Researchers at Washington State University have added digital health sensors to a pacifier in an effort to help pediatric care providers, such as NICUs, monitor and treat infants for dehydration.
Researchers at Washington State University have developed a pacifier fitted with digital health sensors that's designed to help care providers continuously monitor sodium and potassium ion levels, two key indicators of dehydration in infants.
“We know that premature babies have a better chance of survival if they get a high quality of care in the first month of birth,” Jong-Hoon Kim, an associate professor at the Washington State University School of Engineering and Computer Science and a co-corresponding author on the study, said in a press release issued by WSU. “Normally, in a hospital environment, they draw blood from the baby twice a day, so they just get two data points. This device is a non-invasive way to provide real-time monitoring of the electrolyte concentration of babies.”
The pacifiers contain sensors that measure sodium and potassium in saliva, relaying that data through the cloud via a Bluetooth connection to an app on the caregiver's phone, tablet or laptop.
Aside from the challenges of drawing blood samples from infants, especially those born prematurely, the smart pacifier offers care providers an opportunity to view continuous data, rather than relying on information gathered once or twice a day. And the platform could eventually be expanded to include more sensors tracking more biometric data points.
The technology holds promise for neonatal intensive care units, where care providers are charged with treating some of the most fragile patients in the hospital system.
“You often see NICU pictures where babies are hooked up to a bunch of wires to check their health conditions such as their heart rate, the respiratory rate, body temperature, and blood pressure,” Kim said. “We want to get rid of those wires.”
Beyond that setting, the smart pacifier could be used in pediatric clinics, medical offices, even in remote patient monitoring programs that allow healthcare providers to track their young patients' progress at home.
Researchers say the next step is to reduce the cost of the smart pacifier by using more affordable and recyclable materials, and to expand the study to more health systems to establish efficacy.
A new C-Suite survey by West Monroe finds that health system leaders looking to establish a digital health strategy are challenged most by attracting and keeping IT talent and understanding how to define digital health.
Workforce shortages in the healthcare industry aren't limited to clinical care. A new survey finds that more than a third of health system leaders are worried about how to staff and maintain their IT departments.
The Q2 C-Suite Healthcare Poll, issued this month by West Monroe, finds that health systems are faced with unique challenges in expanding their digital health footprint, beginning with increased competition and including a difference of opinion on definitions.
According to the survey, some 34% of C-Suite executives said their biggest challenge when activating digital strategies was in attracting and retaining talent for digital health. And when asked for the biggest impacts from inflation, 68 percent picked wages and another 59 percent selected talent recruiting or retention.
This comes at a time when the healthcare industry is expanding, largely due to the advent of digital health and telehealth platforms that are attracting new players to the sandbox. Health systems now have to contend with competitors using virtual health to attract new business, as well as stand-alone clinics, retail giants like Amazon, Google and CVS Health, and telehealth companies with their own ranks of providers.
The topic came up at the recent American Telemedicine Association conference in Boston, during which Joseph Kvedar, a Harvard Medical School professor and longtime digital health expert, pointed out that there’s an ongoing “battle for primary care.”
Some experts say that healthcare will struggle to attract and keep IT talent because health systems don’t have the budgets to pay those people at the same rate as Amazon, Google or even many healthcare IT companies.
Aside from staffing the IT department to handle digital health initiatives, some 32 percent of executives surveyed by West Monroe said their biggest challenge is a lack of industry consensus on the definition of digital health. This points to a long-standing challenge facing the healthcare industry: The many names and phrases associated with innovative technology, including telehealth, telemedicine, mHealth, digital health, connected health, virtual care, telecare, i-health, and mobile health. Add to that the nuances of remote patient monitoring, remote physiological monitoring and remote therapeutic monitoring, as well as telemental health, telebehavioral health, and so many other tele-services, and the list grows.
The problem isn’t just with semantics. Payers (including the Centers for Medicare & Medicaid Services) often have specific definitions for the services they will or won’t cover, and a healthcare provider who defines digital health or telehealth differently risks losing out on reimbursement. Likewise, how a certain service is defined may affect how it’s managed, staffed and budgeted.
Aside from those two issues, the third challenges identified by healthcare executives in activating digital strategies is a lack of alignment of business and technical priorities, cited by 18% of those surveyed. This number may rise as more healthcare organizations adopt value-based care and struggle with how to identify the value of the digital health program.
Beyond that, according to the survey, 6% identified technology debt and 5% cited identifying, building, and governing uses cases.
“Taken together, an entire 84% of respondents indicated that the industry is facing fundamental misalignments when it comes to digital health,” the West Monroe survey states. “This dramatically underscores the need we see for redirecting some of the attention away from fancy technologies and focusing on conceptual and operational readiness to bring those technologies in the healthcare fold. Only in this way will those technologies make the impacts they’re designed to make—and make them continuously over time.”
Bon Secours Mercy Health is launching a new program for roughly 8,000 patients in Ohio living with chronic kidney disease or end-stage kidney disease that uses technology and multidisciplinary teams to improve chronic care management.
Bon Secours Mercy Health is launching a new program aimed at improving care management and coordination for an estimated 8,000 patients in Ohio who are living with chronic kidney disease (CKD) and end-stage kidney disease (ESKD).
In a partnership with Denver-based Strive Health, the Cincinnati-based health system, which includes 50 hospitals across several states, will use a technology platform and “Kidney Heroes” interdisciplinary care teams composed of nurse practitioners, dietitians, pharmacists, care coordinators and licensed clinical social workers to create a personalized care plan for patients. Among other things, the platform will allow care providers to chart the progression of the disease and the patient’s risk for hospitalization.
The program brings new technologies and strategies to bear on chronic care management, and builds on the idea of extending care outside the hospital, clinic or doctor’s office and into the home, where the patient and care team can collaborate on services. This includes using AI-enhanced technology to design a holistic profile of the patient and identify care needs and gaps.
In an e-mail Q&A with HealthLeaders, Chief Population and Community Health Officer Jean Haynes explains how the program will work.
Q. How will clinical care be delivered under the new model of care?
JH: Strive will deliver additional, specialized clinical services to Mercy Health’s kidney disease patients as an extension of the care already provided by the Mercy Health care team and physicians. The goal is to move upstream in the kidney disease journey and help patients better understand and manage their conditions to slow progression of disease. Chronic Kidney Disease (CKD) affects more than one in seven American adults and 90% do not know they have kidney disease. One in three adults is at risk for developing CKD, making early diagnosis and treatment intervention critical to helping patients stay healthier longer.
Q. How is this different from the "old" model of care?
JH: Technology-enabled data insights allow us to identify and intervene earlier in a patient’s kidney disease journey. … We will be able to identify patients needing earlier outreach and support services including nutrition education, social work services, complex medical coordination, and more.
Q. How will this improve clinical outcomes?
JH: [The} care model combines technology-enabled earlier identification coupled with robust clinical support services to address each patient’s individual, whole-person care needs. By helping to educate patients about their kidney disease and the care options available to them, we can address barriers to medical access that often go unmet, resulting in both an unplanned and unnecessary hospitalization. By reaching patients sooner, we can slow progression of disease, help patients navigate transplant programs, help patients select renal replacement therapies at the right time and increase home dialysis utilization, while helping them to manage other medical conditions. {The] care team is available 24/7 and can meet with patients in their preferred setting (in-person, virtual, telephonic).
Q. What does this mean for the health system? How does it help your doctors and nurses (i.e. workflow changes)?
JH: Bon Secours Mercy Health has been focused on value-based care for many years, and our relationship with Strive helps us elevate our ability to reach patients in their communities and homes to continue delivering care at the right place and the right time. Mercy Health’s physicians and clinical care team coordinate and deliver care through a seamless continuum for their patients, working closely with Strive’s Kidney Hero care team. Strive adds both scale and specialized focus to our already strong primary care network capabilities.
Q. Will new technology (digital health, telehealth, RPM) play a part in this new model of care?
JH: Wherever possible, we will implement technology to be more efficient and provide care in a setting that meets patients’ needs. Bon Secours Mercy Health has been investing in digital strategies for years, and the pandemic highlighted the need to bring them to our patients as quickly as possible. We’ve been using telehealth, digital health, and remote patient monitoring, and we would expect to utilize these tools with our kidney disease patients wherever it is appropriate and desired.
Q. What are the challenges you're addressing in implementing this model?
JH: Early identification of patients with CKD: Technology-enabled data insights allow us to identify and intervene earlier in a patient’s kidney disease journey. … We will be able to identify patients needing earlier outreach and support services including nutrition education, social work services, complex medical coordination, and more.
Preventing crash starts for dialysis: Unfortunately, across the country, over 50% of dialysis starts are unplanned. The majority of ESRD patients receive dialysis treatments in a dialysis center. Our goal is to ensure that every patient who has the desire and meets the criteria for home dialysis is provided that opportunity.
Q. How will this platform evolve?
JH: Our initial focus is with the Medicare population, with the intention to expand.
Q. Do you anticipate using this model or applying this strategy to other chronic care populations?
JH: Yes, we currently do this today. We support eight ACOs/CINs across four states. Each of these CINs provides whole person care for populations which include commercial, Medicaid and Medicare. Focusing on whole person care has provided great outcomes and experience for the patients we serve.
Q. What one piece of advice (non-vendor-specific) would you give to other health systems considering this model of care?
JH: Health systems can and should play a critical role in the redesign of how care is provided for patients with kidney disease. [The Centers for Medicare & Medicaid Services] has been very clear that kidney care as a specialty will be a focus area for the Innovation Center moving forward, as evidenced by programs like CKCC (Kidney Care Choices) and ETC (ESRD Treatment Choices). Second, we believe there is a great opportunity to partner to quickly build and scale these new clinical capabilities.
The University of Missouri is partnering with Cognoa on a Project ECHO telemedicine program that will help train rural and remote primary care providers to use digital health technology to diagnose autism spectrum disorder (ASD).
The University of Missouri is launching a telemedicine program aimed at helping rural and remote primary care providers use digital health to diagnose children living with autism.
The university’s ECHO Autism Communities Research Team is partnering with pediatric digital health company Cognoa on the project, which will train remote PCPs on a Project ECHO telemedicine platform to use Cognoa’s Canvas Dx in the diagnosis of autism spectrum disorder (ASD).
“We are excited to incorporate Cognoa’s Canvas Dx within our existing diagnostic model in hopes of expanding primary care physicians’ tools to reliably identify and diagnose children with autism,” Kristin Sohl, MD, executive director of ECHO Autism Communities and a pediatrician who specializes in autism at University of Missouri Health Care, said in a press release. “We are continuously exploring how innovations like Canvas Dx may help streamline the pathway to care, make more efficient use of specialty centers, and drive down wait times in a way that overcomes geographic and socio-economic barriers.”
The project aims to help PCPs who may not have easy access to resources to coordinate and manage care for their patients living with autism, and it may help prove the value of virtual care and digital health tools in treating this population.
And it’s a significant population. Studies estimate as many as one in every four children is at risk for a developmental delay, while one in 44 are affected by ASD. Autism can be diagnosed in children as early as 18 months, yet many aren’t diagnosed until they’re 4 years old. Earlier interventions, especially prior to age 3, can significantly improve lifelong outcomes.
Telehealth advocates say those interventions can be improved by giving primary care providers access to more resources through digital health and telehealth channels, enabling those providers to connect with families in their homes or community health clinics instead of making them drive to a distant clinic or specialist.
The study, conducted by the University of Missouri’s ECHO Autism Communities Research Team, will connect as many as 15 primary care providers in both rural and suburban areas of the state and involve as many as 100 children in their care who are at risk of ASD or developmental delay.
The Project ECHO (Extension for Community Health Outcomes) platform, developed in 2003 at the University of New Mexico, enables experts at a large health system or teaching hospital to mentor and train rural care providers on a specific topic through a hub-and-spoke telemedicine model.
Classified as software-as-a-medical device (SaMD), Canvas Dx uses AI technology to help clinicians identify signs of autism in children between the ages of 18 and 72 months who are at risk of developmental delay. It includes a questionnaire for the parent/caregiver, a separate questionnaire completed by a video analyst who reviews two videos of the child recorded by the parent/caregiver, and an HCP questionnaire completed by the PCP who meets with the child and parent/caregiver, with the data gathered through a telehealth portal.
“We are excited to collaborate with the ECHO Autism team to evaluate how Canvas Dx can support physicians to diagnose or rule out autism in the primary care setting,” Sharief Taraman, MD, Cognoa’s chief medical officer, said in the press release. “The demand for diagnosing children at risk of developmental delay far exceeds the ability of prevalent processes to provide timely diagnosis. ECHO Autism is an exemplary model to increase the capacity of care for children with neurodevelopmental conditions. Through this study, we hope to learn that the combination of Cognoa’s … technology, along with improvements in clinician knowledge, clinical expertise and longitudinal care that is the basis of ECHO Autism, can improve the quality of care for children and families.”
Illinois-based Blessing Health is one of three health systems involved in a pilot to test the innovative platform in a rural setting, where these services could be a lifeline for struggling hospitals.
An Illinois-based health system is taking part in a unique Hospital at Home project aimed at proving the platform's value for rural healthcare providers.
The Blessing Health System is one of three rural health networks (along with Appalachian Regional Healthcare, serving parts of Kentucky and West Virginia; and Wetaskiwin Health Center, part of the Alberta Health Services network in Canada) to test the model, which combines telehealth and digital health tools with in-person services to treat patients, who would otherwise be in a hospital, at their home. Blessing Health is running the program on a technology platform developed by Boston-based Biofourmis.
"This is transforming how we are able to care for patients needing acute care services," says Mary F. Barthel, MD, the health system's chief quality and safety officer. "Instead of providing care under our roof, we're going to provide care under theirs."
The innovative model of care was initially mapped out at Brigham & Women's Hospital in Boston, then molded into a program by the Centers for Medicare & Medicaid Services (CMS). More than 200 hospitals have taken advantage of CMS waivers on telehealth access and coverage during the pandemic to launch Acute Hospital at Home programs.
Blessing Health is following a slightly different path, one that focuses on how this model can help rural health systems, which are struggling to stay afloat. While larger and urban health systems may have the resources in-house to handle patients with acute needs, rural hospitals often lack those resources or have limited access to providers, forcing them to transfer patients to other hospitals when they should be keeping them closer to home.
"It's important for us to be able to keep our capacity," says Barthel, whose tertiary care, safety-net hospital is the largest in more than a 100-mile radius. "We want to be able to care for our patients in our [communities] when we can, and this will help."
A New Strategy for Rural Healthcare
Roughly one year ago, Blessing Health joined the Rural Home Hospital program developed by Ariadne Labs, a joint center for health system innovation overseen by Brigham and Women's and the Harvard T.H. Chan School of Public Health. Using funding from the Spark Grant Program, Ariadne Labs used the Brigham and Women's Hospital at Home model and fine-tuned it for use in rural locations.
"Nearly 80 percent of rural America is deemed medically underserved by the federal government," the organization says on its website, explaining the Rural Home Hospital program. "One in five Americans live in rural areas and depend on their local hospital for care, but rural hospitals are closing and consolidating in record numbers. Residents must drive farther not only for emergencies but for the kinds of diagnostic tests and treatments usually provided in a hospital."
Ariadne Labs partnered with the University of Utah Health system in 2019 to test the model in two remote Utah communities, and is conducting a feasibility study with funding from the Rx Foundation to measure outcomes in rural Utah. More recently, Ariadne Labs has partnered with the Thompson Family Foundation on a three-year project to conduct randomized, controlled pilots of the model at Blessing and the other two rural locations. The organization is also working with the Indian Health Service and First Nations to launch pilot programs for Native American communities.
Under the model of care being tested at Blessing and the other two sites, patients are screened in the Emergency Department and, if they meet qualifications, are sent home with a tablet for telemedicine visits and the appropriate digital health monitoring devices, if needed. A specially trained nurse visits the patient twice a day, and the patient meets with a clinician via the tablet once a day. Vital signs are captured via digital health devices and relayed to the care team, and the patient can connect with that team at any time via the tablet.
Barthel says Blessing Health tried to stand up a remote patient monitoring program to handle patients infected with COVID-19, but "it didn't get off the ground quite as we expected." With the Rural Home Hospital program, she says, Blessing is looking beyond the pandemic. They want to take care of patients dealing with certain infections, pneumonia, congestive heart failure, and COPD, who might otherwise spend three or four days in the hospital.
"These are patients who need [acute care services], but if they could sleep in their own beds, they might do better," she says. Those being treated at home rather than in a hospital tend to sleep better and longer and get more exercise, and they're often in a better frame of mind to follow doctor's orders and manage their medications, she adds.
Those benefits are especially important in rural communities, where residents rely on their healthcare providers and those providers rely on their community to survive. Rural hospitals, clinics, and medical practices don’t want to send their patients away to a larger health system, which might be hundreds of miles away and a stressful journey by ambulance or car.
Barthel says the program has planned carefully to take into account what services can be provided, and to include local healthcare providers who can provide those services. In addition, it may take a little bit of coaxing to convince patients that they'll get the care they need.
"There are patients who come to a hospital who are not doing well, and they want to feel better before they leave," she points out. Others, she says, might not visit a doctor or the hospital at all because they don't want to be hospitalized.
Barthel also hopes to use lessons learned in this model to restart their remote patient monitoring services, saying they could be an important bridge for patients transitioning from inpatient to outpatient care.
A study conducted by Brigham and Women's has shown that the Acute Hospital at Home concept reduced the cost of care by 38% per patient, while also reducing rehospitalizations, laboratory orders, imaging studies, consultations, and improving activity levels. Executives at Blessing Health, Appalachian Regional Healthcare, and Wetaskiwin Health Center will certainly be looking for similar outcomes in their programs, but they'll also be looking for data that shows the model can help rural providers improve outcomes and help resource-thin hospitals improve their bottom line.
Barthel says Blessing Health is taking advantage of the CMS waivers, though those will end with the COVID-19 public health emergency. They're working with the state of Illinois for public health funding and will talk to payers like Blue Cross Blue Shield for support, but long-term sustainability for this program will rely on data that proves its value.
"I think there is a need for this," she says, noting the model would help their large population of seniors, as well as young families and those living with chronic conditions.
"It's tough for people to be in a hospital when they could be at home, in their own beds," she says.
The new platform adds another player to the competitive primary care market, and could push healthcare providers, ranging from large networks to the solo doctor, to embrace telehealth and digital health as a means of keeping patients and attracting new ones.
The competition for primary care services is getting more crowded.
CVS Health has announced the launch of CVS Health Virtual Primary Care, a new telehealth service being rolled this year to CVS Caremark members and next year to eligible Aetna members. The new platform gives members an on-demand virtual care link to primary care providers, as well as urgent care, chronic care management and behavioral care services, with the option of being seen via telehealth or in person through an in-network provider or MinuteClinic visit.
“We’re meeting people where they are on their healthcare journey and providing care that is more convenient and easier to access," Creagh Milford, DO MPH, FACOI, vice president of enterprise virtual care for Rhode Island-based CVS Health, said in a press release. "When we make it simple, we can help people lead healthier lives.”
The announcement adds another high-profile player to the primary care marketplace, and may further push health systems, hospitals, medical practices and even solo doctors to enhance their virtual care presence to keep patients and attract new ones. Even now they're facing competition from telehealth vendors with their own provider resources, stand-alone clinics, health plans and retail corporations like Amazon and Walmart.
“Who’s going to win the battle for primary care?” asked Joe Kvedar, a Harvard Medical School professor and longtime digital health expert.
"I think we all agree that patients are the ultimate stakeholders," Zachariah Reitano, chief executive officer of Ro, a digital health company that started as a platform to help men with health concerns like erectile dysfunction and has now grown to include primary care services, said in a main stage keynote.
"This patient revolution, as cheesy as it sounds, is going to happen," he said.
The CVS Health announcement addresses recent surveys that a primary care visit takes, on average, 24 days to schedule, while an appointment to see a behavioral healthcare provider averages 48 days. CVS officials say their platform will "schedule timely virtual appointments with [the member's] care team."
That team, officials said, will be led by a physician who is selected by the member, and can include nurse practitioners, registered nurses, and licensed vocational nurses. The platform will include virtual access to a CVS pharmacist and "an interoperable electronic health record."
“By offering a connected care team where providers can easily exchange clinical information on behalf of their patients, and an extensive local footprint for in-person care follow-up, we’re able to provide consistent, high-quality care," Milford said in the press release. "This model shifts from reactive to proactive care that can ultimately improve outcomes and help lower costs."
In a Q&A with HealthLeaders, Jessica Beegle, senior vice president and chief innovation officer for LifePoint Health, explains how new ideas and strategies are integrated across the private health system spanning some 30 states and roughly 90 community, rehabilitation, and behavioral health hospitals.
Healthcare organizations address innovation in different ways, and with different management structures. At LifePoint Health, a Brentwood, Tennessee-based private healthcare network operating 63 community hospital campuses, 30 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care in 30 states, it's managed by Jessica Beegle, senior vice president and chief innovation officer.
As part of a continuing series, HealthLeaders is talking with executives at health systems around the country about how they define, manage, and plan healthcare innovation. Here's our conversation with Beegle on how she sees her job, and how it's so much more than "making widgets."
Q. How do you define innovation in healthcare?
JB: Innovation in healthcare is about seeking to solve challenges – access, cost, quality, efficiency, staff burnout – in new ways.
Q. Can you give an example of an innovative technology you’re now testing or using? How about an innovative strategy?
JB: Extending our ability to care for patients outside of traditional care settings and being able to engage with them where, when, and how they want to connect is a foundation of our strategy. With this in mind, one of the most exciting areas where we are expanding our work right now is remote patient monitoring. We’ve been working closely with Cadence on remote care for those with heart failure, and this work has underscored just how much remote monitoring and support can improve experiences and outcomes for patients and their families.
Jessica Beegle, senior vice president and chief innovation officer for LifePoint Health. Photo courtesy LifePoint Health.
While we have many more opportunities to support our patients outside the four walls of our hospitals and clinics in different ways, extending our reach into homes and the community, we are also very focused on supporting our nurses and physicians by bringing in tools that can remove the undifferentiated heavy lifting of some of their current tasks, in an effort to make their jobs easier. We will be announcing a new partnership along these lines in the months ahead.
Q. How should a health system integrate innovation into its mission?
JB: Every health system is unique, and every organization has to determine how and when innovation fits into its strategic plans. At LifePoint, the leadership team has made innovation one of our strategic priorities, along with things like quality and safety and talent development. Having the buy-in and strong support of company leadership from an innovation perspective is critical to our ability to try new things and freely explore opportunities that can help solve pain points for our people. We are focused on evaluating and implementing cutting-edge ideas, partnerships, and technologies that meet patient needs, drive growth, and advance our mission of making communities healthier.
As part of this effort, we created what we call LifePoint Forward, which represents our approach to cultivating ideas and investing in technology-enabled solutions to improve quality, access, and outcomes while lowering costs. Through LifePoint Forward, we are partnering with organizations that are positively disrupting the healthcare ecosystem, building companies and solutions to address new opportunities and areas of unmet market need, and buying capabilities we believe will add value to our organization, the communities we serve, and the broader healthcare system.
Q. Where do you look for innovative ideas or technologies?
JB: We take an 'outside-in and inside-out' mindset to how we approach innovation. I want to make sure that our work and the solutions we bring in or build are focused on the real, on-the-ground needs of our employees who are on the front lines working with patients. It is important for us to seek their feedback and input on what is needed within our system to help them do their jobs every day and help us collectively provide even better care and then look for technologies and solutions to address those needs.
Coupling the perspective from our people in the field with key technology leaders and investors in the market, we closely survey the best-in-class solutions available and assess whether to bring in a current technology/solution or whether there is a gap we may need to build a solution for ourselves. We are fortunate to have our joint venture, 25m Health, an in-house health tech venture studio, to build new companies that are focused on developing new technologies that may be needed within LifePoint communities and beyond.
Q. How do you get buy-in from the administration and staff for a new product or strategy?
JB: First, communication and trust are key. Every discussion I have underscores that our focus is on creating solutions that solve real, everyday problems, and why we believe a particular innovation will realistically solve an issue our teams are facing.
Innovation can be very aspirational at times. I’m the biggest fan of emerging technology and the 'art of the possible' conversations, but I try to balance my own personal excitement with the realities of innovating in healthcare. It’s hard and complicated, but with proper grounding we are making good strides to bring new innovations into our markets to positively impact our patients and staff.
We are regularly pitched by some of the smartest entrepreneurs out there, but often they are too focused on being 100 times better than the existing solutions. I coach a lot of entrepreneurs on balancing the 'art of the possible' of what their technology can do with tempering their pitch to show how they can meet their customers where they are today. This helps set the stage for traditional healthcare companies and new entrants to work well together.
We’ve built trust by listening to our teams in the field, and we maintain it by being as transparent as we can about what challenge a particular innovation is addressing – and what the adoption and implementation of this innovation will really look like. Setting proper expectations up front helps to bring internal and external stakeholders along.
We also have set clear areas of focus to help everyone understand what we are working toward. These include:
Operational Efficiency & Employee Experience: easing operational burdens for our team members by removing the undifferentiated heavy lifting so they can regain time to spend with patients, helping to bring joy back to medicine;
Care Anywhere: meeting people whenever and wherever they need to access care, regardless of the channel. We aim to extend the reach of our care teams outside of the traditional four walls of a hospital to deliver high quality, convenient care to our patients in the setting of their choosing;
Inclusive Health: supporting populations with specific needs, such as women’s health, specialty care, and behavioral health; and
Consumerism: empowering our patients by delivering the right information at the right time, in a dynamic manner, that individuals can understand, to enable them to make more informed healthcare decisions (financial transparency, care navigation, patient empowerment, etc.) for themselves or for a loved one.
Q. Do you incorporate patients/consumers in the planning process?
JB: By getting input from our employees and care settings on where technology and innovation is needed, we are directly incorporating our most important stakeholders into our decision making – both the patients and the staff who are caring for them.
Q. What are the biggest challenges to innovation in the healthcare space? What has surprised you the most about innovation in healthcare?
JB: I come from a more tech-focused background, and a challenge I’ve seen is that the technology and healthcare worlds speak entirely different languages. A big part of my job has been acting as 'chief translation officer,' bridging the gap between tech and healthcare and helping to decipher what challenges our healthcare system is experiencing and which technology capabilities exist that can help address those in a meaningful way.
This language issue is exacerbated by the fact that healthcare is incredibly complex. The industry is often criticized for being slow to adopt technology, but this caution is called for, and vital in some cases, because of the tremendous complexity that exists and the fact that human lives are always what is on the line. We don’t make widgets; we are caring for people during their times of greatest need, and we take this responsibility very seriously.
Q. What would you like to change about the typical health system to make it more innovative or accepting of new ideas?
JB: The challenges of the COVID-19 pandemic have created opportunities – an openness to new ideas, changes in regulation, an acceptance of technology, and a renewed drive to make our health system better. Change, though, which is what innovation is, requires buy-in and understanding. It takes time and focus. It can’t be a part-time job, and it can’t happen in a vacuum. A commitment to innovation has to be part of an organization’s strategy and supported by and encouraged at all levels of leadership.
But those driving innovation can’t be in an ivory tower either. They have to listen to and collaborate with the people in the field caring for the patients, and they have to strive to ensure that any new solution they bring to the table addresses a real-time challenge.
Q. What new technologies or strategies are on the horizon? What are you looking forward to trying out?
JB: I am excited about continuing to work toward extending our care teams’ reach outside of the traditional in-patient hospital setting. The COVID-19 pandemic spurred innovation and interest in receiving care through non-traditional channels, and I’m looking forward to seeing how those remote technologies continue to be used and adapted.
Propelled by more engaged consumers and available digital health devices, healthcare providers are taking that next step and replicating the physical exam at home.
Healthcare organizations are starting to look beyond the video visit to connect with patients at home, with new programs that pull in smart devices, wearables, and other digital health technology to make the experience more than just a video chat.
At MemorialCare, a health system in southern California, administrators have expanded their Virtual Urgent Care platform to include technology that allows patients to conduct guided physicals at home. In a partnership with New York-based TytoCare, the health system is sending handheld examination kits that allow users to conduct examinations of the heart, skin, ears, throat, abdomen, and lungs, and measures, among other things, heart rate and temperature.
"We can actually allow a physical exam to take place in the patient's home," says Mark Schafer, MD, CEO of the MemorialCare Medical Foundation, which comprises more than 300 primary care physicians and 2,000 specialists.
The typical definition of a telehealth visit is an audio-visual platform accessed through a computer, laptop, tablet, or even a smartphone, which allows a consumer to get in front of a healthcare provider when and where needed. That concept was pushed into overdrive during the pandemic, when telehealth use soared and healthcare organizations embraced whatever platform they could find to deliver a virtual visit in place of in-person care.
But many health systems are eager to move beyond that platform. Prodded by consumers who are adopting health and wellness technology and intrigued by digital health tools that capture more relevant data at the point of care, they're moving into remote patient monitoring and direct-to-consumer services that turn the healthcare experience into more than just a conversation.
To that end, health systems like MemorialCare are using technology to enhance collaboration between provider and patient.
"We already had the framework in place around video as one of our first virtual health tools," says Schafer. "That's a nice core capability, but digital and virtual care isn't just video. There are a lot of different ways to access healthcare."
With companies like TytoCare offering products that allow the user to collect more physiological data, health systems are looking to make digital health devices as ubiquitous in the home as the vacuum cleaner or toaster oven. These kits are now showing up in retail stores like Best Buy, Target, and WalMart, as well as in pharmacies and on Amazon. Pick one up, store it in the bathroom closet or cupboard, and pull it out when there's a health concern that would normally necessitate a trip to the doctor's office or ER.
"It changes the way we think about care," says Anne LaNova, MemorialCare's director of virtual care, who tested out the device when she was home dealing with COVID-19.
"MemorialCare is committed to finding ways to enable patients to manage their health through a personalized healthcare experience and ensure that no matter their circumstance, they have easy access to clinic-quality examinations from the comfort of home," Barry Arbuckle, PhD, MemorialCare's president and CEO, said in a press release. "TytoCare enables us to do just that."
Schafer says the challenge will lie in getting the devices into the right homes.
"There is a definite benefit to certain populations," he says, such as expectant and new mothers, families with young children, and people living with chronic conditions who have mobility issues.
While patients can choose to buy their own devices, to get those tools into the right hands, the preferred course of action is to have a care provider recommend that a patient get one (in certain instances the health system can give one to the patient). To help push this program forward, Schafer says MemorialCare started with a dedicated team of physicians and nurse practitioners, to help both patients and other care providers understand the benefits of the technology. Many new programs or strategies begin with physician champions, who help illustrate the benefits and smooth over the rough edges before a certain program is scaled outwards.
"We had to convince [our physicians], but once they tried this out, they were really impressed," says Schafer, who plans on rolling the program out to primary care physicians soon.
The next step, he says, will be collecting data from these encounters, to understand how these devices are used in virtual visits, and whether they improve the experience for patients and give providers the data they need to boost clinical outcomes. This information will enable administrators to fine-tune the program, make plans to expand its reach and— more importantly—convince payers to make this a standard of care.
"This offers a more rich physical exam and gives us more data than a video visit," he says. "We don’t think that video visits are going to go away, but it's good to have more options. The big thing is that we'll be able to try out different use cases," such as patients who often visit the doctor's office or ER for a variety of concerns.
"There's so much more that we want to do in this space," says LaNova, who envisions sending these devices to schools, businesses, urgent care clinics, and other locations to facilitate telehealth services with MemorialCare. They could also become part of the standard of care for health plans, employers, and population health programs looking to monitor and improve urgent care costs.
The devices coming onto the market now "have a lot of different capabilities," says Schafer. "We need to measure benchmarks to find out what works and what doesn't."
More than 200 hospitals are taking advantage of federal waivers to develop and manage Acute Hospital at Home programs. But those waivers won't last forever, and supporters need to prove that the concept should continue beyond the pandemic.
An innovative program that gives healthcare organizations an opportunity to provide ICU-level care for patients at home is facing an uncertain future, even though 202 hospitals and 92 health systems across the country are using it.
The Acute Hospital Care at Home program was developed by the Centers for Medicare & Medicaid Services to reduce expensive hospitalizations and give patients the opportunity to receive care at home. Healthcare organizations were encouraged to launch these programs by CMS waivers enacted during the COVID-19 public health emergency that boost reimbursements and reduce barriers on the use of telehealth and other services.
But with the PHE coming to an end, many participating health systems are scrambling to determine how to keep those programs going without the waivers – and how to redesign them to help populations other than those infected by the virus.
“It would significantly curtail the ability for these programs to either continue or expand,” says Stephen Parodi, MD, executive vice president of external affairs, communications, and brand at The Permanente Federation and associate executive director of The Permanente Medical Group.
Parodi has been guiding the hospital at home strategy at Kaiser Permanente since the health system launched its program in 2014-15. He was a participant in one of two panels devoted to the topic at the recent American Telemedicine Association conference in Boston, and he’s also part of the Advanced Care at Home Coalition (AHCAH), a group of some 20 health systems and connected care advocates lobbying the federal government to continue supporting the program beyond the end of the PHE.
Putting the Concept Into Action
Kaiser Permanente is one of several high-profile health systems that see the hospital at home strategy becoming intrinsic to value-based healthcare. The program is designed to take patients who would otherwise occupy a hospital bed and put them at home, in their own beds, while the health system designs a care plan around them that includes in-person and virtual services. Each program is different, with some health systems incorporating home health services, community paramedicine, pharmacy services, even social services.
"The whole idea of remote patient monitoring has really been taken to the next level with this type of program," Parodi says, .
Supporters say the program reduces expensive hospital stays and costs, saves hospital beds for those who need inpatient care, cuts down on adverse health events and rehospitalizations and improves clinical outcomes.
Carolyn Yang, MD, an internist with Brigham and Women's Hospital and part of their Acute Hospital at Home program and a panelist at the ATA conference, noted that their latest study saw a cost reduction of 38% in the hospital at home program when compared to inpatient costs.
"It is exciting to see this space grow fast," she said.
“We all know the best place in this world is home,” added Swetha Gudibanda, MD, a hospitalist at Wisconsin's Marshfield Clinic who appeared on the same ATA panel as Parodi. “So why not [provide that care] at home?”
Home-based care is far different from inpatient care, and these programs have to be designed and managed carefully to take into account changing workflows, on-demand access to care providers, reliable power sources, even safety and security.
Parodi noted that these programs have to build in redundancies that aren't needed in a hospital setting.
"You've got to think through all these different layers to make sure the program is safe," he said during his panel.
But the home setting also offers care providers a lot more insight into the patient, including diet and exercise habits, family interactions and other issues that might affect one's health.
"We've had instances where there's hoarding, or there [are] 40 cats, or there's a giant snake as a pet," said Margaret Paulson, DO, medical director of the Mayo Clinic's Advanced Care at Home & Home Health programs, which are serving patients in Minnesota, Wisconsin and Florida via a telemedicine hub in Jacksonville, Florida.
Parodi says the Hospital at Home program, in whatever form it's being used, "really is opening doors at a number of levels." It allows the health system to engage with patients at a new level, promoting overall and continued health and well-being instead of episodic care, and it enables providers to identify and address other concerns, including social determinants of health. And it's all built into the patient's daily routines.
"We can literally schedule around the patient's day," he says
"What we're seeing is a level of interaction that's quite different than what we've had before," Parodi adds. "And we'll continue to learn" how to improve that interaction with newer and better services, including medical management, social services and preventive care.
Looking Beyond the CMS Waivers
But that growth will need some help. With the CMS waivers due to end with the PHE, health systems are looking to augment coverage from other payers and redesign aspects of the program that won't be allowed after the PHE, such as the use of telehealth and digital health and certain home health care services. They're also looking at new business cases for the program, such as identifying other patient populations who would benefit from this type of care.
"Hospital at Home is really this shiny bright object right now, which is great, but what is the 'Why?'" asked David Houghton, MD, medical director of digital medicine at New Orleans' Ochsner Health system and an ATA panelist. And Yang, of Brigham & Women's, who was on the same panel, noted that the program "has aligned opportunities" within the payer market, "which is exciting," but more work needs to be done to establish long-term sustainability.
To help the transition from pandemic to post-pandemic healthcare, the AHCAH has thrown its support behind the Hospital Inpatient Services Modernization Act, a bill introduced in both the House and Senate that would extend the CMS waivers for the Acute Hospital at Home program two years after the end of the PHE and require CMS to issue regulations on health and safety requirements for the program, which some see as a step towards making the program more permanent.
“The benefits of advanced care at home will serve patients well beyond the pandemic,” Parodi said in a March 2022 press release by the AHCAH supporting the bills. “By extending these flexibilities, Congress will create a predictable pathway for medical professionals to fully realize advances in the care delivery system that enable patients to be treated with safe, equitable, person-centered care in the comfort of their own homes.”
At the ATA event and in a separate interview, Parodi said those with Hospital at Home programs "need to have outcomes data" to prove the program's long-term value to both Congress and CMS. He said supporters are also asking that the Center for Medicare & Medicaid Innovation (CMMI) study the program.
He said the concept offers more opportunities for health systems to partner with local and community health resources to shape healthcare delivery and push health and wellness resources. And it will help healthcare executives rethink how care is delivered within the hospital itself.
"There's a lot of innovation going on in this space … that will have an impact on healthcare," he says. "And we still have a lot to learn about how to do this."
The organizations are partnering with Brigham & Women's Hospital to create a network of eight health systems that will help other healthcare organizations integrate health equity into their quality and safety practices.
The American Medical Association and Joint Commission are partnering with Brigham & Women's Hospital to create a network of health systems that will help other healthcare organizations integrate health equity into quality and safety practices.
The Advancing Equity through Quality and Safety Peer Network launched in January as a year-long mentorship and networking program for eight early adopter health systems: The Atlantic Medical Group/Atlantic Health; Children's Hospital of Philadelphia; Dana-Farber Cancer Institute; University of Iowa Hospitals & Clinics; Ochsner Medical Center; University of Texas MD Anderson Cancer Center; Vanderbilt University Medical Center; and University of Wisconsin Hospitals & Clinics.
Those health systems will use a Quality, Safety, and Equity framework designed in 2019 by Brigham & Women's and the Institute for Healthcare Improvement (IHI) that "merges patient-centered approaches to quality and safety of care with robust structural analyses of racism and equity to support an overall mission of delivering equitable high-quality care to every single patient." They'll also convene interdisciplinary teams comprised of experts in quality and safety; diversity equity; inclusion and belonging; and population health.
The idea is to create a network that focuses on improving health outcomes for "historically marginalized populations" by training health systems to address gaps in care caused by, among other factors, social determinants of health.
“For the past two years, the COVID-19 pandemic has further exposed systemic inequities in the quality and safety of the patient care experience – including gaps in interpretation services, telemedicine access, and crisis standards of care,” AMA President Gerald E. Harmon, MD, said in a press release. “Through collaborations like the Peer Network, the AMA continues its work to remove the social and structural factors that interfere with patient-centered care – providing health systems with guidance to inform equitable solutions, dismantle inequities, and improve health outcomes for our patients from historically marginalized communities.”
The peer network will focus on four strategies:
Systematically revealing and measuring the omnipresent and toxic effects of structural racism and other inequities on the health and well-being of patients, families, health care workers and communities;
Highlighting the critical role of health care organizations in preventing inequities;
Incorporating equity into the operational DNA of healthcare delivery and innovation; and
Promoting high-quality, safe and equitable outcomes for every patient, family and community served.
“Every patient deserves the right to safe, equitable healthcare,” Joint Commission President and CEO Jonathan B. Perlin, MD, PhD, said in the press release. “The COVID-19 pandemic placed sharp focus on the unacceptable disparities in health outcomes, demonstrating significant work that must be done. All healthcare organizations have a responsibility to identify and address the disparities that their unique patient populations face."
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