally can't or don't access care is giving these programs added value.
According to research published in 2020, there are roughly 2,000 mobile health clinics operating in the U.S., providing an average of almost 3,500 annual visits. Slightly less than half are federally funded, and about 30% are affiliated with a health system (about a third are independent and 24% are affiliated with a university). They focus on primary care and prevention, and serve an equal mix of insured and uninsured patients.
Nowadays mobile health units can be seen in many large cities, offering everything from primary care to specialty services like behavioral health, substance abuse care, and sexual health information in underserved neighborhoods. And they're starting to show up in small towns and rural areas where providers are scarce and travel to the nearest clinic or hospital can be tough.
These vehicles are often repurposed or specially designed RVs to replicate the clinic or doctor's office, and containing the technology necessary to conduct exams and some tests, connect virtually with healthcare providers, and link with the electronic medical record.
Rubin says HHHN worked with a company that manufactures food vans—an industry that faces similar regulations regarding delivery vehicles—to design the mobile health unit. It includes two exam rooms, an area set aside for tests, some telehealth capabilities, and a refrigerator for storing medications.
John Dudla, CIO of the Hudson Headwaters Health Network. Photo courtesy HHHN.
"It operates pretty much as if we were in a brick-and-mortar building," says John Dudla, the health system's chief information officer. "Although when you take something on the road, there are a bunch of challenges to think about."
For example, HHHN must work with each community it visits to find a good location to park the van for the day, allowing visibility and easy access for patients. In Salem, New York, it's parked at the courthouse, while in Lake Luzerne the van sits outside town hall. In Whitehall, it is parked next to the town's recreation center. The vehicle can't be parked overnight, at least during the winter, when low temperatures might damage the medications stored inside. That's why HHHN chose its first sites within an hour of the home base.
While HHHN looks for sites with Wi-Fi access, the vehicle does have a mobile hotspot for backup and makes use of cellular services when it can. Internet connectivity must be worked out well in advance, as many small towns don't have reliable broadband capability, and the mobile crew can't just pull into the parking lot of a Starbucks or McDonald's and tap into their Wi-Fi.
Rubin says it's important to meet with the community prior to setting up shop—not just to sign all the necessary paperwork, but to push the narrative that a mobile health unit is just the thing for people who can't or don't want to go to the doctor's office.
"We'll be asked, 'Who is this for?' It's for anyone and everyone," she says. "It's important to get that word out so that [people] know we're here and what we do."
What the mobile unit doesn't have is a waiting room, which is not a big problem during the warmer months, but can be a hassle during winter. Dudla says HHHN is encouraging people to schedule appointments through its mobile devices. Using the devices, people can register and submit needed information on-site through a digital health platform developed by Florida-based Qure4u.
The services offered through the mobile medical unit focus on primary care: family and internal medicine, pediatrics, well child services, gynecological care, screenings and immunizations, voluntary family planning, care management and health education, along with some scheduled lab tests.
The van has become an important resource during the pandemic, giving these small upstate New York communities access to both testing and some vaccinations. It was especially helpful last autumn, Dudla says, in providing testing services for several apple orchards, where Jamaican immigrants are often employed during harvest season.
Rubin says the mobile health program's future offers lots of options and opportunities, provided the program can secure long-term funding. And by the growing number of patients HHHN is seeing at each of the four locations, she knows the need is there.
"In one word, it's all about access," she says, adding that HHHN is fielding calls all the time from other communities interested in hosting the mobile unit. "It's the next generation of access in healthcare. It literally drives our mission. And I feel like every day we're learning something new about it."
"Primary care is shifting all the time," adds Dudla, who's crunching the numbers to see what services and locations are generating demand. "We can use this to fill in the gaps."
