With an emphasis on mobility and innovation, mobile health clinics are helping to tackle care gaps, reach underserved populations, and give hospitals a new access point.
Healthcare organizations are realizing that some services need to be brought to the consumer, rather than waiting for that person to visit a doctor. And they're using mobile health clinics to make that connection.
Mobile health clinics come in many shapes and sizes, from fully equipped, customized RVs or trailers offering a range of primary and specialty care services, to small vans with the supplies and resources needed to address one particular goal, such as sexual health education, mammography screenings, or vaccinations. They're designed to go into communities that lack brick-and-mortar healthcare resources or have populations that won't or can't access healthcare services.
"They are becoming more prevalent, in part because of the pandemic," says Mollie Williams, DrPH, MPH, a lecturer on global health and social medicine at Harvard Medical School and executive director of The Family Van and the Mobile Health Map, a resource for mobile health clinics with more than 700 members.
Mollie Williams, DrPH, MPH, executive director of The Family Van and the Mobile Health Map and a lecturer on global health and social medicine at Harvard Medical School. Photo courtesy of Harvard Medical School.
"One of the benefits of mobile health clinics is their adaptability," adds Elizabeth Wallace, executive director of the Mobile Healthcare Association (MHA), the leading membership organization for mobile health professionals in the US and Canada. "They're designed to turn the traditional healthcare relationship on its head … and create a new model of care."
Williams and Wallace were part of a team that put together The Case for Mobile, a report recently released by the Mobile Health Map and the MHA that examines how mobile health clinics support the business objectives of health systems and impact community health and health equity initiatives.
A surge in popularity as healthcare goes mobile
Williams estimates a few hundred mobile health clinics were in operation prior to the pandemic, and that number has increased to about 2,000 as healthcare organizations look at new ways to deliver care that meets consumers where they are. In addition, they're as popular in urban areas, such as inner cities, as in rural regions.
"The pandemic has sparked innovation in healthcare, including greater interest in mobile programs," the Case for Mobile report states. "Healthcare providers have adopted or scaled up other innovations, including telemedicine, drive-through testing and vaccination sites, and 'pop-up' clinics. It is very likely that innovations sparked by the pandemic will continue in various forms long after the crisis has ended. For example, many mobile clinics that began as a way to expand access to COVID testing or vaccinations are planning to continue operating and adjusting their service offerings to meet other community needs."
"Because of the pandemic, everyone had to think creatively," says Williams. "Now [healthcare executives] are thinking about new ways to use mobile clinics. Some are using them to expand business lines, while others want to expand capacity or reach new communities."
And while some have classified mobile health clinics as "alternatives" to healthcare models, a 2017 study published in the National Library of Medicine and authored by researchers at Harvard Medical School indicates these vehicles can also serve as entry points to a health system, helping consumers navigate the complexities of healthcare access, and paving the way for future in-person and virtual connections.
"In many contexts, [mobile health clinics] can and do play an integral part in a healthcare system, providing accessible and sustainable care with quality that matches traditional healthcare settings," that study concluded.
These mobile access points "can identify pressures that a hospital is facing and address them in a different way," Wallace says. They can be located next to a retail center, like a mall or supermarket, or alongside a library or town offices, even next to a theater, park, beach, or motel, attracting people who might need care but are wary of going to a crowded ER or urgent care clinic.
Finding the right use case for a mobile health clinic
Williams says a common misperception about mobile health clinics is that they have to be expensive or filled with the latest in digital health technology. A health system can spend as little as $150,000 or $200,000 in startup costs for a mobile health program and see success, as long as the program reaches and engages its target population with services that meet a gap in care.
"Those costs don't have to be substantial compared to what you're probably spending" to address the care needs of that population, she says.
And they can be flexible. If one approach or one location isn't working, pull up stakes and move, or redesign the mobile clinic to address a different healthcare concern.
Wallace says healthcare organizations looking to launch a mobile health program should first conduct a community needs assessment. This gives the organization an opportunity to talk to the community about what it wants and needs, as well as identifying partners in the project. That may include health systems and local doctors, charitable groups, civic organizations, and even local government. The idea is to create a group of stakeholders who can help guide the program as it launches and evolves and identify any issues it may have to address.
Elizabeth Wallace, executive director of the Mobile Healthcare Association. Photo courtesy of the MHA.
"It shouldn't be thought of as a pilot project," she adds. That evokes images of a test, or something that's being tried out and can be cancelled at any moment. This, instead, is a program that aims to stay in the community and foster a lasting relationship.
In addition, mobile health clinics don’t have to be dependent on technology to be effective.
"Technology and mobile healthcare, they're not in the same universe," Williams says. "I would say they can complement each other and stimulate each other … but they don’t have to both be there."
"We've found, in some cases, that technology doesn't resonate with them," she says of the typical mobile health clinic visitor. "They don't seek out [healthcare services] like you or I. They are coming to a mobile clinic, in many cases, for that personal touch."
This, in turn, can help a health system connect with its surrounding communities. That point was made by a health clinic operator interviewed for the MHA/Mobile Health Map report.
"For communities that have been disinvested or marginalized by our healthcare system through generations, being able to go to them, make the effort to get right where they are-say here I am," the clinic operator said. "I’m here to respond to you. It’s a good way to be able to bring them into a healthcare system that maybe they are distrustful of."
Sowing the seeds for sustainability
The challenge for many mobile health programs lies in finding a means of continuing past the loan, grant, or award used to get the program up and running.
"The launch is just the beginning," says Williams. "You need to establish a plan for getting support, especially from payers."
The key, as with any new healthcare program, is to gather evidence that the program works. That may be in reduced ER visits, which help a hospital's bottom line and lessens the pressure on 911, ambulance and EMS services, or an improvement in screenings, public health education, chronic care management, and other services that boost clinical outcomes down the line. The unmeasured effect, meanwhile, lies in an improved community.
The drawbacks? It's hard to find any.
"We worked really hard to find people who would disagree with us," Williams chuckles. "We tried really hard to find people to tell us that mobile clinics were a bad idea, and that just didn't play out."
The New York health system is looking for 1 million patients to participate in a program aimed at developing genetics-based precision medicine treatments and new therapies.
The five-year project, launched in a partnership with Regeneron, aims to provide researchers with data that will help in the development of genetics-based precision medicine treatments and new therapies.
“For decades, we have hoped that genetics would offer doctors the blueprints to each patient’s unique health care needs," Alexander W. Charney, MD, PhD, an associate professor of psychiatry, genetics, and genomic sciences at the Icahn School and project leader, said in a press release. "While genetics has proved to be a powerful tool for understanding rare disorders, we still do not have enough data to know how effective it may be in helping to treat and diagnose most patients. A big reason for this is that most gene sequencing studies are not designed for this.”
“For this project, we found several key ways to provide researchers with the massive, clinically focused, real-world data that are needed to truly determine the effectiveness of precision medicine and hopefully improve patient care,” he added.
The Mount Sinai Million Health Discoveries Program, developed on a digital health platform created by Vibrent Health, will be led by Charney; Girish N. Nadkarni, MD, MPH, the Irene and Dr. Arthur M. Fishberg Professor of Medicine; Dara Meyer, MS, PMP, director of operations and project management; and Rachelle Weisman, MPH, associate director of clinical operations, all of whom are based at the Icahn School. Charney and Nadkarni are co-directors of The Charles Bronfman Institute for Personalized Medicine at Icahn Mount Sinai, which will over see the program.
Patient recruited by the health system who give their consent will have their DNA sequenced and analyzed, after which a de-identified version of the electronic medical record profile will be sent to researchers. At the Regeneron Genetics Center, researchers will perform exome screening and whole-genome genotyping.
“At Mount Sinai, precision medicine rests on a three-legged stool of gene sequencing, advanced electronic medical records, and cutting-edge algorithmic data analysis techniques," Eric J. Nestler, MD, PhD, the Nash Family Professor of Neuroscience, director of The Friedman Brain Institute, Dean for Academic Affairs at Icahn Mount Sinai, and chief scientific officer of the Mount Sinai Health System, said in the press release. "This project exemplifies that highly promising approach. We expect that the unprecedented size and diversity of this study will provide researchers with clinically actionable information to deliver better care for patients.”
"Almost all the information we need for this study is already embedded in the electronic medical records," added Nadkarni. "This means that we can greatly shorten the interview process, which in the past has reduced the chances a patient would consent to being enrolled in a study. In general, we believe that by re-evaluating each detailed step of the enrollment process, we can raise the participant levels we need to produce meaningful data that will one day help patients’ lives.”
The COMPASS-CP program, accessible through a hospital's EHR platform, pulls together care providers, patients, their families, and other participants to create a care management plan that includes remote patient monitoring, medication management, and resources to address social and functional determinants of health.
COMPASS-CP (COMprehensive Post-Acute Stroke Services – Care Plan), which can be accessed through the electronic health record platform, pulls together a variety of resources, including remote patient monitoring services, wearables, virtual care, medication management services, and algorithms identifying relevant social and functional determinants of health.
The program aims to facilitate stroke care and recovery outside the hospital on one platform, pulling together not only care teams but patients and their families, therapists, pharmacists, and even social workers.
According to the health system's website, the program "is a patient-centered electronic application that captures the social and functional determinants of an individual’s health at the point of care. Designed to be administered by a clinician in a clinical or home setting, the tool also assesses caregiver abilities and resources critical for patients during the post-stroke care period. Housed as a web-based or iPad application, the functional assessment is simple to administer, yet provides a comprehensive overview of potential barriers that can impair a patient’s ability to manage their personal health and recovery."
“COMPASS-CP allows clinicians to securely receive and easily interpret remote monitoring data, such as blood pressure and physical activity, which helps them, their patients and coaches make timely decisions and adjustments to lifestyle behaviors and medications aimed at reducing the likelihood of patients suffering future strokes,” Pamela Duncan, PhD, a professor of neurology at the Wake Forest University School of Medicine, said in a press release. “This is a great example of how our academic learning health system can take research findings and develop solutions to help improve the health of patients right here at home and across the country.”
The program is supported by the results of the massive COMPASS study, launched in 2015, which tested a digital health model of care on roughly 3,000 patients across 41 North Carolina hospitals and compared the outcomes to 3,000 patients undergoing traditional post-discharge care. The study was supported by a five-year, $14 million grant from the Patient-Centered Outcomes Research Institute (PCORI).
To help pitch the program to other health systems, Wake Forest Innovations helped launch Care Directions, a start-up targeting the stroke care space.
Officials say the program could position participating health systems for value-based care incentives from the Centers for Medicare & Medicaid Services, and eventually be scaled up and out to other settings, such as primary care and sub-specialty sites, and chronic diseases.
Providence St. Jude Medical Center is using a robotics platform developed by Globus Medical to transform a five-day hospital procedure into an overnight process, reducing stress on patients and improving clinical outcomes.
Providence St. Jude Medical Center is using an innovative robotics platform with real-time, 3D imaging software to transform once-complicated back surgeries into minimally invasive procedures.
The Fullerton, California-based hospital is using Globus Medical's ExcelsiusGPS Premier Center platform for the delicate surgeries. The platform copies a surgeon's hand movements so that a robot can perform the procedure, including placing screws along the spine.
“Spine surgery often involves challenging anatomy and very difficult trajectories,” Erick Westbroek, MD, a Stanford-trained neurosurgeon who completed his fellowship in complex spine surgery at Johns Hopkins Hospital before joining Providence St. Jude, said in a press release. “The robot’s 3D modeling and image guidance capabilities design the ideal trajectory, moving us as close to perfect accuracy as possible.”
The process enables patients who used to spend 4-5 days in the hospital to be discharged the next day. It also significantly reduces the number of x-rays needed prior to surgery, reducing radiation exposure, allows surgeons to maneuver around muscles along the spine rather than cut through them, and replaces the typical 15-inch scar on a patient's back to a few small incisions.
“Eliminating the need to remove or cut through the muscles along the spine is a game-changer in terms of pain and recovery,” says Bowen Jiang, MD, medical director of the St. Jude Neuroscience Institute, in the press release. “We’re leveraging technology and expertise to create extraordinary outcomes for patients.”
As a result, according to the press release, "some patients are back at the grocery store before conventional back surgery patients have left the hospital."
Hospital officials say the platform can be used to treat degenerative diseases, herniated discs, stenosis, scoliosis, nerve compression, and spinal tumors. And with this technology, Providence St. Jude Medical Center has become one of a handful of sites across the country to be classified as an observation and training site for robot-assisted spine surgery.
According to a report by the Office of the Inspector General, the Veterans Health Administration's Digital Divide program issued about 41,000 telehealth tablets to veterans to conduct virtual visits, yet less than half actually had those visits, and many of those devices haven't been returned properly.
The Veterans Health Administration has found that it's one thing to give veterans digital health tools, but another thing to see them use the technology.
The VA's Office of the Inspector General (OIG) has issued a report on a VHA's Digital Divide program, developed by the Office of Connected Care and launched in late 2020, which furnished roughly 41,000 veterans with iPads so that they could connect with care providers on a virtual platform. Investigators found that more than half of the veterans hadn't used the devices by late 2021.
And that was only one of many problems with the program.
"In total, the review team determined that VHA could have made better use of approximately $14.5 million in program funds with better device monitoring and retrieval controls and oversight," the OIG report concluded.
The study highlights the challenges with developing and launching a telehealth program, along with the many boxes that need to be checked to make sure it's working properly. And this is all before any clinical data is even collected.
Launched during the height of the pandemic, the program was designed to give veterans access to digital health tools so that they could connect with care providers without having to go to a hospital, doctor's office or clinic. Those in charge of the program said it would not only reduce the chance of infection for veterans, but improve access to care and lead to better clinical outcomes.
According to the report:
Only an estimated 20,300 of the 41,000 patients, or 49 percent, used the device to schedule and complete a virtual visit.
An estimated 10,700 patients never scheduled a virtual visit, in part because there was no requirement to do so and neither the patient nor the care team took the initiative.
Another 10,000 patients scheduled a virtual visit but didn't follow through.
Multiple devices were issued to 3,119 patients.
Some 11,000 devices were not retrieved after the patient's participating in the program ended, and after a review was launched in November 2021, nearly 8,300 devices were still unaccounted for, costing the VHA roughly $6.3 million, plus another $78,000 in cellular data fees.
As of January 2022, some 14,800 devices that had been returned had not yet been refurbished, in part because of technical issues within the refurbishment process, so those devices were not yet ready to be used again. Despite that backlog, the VHA purchased 9,720 new devices, at a cost of $8.1 million.
Many of the issues cited in the OIG report are blamed on poor program design and management, with no clear protocols for scheduling virtual visits, managing the devices or returning them. In response, the OIG listed 10 recommendations:
Establish clear oversight rules and responsibilities for care providers involved in the program with a "Digital Divide Standard Operating Procedure."
Create a mechanism for alerting care providers when their patient has received a device and is ready to schedule a virtual visit.
Clarify the value of scheduling virtual visits and establish timelines, combined with a timeline for device ordering.
Make sure all care providers involved in the program are properly trained and updated whenever protocols are changed.
Implement protocols to ensure that each patient gets one device, and no patients are given more than one device.
Establish an alert if a patient receives a second device and a protocol for retrieving that device.
Make sure program managers are monitoring a dashboard for device use, virtual visits scheduled and completed, and devices retrieved.
Establish an automated mechanism for identifying devices that need to be retrieved and initiating the retrieval process.
Track all devices sent to patients and returned to the VHA so that they can be refurbished and ready for use in an appropriate time frame.
Address challenges in the refurbishment process, improve the tracking process for devices waiting to be retrieved and refurbished, and create a structured purchasing model to ensure these problems don’t happen again and new devices are purchased when they're needed.
In response to the report, VHA officials said they "concur or concur in principle" with all of the OIG's recommendations.
New York City's Mount Sinai Health System is launching a digital health program aimed at relaying teenager-friendly messaging for teenagers at risk of type 2 diabetes.
It's never easy to communicate with a teenager—just ask any parent. But care providers at the Mount Sinai Health System are making that connection with a new digital health platform aimed at young adult at risk of developing type 2 diabetes.
The New York City-based health system is partnering with digital health company mPulse Mobile on a digital health engagement platform that meets teens where they want to be met and gives them access to resources focused on education and prevention.
The key to engagement, say researchers, is involving teens in the planning process.
"We did a lot of the buy-in work early on," says Nita Vangeepuram, MD, MPH, a pediatrician, clinical researcher, and assistant professor at Mount Sinai's Icahn School of Medicine. "We turned the program on its head a little bit and decided, why not ask them for their thoughts and how to make this work? I don't know if that's been done before."
Type 2 diabetes was once thought to be an older person's disease, while Type 1 diabetes was called pediatric diabetes. Type 1 is genetic, while type 2 develops over time, often due to a predisposition toward diabetes combined with bad diet and exercise habits. More and more teens and young adults, however, are becoming type 2 diabetic. According to the National Health and Nutrition Examination Survey (NHANES), one in every five teens and one in every four young adults can now be classified as prediabetic.
Put those teens and young adults in an underserved population, such as East Harlem, and the risk increases. Between one-third and one-half of the teens in that area are prediabetic. Access to health resources, including digital literacy education, telehealth technology, and even in-person primary care services, is more complicated.
"We actually don’t know what's going to work," says Vangeepuram, who's been working on the program for the past few years and is eager to start collecting and analyzing engagement data. "We know that what's been tried in the past hasn't worked, and pediatricians are struggling. It's time to recognize that the patients here are the experts."
Making the Message Matter
Those experts are telling Mount Sinai's care teams how they want to communicate. For example, Vangeepuram says the teens involved in the early part of the program prefer texts, rather than either an mHealth app or social media. And while automated messages are good to get certain points across, they still want to talk to real, live care providers, either in person or virtually.
"We're seeing that there's some balance that needs to happen," she says. "Not all of the interactions can be automated; there has to be some interaction."
Vangeepuram and her colleagues are being specific in how they tailor the program. Choose the wrong medium or message, and teens won’t be interested in collaborating with the care providers on better lifestyle choices, and the advice will fall on deaf ears. They also won’t be interested in a generic, cookie-cutter approach that uses the same message for everyone.
"This is why research and behavioral science are important," Vangeepuram says. "You have to understand what works and what doesn't. And you do it by telling a story … that engages them."
Teens helping to develop this platform preferring texting over social media and apps surprised her in a way. So much of today's teen culture is wrapped around social media and apps that it just seemed natural to follow that route. They weren't interested in sharing photos, either.
"They prefer messaging, and goal-setting is extremely important," she says. "They want to be involved in the process."
Making Prevention a Priority
Programs like Mount Sinai's hold significant promise for value-based care because they target chronic disease prevention, alongside health and wellness. According to the Centers for Disease Control and Prevention's National Diabetes Statistics Report, some 37.3 million Americans, or more than 11% of the population, have been diagnosed with diabetes, while another 96 million people aged 18 and older are classified as prediabetic.
The American Diabetes Association, meanwhile, notes 1.4 million Americans are diagnosed with diabetes each year, and that number is going up. Also increasing are the costs to treat people living with diabetes: $327 billion in 2017, with $237 billion tied to direct medical costs. This means a person living with diabetes spends 2.3 times more on healthcare than someone without diabetes.
Due to the nature of type 2 diabetes, which can be avoided through better diet and exercise, healthcare organizations are planning and launching diabetes prevention programs (DPPs), which funnel in-person and group counseling with targeted resources aimed at helping people live a healthier lifestyle.
Federal officials have also gotten involved. The National Institutes of Health's National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) developed a DPP model in the 1990s. The Centers for Medicare & Medicaid Services (CMS) used that model to create the Medicare Diabetes Prevention Program (MDPP) in 2018, enabling care providers to qualify for Medicare reimbursement for diabetes prevention services.
The program has been met with skepticism, with critics arguing that it isn't reducing costs or keeping a measurable amount of the prediabetic population from developing diabetes. The main problem is that few health systems are launching or supporting DPP programs, and despite intense lobbying, CMS has not expanded coverage to include virtual programs.
Proving the Program's Value
Vangeepuram says Mount Sinai will be looking at engagement metrics with this program. She wants to see that teens are getting these messages and responding to them and interacting with their care providers, and she wants to see that these actions help teens improve their health and reduce the chances of developing diabetes.
For now, they'll be rolling out the digital health platform, looking for engagement, and making any tweaks necessary to improve the process. They'll be working closely with not only primary care providers and diabetes educators, but with the teens, themselves.
Eventually, Vangeepuram says, they'll launch a clinical study, which will look to tie engagement into clinical outcomes. Those numbers might help state and federal payers, like CMS, to show more support for the program. They could also be the catalyst to scale the program out to other populations and target other chronic disease or health concerns.
After all, if you can connect with a teenager, you've made quite an accomplishment.
"It's better to teach them to be healthy, and that part isn't really complicated," she says. "You have to make sure that they're listening. That's the hard part."
The Health and Human Services Department is continuing its contract with Avel eCare to provide telehealth services for roughly 150,000 American Indians and Alaska Natives.
The Health and Human Services Department is extending its partnership with Avel eCare to deliver telehealth services to roughly 150,000 American Indians and Alaska Natives.
The HHS' Indian Health Services launched a virtual care platform in 2017 with the South Dakota-based Avera Health network, with a contract to deliver specialty clinic services to reservations in Nebraska and the Dakotas. The project expanded to Montana and Wyoming in 2019 and was kept in place when Avera sold its telehealth services to Aquiline Capital Partners in 2021.
The program offers improved access to healthcare services for a population that is predominantly located in rural areas, where access is difficult, and whose life expectancy is 5.5 years less than the average.
“Telemedicine is one of the best ways to ensure vital access to quality healthcare in these remote, hard-to-reach tribal communities," Brian Erickson, vice president and general manager of behavioral health and specialty clinic at Avel eCare, said in a press release. "Before this, many tribal members would either travel hundreds of miles to see a doctor or forgo care altogether."
The new deal extends the partnership another five years and expands the services offered to include psychiatric support for emergency departments and sexual assault medical forensic exams (eSANE).
The Defense Department's health plan will require copays for telehealth services used by military members and their families after waiving those charges for more than two years, while continuing to allow patients and their care providers to conduct some healthcare services by phone.
Military members and their families will soon be charged copays for telehealth visits again, after more than two years of free use, but they'll be able to continue using the telehealth for certain healthcare services.
"The Defense Health Plan faces significant budget shortfalls," they said in the final notice calling to reinstate copayments. "Termination of this provision will save the DoD $4.8M for every month it expires prior to the end of the national emergency, allowing DoD to focus resources on testing, vaccination efforts, and treatment for COVID-19-positive patients."
According to the final rule, the ruling was expected to go into effect on July 1 or when the federal public health emergency expires, but the DoD now says it will set a date at a later time. The PHE is expected to expire in 2023, though that isn't certain.
Telephone calls, or audio-only telehealth services, became popular during the height of the COVID-19 crisis, when both federal and state regulators relaxed the rules to enable care providers to conduct some services on the phone. Opponents have long argued that the phone isn't a reliable technology platform for telehealth services, and that it doesn't meet the guidelines to establish a doctor-patient relationship.
With the pandemic easing, some states have put restrictions back in place on audio-only telehealth services, while others have made coverage permanent. The Centers for Medicare & Medicaid Services, meanwhile, is planning to eliminate Medicare coverage for the modality, except for certain behavioral health services, six months after the federal PHE ends.
According to the DoD, 80,451 healthcare visits were conducted by phone between March of 2020 and September of 2021. In the final rule, officials said those visits were "a small portion of all telehealth claims," but they were well-received by both patients and physician organizations, including the American Medical Association and American College of Physicians.
"Furthermore, the DoD received positive public comments regarding telephonic office visits including multiple requests for the agency to consider it as a permanent benefit," the rule noted.
The Atlanta hospital is the first in the country to receive an AI-enhanced technology platform donated by Medtronic.
Grady Memorial Hospital is using a new technology platform donated by Medtronic to improve colon cancer screening in medically underserved communities.
The Atlanta hospital was the first to receive GI Genius modules through Medtronic's Health Equity Assistance Program. The FDA-authorized technology uses AI algorithms to help clinicians detect colorectal polyps in real time.
"Gastroenterologists at Grady Memorial Hospital perform more than 7,000 colon cancer screening procedures each year among a predominantly Black community," Benjamin Renelus, MD, a gastroenterologist at Grady Hospital, said in an e-mail to HealthLeaders. "Accounting for 80% of the specialty's patient population, Black adults are disproportionately burdened by colon cancer, at greater risk of diagnosis, worse outcome, and death."
Renelus says the technology will help the hospital improve the screening rate by reducing barriers to care faced by Black and other populations.
"There are different obstacles that patients face when they seek colon cancer screenings," he said. "For some, they remain uninsured and may not be aware that they can access screening for colon cancer. At Grady Memorial Hospital, 30% of our patients are uninsured."
"For some, the barrier might be perceived cost, especially considering that the average income of a patient at Grady Memorial Hospital is $20,000," he continued. "For others, there might be a barrier of knowledge: Many may not know that 45 years old is the new recommended age for getting a colon cancer screening. Installing AI-assisted colonoscopy technology ensures that regardless of the barriers patients might face when seeking a colonoscopy, when they come here, they will benefit from technology that helps physicians to detect more cancerous lesions and polyps sooner."
According to Medtronic officials, a multi-center study conducted this past spring and published in the American Gastroenterological Association's medical journal found that AI-enhanced technology helped to improve colorectal polyp detection by some 50%.
"Considering that 90% of patients with certain types of colon cancer can beat it if caught early, the impact of missed polyps can make a dramatic difference for patients," Austin Chiang, MD, MPH, chief medical officer for Medtronic's gastrointestinal business line, said in the e-mail. "As effective as a good gastroenterologist can be while performing a colonoscopy, they are still only human. … By improving a doctor’s ability to detect polyps, AI technology has become critical in the fight against colorectal cancer for providers and patients."
Medtronic's Health Equity Assistance Program, supported by the American Society for Gastrointestinal Endoscopy and Amazon Web Services, aims to get this technology into hospitals and health systems by reducing the initial cost barrier.
The initial plan was to donate 50 modules "to facilities that face the most barriers to accessing the technology and its benefits." Officials now expect to place 133 modules in 62 facilities around the country.
Rice County District Hospital, a 25-bed critical access hospital in the heart of Kansas, is improving inpatient care and critical patient transfers with technology. Officials say the platform is a life-saver and a crucial cog to staying open.
When you're the only critical access hospital around for hundreds of miles, you'd better have the resources for treating patients in need of emergency care—or the means for quickly and effectively getting patients to the care they need.
At Rice County District Hospital in Lyons, Kansas, staff are using patient placement technology to coordinate care for both patients inside the 25-bed, level 4 hospital, and those needing to be transferred to another facility. The platform integrates local EMS and other transport services, such as helicopters and planes, with health systems hundreds of miles away who have the specialists necessary to treat a critically injured patient.
"It has been complex at times, and very stressful," says Bonnie Goans, RN, the hospital's trauma and emergency preparedness coordinator, who remembers instances where it has taken two weeks to get a patient to the right hospital. "The technology we have now is really helping to make things smoother and more efficient."
Bonnie Goans, RN, trauma and emergency preparedness director, Rice County District Hospital. Photo courtesy Rice County District Hospital.
With a population of about 3,500 in a county of only 9,500, Lyons sits right in the middle of Kansas and the Great Plains, an area that could be used as the dictionary definition of "rural." There's plenty of farmland and a few industries, including an ethanol plant. The hospital sees its fair share of farming and industrial injuries, vehicle and ATV accidents, and, like everywhere else, chronic diseases.
And it offers an ideal location to prove the value of innovative new technologies in improving healthcare access and outcomes in rural America.
Of the estimated 6,000 hospitals in the US, according to the American Hospital Association, almost 1,800, or about 30%, are in rural locations. More than 130 rural hospitals have closed over the past decade, and another 600 are at risk of closing.
Telehealth advocates have been pushing virtual technology as an avenue by which these small, remote hospitals can keep more patients in-house and improve access to services and specialists, and Goans says Rice County District Hospital has been using telehealth for a variety of services, including cardiac, pulmonary, and neurological care. But there's only so much a 25-bed hospital with a staff of about 150 can accommodate, and some patients need care that the hospital just doesn't have.
That's where technology comes in—and one's neighbors.
"That's the good thing about being in a small community," Goans says. "Everyone pitches in. Everyone helps when they can."
The hospital has one EMS crew on hand and one backup, as well as access to a few helicopters and fixed-wing aircraft. There's a level 3 trauma center 30 miles away, and a pair of level 1 hospitals in Wichita, roughly 80 miles away. But anything that takes three hours or more "is a no-go," Goans says, because it leaves the community short of resources in case of an emergency.
The old process of arranging transports focused on the telephone, and it basically meant that anyone with hands free would place calls to (a) find the necessary transport and (b) find the right location. Now the information is pulled out of the electronic health record and fed into a platform that scans available health systems for the right clinicians and an available bed, while making sure transportation is available.
"A lot of times in the past it was your doctor making the phone calls because the nurses were busy doing something," Goans recalls. "And there were lots of calls to make. You needed the right doctor at the right hospital, and you needed a room available, and you didn't stop until you had the room. Then it was a race to get the patient on the road" to get to that hospital before that room was taken.
'We were used to being accepted. And suddenly that went away.'
The catalyst for change was the pandemic. That, combined with a nationwide shortage of staff, created a crisis.
Suddenly every hospital was at or near capacity, and everyone was scrambling to find a bed. Hospitals across the state (and the nation) struggled not only to support and care for patients with the virus, but also to care for patients with other health concerns who had to be kept separate from infected patients, while also taking steps to shield doctors and nurses from COVID-19. One news report estimated that nearly 80 patients in Kansas alone died waiting for a hospital bed.
"We were used to being accepted" for a patient transfer, Goans says. "And suddenly that went away."
The pandemic pushed state officials to invest in technology and resources allowing health systems to coordinate care. The state's Department of Health and Environment and Department of Emergency Medicine signed and then extended a contract with digital health company Motient to create a network enabling more than 110 of the state's hospitals and correctional facilities to use the company's Mission Control platform to coordinate transfers.
"In terms of preventative healthcare and resource redeployment, the wealth of data that will come out of a statewide program like this will be invaluable in a few years," Alana Longwell, MD, the chief medical officer at Newman Regional Hospital, a 25-bed critical access hospital in Emporia, about 160 miles from Rice County District Hospital, said in a 2021 press release announcing the contract extension. "We started using the platform to find beds, and now we use it for more than 90% of our transfer patients. The platform lets us slice and dice our data around time-critical diagnoses to help us increase efficiency and improve our transport processes."
At Rice County District Hospital, Goans says the platform reduced the frustration level of staff almost instantly. Doctors are now able to spend more of their time with patients, while nurses handle all of the transportation details, while phone calls are only made to make sure everything is in place.
Goans says the platform allows the hospital to run more smoothly, managing inpatient resources as well as transfers, and gives administrators the data needed to stay on top of things. For a small hospital with razor-thin margins, battling a staff shortage that's affecting the entire country, those capabilities are key to ensuring the right staff are in the right place.
"This does help us to manage care better, and in some cases, keep more of our acute care patients," she says. "Our doctors are practicing at the top of their license now, rather than making phone calls … and we are identifying delays [and gaps] in care that can be corrected more quickly."
The platform also facilitates telehealth and other digital health services, opening the door to more care opportunities on-site and collaborations with larger hospitals and health systems. That's crucial for small hospitals like Rice County District Hospital that aren't going to be expanding any time soon and need to make do with what they currently have at their disposal.
"There will always be a need to transfer patients," Goans says. "That won’t go away." But they can make sure those transports are quick, efficient, and necessary.
Goans expects to use more telehealth and digital health tools in the future to improve care in the hospital and surrounding community. And she has her eye on some new technology as well.
