UNC-Chapel Hill will use a five-year, $3.73 million NIH grant to establish the Center for Virtual Care Value and Equity (ViVE)
A new program in North Carolina aims to research and develop virtual care services that address health inequity.
The University of North Carolina at Chapel Hill will use a five-year, $3.73 million grant from the National Institutes of Health's National center for Advancing Translational Sciences to launch the Center for Virtual Care Value and Equity (ViVE).
“This groundbreaking initiative is pivotal for healthcare innovation and demonstrates Carolina’s leadership in virtual care research,” Saif Khairat, PhD, MPH, an associate professor and Beerstecher-Blackwell Distinguished Term Scholar in the UNC School of Nursing, associate director of the Carolina Health Informatics Program and director of the Carolina Applied Informatics Research Lab, said in a press release. “The Center for ViVE will foster expertise in virtual care data and create workforce development opportunities with its partners throughout North Carolina and the nation.”
The project is one of many across the country aiming to apply new technologies and strategies to an ongoing challenge: Breaking down the barriers to care that impact underserved populations. Those barriers are often called social determinants of health, and can include family, work and transportation issues, cultural pressures, technical literacy, and behavioral health concerns.
The pandemic brought to the forefront the value of telehealth in improving access to care, but it also highlighted those barriers.
"While telehealth services have made healthcare more convenient to some groups, certain populations remain underserved due to lack of access to technology and financial instability," UNC officials said in the press release. "The challenge of promoting health equity in virtual care is often overlooked due to the complex issues involved in implementing virtual care, such as patient privacy, reimbursement models, new workflows, and technology adoption."
A recent survey finds that consumers aren't concerned about protecting their personal health information on digital channels, and they may not understand what HIPAA does and doesn't do. But that doesn't mean providers can take it easy on cybersecurity.
Healthcare organizations that are working to protect patient data on digital channels may be coming up against an unexpected barrier: Their patients may not care.
Some 58% of consumers surveyed earlier this year by The Harris Poll on behalf of ClearDATA said they've never considered where their health information is shared while they're using digital health apps, and only 27% of those surveyed place privacy and security among the top three factors when choosing and online care provider.
The May survey of some 2,053 consumers raises an interesting question: Are consumers not that interested in cybersecurity, or are they mistakenly assuming their sensitive health information is being protected?
“As more and more Americans flock to direct-to-consumer digital health apps and resources, most people don’t know the sensitive health data they share with these companies could be passed on to third-parties or sold to data brokers, without so much as a single consent form,” Chris Bowen, ClearDATA's founder and chief information security officer, said in a July press release on the survey's results. “No company should ever be allowed to profit off a person’s private health information. Far more needs to be done to protect PHI at a regulatory level and, in the meantime, digital healthcare companies bear a particular responsibility to better educate patients about how their data will be used, and what they can do to keep their data private.”
Ignorance may be a factor. Some 81% of consumers surveyed said that assumed their data was protected by the Health Insurance Portability and Accountability Act (HIPAA), and 68% reported they're somewhat or very familiar with HIPAA. Yet HIPAA makes no mention of protected health information (PHI) used or stored on digital health apps or by healthcare organizations that aren't "covered health entities," like health systems and providers.
That could be a problem as more and more consumers use digital health apps or seek care from non-traditional care providers, particularly through online channels. It also reinforces an effort within the healthcare industry to have the federal government update HIPAA.
Regardless of the debate around HIPAA, the survey points to a lack of interest among consumers to place a value on privacy and security. While 27% listed privacy and security as one of their top three concerns when picking a care provider, other factors getting more support were acceptance of health insurance (68%), the option for in-person care (49%), and an immediate response to booking an appointment or getting medication (41%).
That's especially true among younger generations who are more accustomed to going online for healthcare. While 69% of those over 65 surveyed regarded privacy and security as more important than convenience, only 54% of consumers between the ages of 18 and 34 agreed. And while only 17% of seniors said they'd still use a digital health app if they knew their data would be shared with third parties for marketing purposes, a staggering 60% of those 18-34 said they'd still use the app.
That said, just because consumers don’t seem to place value in health systems protecting their PHI doesn't mean those health systems can slack off. On the contrary, data breaches, hacks and ransomware attacks are happening with more frequency and complexity, and health systems need to expend more time and effort to make sure their cybersecurity defenses are effective.
In addition, these breaches may result in litigation. Several healthcare organizations, including HCA Healthcare, Johns Hopkins, Norton Healthcare, Mercy Health, Harvard Pilgrim Health Care Plan, and NextGen Healthcare, are facing class action lawsuits over recent data breaches.
The answer, then, may lie in education. Health systems should inform their patients not only what they're doing to protect PHI, but to explain the importance of securing that information from prying electronic eyes. And that education should include information on what HIPAA covers and what it doesn't.
Ellis Medicine is partnering with the city of Schenectady and AION Biosystems to monitor the temperatures of oncology patients for between 30 days and 60 months.
A Schenectady, New York health system is launching a remote patient monitoring program to track the temperatures of oncology patients at home.
Ellis Medicine is partnering with AOIN Biosystems and the city on the Stay Well program, which will equip selected patients with AION's iTempShield wearable patch to measure body temperature for 30 days to six months. Patients undergoing cancer treatment are much more susceptible to infections like sepsis, which can be deadly if not detected and treated quickly.
“In many oncology patients, infection detection is the key,” AION Biosystems CEO Samara Barend told the Daily Gazette after a Thursday press conference at Ellis Hospital announcing the program. “Being able to stay ahead of it [is crucial] because a low-grade fever, even around 100, can be dangerous for these patients. Many of them don’t even realize they have an infection or that they’re on the verge of an infection, so being able to track it early and continuously is critical.”
The RPM program is part of the Smart City project launched earlier this year by the city with $2.6 million in federal Community Development Block Grants. As part of that project, the city is expanding free Wi-Fi services to bolster connectivity in underserved parts of the community.
As healthcare organizations across the country shift services out of the hospital and into the home, RPM programs are becoming a popular method for staying in continuous or regular contact with patients at risk of health complications or hospitalization. Along with patients undergoing chemotherapy, programs have been established to monitor those with chronic conditions like COPD, diabetes, and congestive heart failure, patients recovering from surgery, and new mothers and their babies.
Ellis Medicine officials said 250 patients would be monitoring through the RPM program, with plans to expand at a later date to include other patient populations.
“We wanted to start somewhere where it made a lot of sense and when you’re a cancer patient you’re immunocompromised and if your temperature starts to go up, the technology jumps on it,” Ellis Medicine President and CEO Paul Milton told the Daily Gazette.
Patrick McGill, executive vice president and chief transformation officer at Indianapolis-based Community Health Network, talks about the health system's digital health strategy and efforts to attract consumers.
Search engine optimization (SEO) might not come up often in healthcare conversations, but to Patrick McGill it's an important strategy for a health system. Being the first brand consumers think of when they are looking for healthcare affirms that your organization has made a connection with potential and existing patients.
"We're taking friction out of the healthcare experience," he says. "I want this to be as seamless as when [consumers are] Googling care."
And that means taking control of the digital points of entry into the healthcare system, from online searches to patient portals and scheduling apps so consumers can access what they need for care.
McGill, MD, MBA, is the executive vice president and chief transformation officer for the Community Health Network (CHNw), an Indianapolis-based organization of more than 200 sites of care. The health system sits at the epicenter of a competitive healthcare market, which includes Ascension St. Vincent Health and Indiana University Health as well as a growing number of telehealth companies, health plans, and retail firms with their own providers.
Amid that competition, McGill says CHNw understands the imperative of making the healthcare journey as intuitive and smooth as possible. He's at the helm of that effort, which has been underway for several years.
"We used to have a hodgepodge of web pages," he says. "Some of them would lead to dead ends. We saw lots of drop-offs [as] people didn't continue their journey. Our goal was to create one digital front door that [would offer] a consistent online experience for consumers. We have to be the connector that brings them to the care they want."
According to a 2021 study posted in the National Library of Medicine, roughly three-quarters of consumers search for online healthcare services before making an appointment, and just as many (if not more) go online first to ask healthcare questions. That inclination to search online for a care provider is even more prominent among younger generations who aren't interested in having a primary care provider and who are used to the convenience of shopping online for banking, travel, hospitality, and retail services.
McGill says CHNw needs to have an online presence just like Amazon, Walmart, and other healthcare providers, because that's where the healthcare journey starts for many people.
After chatting with executives at Providence, CHNw partnered with DexCare, a digital health company launched out of the Pacific Northwest—based health system to develop a unified online platform. McGill says the health system didn't have the infrastructure in place or the expertise in-house to create the consumer experience that the market now demands.
"How do we understand that journey?" he asked. "We were trying to think about it in terms of the customer experience."
To do that, McGill says, the health system had to understand "stickiness," or strategies to attract and keep a consumer's attention during online visits and transactions. That includes coupling the initial reason for the consumer's visit with relevant information and resources, and then integrating data from with the medical record so that providers can add appointment reminders, wellness check-ups and other services. That might include pharmacy services, labs and tests, even virtual care options.
"This allows us or even forces us to have a strategic conversation" about how to integrate in-person and virtual care, he says. And it allows the health system to create "warm hand-offs" for consumers who are looking for on-demand care via telehealth.
"The more self-service tools that we can put onto this platform, that's one more phone call (from a confused patient) that doesn't have to be made," McGill says. Or one more patient who will continue a relationship with CHNw instead of looking elsewhere.
As the health system moves forward with its digital health blueprint, McGill says the health system must become more attuned to a patient's healthcare journey, not just the episodes of care. That's part of the plan for evolving from episodic care to value-based care. And it means combining information with channels to interact more frequently with patients, giving them options that affect both immediate care and overall health and wellness.
"It's smart navigation," he says. "At the same time, we're looking at new ways to learn the behavior of a patient, [so as to] understand the journey better than we've been able to do before."
The agency will meet in September with interested parties to discuss a long-debated proposed registration for providers wishing to prescribe controlled substances via telemedicine without first conducting an in-person exam.
The US Drug Enforcement Administration may finally be open to giving healthcare providers more freedom to prescribe controlled substances via telemedicine.
The DEA has scheduled two public listening sessions, to take place on September 12 and 13, to discuss creating a special registration for providers who want to prescribe controlled substances without first conducting an in-person evaluation.
The notice marks a change in tone for the agency, which has long resisted creating that registration process even though it was mandated by Congress in 2008 through the Ryan Haight Online Pharmacy Consumer Protection Act. Telehealth advocates have long argued that providers should be able to prescribe certain medications without first needing an in-person exam as a way of expanding access to and treatment for mental health and substance abuse issues. Several members of Congress and the American Hospital Association have also chimed in, urging the DEA to take action.
Relaxed rules for prescribing controlled substances via telemedicine were included in waivers put in place during the COVID-19 Public Health Emergency, but the PHE ended in May. The DEA proposed a new set of rules set to take place after the PHE, then backtracked and extended the waiver for six months after those new rules drew strong criticism.
"Among the 38,369 comments submitted in response to the [proposed new rules] a significant majority expressed concern, with respect to at least some controlled substances, that the proposed regulations placed limitations on the supply of controlled substances that could be prescribed via telemedicine prior to an in-person medical evaluation," the DEA said in its meeting notice. "In addition, several hundred comments specifically raised the possibility of a separate Special Registration for those practitioners who seek to prescribe controlled substances without conducting an in-person medical evaluation of patients at all."
"DEA is open to considering—for some controlled substances—implementation of a separate Special Registration for telemedicine prescribing for patients without requiring the patient to ever have had an in-person medical evaluation at all," the agency continued. "DEA also observes that making permanent some telemedicine flexibilities on a routine and large-scale basis would potentially create a new framework for medicine that fundamentally expands access to controlled substances in a way that warrants a new framework for accountability based, in part, on increased data collection and visibility into prescription practices in order to ensure patient safety and prevent diversion in near-real-time."
With that in mind, the agency is asking those attending the upcoming meetings to consider the following questions:
If telemedicine prescribing of schedule III-V medications were permitted in the absence of an in-person medical evaluation, what framework, including safeguards and data, with respect to telemedicine prescribing of schedule III-V medications do you recommend to help the agency ensure patient safety and prevent diversion of controlled substances?
Should telemedicine prescribing of schedule II medications never be permitted in the absence of an in-person medical evaluation? Are there any circumstances in which telemedicine prescribing of schedule II medications should be permitted in the absence of an in-person medical evaluation? If it were permitted, what safeguards with respect to telemedicine prescribing of schedule II medications specifically would you recommend to help the agency ensure patient safety and prevent diversion of controlled substances?
If practitioners are required to collect, maintain, and/or report telemedicine prescription data to DEA, what pieces of data should be included or excluded? What data is already reported to federal and state authorities, insurance companies, and other third parties?
If pharmacies are required to collect, maintain, and/or report telemedicine prescription data to DEA, what pieces of data should be included or excluded? What data is already reported to federal and state authorities, insurance companies, and other third parties?
The head of innovation and product discusses why healthcare shouldn't mimic either Amazon or the banking industry, but it should harmonize with the music industry's transformation.
The path to healthcare transformation isn't an easy one, and there are many examples of how to do things wrong. A health system has to invest in leadership that knows how to plan innovation strategy and develop the technologies and services that show true value and improvement.
HealthLeaders recently sat down (virtually) with Brian Mullen, head of innovation and product at The Clinic by Cleveland Clinic, to get his take on how healthcare should be evolving and where healthcare providers should look for inspiration.
Q: How do you define innovation within healthcare?
Mullen: Innovation in healthcare is simply about moving the field forward to improve quality of life outcomes.
If you’re involved in digital transformation at a healthcare organization, one of the first assumptions you need to abandon is the view that healthcare isn’t innovative. Healthcare is by far the most innovative industry in the world today. Considering the different stakes involved in healthcare and other technology delineates this point quite clearly: The challenges in healthcare aren’t often simply a matter of incremental improvement but more likely involve earth-shattering paradigm change like curing cancer, replacing a heart, or developing and deploying a vaccine to millions of people in a matter of mere months.
Brian Mullen, head of innovation and product at The Clinic by Cleveland Clinic. Photo courtesy The Clinic by Cleveland Clinic.
An app, which is the sort of innovation we’re seeing in many other industries, doesn’t cure anything, nor does it change a terminal illness to a chronic condition yet. Digitalizing and automating existing processes and interaction is impactful but not the only way to innovate.
Q: You've said that the future of healthcare will look more like the music industry rather than banking. What do you mean by that?
Mullen: We’ve heard people for years say that 'Healthcare needs to be like the financial industry.' But do you really love your bank? Why in God’s name do we want healthcare to look like banking?
Frankly, the analogy has gotten us incremental change. We may have an app now that can remind us of an appointment or allow us to pay an outstanding bill, but that doesn’t move the needle on an individual or population’s health. Chronic care programs essentially just remind people to do things, which is helpful but limited. Healthcare has focused so much on automating transactions the same way that banks do, but it hasn’t transformed into true impact to patients like we see in other areas of healthcare innovation like biotech, medtech, etc.
The reason I think the future of healthcare may and should look more like the music industry is because of the advances we’ve seen in music in both alignment that serves the interest of all key stakeholders and personalized services for the consumer.
For instance, years ago you had to buy a whole CD for $15 to get the one song you wanted. Napster and others created ways for customers to get the music they wanted when they wanted it, but free music didn’t work for the labels or the artists. Apple found a way to offer songs for $1 that made customers happy and worked for the labels and artist. It was a solution that benefited everyone.
The next generation of the music industry aims to deliver more personalized experiences. Both Apple and Spotify, as well as other services like Pandora or Deezer, are leveraging historical data and predictive algorithms to anticipate the sort of music you might like and recommend it.
In healthcare, finding solutions that provide value to all parties—patient, provider, and payer—are positioned to deliver better patient outcomes, higher customer satisfaction, and more efficient business models for everyone involved. Once the alignment happens across parties, will we be able to offer customized personalized services to patients that will support and enable them to improve their care.
Q: What are the biggest challenges or barriers you see to healthcare innovation?
Mullen: Better regulatory structures are critical, especially when it comes to patient access. Other than healthcare, I can’t think of any other major industry where you can’t access services across state lines.
The good news is healthcare has already shown its ability to adapt and change radically. During the COVID-19 pandemic, for instance, the number of telehealth appointments in the nation grew close to 800%, according to the National Institutes of Health, and telemedicine is now a permanent part of our healthcare landscape.
That’s important. I live in Boston, where within 10-15 miles I have top-class medical specialists of every sort easily available to me. But for most of the world it's not like that, and I expect the growth of telehealth to be a key enabler in breaking down access to care.
Overcoming this lack of access is core to our mission at The Clinic. Our mission is to increase access to the world's best clinicians anywhere in the world. It shouldn’t just be limited to those lucky enough to live in a few select geographic locations like Boston and Cleveland.
Q: How should traditional healthcare organizations react to the emergence of new, direct-to-consumer participants in the healthcare space like Amazon, Google, Walgreens, and others?
Mullen: The call for healthcare delivery to 'be more like Amazon' is getting louder. But as someone who is deeply entrenched in digital health, I can tell you the 'Amazonification' of healthcare might not be what we want.
Amazon is a master of distribution. It delivers but doesn’t exercise much control on the quality and services provided through its marketplace. In healthcare, the platform to use for care delivery is only as good as the care itself. A great digital platform with sub-par providers is still a sub-par solution. Digital transformation to increase access isn't enough.
Trust is critical in healthcare. Patients need to trust they are getting the best advice and aren't being upsold. We work every day at The Clinic to make sure we are increasing access to the world’s best, but we're also delivering quality and building trust with our customers. If the patient has trust in the quality, then they can have the confidence and peace of mind they are seeking when getting a second opinion.
Healthcare institutions are increasingly realizing that preserving brand quality plays an essential role in successful digital transformation. Healthcare’s future relies on change that will come from collaborations with tech companies and key players in the healthcare system. Just like what transformed the music industry: When tech companies like Napster made changes without the rest of the industry following suit, it failed, but when Apple aligned their tech with the broader music industry there was a paradigm change where the customer won.
Q: The Clinic by Cleveland Clinic was launched via an intriguing partnership between the Cleveland Clinic and Amwell. How has this partnership helped the health system?
Mullen: What’s been fantastic about our partnership is how fully it’s helped both patients and providers. The Cleveland Clinic has a vast team of world-class providers in almost every specialty you can imagine. The Amwell platform enables us to deliver a connected digital care experience to the patient and providers
Patients love it because they now have a chance to get a second opinion consult by one of the world’s best specialists or subspecialists from the comfort of their home without traveling, which wasn’t possible just a few years ago. Providers like it, and consistently give us high scores, because they feel empowered and engaged, and they know they are having an impact on people who don’t have access to the highest quality of care.
Q: What new technologies or strategies are you hoping to use in the future? What's on the horizon for healthcare innovation?
Mullen: I am particularly excited about the use of AI and data analysis. I think we’ll soon see solutions that will support doctors in offering patients highly personalized and accurate diagnoses, treatments, and medications. I also think AI has a huge opportunity to improve safety in healthcare by helping to detect things like negative drug interactions at an individual level.
A challenge for healthcare—and an opportunity—that comes with assimilating and analyzing the huge amount of data we have available today is streamlining the presentation of it in personalized ways to provide better dashboards, portals, and medical device interfaces that offer patients fast, understandable updates on their condition. In addition, how do we ensure that historical bias isn’t further amplified in the AI tools that we build?
Q: What has surprised you about healthcare innovation to date, good or bad?
Mullen: There is so much good. I’m fascinated by it. Today we have things many of us couldn’t imagine as kids: artificial hearts and kidneys. Face transplants. More medications to help turn potentially fatal ailments into chronic diseases, the number of cancers we can now cure, and a whole set of more proactive and personalized ways to treat chronic disease.
Most strikingly in recent history has been the almost overnight ramp-up of telehealth to serve populations everywhere during the pandemic. We’re no longer tethered geographically to the medical experts within just a few miles of where we live.
The downside, perhaps, is that with the proliferation of modern information we’ve had so many innovators, and we now have thousands of apps out there for each different condition. I’d like to see us get to a place where a patient who has, say, diabetes and heart problems will have a single app to manage both and have information presented to them in a way that’s easy to understand, helpful, and motivating. We’ve made a lot of improvements in providing a better patient experience, but I think we have a lot of room for improvement, too.
Q: How do you see The Clinic by Cleveland Clinic evolving?
Mullen: I am tremendously excited to see faster development of both our national regulatory structure and our national insurance payer models, which I know will facilitate the simpler, faster, more affordable, and more widespread use of telehealth.
The tools we have today in telehealth can provide expert access at the right time to people in need to provide both peace of mind and the best care available, but we’ve only begun to make that promise available nationally and internationally. I think we have some very exciting years ahead that will make both patients and providers much more satisfied with our healthcare system.
The two organizations, members of the Coalition for Health AI, have forged a five-year partnership built around the new Duke Health AI Innovation Lab and Center of Excellence.
Duke Health and Microsoft are aiming to get ahead of the AI wave with the launch of an AI Innovation Lab and Center of Excellence.
The two organizations announced a five-year partnership this week "aimed at responsibly and ethically harnessing the potential of generative artificial intelligence (AI) and cloud technology to redefine the healthcare landscape."
The news comes as healthcare organizations across the globe are experimenting with AI and as federal and state governments, tech firms, and health systems grapple with how to oversee the technology. Just last month, the White House and the heads of several major tech companies—including Microsoft—announced a non-binding commitment to responsibly govern how AI is developed and used.
The Duke-Microsoft collaboration aims to give the healthcare industry a place to forge those standards.
"The partnership is a milestone in the evolution of digital healthcare," Jeffrey Ferranti, MD, senior vice president and chief digital officer of Duke Health, said in a press release. "Our unrivaled expertise in data science, patient care, and technology innovation synergizes perfectly with Microsoft's healthcare solutions and AI technology. Together, we are poised to propel Duke into the forefront of digitally focused health systems, while simultaneously studying the reliability and safety of generative AI in healthcare."
Through the partnership, Duke Health will use Microsoft's Azure cloud platform to develop AI-based programs to support healthcare services, both administrative and clinical.
“Microsoft is excited to collaborate with Duke Health to operationalize responsible AI principles, helping to ensure that AI is deployed safely, effectively, and in an unbiased and transparent manner,” David Rhew, MD, Microsoft's global chief medical officer and vice president of healthcare, said in the press release. “Together we will apply the latest Microsoft technologies to expedite and scale Duke Health’s nationally recognized model of AI governance. By sharing best practices and lessons learned, we hope other organizations will benefit from our experience.”
Microsoft is also looking to get a handle on telehealth applications. Last month, the company announced a partnership with Teladoc to use AI to help streamline administrative challenges and documentation in virtual care.
The Maryland-based health system's vice president and chief innovation officer says healthcare must create platforms that connect patients to the resources they want and need.
To William Sheahan, the future of healthcare lies in connected care.
That's not exactly a new idea, says the vice president and chief innovation officer of MedStar Health, a 10-hospital, 300-plus-site health system centered in the Baltimore-Washington D.C. area, and executive director of the MedStar Institute for Innovation. But it is rooted in change management and focused on the redesign of traditional healthcare practices.
And that's a lot to swallow for an industry that hasn't quite caught on to consumer-based care.
"We have a lot to learn from other industries," he says. "I think we need to do a lot more to … improve the patient experience."
William Sheahan, vice president and chief innovation officer at MedStar Health and executive director of the MedStar Institute for Innovation. Photo courtesy MedStar Health.
For connected care to work, Sheahan says, healthcare organizations need to understand where and why those connections are necessary. Healthcare is moving away from the idea of having the patient go to the care provider and toward "the distribution of expertise using technology," whereby the provider connects with the patient, either in person or through virtual channels.
"We need to meet patients where they are," he says.
Sheahan, whose career includes time spent as a paramedic, educator, and chief officer of an emergency services organization, joined MedStar Health in 2013 as executive director of the MedStar Health Simulation Training & Education Lab (SiTEL), then took over the MedStar Telehealth Innovation Center in 2017, just in time to guide that group's exponential growth during the pandemic.
He's part of a wave of innovation and transformation leaders at healthcare organizations across the country who are taking lessons learned from the COVID-19 crisis to advocate for systemic change in a struggling industry.
"We have to look at each service line … [and] deconstruct and reconstruct it with digital care" as one of the core components, he says.
That's because consumers are demanding more convenient access to care, he says, through channels that allow them to see information (including their health data) and care providers when and where they want. If a health system or hospital is reluctant to offer those services, he says, those consumers will shop around for other care providers.
And that marketplace is growing. Retail giants like Amazon and Walmart, health plans, telehealth companies with their own cadre of doctors, and others are staking a claim in the healthcare sandbox, offering convenience and lower costs.
Sheahan says MedStar Health, like all other health systems, is faced with a "transformation imperative" that goes beyond consumerism. Operating margins are razor-thin, healthcare costs are too high, and the workforce is struggling with stress and burnout and shrinking. Health systems from the top down need to be aligned to address those issues with new ideas and technologies, including drawing ideas that have worked in banking, retail, travel, and hospitality.
"Why can't we have an experience like a Marriott or a Hilton?" he asks.
That's where efforts like the MedStar Institute for Innovation come into play. Sheahan says the center helps create a culture of innovation within the health system, creating an environment for unique ideas to improve both business workflows and clinical outcomes; which are both integral to establishing a new healthcare paradigm. Novel ideas and technologies that improve business processes and reduce stress and workflow issues for staff will, in turn, improve the patient experience and boost clinical outcomes.
"There is a lot of opportunity for automation and efficiency," he says, noting the integration of AI and analytics tools at the back end and the slow-and-gradual development of generative AI.
To address workflow shortages, particularly in the nursing ranks, Sheahan says MedStar Health needs to rethink how technology is used in the hospital setting. Concepts like interactive TV sets in patient rooms, virtual nursing (also known as telesitting), and wireless sensors that drive the "hospital room of the future" not only improve patient engagement and satisfaction but help nurses and other staff improve their outcomes and outlook.
That's not to say every innovation finds a place in the healthcare setting. Health systems like MedStar Health don’t have endless amounts of money to spend on bright new ideas.
"Investments have to be well rationalized," Sheahan says. The "burden of technology on the workforce" means that new tools must prove their value before being embraced.
Sheahan says MedStar Health can be a national leader in connected care, and points to an ongoing collaboration with Intermountain Health and Stanford Medicine as evidence. The three health systems, supported by the Agency for Healthcare Research and Quality (AHRQ), have formed the Connected CARE (Care Access, Research, Equity) & Safety Consortium to dig deeper into how healthcare organizations can use technology to connect patient and providers.
"There's a focus on building technology with our partners that will really drive this transformation," he says.
And that, he says, is how healthcare can and should evolve.
An ONC data brief finds that most hospitals are collecting data on social determinants of health, and many are using technology to gather that information, but a lot fewer are collecting that data regularly.
More than 80% of hospitals recently surveyed by the American Hospital Association are collecting data on social determinants of health (SDOH), many through their EHR platform and health information exchanges. Yet only half of those hospitals are collecting data regularly.
Social determinants (or drivers) of health are non-clinical factors that can affect one's health and wellness, including family and housing issues, employment, transportation, food insecurity, and cultural and societal pressures.
"If left unaddressed, the social needs experienced by an individual may lead to poor health outcomes and more time spent in hospitals and interacting with the healthcare system," ONC staffers Wei Chang, Chelsea Richwine, and Samantha Meklir wrote in a recent blog post accompanying the ONC data brief. "Hospitals, therefore, are uniquely situated to help address social needs and mitigate social risk factors by screening for social needs, assisting with transitions of care, and making connections to social service organizations."
According to the AHA survey, administered in 2022, some 83% of hospitals are doing just that, with nearly 75% using a structured screening tool to collect that information, 36% using free-text notes, almost 30% using diagnosis codes, and 20% using non-electronic methods.
Some 60% of hospitals collecting SDOH data are getting some of that information from external sources, the survey found. Those sources include HIEs (46%), other healthcare organizations (28%), social service or community-based referral platforms (22%), and community/social service organizations (18%).
As for how they're using the data, 72% of hospitals collecting SDOH are using the information to inform discharge planning, while 67% cited clinical decision-making, and 65% cited referrals to social service groups. In addition, 48% of the hospitals are using the data for population health analytics, 46% to inform community needs assessments or other equity issues, and 42% for quality management purposes.
These tools and tactics are crucial to improving access to care and clinical outcomes among underserved populations, yet the survey finds that healthcare providers serving those populations aren't necessarily addressing SDOH.
According to the survey, 54% of hospitals collecting SDOH data are doing so on a regular basis, yet lower-resourced providers, such as small, critical access, rural, and independent hospitals, were "significantly less likely" to regularly collect data.
In their blog, Chang, Richwine, and Meklir note that the Centers for Medicare & Medicaid Services (CMS) recently added two SDOH data elements to the Inpatient Quality Reporting (IQP) program. That's one step in the right direction toward compelling providers to collect and use that data.
"While much attention has been devoted to screening—a critical first step to understanding patients’ health-related social needs—additional focus is needed on effective usage of data collected through screening since not all patients who screen positive for social needs are successfully connected to the resources they need," they wrote. "This may be attributable to a number of challenges providers face in using social needs data, including a lack of standardized referral processes and sustainable financial resources, which speaks to a need for building partnerships with community-based partners and increasing their capacity to respond at the community level, and tracking changes in health outcomes following the identification of social needs."
"Looking ahead, more work is needed to capture social needs data in an actionable way so that this information can be used to support shared decision making and address social needs, with the ultimate goal of improving individual and population health," they concluded.
A new study finds that a third of providers surveyed are using digital health to treat OUD and substance abuse, yet the tools aren't being used to expand treatment or reach those who need help.
Digital health tools are increasingly becoming the weapon of choice for healthcare providers treating patients living with opioid use disorder (OUD), according to new research from several New England healthcare organizations.
But that weapon isn't being used as well as it could be.
More than a third of health systems with accountable care organization contracts are using at least one type of technology, including remote patient monitoring and on-demand support tools, says a study recently published in JAMA Network Open. Oftentimes those tools are used alongside the traditional treatment path of in-person care, suggesting that those using the technology are doing so because they can, rather than because they need to.
"Our results suggest that digital health technologies for OUD are more likely to be deployed by organizations with relatively robust traditional SUD treatment resources," the study, conducted by researchers from Harvard, Yale, Dartmouth, UnitedHealthcare and Beth Israel Deaconess Medical Center, concluded. "As such, the technology appears to complement existing SUD treatment resources rather than substitute for unavailable SUD treatment resources."
OUD and substance abuse combine to form one of the nation's most devastating health concerns, one that has been increasing in the wake of the pandemic. The issue is complicated by the fact that many patients conceal their problems or avoid medical treatment, as well as the fact that many are also living with behavioral health issues in need of treatment.
The study, drawn from a 2021-22 survey of 505 ACOs, of which 276 responded, finds that 33.5% of those responding are using some type of technology, such as virtual mental health therapy and tracking, virtual peer recovery support, and digital recovery support for adjuvant cognitive behavioral therapy (CBT). Just as important, that percentage increased among providers with a dedicated addiction medicine specialist or a registry to track mental health.
That's an important distinction. Digital health has long been considered an import platform to reach patients who either can't or won’t access healthcare providers for treatment. This means providers can and should be using these tools to connect with people who they might otherwise not treat or who would skip treatment. The study suggests that providers are using the technology to bolster care for patients they're already treating, and that providers who already focus on OUD and substance abuse care are using the tools.
"Organizations with substantial resources may have the ability to effectively integrate digital services," the study reported. "On one hand, organizations can extend treatment provided by their clinicians through mobile tools to track mental health symptoms remotely. On the other hand, technologies could substitute for insufficient SUD resources to meet clinical demand for patients with OUD. If technologies are primarily available in organizations with robust SUD treatment resources, then they are not yet reaching their full potential to advance access to care for patients with unmet needs in organizations without traditional treatment alternatives."
Therefore, for digital health to really have an impact on OUD and substance abuse treatment, it has to be used to reach those not receiving treatment. As well, this technology has to be made available to more healthcare providers who haven't traditionally treated patients with OUD or substance abuse issues but who can, including primary care providers and rural and community health clinics.
The study offers suggestions for expanding use of the technology to more organizations, as well as addressing health equity concerns.
"Our findings suggest a mismatch between need and deployment," researchers pointed out. "Organizations with fewer SUD treatment resources were less likely to adopt emerging technologies. To address this mismatch, policy initiatives could focus efforts on overcoming barriers to technology implementation in high-need, resource-limited healthcare settings. For example, policy makers and payers might test policies and reimbursement schemes that support health care organizations without local SUD treatment resources to integrate digital health technologies for OUD into their practices and workflow."
"Initiatives to advance the uptake of technologies may address costs, knowledge, user engagement, organizational culture, leadership, interoperability, and data security concerns," the study continued. "Training and education for patients and clinicians may be a productive avenue to increase adoption. For example, Kaiser Permanente used both clinician referrals and direct-to-patient approaches to drive service use during a large-scale integration of digital mental health technologies. Future efforts may require investing in trained staff, such as digital navigators, to support patients and clinicians to overcome technological, workflow, and digital literacy constraints. Digital navigators offer an opportunity to overcome both patient- and staff-level barriers to technology use even in low-resource settings."
The implication is that while digital health is being used to address the substance abuse crisis, it could be used much more effectively, not only as a complement to existing programs but as a platform for more providers to reach more people in need of help.
