The Weekly Wrap, HealthLeaders' new video series, brings you a quick look at what we're covering around the healthcare industry.
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New episodes will be released each Friday.
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Recalls of home-based medical devices and defective single-use devices are the top two concerns on the Pennsylvania-based non-profit's top 10 technology hazards for 2023.
The growing popularity of smart home technology and home-based healthcare, including remote patient monitoring programs, means there are more medical devices in the home to oversee, either by the care team or the patent. That could lead to problems if the devices aren't working.
The challenge of identifying recalls for at-home medical devices tops the Top 10 Technology Hazards for 2023, an annual report issued by ECRI, a Pennsylvania-based non-profit focused on safety, quality, and cost-effectiveness in healthcare. Now in its 16th year, the report highlights the problems associated with healthcare technology, and spots trends in care delivery that might be catching both providers and patients by surprise.
With at-home medical devices, ECRI notes that patients using those devices at home might be the last to hear of a recall, and they might not understand what the recall means or how the address one.
"Device manufacturers seldom have direct communication with home care patients; and healthcare providers may not proactively contact patients about recalls," the report notes. "As a result, patients who use medical devices in the home may learn about a recall—and the steps needed to ensure safe use of the device—long after it was issued, and potentially from an unreliable source, such as a television commercial for a class-action lawsuit or through social media."
In addition, the recall notice might be filled with technical language that patients wouldn't understand clearly. They might not understand the risks involved with the device and continue using it.
"ECRI challenges manufacturers of medical devices that can be used outside the hospital environment to implement measures such as: providing users with easy-to-follow device registration instructions, writing simply worded recall notices, maintaining up-to-date databases of device distribution, and designating staff to ensuring that recalls reach home users," the report says.
Coming in second on the list is another growing trend in healthcare: The growing number of single-use medical devices, designed to be used once and then discarded. ECRI reports an "unacceptably high number of defective single-use medical devices," which can negatively impact patient care, lead to delays in care or treatment, and even harm patients.
"ECRI has received reports of cracked tubing and connectors; compromised sterility of needles, catheters, and procedure kits; and incorrect product labeling," the report notes. "These are just a few examples of product defects that can lead to waste, delays, incorrect treatment, healthcare-acquired infections, or other patient harm."
"ECRI is concerned that some device manufacturers are not making sufficient efforts to address the problem," it continues. "In fact, rather than seeing improvements over time, we’ve noticed a continuing increase in problem reports. ECRI urges manufacturers to take decisive steps to improve their quality control (QC) processes."
The rest of the list is as follows:
Inappropriate use of automated dispensing cabinet overrides.
Undetected venous needle dislodgement.
Failure to manage cybersecurity risks associated with cloud-based clinical systems.
Inflatable pressure infusers.
Confusion surrounding ventilator cleaning and disinfection requirements.
Common misconceptions about electrosurgery.
Overuse of cardiac telemetry.
Underreporting device-related issues.
Many of the items on this list were caused or exacerbated by the pandemic. Healthcare organizations struggled to maintain operations during the height of the COVID-19 crisis, and most are still dealing with stress, burnout, and staffing issues. In this environment, healthcare providers are more likely to consider work-arounds or bypassing established procedures to get something done, which could lead to unsafe or dangerous practices. It's inherent on management at this time to emphasize the importance of safety protocols.
At the same time, the report calls on the medical device industry to be more diligent.
"This year we’re extending a challenge to our industry colleagues," it notes. "We believe some of the hazards outlined in this report could be mitigated—and possibly even eliminated—by improved device designs or manufacturing practices. As a rule, an engineering solution that eliminates a hazard will always be preferable to a training solution that can only warn of a hazard. With the COVID-19 pandemic leaving healthcare facilities understaffed and healthcare workers overstressed, it’s more important than ever that medical technologies be designed in ways that help ensure their safe use."
ECRI also noted the trends it has spotted over the years in its reports that have led to industry-wide improvements. In the 1970s, it helped spur improvements to manual resuscitators to prevent inadequate lung inflation, and the 1980s saw a move to safer electrode connections for patient monitoring equipment to prevent electrocution.
In the 1990s, the reports pushed the industry to improve on bed safety to prevent entrapment and strangulations, as well as adding free-flow prevention mechanisms infusion pumps to prevent overmedication. And since 2000, the organization has prodded the industry to improve integration of drug libraries and infusion pumps to prevent drug dosing errors; improve CT scanner dose-control technologies to reduce radiation exposure; and improve endoscope reprocessing procedures and technologies to prevent cross-contamination.
The two are joining forces to create analytical technology that would help digital health studies attract a more diverse and representative patient population.
Duke University is joining forces with a California-based digital health firm to develop technology to measure health equity in clinical studies.
The North Carolina university's BIG IDEAs Lab is partnering with Evidation to create "an analytic structure to better predict study participation, adherence, and retention across racial and demographic lines," according to a press release.
While the COVID-19 pandemic saw a huge increase in the use of telehealth and digital health to boost access to care for underserved populations, it also trained the spotlight on social determinants of health and other barriers to care experienced by those groups.
This includes identifying non-clinical factors that hindered access to care and highlighting the lack of diversity in many clinical trials and healthcare studies. Studies indicate that racial and ethnic minorities only comprise 6% of clinical trial populations, yet account for 28% of the US population.
“As digital health research grows and evolves, we need to ensure that research populations are truly representative so that the technologies benefit everyone,” Jessilyn Dunn, PhD, an assistant professor of Biomedical Engineering at Duke University, said in the press release. “With our combined expertise, we aim to overcome some of the most persistent challenges in diversity and representation in digital health research.”
Duke's BIG IDEAs Lab uses biomedical and health data to create programs for the early detection, intervention, and prevention of disease. This includes projects that highlight "improved health monitoring through personalized, real-time risk classification and tailored, remote intervention strategies."
“Inclusion of underserved and underrepresented populations in research and study adherence among all groups are key challenges for enabling patient-centered healthcare," added Iredia M. Olaye, PhD, MSc, MHA, a member of Evidation and the Covered By Group investment and advisory firm. "Evidation has deep experience using advanced statistics and machine learning methodologies to rapidly connect with and understand diverse groups of individuals. Together, our work will equip researchers and providers with insights for more rigorous study design. If we can enable more equitable research, we can achieve more equitable care.”
The two organizations said the statistical framework, once created, will be made available to other digital health researchers.
A new messaging program embedded in the EHR is helping the hospital connect with parents who have avoided or skipped important medical check-ups for their children.
"There's a lot of value here in something that isn't that difficult to do," says William Brinkman, MD, Med, MSc, a board-certified pediatrician and director of the Division of General and Community Pediatrics at Cincinnati Children's.
Brinkman and Anne Berset, BA, a clinical research coordinator at Cincinnati Children's, used a messaging platform in a pilot project involving some 900 families of patients aged 6 to 17 years old, spread across three primary care practices in 2021. Using a platform that could deliver phone and text messages, they saw an almost 50% increase in scheduled well-child visits.
"There was a significant increase in the scheduling and completion of appointments after receiving the standard and tailored message compared with no message, indicating that simple outreach nudges via patient portal may prompt action," the two wrote in an analysis of the project published in November 2022 in the Journal of the American medical Association (JAMA). "The standard message group had higher rates of receiving COVID-19 vaccination within 8 weeks, suggesting that messages that reengage patients subsequently provide opportunities to promote healthy behaviors, such as vaccine acceptance."
William Brinkman, MD, Med, MSc, director of the Division of General and Community Pediatrics at Cincinnati Children's Hospital Medical Cener. Photo courtesy Cincinnati Children's.
Brinkman and Berset launched their program during the height of the COVID-19 pandemic, when access to healthcare services was in flux. Because of the virus, many healthcare organizations were shifting many in-person services to virtual platforms, and families were postponing or cancelling what they considered non-vital healthcare services. This included well-child visits, which plunged by at least 20% during the pandemic.
And while in-person healthcare appointments increased as the pandemic waned, Brinkman and Berset said parents still weren't bringing their children back to the office.
"Healthcare access was shifting all over the place," says Brinkman. "It became really glaringly obvious that something needed to be done" to boost interest and attendance.
It was also important, they said, to make parents aware of the value of a well-child visit.
"There's definitely a lot of education that needs to be done," says Berset. "Folks don't specifically know what a well-child visit is. They don't understand the value."
Anne Berset, BA, clinical research coordinator at Cincinnati Children's Hospital Medical Center. Photo courtesy Cincinnati Children's.
For their program, Brinkman and Berset chose a platform that could personalize a message to parents and send it via different modalities—text or phone—based on the recipient's preferences. They opted for this platform after studying other, similar programs and talking to patients and medical assistants who call and text families on a regular basis.
Brinkman says it's important to fit the messaging into a provider's regular workflow. This was done by going through the EHR and tacking the messages onto an already existing program—in this case a message regarding COVID-19 vaccinations. The message was personalized to include the patient's first name, reminded parents that their child was due for a well-child visit, and asked them to either call or use the patient portal to set up an appointment.
Berset says they learned through the program that some 44% of patients are using their patient portal.
"A lot of people were expecting that number to be higher, but that's OK," she says. "Finding out that the patient portal was successful in reaching patients was definitely rewarding for us. And it told us that we still have work to do."
They also found that this platform resonates with underserved populations, many of whom face barriers to accessing healthcare because they don't have the access, technology, or broadband capacity to attend virtual visits. But they do have smartphones.
Above all else, the project proved that simple, succinct phone and text messages are capable of nudging parents into scheduling well-child visits, and that a messaging platform can also bridge that gap between making that appointment and following through.
And that's important, particularly at this time. Brinkman notes that those well-child visits have picked up a variety of health concerns, both minor and serious, that weren't caught during the pandemic because of the skipped appointments.
"When [parents] came back in for the check-ups, there was a lot more to deal with," he says.
Brinkman and Berset are using the results of the pilot program to make it a permanent fixture in primary care and pediatric practices across the health system, as well as in HealthVine, the hospital's Medicaid accountable care organization, which serves more than 130,000 children.
Both see a lot of room for continued study. They'd like to test the value of different messages and modalities, as well as trying new strategies to boost patient portal adoption—which in turn may be an important step in boosting access to care for underserved populations.
"Using patient portals offers an additional layer in the approach to engage families, as outreach attempts need to be varied, especially in marginalized populations," they concluded in their study. "Future qualitative research should be done to (1) incorporate multiple communication modes, such as videos and storytelling; (2) offer and encourage choice; (3) develop patient-centered messages by cocreating with families; and (4) use interventions that leverage effective community partnerships and trust."
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The New York-based health system is rolling out Northwell Health Pregnancy Chats, an AI-enhanced chatbot that can act as both a resource for important information about pregnancy and a care management tool that can alert care providers to an urgent health concern.
Northwell Health is launching a digital health platform aimed at addressing the nation's high maternal mortality rate.
The New York-based health system is rolling out Northwell Health Pregnancy Chats, an AI-enabled chatbot that can act as both an information resource and care management tool, alerting providers to any health concerns that require immediate follow-up.
“Northwell Health Pregnancy Chats are both extremely comprehensive and highly individualized and are designed to complement the interactions patients have with their providers,” Michael Nimaroff, MD, senior vice president of Northwell’s OB/GYN service line and chair of Obstetrics and Gynecology for North Shore University Hospital and Long Island Jewish Medical Center, said in a press release. “It’s a way to ensure women are never without support, whether they’re in a doctor’s office or in their own home.”
The chatbot targets a growing health concern in the US that has attracted the attention of health systems and the federal government. Roughly 26 of every 100,000 women die during childbirth, a rate much higher that many other countries and a particular concern among minorities, where the rate is even higher.
While the Biden-Harris Administration has targeted the issue in a Maternal Health Blueprint released in June 2022, many healthcare organizations are using digital health tools like mHealth apps and remote patient monitoring programs to connect with mothers-to-be at home and monitor them through their pregnancy. Many of these programs continue after childbirth, to monitor the baby's health and the mother's well-being.
“Far too many pregnant and birthing people in this country suffer harm or even die because of problems that are entirely preventable," Dawnette Lewis, MD, MPH, director of the Center for Maternal Health, said in the press release. "Northwell is committed to doing whatever is necessary to reduce those risks. By bringing together high-tech innovation and high-touch clinical care, the Northwell Health Pregnancy Chats will help keep women and babies safe.”
Developed in a partnership with Portland-based digital health company Conversa Health, which is now part of Amwell, the chatbot was deployed in a pilot program and used by some 1,632 patients. The program helped to identify several urgent health problems, including severe preeclampsia and behavioral health concerns, and was positively received by 96% of the users.
The no-cost digital health tool, accessible via smartphones and other mobile devices, will eventually be offered to women receiving pregnancy care throughout Northwell Health's coverage area, according to the health system.
The Weekly Wrap, HealthLeaders' new video series, brings you a quick look at what we're covering around the healthcare industry.
Looking for a quick review of what’s hot in the healthcare industry?
Our Weekly Wrap video recaps the latest news and analysis that HealthLeaders covers each week and features health system, hospital, pharma, and payer executives.
New episodes will be released each Friday.
Subscribe now to HealthLeaders YouTube channel to catch all the episodes. Don’t miss out!
Check out our featured story, podcast, and event for the week:
The state's Medicaid program is partnering with digital health company Pear Therapeutics on the precision digital therapeutics program aimed at treating residents in 24 counties who are living with stimulant use disorder.
The state of California is launching a precision digital therapeutics program aimed at helping people living with substance use disorders.
The California Department of Health Care Services (DHCS) is partnering with digital health company Pear Therapeutics to support the state's Recovery Incentives program, which was launched in 2022. The contingency management (CM) program, operated through the state's Medi-Cal Medicaid department, targets those dealing with stimulant use disorder by offering motivational incentives and tracking behaviors.
Some 24 California counties will take part in the program.
"Participating Drug Medi-Cal Organized Delivery System (DMC-ODS) counties will launch the CM benefit in the first quarter of 2023, in accordance with approval from the Centers for Medicare & Medicaid Services as part of the CalAIM 1115 Demonstration," DHCS reports on its website. "Eligible Medi-Cal beneficiaries will participate in a structured 24-week outpatient program, followed by six or more months of additional recovery support services. Individuals will be able to earn motivational incentives in the form of low-denomination gift cards, with a retail value determined per treatment episode."
Pear Therapeutics, based in Boston, develops digital therapeutic treatments, or software-based tools designed to allow providers and patients to track engagement and adherence and target behaviors through incentives and other methods. An important part of the process is the use of digital health to track patients and enable on-demand collaboration and long-term engagement with care providers.
Advocates, including the Digital Therapeutics Alliance, say the digital health platform is effective and can replace traditional medication-based treatments.
Hinge Health, which focuses on virtual physical therapy for businesses and health plans, is adding in-person visits. It's a nod to the growing popularity of hybrid healthcare.
A digital health company specializing in physical therapy is adding house calls to its portfolio.
San Francisco-based Hinge Health has unveiled a physical therapy house call service aimed at improving the long-term value of virtual care. The service, which will launch in Chicago before a nationwide rollout, aims to complement the virtual care platform by giving patients in-person evaluations.
“As the market leader in MSK [musculoskeletal] care, it’s incumbent on us to transform the member experience by challenging the status quo,” Daniel Perez, the company's co-founder and CEO, said in a press release. “Integrating digital and in-person care is a leap forward in bridging care gaps and reimagining a healthcare model that works for everyone.”
The announcement follows a post-pandemic trend in the healthcare industry in combining virtual and in-person services on a hybrid platform. While telehealth and virtual care saw huge increases in use during the height of the COVID-19 crisis, the pendulum has since swung back in the other direction, with patients often asking for a return to office-based care.
Company officials say the virtual platform improves access to healthcare services, allowing patients to receive physical therapy in the comfort of their own homes and on their own schedules. But many patients, especially those with back, joint, or muscle pain, would also benefit from in-person evaluations that can be more thorough and comprehensive than virtual consults.
The company, which contracts with businesses and health plans, says the house call service will include physical and environmental assessments, hands-on therapy, and guided digital setup services and can be scheduled the next day, evenings, or weekends.
The strategy might appeal not only to those who prefer virtual services, but also to that percentage of consumers who are hesitant to try virtual care or prefer in-person care.
