Voice-enabled technology supports residents' independence and connects them with caregivers.
A senior care facility owned by one of the largest health systems in the country is deploying voice-activated "digital concierges" to bring together residents, their care teams, and loved ones to improve their quality of life and health.
The Gardens at St. Elizabeth, a Denver, Colorado-based CHI Living Community and division of CommonSpirit Health, is using Serenity, a network platform based in part on Amazon Echo Show devices, to reduce the burden on staff and empower residents to receive timelier updates on their health and living situation.
Overseeing this effort is Jane Woloson, executive director of The Gardens at St. Elizabeth.
"Serenity is an essential part of our communication by helping support independence for our residents, connecting our internal and extended care teams, and giving families more peace of mind that their loved ones are receiving the excellent care we are known for," she says. "Each day, we see the powerful impact this solution has on our residents and our community."
With her professional roots in the hospitality industry, Woloson sees similarities between running hotels and senior living communities. Since 2008, these communities have been more focused on the clinical aspects of the business, she notes.
Jane Woloson, executive director of The Gardens at St. Elizabeth, part of the CommonSpirit Health network. Photo courtesy The Gardens at St. Elizabeth.
The Gardens at St. Elizabeth features 132 independent living apartments and 57 assisted living apartments, with another 12 assisted living apartments and 36 memory care apartments opening within a month. The building has a long history, containing a 125-year-old chapel, and serving originally as a tuberculosis sanitorium and, later, an orphanage. It became an assisted living facility 40 years ago.
"One of my personal philosophies is to support independence," Woloson says. "If we can set residents up or give them the tools to be as independent as possible, I think we're moving in a successful direction."
Each participating room is equipped with an Alexa smart device. Residents can ask and receive voice-enabled answers to common questions, such as the day's lunch menu, or activities, and they can summon staff. Front desk personnel can communicate via the device to let residents know when a package is waiting for them. Residents will also be able to sign up for activities such as beauty appointments and transportation.
On the clinical side, Woloson says, these devices can help implement care plans for residents. Rounding physicians, hospice, home care, pharmacy, home health, and other providers are able to participate on the platform with patients.
"It saves a lot of phone calls to the front desk," she says. "Patients are not relying on someone else. Maybe they have failing eyesight, and they can't see the daily menu themselves."
The Serenity Connect platform and accompanying app, and its secure messaging, are HIPAA compliant, and also allow authorized family members to keep tabs on the resident's communications via the Alexa devices. These family members also have a direct line to key staff at the facility.
"Our nursing staff are getting instantaneous information," Woloson says. "Nurses can look at the app and have a great pulse on exactly what's happening with each individual resident's care."
A corporate leadership group at The Gardens at St. Elizabeth worked with corporate attorneys and the IT department to select and deploy the technology, initially as a pilot project. If residents ask the Alexa device something that would go against HIPAA guidelines, the device responds that it cannot answer that question, Woloson says.
"There's a false perception that senior citizens have no interest or bandwidth to work with such devices," she says. "That's not the case. The feedback from residents has been extremely positive. The data says they're using it, on average, four times a day. I think that's fantastic."
A study performed by Serenity and The Gardens at St. Elizabeth found that the platform saves five to 10 hours per week per key staff member at the facility. In addition, the platform reduces resident isolation and loneliness.
The Gardens at St. Elizabeth deployed the platform during the pandemic.
"It was a great time to do it, because of the importance of communication," Woloson says.
The platform has also become a selling point for the facility, as prospective residents and their families shop around for assisted living. So far, the platform has led to three new waitlist sign-ups and two new move-ins, she says.
Prospective residents who may be on a waitlist will soon be able to begin participating in the Serenity platform before moving in, providing a new kind of onboarding, Woloson says.
"At the time that Serenity Connect was introduced to us, I jumped all over it as something I wanted to participate in," she says.
The CIO of Phoenix Children's Hospital is an active participant in the hospital's efforts to improve care for both patients and their families.
Innovation for pediatric care is critical—and complex. Some of the best new ideas for clinical care are coming out of the nation's 46 free-standing children's hospitals, where providers are tasked with treating some of the smallest and most fragile patients and supporting their families.
"There are a lot of audiences to satisfy," says David Higginson, executive vice president and chief innovation officer at Phoenix Children's Hospital. "The enthusiasm and the acceptance of change," he says, are energizing, as is "the impact you see on family members' faces."
A veteran of some 25 years in children's healthcare, Higginson joined Phoenix Children's in 2011 as its chief information officer, after stints as the chief information technology officer for Arkansas Children's Hospital and CEO of Bluefish Systems, an innovative healthcare software company that he had launched. As CIO (information), he helped Phoenix Children's integrate its electronic medical record platform with billing and ancillary clinical systems and was named "CHIME Innovator of the Year" in 2016 and AZ Top Tech's "CIO of the Year" in 2017.
All that technology stuff is fun, but innovation really gets the brain working. Higginson became chief operating officer in 2018, then CIO (innovation) in 2020. Under his leadership, Phoenix Children's has become one of the nation's top children's hospitals.
Higginson's leadership strategy involves being in the trenches rather than the office behind a desk. He wants to be a part of the process.
David Higginson, executive vice president and chief innovation officer of Phoenix Children's Hospital. Photo courtesy Phoenix Children's Hospital.
"It's not sitting in a box by myself dreaming up what's going to happen in 10 years, but being in the hospital," he says. "You need to be there and to take part."
That's why Higginson says he spends a lot of time in waiting rooms, the cafeteria, and out by the hospital's entrance, unannounced and unobtrusive, watching how patients, visitors, and caregivers interact. He's looking for clues on how to make those interactions better, and ideas that can help shape how care is delivered.
"We are driven by outcomes and need, but we are also fundamentally trying to treat all the patients we have with limited resources," he says, hinting at the challenges facing healthcare after a pandemic and in the midst of economic turmoil. "We're not going to go out there and buy the biggest product, and we are also not afraid to build things ourselves."
A unique challenge to children's hospitals is the audience. Patient-facing technologies like patient portals "are incredibly complicated for children," Higginson points out, and their value has to be figured not only for kids but for the parents and caregivers who use them to access resources and coordinate care.
As an example, in 2014 Phoenix Children's decided to put an iPad in every room. The reasoning for this project was that children in a hospital are isolated from their friends, and need a platform to connect, play games, and access other entertainment. Higginson says the hospital had to build out a process where those iPads had the apps that children would want and use, while also creating channels that their parents would appreciate.
"It was really a quality of life issue," he says, "but there was a lot more that we had to take into account and build for."
That's how he's approaching an ongoing project to equip every hospital room with Amazon's Alexa virtual assistant technology, synchronized with a video platform like Zoom. Higginson says the platform needs to be configured for multiple parties so that providers can link in family members and specialists for meetings with the patient and his/her family, as well as interpreters. But it can also be used by care teams to check in on and communicate with patients when needed, and it can be used by patients and family members to access resources.
Higginson is also bullish on the use of AI in clinical care, particularly in helping clinicians identify health concerns. A project that sifted through some 20 years of data to spot early indicators of malnutrition, he says, has helped identify, on average, eight patients a week whose symptoms were so slight that they would have been missed.
"There's a lot of potential there," he says.
What he's not a big believer in is wearables and remote patient monitoring. They're not a good fit for children, he says, who aren't likely to wear something every day or hold to a certain schedule. Those platforms aren't sustainable for pediatric care, he says, often because of connectivity issues.
In fact, Higginson sees a future in healthcare innovation that focuses less and less on the technology and more and more on the connections.
The technology will get more sophisticated, he says, so that it stays in the background while giving care teams, patients, and families more and better opportunities to interact. Through these platforms, care teams will not only be able to improve clinical care, they will also be able to fine-tune their own workloads and offer more help to families who quietly deal with a lot of responsibilities and stress.
That's what makes children's hospitals so unique.
"We don’t treat little adults—we treat children," Higginson says. "They have different sets of needs." And they have families, also with different sets of needs. It's a complex environment that needs the right type of clinician—and chief innovation officer—to work well.
The Indiana-based health system's new program supports recovering patients at home through personalized engagement and remote patient monitoring.
Parkview Health, a not-for-profit, Indiana-based network of 10 hospitals and more than 100 clinics, will be offering virtual care programs designed to support patient recovery and self-management at home.
The program, featuring patient engagement, device-based monitoring, and telehealth tools to manage patients who are at risk of readmission, is being deployed in partnership with Veta Health, a provider of remote patient monitoring services.
"A strong virtual care offering is essential to how we best serve our post-acute and chronically-ill patients who are most at risk," Maximilian Maile, senior vice president of digital health at Parkview, said in a press release.
Parkview selected Veta Health to replace its existing telehealth platform, with plans to support more services soon. The multi-year partnership, which encompasses integration with the Epic EHR, will enable the health system to move patients more seamlessly through its care settings and reinforce the clinician-patient relationship.
Once they are enrolled, patients receive biometric monitoring devices to record their vital signs and a digitized care plan to report their symptoms, with communication via cellular data networks to Veta and Parkview. Patients can also view educational content and communicate with their care team via video conferencing. Digital care plans are uniquely tailored to each patient.
The RPM platform is designed to alert care teams about risk factors and disease exacerbation, permitting proactive, early intervention. By leveraging remote monitoring devices and telehealth capabilities to support the care journey, the program will offer connected layers of interaction and support from care teams to optimize recovery and outcomes.
Parkview Health is a not-for-profit, community-based health system, which serves northeast Indiana and northwest Ohio, covering a population of more than 850,000 people.
CHIME will distribute information collected by Health-ISAC, including newsletters, lists of vulnerabilities, threat bulletins, and other actionable and relevant information. This may include indicators of compromise, tactics, techniques, and procedures (TTPs) of threat actors, advice and best practices, mitigation strategies, and other related material.
Members will also have access to the Health-ISAC annual report, focused security research prepared by or in collaboration with the Health-ISAC, white papers, and other relevant non-technical material to healthcare CIOs.
“We are very excited to have this opportunity to share with the members of CHIME and AEHIS,” Denise Anderson, president and chief executive officer of Health-ISAC, said in a press release. “We see it as our mission to strengthen the resilience of the health sector through the sharing of actionable situational awareness, threat indicators, vulnerabilities and best practices among other intelligence vital to the security of health organizations. In addition, through this partnership we offer an opportunity to join our trusted community and the valuable information, connections and services we provide.”
CHIME is an executive organization serving chief information officers, chief medical information officers, chief nursing information officers, chief innovation officers, chief digital officers, and other senior digital health leaders. CHIME serves more than 5,000 members in 56 countries and two US territories, and partners with more than 160 healthcare IT businesses and professional services firms.
Health-ISAC is a global, non-profit, member-driven organization offering healthcare stakeholders a trusted community and forum for coordinating, collaborating, and sharing vital physical and cyber threat intelligence and best practices.
A New York company has received a federal grant to test a digital health platform that captures brainwaves from a healthy sleeper and transplants them into someone with a sleeping disorder.
Imagine using someone else's thoughts to combat sleep deprivation and get a good night's sleep. One digital health company is looking to make that possible.
NeuroLight, a New York-based company focused on neuromodulation, is using a grant from the National Science Foundation (NSF) to, basically, transplant the brainwaves of a healthy sleeper into someone who is struggling to fall asleep.
The science behind this concept was described by Alexander Poltorak, the company's founder and president and a researcher at City College of New York (CUNY), in a September 2021 article in Frontiers in Human Neuroscience.
"Brain states, which correlate with specific motor, cognitive, and emotional states, may be monitored with noninvasive techniques such as electroencephalography (EEG) and magnetoencephalography (MEG) that measure macroscopic cortical activity manifested as oscillatory network dynamics," Poltorak wrote. "These rhythmic cortical signatures provide insight into the neuronal activity used to identify pathological cortical function in numerous neurological and psychiatric conditions. Sensory and transcranial stimulation, entraining the brain with specific brain rhythms, can effectively induce desired brain states (such as state of sleep or state of attention) correlated with such cortical rhythms. Because brain states have distinct neural correlates, it may be possible to induce a desired brain state by replicating these neural correlates through stimulation."
According to a press release issued this week, Neurolight will use the $255,851 NSF Small Business Innovation Research grant to create a platform that records the cortical signatures, or brainwaves, of a healthy sleeping person and, through a mobile digital health device, transmit them into the brain of someone dealing with a sleeping issue like insomnia to train them to sleep.
"We propose that brain states may thus be transferred between people by acquiring an associated cortical signature from a donor, which, following processing, may be applied to a recipient through sensory or transcranial stimulation," Poltorak said in the journal article. "This technique may provide a novel and effective neuromodulation approach to the noninvasive, non-pharmacological treatment of a variety of psychiatric and neurological disorders for which current treatments are mostly limited to pharmacotherapeutic interventions."
Company officials said the research may help millions of people dealing with sleep issues, and note that seven of the 15 leading causes of death in the US have been linked to sleep deprivation.
The science of neuromodulation, or harvesting the power of electrical impulses for therapeutic benefit, dates back to 1967, when neurosurgeon C. Norman Shealy developed an implantable dives to use deep brain stimulation (DBS) to treat chronic and intractable pain. Early efforts ran into problems, mainly due to the technology of that era, but in 1974 physicians developed less invasive electrodes that could do the job without damaging the spinal cord.
Today's technology has evolved significantly since 1974, with digital health devices and platforms that can capture and transmit without damaging the human body. Neurotech Reports estimates that the worldwide neuromodulation industry will see $13.3 billion in business in 2022, addressing issues ranging from pain to chronic conditions like epilepsy, migraines and urinary incontinence.
NeuroLight officials say they're the first company to develop the technology for "transplanting mental states from one person to another," and early, small trials have been positive. Should this NSF-backed project see positive results, the company could be eligible for as much as $17 million in additional funding to continue the work.
"We are honored and gratified to have been awarded this highly competitive grant by the NSF," Poltorak said in the press release. "This grant will support R&D efforts to develop a prototype for the proof-of-concept study."
This week's HLTH conference in Las Vegas featured several intriguing partnerships and digital health products. Here are the highlights.
This week's HLTH conference included several notable announcements in the connected health space.
Pittsburgh-based Highmark Health, a care management organization spanning three states and including the Allegheny Health Network, announced a partnership with Google Cloud and League to develop a digital health platform, including a member portal and mHealth app. The new My Highmark digital front door will be designed to give members a single online access point to a wide range of services.
"While many in the health and tech industries are in early discussions to evolve the consumer health experience, Highmark Health, Google Cloud, and League are in a period of action," Karen Hanlon, executive vice president and chief operating officer of Highmark Health, said in a press release. "The blended, personalized experience within My Highmark is a milestone in our Living Health strategy to make health care less fragmented and frustrating to navigate, and simpler for members to proactively engage in their health."
Google also announced a deal with COTA, a New York-based digital health company focused on the oncology sector. Through the partnership, COTA will be developed new algorithms aimed at pulling unstructured data out of electronic health records for use in cancer research and treatment.
"Imagine a scenario where we can be alerted, in real time, to new diseases or receive signals from geographies where patients are experiencing better outcomes, or poorer outcomes, so that we can take action quickly,"Miruna Sasu, COTA's president and CEO, said in the press release. "In order for this to become our reality, we must leverage technologies to ingest healthcare data responsibly, accurately, and expeditiously. We are delighted to partner with Google Cloud to combine our respective strengths in technology and data science with the ultimate goal of improving care for patients."
Amwell, one of the giants in the telehealth space, announced a partnership with LG Electronics to tackle one of the biggest concerns in healthcare: workforce shortages. The two have developed the Carepoint TV kit and accompanying Amwell Converge digital health platform, which enables providers in busy care facilities and hospitals to remotely engage, monitor and discharge patients through their in-room TV system.
"We are facing an all-time high level of healthcare worker burnout and financial constraint spurred by the pandemic," Amwell Chief Marketing Office Susan Worthy said in the press release. "Technology innovation such as this can reduce the burden on clinicians and care teams while improving patient engagement and ultimately enabling a better care experience for all."
Dexcare, which focuses on digital health coordination services, announced a partnership with Kaiser Permanente to develop AI tools to help health systems improve capacity optimization and load-leveling services. The platform is designed to help providers tackle workforce issues, reduce stress and burnout and improve care coordination across multiple care lines, including virtual and in-person.
Other announcements made at HLTH include:
Henry Schein Medical announced a partnership with Rimidi to integrate remote patient monitoring tools and decision support services to its SolutionsHub platform.
Teva Pharmaceuticals and HealthSnap announced a collaboration to create a digital health platform around Teva's Digihaler system, a chronic care management system designed for patients with respiratory health concerns.
CancerIQ announced an expansion to its platform that enables primary care providers to assess a patient's comprehensive cancer risk and recommend personalized resources and treatments, such as genetic testing, colonoscopies and lung scans. According to company officials, a trial run at three health systems saw both clinical and financial benefits.
BrightInsight, a digital health company in the biopharma space, announced a an enterprise agreement with CSL Behring to expand the platform for the recently launched Hizentra mHealth app and other apps and services aimed at late-stage and marketed rare disease therapies.
Included Health unveiled All-Included Care, designed as a platform to coordinate both virtual and in-person care across the entire benefits ecosystem.
Virtual care provider MDLIVE announced the expansion of its virtual primary care platform to enhance support for chronic care management.
General Catalyst, a venture capital firm targeting health assurance investments and collaboration, announced partnerships with 15 more health systems, including Banner Health, Cincinnati Children's Hospital Medical Center, Hackensack Meridian Health, MetroHealth, UC Davis Health and the Medical University of South Carolina (MUSC).
Twilio, a provider of customer engagement solutions, unveiled the Twilio Segment for Healthcare & Life Sciences, a HIPAA-eligible customer data platform designed to gather and support protected health information (PHI) across the care journey.
Bamboo Health unveiled Real-Time Care Intelligence, a platform designed to give care providers actionable insights and care decision support tools for a patient's physical, behavioral and social health concerns.
NovaWell, an affiliate of Horizon Healthcare Services, introduced a suite of integrated behavioral health solutions designed for health plans (including Blue Cross Blue Shield) and care providers that can integrate mental health and substance abuse treatments with other services, such as primary care.
Hello Heart, a digital therapeutic company focused on heart health, unveiled Dot-to-Dot, an AI-enhanced platform designed to help patients connect lifestyle choices to heart health.
Wolters Kluwer Health announced the launch of the Digital Health Architect Consumer Education Suite and EmmiGuide, designed to help payers and virtual care providers manage their members' health concerns. The company also announced a partnership with Microsoft to expand its digital health services to the Microsoft Azure cloud platform.
Vivalink has expanded its biometrics data platform to support a wide range of wearables and digital health devices in the remote monitoring space, offering providers the opportunity to integrate sensors, edge networking, and cloud services for continuous and episodic monitoring. The platform can capture data ranging from weight and sleep to respiratory rate, heart function, temperature, oxygen saturation and blood pressure.
Sprinter Health, a digital health and diagnostics company focused on the home, has announced a partnership with Firefly Health, a virtual care-based health plan. The partnership will integrate the former's in-home clinical services with the latter's virtual primary care platform.
PreventScripts, a digital health company that helps care providers find reimbursable digital health tools for preventive health services, announced an expansion of its platform to 12 providers who are managing patients with metabolic conditions. The platform enables care teams to identify and treat patients, including through remote patient monitoring.
Particle Health, which offers digital health data exchange services, has unveiled Specialty Search, an expanded record locator service (RLS) capability designed to enable providers to search for condition-specific patient data at specialty sites. The company has also announced that Jasper Health, a provider of digital guiding and navigation services in the oncology space, is using Particle's FHIR-based solution to improve oncology services.
The healthcare conference celebrated its 5th year in Las Vegas, where almost 10,000 attendees discussed the biggest challenges in healthcare alongside gambling, gin and tonics, and glowsticks.
At times it felt like a rock concert or a rally. There was food, drinks, a meditation tent, beauty salon, games, mimosas in the registration line, popcorn and ice cream. And the glitz and glamor of Las Vegas was just beyond the walls of the Venetian's conference center.
Was this really a healthcare conference?
Yes, it was. And while HLTH 2022 put on quite a show, it was still all about healthcare. But a new definition of "healthcare," which has been battered by the pandemic and bruised by the politics. Now, it's about both health and care, and all the connections that can—and should—be made to support that strategy.
Witness the exhibit hall, an engaging network of booths and pavilions connected by a circular walkway and encircled by the various stages on which presentations and panels were held. Familiar healthcare names like TytoCare, the Mayo Clinic and Bamboo Health dotted the landscape, alongside a good number of start-ups, but included in that mix were Best Buy, Lyft and Salesforce, and a half dozen organizations focused on food insecurity and meal planning/delivery.
The upshot of all this is that healthcare, or value-based care, isn't limited to clinical services. Gaps in care, and barriers to accessing care, are often caused by factors outside what had long been seen as the healthcare enterprise. So-called social determinants of health include transportation, diets and exercise, family life (including elder and child care), work and school concerns, housing, cultural norms, even social services and legal concerns.
With that in mind, healthcare organizations are recognizing that the key to reaching underserved populations may lie in expanding the healthcare platform to address any and all of these issues. Imagine a primary care doctor who can refer a patient to a local food bank, set up rides to and from healthcare appointments, arrange child-care or even prescribe an app or digital therapeutic treatment that uses art, music, mushrooms, or trips to the park or museum.
HLTH 2022 imagined all of this, while also tackling the hot-button issues of provider stress and burnout, data integration, AI, interoperability and the often underappreciated role of the nurse in innovation and program development. That these issues were addressed alongside an event that included Ludacris, Lance Armstrong and Amelia Anisovych, the Ukrainian girl who sang "Let It Go" in a Kyiv bomb shelter, may have rubbed some people the wrong way, but it worked.
Healthcare innovators pride themselves on "looking outside the box" for the next great thing, and this event made sure that no one was boxed in. It also challenged the many healthcare executives to think differently about how they deliver care. Keynotes and fireside chats from Kaiser Permanente Chair and CEO Greg Adams, HCA Healthcare CEO Sam Hazen, and Amazon Health Chief Medical Officer Nworah Ayogu, to name a few, talked about breaking down barriers and redesigning healthcare.
"This is the first stop on our journey to capturing societal risk," said Nebeyou Abebe, Highmark Health's senior vice president of social determinants of health, during a main stage session.
HLTH offered a place where everyone could exchange ideas, debate issues like the supposed decline of telehealth and the looming healthcare workforce shortage, test out VR equipment, visit intriguing start-ups from Australia, Israel and the Cedars-Sinai network, and talk payer reimbursement, the end of the Public Health Emergency and Medicare-backed innovation. And if that happened alongside a game of table hockey, a juice bar offering something with beets and ginger, or a race car, so much the better. That's one way to spark the synapses.
The big question, of course, is what we all get out of this. Was this all show and no substance? Will we see action taken based on the discussions held at HLTH? That, of course, will be the topic of many more stories to come.
Health information exchange technology helps reduce wait times for follow-up care after ED visits.
A certified community behavioral health clinic in Richmond, Virginia, is benefitting from a real-time statewide health information network that lets clinicians track their patients' emergency room visits.
Powering this data feed is Virginia Health Information (VHI), a private 501(c)3 organization in existence since 1993, which recently implemented a layer of technology to speed the flow of patient admission, discharge, and transfer information between different healthcare organizations around the state.
This enables allows care teams at Richmond Behavioral Health Authority (RBHA) to identify their patients presenting at other points of care, enabling rapid response for behavioral health crises and other urgent matters and connecting them to RBHA's case management services for longer-term support, tailored to their unique needs.
VHI Chief Executive Officer Kyle Russell is basically the second leader of the organization, starting as a data analyst working on an all-payer claims database in 2013. Back then, received claims information lagged could be six or nine months behind, but since its primary use was in research and setting health policy, that kind of lag was acceptable.
In 2019, by an act of the legislature, VHI became the health information exchange for the commonwealth of Virginia. Real-time reporting, such as vaccinations, became imperative.
Now, "the biggest program by far within the health information exchange is the Emergency Department Care Coordination Program (EDCC)," Russell says.
VHI became the vehicle through which clinicians could determine whether a patient had been in any of 10 different clinics or emergency rooms in the past six months, for instance.
RBHA's BeWell, part of its certified community behavior health clinic, began eight years ago with funding from the state and the Substance Abuse and Mental Health Services Administration (SAMHSA), a program of the US Health and Human Services Department, and has served more than 3,000 people since then. RBHA serves a population of uninsured Medicaid patients, providing case management, psychiatry, primary care, group counseling, all over one roof, according to Sara Hilleary, program manager for RBHA's integrated care clinic.
By August 2020, RBHA, which also serves as the community services board for the city of Richmond and surrounding areas, was poised to begin using the new, more real-time information. Rates of domestic violence and suicidal ideation had spiked as the COVID-19 pandemic raged. RBHA received additional SAMHSA funding to connect its systems to VHI's and begin tracking its patients as they presented to clinics and emergency departments in Virginia.
Part of what powers the actionable health information exchanged is when emergency clinicians enter specific ICD-10 codes into each patient's record. Specific ones, such as a code indicating the patient has engaged in self-harm, alerts programs such as RBHA to initiate follow-up outreach to patients. Additional data points, such as missed appointments, can be correlated to ED visits and the ICD-10 codes to paint a more complete picture of patients at risk.
EDCC is also able to generate reports to track ED utilization by various time periods such as one week, a month, or six months, Hilleary says.
Although state and federal grants help maintain the operation of VHI, the information exchange also must rely upon support of health systems who participate in its network.
EDCC was brought into being by mandate of the Virginia state assembly in 2018. Although every health system in the state must connect to EDCC, "we have to operate like a business that either has to provide value to the state of or value to a private entity to make it all work," Russell says. "For most entities, it doesn't cost them anything."
RBHA did not sign on right away, but was an early adopter of EDCC, Russell says.
The care coordination software powering the EDCC is provided by PointClickCare.
"We get e-mail alerts, and then we are able to reach out to hospitals, if individuals are still there, or we are able to reach out to the individuals themselves and see if they need either to get reconnected with services or collaborate with them or their current care providers if there are any other needs," says Jillian Olson, an RBHA care coordinator.
The sudden statewide activation of EDCC posed its own challenges to VHI.
"You have this mass avalanche of connectivity that comes in with the mandate," Russell says. "You're going from zero to like a really big system in six months, but then after that, it's a trickle, because it's voluntary," with variation in what the attached providers do with the exchanged information. RBHA excels at doing a lot with it, he adds.
The pandemic complicated this next growth phase of EDCC, Russell says.
"With COVID, [ER] utilization went down," he says. "So how do you know how it's really doing?"
But over time, EDCC data shows that by implementing a care coordination program such as that in place at RBHA, ED utilization consistently drops 20% to 40%, Russell says.
And the care coordination platform also decreases wait times for patients requiring post-ED follow-up care at RBHA, Hilleary says.
As for other health systems that haven't yet tapped the potential of EDCC, Russell says many eyes are on the state to see how various players are participating.
"The health plans notice," he says. "RBHA is like this rock star contributor. If someone [else] is connected and doesn't do anything with it, what does it take to also get them to become strong, active users? That's where the real value-add change happens."
Part of that is being driven by informal regional collaboratives, such as one in the Tidewater region of Virginia, sharing best HIPAA-compliant data sharing practices among hospitals, health plans, freestanding and ambulatory practices.
"We don't have to push that," Russell says. "They're taking ownership of it themselves. We're looking at doing something like it in the Piedmont area" of Virginia as well.
Tami McMasters-Gomez, the director of coding and CDI services at the University of California Medical Center at Davis, chats with revenue cycle editor Amanda Norris about UC Davis’ CDI reconciliation process and how reworking that process boosted productivity for the organization by 33%.
As the HLTH conference kicks into gear this week in Las Vegas, Thirty Madison President Michelle Carnahan explains how direct-to-consumer digital health companies are thriving, and how they may help create 'a different type of center of excellence.'
The popularity and growth of HLTH, taking place this week at The Venetian in Las Vegas, and CES 2023, which takes over Sin City for a week in January, point to the incredible growth of consumer-facing technology and healthcare. And the innovation arena is filled with companies that are using today's technology to deliver healthcare services directly to the consumer.
These companies, offering everything from primary care services to specialty and niche care, have changed not only how consumers look for an access care, but how healthcare organizations and payers are operating.
Among the companies standing out in this DTC market is Thirty Madison, which recently bolstered its platform through the acquisition of Nurx. It now offers a wide array of specialty healthcare services, including dermatology, allergy care, migraine treatment, hair loss, and sexual and reproductive health.
And while some view these companies as competitors to traditional healthcare providers and point out the deficiencies in direct-to-consumer care, Thirty Madison President Michelle Carnahan believes they serve a valuable role in healthcare delivery, filling in gaps and improving access to care and outcomes.
"We're offering a solution to what we've defined as healthcare's biggest opportunities," she says. "We've built a platform around a range of conditions and a continuum of severity. This is what we could call tailored healthcare."
Carnahan was scheduled to take part in a HLTH panel titled "The Vertical re-imagination of Health & Wellness" at 11 a.m. PST Monday at The Venetian.
Companies like Thirty Madison, Ro, Hims & Hers, and Maven operate on the strategy that they offer specialized services that fall outside the typical boundaries of a primary care practice, clinic or hospital. And while a lot of their marketing and outreach is focused on DTC channels, there is considerable value in partnering with health systems and payers to become a preferred provider.
"The one-stop shops in this space don’t really work," Carnahan says. "The thing we need to remember is that we aren't selling paper towels."
Thirty Madison, she says, set out to target chronic health concerns that are easy to diagnose, treat, and monitor—and which could be done in a virtual setting just as easily, if not easier than, a brick-and-mortar location like a doctor's office. They started with hair loss, then moved on to more complicated health issues like migraines.
"We scaled up slowly," she says. "It allowed us to test that care model carefully."
DTC digital health companies usually market directly to the consumer, but they can also partner with health plans—often being included in a digital health formulary, or roster of preferred providers—and businesses with an eye on improving employee health and wellness.
Carnahan says companies like Thirty Madison aren't necessarily competing with primary care providers or health systems, but offer specialized, niche services that appeal to consumers.
"We don't want to exist in a vacuum in healthcare," she says. "We're out to set a new standard of care on behalf of the patient."
Carnahan says DTC digital health companies should partner more often with health systems, creating "a different type of center of excellence."
"We're firmly rooted in evidence-based medicine," she says. "Click-and-mortar would be our next step."
And that may be where health systems fit into the healthcare landscape of the future, operating alongside and in partnerships with DTC digital health companies that give consumers the option to seek virtual care or head over to the doctor's office, clinic or hospital. Such partnerships would also give DTC digital health companies some stability at a time when the market is so crowded.
Carnahan notes that the pandemic helped to elevate digital health, giving consumers more options to seek healthcare at home while allowing health systems to separate in-person services from virtual care. In addition, new players are entering the market, like Amazon and Google, offering new channels for DTC digital health to reach consumers.
"Scale is starting to mean something now," she says.
