The hospital is launching a pilot program in which 80 patients being treated for blood cancer will use a VR platform to address behavioral health and care management issues.
Massachusetts General Hospital will be enrolling 80 patients in a trial program testing the value of a virtual reality digital therapeutic platform on behavioral health.
MGH, which is Harvard Medical School's largest teaching hospital, is partnering with Rocket VR Health on the program, which aims to improve quality of life, symptom burden, psychological distress, and self-efficacy for patients living with blood cancers who are undergoing hematopoietic set cell transplants (HCT). These patients often deal with a wide range of health concerns during their four-week hospital stay that can affect both short- and long-term health and wellness.
"The capacity to use VR to improve the physical and psychological wellbeing of patients with cancer enduring prolonged hospitalization can increase access and potential for scalability and dissemination of this supportive care platform," Areej El-Jawahri, an associate professor of medicine at Harvard Medical School, director of digital health at the Mass General Cancer Center, and a co-investigator of the study, said in a press release.
“Today, we can deliver therapeutic VR interventions on lightweight, affordable and ergonomic headsets with therapeutic experiences that are more engaging than what has been possible in the past," Rocket VR Health Co-founder and CEO Sid Desai added. "This study will guide us towards validating the efficacy of our digital therapeutic in our effort to build the go-to distress management solution for hospitalized patients.”
MGH and Rocket VR Health have been working since 2021 on a digital therapeutic platform incorporating VR technology, leveraging research on palliative care interventions for patients undergoing HCT. They've developed a four-week program that includes interactive sessions, doctor holograms and meditations in nature-based locations.
HealthLeaders editor Melanie Blackman is joined by Tiffany Miller, DBA, MHA, CEO of Yoakum Community Hospital, a 100-year-old, 23-bed critical access hospital located in Yoakum, Texas. During the conversation, Tiffany talks about transitioning into her role earlier this year, strategies she's looking forward to implementing, and shares advice for aspiring healthcare leaders.
Lehigh Valley Health Network's chief of neurological surgery is using the innovative technology to educate his patients and improve surgical procedures.
Healthcare organizations are slowly embracing augmented and virtual reality for a variety of uses centering around education and training. But the ability to take a two-dimensional image or concept and give it depth and substance also holds promise for clinical care—even surgery.
As chief of the division of neurological surgery at the Lehigh Valley Health Network, Walter Jean, MD, has been using AR and VR for more than five years, not only to plan delicate surgeries, but to actually do those surgeries as well. The technology helps him to get a better look at a patient's anatomy both before and during the procedure.
"It's basically operating with GPS," he says. "And it's getting better. Every year the technology improves, and we're seeing more nuances. It's gotten quite apparent that we're going to see surgeries become much smaller and less invasive."
Jean is one of the front-runners in using AR and VR in surgery, where he uses the technology to help his patients understand what they're going through and what he can do for them. He is an integral part of the Fleming Neuroscience Institute at LVHN, which supports the use of those and other state-of-the-art tools and platforms and to attract and train top talent.
"Augmented Reality (AR) is a real-world augmented experience with overlaying or mixing simulated digital imagery with the real world as seen through a camera or display, such as a smartphone or head-mounted or heads-up display (HUD). Digital imagery may be able to interact with real surroundings (often controlled by users). This is sometimes referred to as mixed or merged reality."
"Virtual Reality (VR) is a virtual world immersive experience that may require a headset to completely replace a user's surrounding view with a simulated, immersive, and interactive virtual environment."
Both technologies, the FDA says, "have the potential to transform healthcare, delivering altogether new types of treatments and diagnostics, and changing how and where care is delivered. Central to their potential in diagnosis and treatment is their ability to deliver both standard and entirely new types of content in highly immersive and realistic ways, remotely, and tailored to a variety of clinical contexts. Physicians, patients, and caregivers can enlist AR/VR to help them prepare for, or perform, certain treatments or procedures."
At LVHN, Jean uses the platform first to help his patients understand both their medical conditions and how he treats them. The process is much better, he says, than giving them images and trying to get them to imagine what's going on inside them.
"You're taking 2D images and converting them to multi-colored 3D renderings in VR," he says. "It's much easier for them to comprehend, for example, where a tumor is and what it does. It's also much easier for doctors to explain the intervention."
The platform also gives doctors an opportunity to better understand and map out a surgery before it takes place, an important benefit when one is talking about neurosurgery and the brain. Imagine, Jean says, stepping into the pathology of a patient rather than viewing it in images, and planning your journey before taking it.
Then, he says, imagine taking that technology into the operating room.
Jean says the platform is integrated with technology-aided microscopes that project images onto the patient, guiding surgeons every step of the way. The process enables surgeons to be more precise with their movements, reducing everything from the size of the incision and subsequent surgery to the recovery time, which in turn improves clinical outcomes.
And that, he says, is where the next phase of innovation is likely to target. While the platform is now contained within tech-enabled microscopes, future iterations might separate the technology from the microscope and allow clinicians to use VR goggles or smartglasses, giving them more freedom to move around during the procedure.
In addition, Jean sees the use of AR and VR in surgical procedures expanding to other specialties and other parts of the body as well, especially in surgical procedures that are delicate and complex, like spinal surgery.
And finally, he sees the potential for AR and VT technology in reducing health inequities across the globe. Millions of surgical procedures aren’t being done in underserved parts of the globe because clinicians there lack access to the necessary guidance and resources. AR and VR technology could link those providers to specialists in other countries, such as the US, to teach them how to perform certain procedures and guide them during those procedures.
As an example, Jean points to the pediatric neurosurgery partnership that now connects the University of Alabama at Birmingham (UAB) and the Global Surgery Program at Children's of Alabama with physicians in Vietnam. Using a telemedicine platform called VIPAAR (Virtual Interactive Presence in Augmented Reality) on standard iPads, specialist at UAB and Children's of Atlanta have been guiding doctors in Ho Chi Minh City on certain surgical procedures targeting epilepsy.
"There is a lot of potential here," says Jean. "Yes, there is some nervousness attached to it as it's a new way of using technology, but this is a gift that will keep on giving."
Azizi Seixas, PhD, who is chairing the University of Miami Miller School of Medicine's new Department of Informatics and Health Data Science, talks about the benefits and challenges of using data in healthcare.
Today's healthcare landscape is all about data—collecting it, analyzing it, using it, and making sure that it's accurate and reliable and not stuffed into a silo where it can't be easily accessed.
With that in mind, the University of Miami Miller School of Medicine recently launched the Department of Informatics and Health Data Science, with a goal of "reimagin(ing) academic medicine, healthcare, and the life sciences to make profound improvements in patient care." To lead this new venture, the university has selected as interim chair Azizi Seixas, PhD, director of the Media and Innovation Lab and Population Health Informatics in the school's Institute of Data Science and Computing and associate director of the Center for Translational Sleep and Circadian Sciences.
“We are bringing in data scientists, biostatisticians, and computer scientists, but that’s just the start," Seixas, a noted data evangelist who spent several years at NYU Langone Health before joining the University of Miami in 2021, said in a recent press release. "We are also reexamining the Miller School’s relationship with data to make transformative changes in healthcare. We're entering this space to redefine it.”
Seixas recently sat down—virtually—with HealthLeaders to talk about the new department and his views on the use of data in healthcare.
Q. This is a new department. How was it created?
Seixas: The Department of Informatics and Health Data Science was created at the University of Miami Miller School of Medicine to address the growing need for health data analytics and informatics in today's rapidly changing healthcare landscape. The department's focus is on developing innovative solutions to enhance patient care, improve health outcomes, and optimize the use of healthcare resources through the use of data-driven approaches. With the increasing importance of data in healthcare decision-making and research, the [department] is committed to training the next generation of healthcare informatics professionals and advancing the field through cutting-edge research and partnerships with industry leaders.
Q. How will this department affect how healthcare is measured and delivered?
Seixas: By leveraging advanced data analytics, machine learning, and artificial intelligence techniques, the department will enable healthcare providers to identify patterns, trends, and insights in patient data that were previously undetectable.
Azizi Seixas, PhD, interim chair of the University of Miami Miller School of Medicine's Department of Informatics and Health Data Science. Photo courtesy University of Miami Miller School of Medicine.
This will not only improve patient outcomes and reduce the cost of care, but it will also facilitate the development of more effective treatment protocols, personalized medicine, and innovative medical devices. Additionally, the department will develop new methodologies for managing and analyzing health data, making it easier to securely store, access, and share data across different institutions.
Ultimately, the creation of this department represents a transformative shift in how healthcare is practiced, moving from a reactive model that responds to acute illnesses to a proactive model that focuses on preventing disease and optimizing health outcomes through data-driven insights.
Q. What technologies will you be using?
Seixas: We will be focusing on a range of technologies to improve healthcare delivery and outcomes. This includes leveraging the power of artificial intelligence (AI) and machine learning to analyze complex health data and develop predictive models for disease prevention and management. We will also be using digital technology to improve communication and collaboration among healthcare providers, as well as implementing remote patient monitoring to enhance patient care and access. We will also be trailblazing cloud and edge computing to facilitate the use of internet-of-things digital devices for real-time patient care whereby patients can be monitored at home and provide real-time insights to improve and achieve health and wellness.
In addition, our department will be exploring the use of digital biomarkers and digital therapeutics to personalize treatments and optimize health outcomes for patients. We believe that by integrating these cutting-edge technologies into healthcare, we can revolutionize the way healthcare is delivered and improve the lives of patients across the globe.
Q. What are the challenges you see ahead in obtaining and using data?
Seixas: There are several challenges that we anticipate. One of the biggest challenges is data quality, as there is often incomplete or inaccurate data that needs to be cleaned and standardized before it can be used effectively. Additionally, there are concerns around data privacy and security, which need to be carefully managed to ensure patient confidentiality and compliance with regulations.
Another challenge is interoperability, as different systems and platforms may use different data formats and structures that need to be reconciled for meaningful analysis. Finally, there are issues around data ownership and access, as different stakeholders may have competing interests in how data is collected and used. Addressing these challenges will be critical to maximizing the potential of health data for improving patient outcomes and driving innovation in healthcare.
Q. What new technologies or strategies do you want to use? What's on the horizon?
Seixas: The [department] is focused on leveraging new and emerging technologies to advance healthcare. One exciting area of focus is digital twins, which can facilitate precision and personalized population health. By creating digital representations of patients, clinicians and researchers can gain a deeper understanding of individual health and develop personalized treatment plans.
Other technologies and strategies we are exploring include advanced analytics, machine learning, and remote patient monitoring. We are also committed to addressing the challenges around data privacy, security, and interoperability to ensure that data is collected, analyzed, and used in an ethical and responsible manner. Overall, our goal is to improve patient outcomes and transform the way healthcare is delivered through innovative uses of technology and data.
Q. How will health systems be able to learn from your department? What do you hope to teach them on how to gather and use data?
Seixas: In addition to helping healthcare systems learn how to gather and use data, we also hope to work closely with life sciences and clinical operations to advance innovation in these areas. Our department will provide training and education on cutting-edge technologies such as AI, machine learning, and digital biomarkers, as well as offer courses on precision and personalized population health, digital therapeutics, and remote patient monitoring.
Through these efforts, we aim to create a new cadre of medical providers and scientists who are innovative and have a deep understanding of how to leverage data and technology to improve patient outcomes. This will ultimately lead to better decision-making, more efficient operations, and improved overall quality of care.
Additionally, we plan to collaborate with life sciences and clinical operations [department] on research projects that leverage the power of data and technology to accelerate drug discovery, improve clinical trials, and optimize care delivery. Our goal is to create a symbiotic relationship between the various stakeholders in healthcare, all working towards the common goal of advancing patient care and improving health outcomes.
Q. Are there specific programs or services offered by health systems that you feel this department can refine or improve?
Seixas: There are several programs and services offered by health systems that we believe our department can help refine and improve through digital transformation. Our focus is not on any one specific department, but rather on collaborating across all areas of the health system to drive innovation and improve patient outcomes. We will also be instrumental in the digital transformation of the University of Miami Miller School of Medicine.
One area of particular interest is improving the efficiency and effectiveness of clinical trials through the use of digital technologies such as AI, machine learning, and digital biomarkers. We also aim to improve the delivery of care through the use of remote patient monitoring, digital therapeutics, and other digital technologies that can help patients better manage their own health.
Q. Are there any trends or practices in healthcare now that you would like to end? In other words, what are healthcare providers doing wrong?
Seixas: One trend that I would like to see change is the overreliance on hospital-based care.
Many medical procedures and treatments can now be provided at home, with the right technology and support. Additionally, decentralizing healthcare by making it more accessible to all, including those in underserved and remote areas, is crucial. Healthcare providers are not doing anything wrong, but they are often overwhelmed and suffer from huge burnout.
The use of AI and technology can help alleviate some of these burdens and allow for more focus on patient care. We will be focusing on developing innovative solutions that empower patients and healthcare providers, and promote healthcare at home and decentralized care. We hope to be key players in the digital transformation of healthcare and to help improve the overall health of our communities.
Q. Do consumers or patients have a role to play in this department?
Seixas: By using digital technology and tools such as patient portals, wearables, and remote monitoring devices, patients can actively participate in their own healthcare and contribute to the collection of health data. Additionally, patient feedback and input can be used to improve healthcare delivery and inform the development of new technologies and strategies. The department also aims to educate patients and the general public about health data science and the importance of data-driven healthcare decisions.
Q. How do you see your work evolving in, say, 10 years?
Seixas: In the next 10 years, we expect to see significant advancements in healthcare technologies and data science. Our department will continue to stay at the forefront of these developments and help shape the future of healthcare delivery.
We see ourselves expanding our partnerships and collaborations with other institutions and industries to drive innovation and improve patient outcomes. We also anticipate a greater emphasis on precision and personalized medicine, with the use of digital twins and other cutting-edge technologies becoming more commonplace.
Our focus will remain on using data-driven insights to improve healthcare delivery and patient care. Ultimately, we hope to be at the forefront of a paradigm shift in healthcare, where digital technology and data science play an integral role in shaping the future of medicine.
A new report from the Consumer Technology Association finds that both consumers and providers are bullish on the value of consumer-facing digital health technology, but there are still barriers to widespread adoption.
Consumer-facing digital health technology has the potential to improve healthcare delivery and outcomes, according to healthcare providers eyeing the market. Yet those providers also say the technology isn't living up to that promise.
That's the main takeaway from a new report from the Consumer Technology Association (CTA), Driving Consumer Adoption of Digital Health Solutions. The report, prepared with IPSOS and culled from interviews with 1,000 consumers, 300 providers, and a dozen digital health companies, finds that consumers and providers are both ready to embrace digital health, but they often find issues with the technology that sour their interest.
“Economic, social, and geographic divides make the adoption of health technology at scale challenging," René Quashie, CTA's vice president of digital health, said in a press release accompanying the report. "Digital health technologies need to be adaptable, portable, and meet the needs of consumers. Healthcare providers can drive adoption by building and sharing awareness of the tools available, while lowering barriers to entry.”
The consumer-facing digital health market is large and growing, and includes mobile health devices like blood pressure monitors, insulin pumps and pulse oximeters, mHealth apps , smart devices like scales, wearables (like smartwatches and fitness bands) and smart patches, AR/VR devices, hearing aids, even pacemakers, defibrillators, and portable ECG kits.
The research touches on a long-standing gap between consumer-facing technology and the healthcare industry, which often casts a skeptical eye on the validity and reliability of those products. Many companies are seeking to bridge that gap by developing products that meet clinical standards, while healthcare organizations are exploring innovative ways to use consumer products in health and wellness programs.
According to the CTA, whose annual CES event in Las Vegas is attracting more healthcare organizations each year, digital health companies need to focus more on building consumer awareness around the healthcare benefits of their products, while also talking to providers about their products and rallying behind policies that drive access to digital health.
According to the report, 58% of healthcare providers agree that these digital health solutions can lessen the burden on the healthcare industry, yet 44% say the products aren't living up to their potential. Among consumers, the top reason for using these devices is to take control of one's own health, followed by accessibility, reliability and the support of an insurer.
The cost of these products is the main barrier to widespread adoption or continued use. Providers say adoption could be increased through more clinical evidence proving the value of the technology and more support from payers.
The Health Systems Implementation Initiative features a wide range of healthcare organizations that will be adopting comparative clinical research strategies supported by the Patient-Centered Outcomes Research Institute.
More than 40 health systems have joined a new program aimed at adopting innovative practices and technologies to improve clinical outcomes.
The organizations have joined the Health Systems Implementation Initiative (HSII), a $50 million effort being shepherded by the Patient-Centered Outcomes Research Institute (PCORI). The HSII aims to advance the adoption of comparative clinical effectiveness research results that PCORI has supported over the years.
“Comparative clinical effectiveness research produces actionable information that helps people make informed healthcare choices and improve their outcomes, but even the best evidence only works if clinicians and health systems are aware of it and can use it,” PCORI Executive Director Nakela Cook, MD, MPH, said in a March 2 press release. “Leveraging health systems’ on-the-ground knowledge and experience in care delivery will enhance PCORI’s efforts to implement practice-changing findings in clinical care and accelerate sustainable and scalable efforts to support lasting changes.”
The 42 health systems joining HSII, representing 800 hospitals serving 79 million patients, will also be candidates for funding awards from PCORI to advance capacity-building programs. Each participating health system can earn up to $500,000, with awards being announced this summer. Future funding announcements for health systems that launch programs supported by PCORI research could range from $500,000 to $5 million.
Officials said the participating health systems will not only be part of a collaborative network sharing best practices, metrics and other resources, but will also help PCORI develop new topics for future research.
“HSII provides a unique opportunity for participant health systems with a wide range of capacities and patient populations to adopt evidence-based, care-transforming approaches,” Harv Feldman, MD, MSCE, PCORI’s deputy executive director for patient-centered research programs, said in the press release. “The vital financial and peer support provided through HSII will not only facilitate the uptake of useful evidence that can improve patient outcomes, but also lay the groundwork for future, nationwide scale-up of successful implementation approaches.”
Virtua Health is using AI technology to fine-tune its messages to patients, giving them access to the right information at the right time.
One of the more popular current uses of AI in healthcare is to improve marketing and messaging campaigns. This includes getting the word out to the right population that they’re good candidates for a specific healthcare service.
Virtua Health, for example, has been using AI for several years to refine engagement campaigns. One such campaign targeted people with or at a risk of developing cardiovascular disease. Working with digital health company Actium Health, the 400-site New Jersey health system created a messaging campaign that increased patient engagement and scheduled check-ups and generated roughly $800,000 in revenues.
The health system is also using the technology to target teens and young adults in need of bariatric surgery, a tricky and often underserved population that would just as easily steer clear of healthcare if the message wasn't right. And while one recent study finds that more teens are getting the surgery, experts say this service could save many more lives.
"There's an art and a science to marketing," says Ryan Younger, Virtua Health's vice president of marketing. "You want to connect the right people to the right information that they would find most helpful, so that they can choose their own path. It's not easy."
Whereas healthcare organizations traditionally send out mailers to targeted demographic groups, the advent of AI technology has made the process much more efficient. Using algorithms that comb through claims and EHR data (and, more recently, social determinants of health), health systems, health plans, and CRM companies can drill down to specific people and offer personalized messages.
For Virtua, this platform led to the scheduling of more than 470 bariatric surgeries and 8,500 scheduled appointments to related services, which in turn boosted revenues. More important, it helped the health system get in front of patients who needed access to care, and who otherwise wouldn’t have gotten that care.
"There are a lot of challenges to accessing healthcare, especially in underserved groups," Younger points out. "This helps us to [address] health equity as well."
While emphasizing that the platform gives patients the resources they need to make their own healthcare decisions, Younger notes that the information is more personal than a generic mailer or message. And where those traditional campaigns were lucky to get a 20% open rate, newer outreach efforts are pushing that number even higher. Simply put, the more personal the message, the greater chance that it will engage the reader and make an impact.
"We want to get in front of people [and see that] they're interested in the message," he says. "I know it's still a pleasant surprise when that works … but we're getting better at this."
Younger says the value of these programs goes beyond extra services and revenues. Better engagement means that patients are getting the care they need or the resources they need to improve their health and wellness. That translates to improved clinical outcomes, as well as fewer acute care needs and hospitalizations later on.
Aside from cardiovascular health and bariatric surgeries, Virtua has used the platform to reach out to patients at high risk for breast cancer, a campaign that can save lives through early detection and diagnosis. Younger says the opportunities are plenty, ranging from bone and joint care to kidney care to cancer and behavioral health services.
"Bariatrics is such an important issue because it's a long patient journey," Younger says. "It can take more than a year, with a lot of requirements and choices to make. It's so important that we get the right information in front of them as soon as possible [so that they] can make those decisions."
Bill Arneson, director of process and system support at Moffitt Cancer Center, chats with revenue cycle editor Amanda Norris about the strategies the organization uses to recruit revenue cycle talent and think outside the box when it comes to their workforce.
St. Jude Children's Research Hospital's new (and first) chief business innovation officer talks about new ideas and strategies at the renowned pediatric health system.
An expert in human-centered design, Corbin is charged with working with CEO James Downing, MD, and other senior leaders to guide the health system's $12.9 billion, six-year strategic plan, the largest and most ambitious investment in St Jude's 60-year history. This includes roughly $3 billion in planned construction projects.
Prior to joining St. Jude, she spent four years at the San Francisco-based global design and innovation firm IDEO, where she helped St. Jude develop programs like Family Commons and the St. Jude Global Alliance. She was also a principal at the architectural and engineering firm CannonDesign and was administrative director of orthopedic surgery and neurosurgery at a Chicago health system.
Corbin recently sat down—virtually—with HealthLeaders to discuss her new role.
Q: How do you define healthcare innovation?
Corbin: Since the beginning of time people have had problems to solve, and innovation is about solving those problems better than you have before. That applies to healthcare or any other industry. I view innovation as an outcome rather than a thing you do; innovation is the result of creative problem-solving that is guided by particular activities, behaviors, and mindsets. In my experience, you are more likely to see innovation occur when you:
have curiosity and empathy (mindsets);
engage directly with the problem to understand it rather than make assumptions and include a diverse set of people and viewpoints (behavior); and
commit to experimenting and testing possible solutions, incrementally, so that you learn, adjust, and refine (activities).
A lot of the mystery or magic of innovation lies in your ability to be disciplined in tackling a problem differently and in your willingness to keep going when things inevitably get uncomfortable. Change is uncomfortable, yet you can’t have innovation without change.
Q: What are the biggest challenges or barriers to healthcare innovation?
Corbin: Healthcare is a highly regulated industry where risk-taking isn’t as rewarded or as encouraged as it is in the other industries we often look to as examples of being innovative, such as tech or retail. To an extent, it’s a good thing that there is risk aversion and regulation in healthcare--people’s lives and wellbeing are often at the center of many decisions, but not all. One challenge to innovating in healthcare, then, is to be able to see regulation and risk mitigation on a spectrum and not a binary 'yes/no' choice. That opens up space to try new things, to learn and adapt, and to ultimately implement a new or modified solution to the problem at hand. That’s innovation and it applies to all industries, including healthcare.
Q: Is innovation approached or handled differently at a children's health system? How is it different?
Corbin: The fundamental approach to creative problem-solving still applies in pediatric healthcare. There are plenty of areas inside a pediatric hospital or pediatric-focused research institution like St. Jude that, from a business standpoint, function very similarly to adult institutions, or even organizations outside of the healthcare industry.
Catherine Corbin, chief business innovation officer at St. Jude Children's Research Hospital. Photo courtesy St. Jude.
Now for the nuance. The people we’re most often solving or designing for in a pediatric-focused institution like St. Jude are kids. Kids come into the healthcare system with one or more parents, or a designated caregiver, and sometimes siblings. There is a co-dependency within the family unit when the child is the patient and the pain, fear, or hope that a child feels as a patient is going to have immediate ripple effects on the family unit. That family unit, and how all the researchers, clinicians, hospital staff, and so on interact with the family unit, must be considered accordingly. To put it simply, we must take into account the needs of many--the family--when we are trying to solve for one--the child.
Q: What new technologies or strategies would you like to introduce to St. Jude?
Corbin: I’d look to introduce technologies that are relevant to the problem at hand rather than prospectively attempt to bring in technology that’s in need of an application, however exciting or promising it may seem. Arguably, I see my role and team as a strategy that’s already been introduced. St. Jude is committing resources and energy to enabling innovation as we implement our strategic plan and that is a strategic choice that I’m proud to be a part of carrying out.
Q: Are there any current practices or trends that you would like to see discontinued?
Corbin: I would discontinue the use of the phrase 'healing environments' to describe hospitals and healthcare facilities. I remember hearing this phrase when I started my career in healthcare design in the early aughts and it bothered me, but I couldn’t articulate why. It is meant to differentiate an approach to designing modern, patient-centered facilities from many of the utilitarian hospitals of the 1940s and '50s hospital building boom. Yes, some healing does take place inside hospitals, but so much healing--physically, mentally, spiritually--happens outside and independent of the healthcare facility. I’d reframe it as hospitals are 'helping' environments; they’re there in moments of acute need and can absolutely initiate the healing process. Yet our patients and families often have a long road ahead of them once they walk out our doors and I believe we’d do well to recognize that more overtly.
Q: How has your background prepared you for this position?
Corbin: I’ve held a variety of roles across an array of companies, all related to innovation, design, and healthcare in some balance. You could say I’ve sat in a lot of different seats of the healthcare industry table: hospital administrator, patient experience designer, healthcare architect, non-profit board member, managing director responsible for a lot of people’s professional livelihoods. I’m also a parent to two young kids. On any given day, I see life at St. Jude through one or more of these lenses and would like to believe I’ll be valuable to the organization because of that.
Q: What has surprised you about healthcare innovation so far?
Corbin: That the essential and ubiquitous patient care space--the exam room--is still a 10x12-foot box with some chairs, a desk, and freezing cold air blowing on you while you wait nervously in a paper gown on a table. Innovation here is an enigma.
Q:How do you see this role and this department evolving? What's on the horizon?
Corbin: What’s on the immediate horizon is beginning recruitment of my team so that, together, we can build out the department and identify prioritized projects to partner on with other departments and teams at St. Jude. We will start and operate initially as a small team so we can be nimble and adapt our way of working as needed in order to be effective within the larger ecosystem of St. Jude. Longer term, I’d like to see this role and department evolve to a place where design and innovation methods are used in a strategic fashion throughout the organization and aren’t exclusively the domain of me or my team.
The US Drug Enforcement Agency has proposed expanding the rules to allow providers to use telemedicine to prescribe controlled medications. Telehealth advocates say the new rules aren't that helpful.
Federal regulators are taking steps to expand the use of telemedicine in prescribing controlled substances, a key pandemic waiver that has helped behavioral health and substance abuse providers but which is scheduled to end soon.
“DEA is committed to ensuring that all Americans can access needed medications,” DEA Administrator Anne Milgram said in a press release. “The permanent expansion of telemedicine flexibilities would continue greater access to care for patients across the country, while ensuring the safety of patients. DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm.”
“Medication for opioid use disorder helps those who are fighting to overcome substance use disorder by helping people achieve and sustain recovery, and also prevent drug poisonings,” Milgram added. “The telemedicine regulations would continue to expand access to buprenorphine for patients with opioid use disorder.”
While the proposed new rule would be an improvement for some providers, there are limitations. According to the DEA, the proposed rules do not affect telemedicine consults that don’t involve the prescribing of controlled substances or consults with established patients. They would also not affect consults by a care provider to whom a patient has been referred, as long as the referring provider has previously conducted an in-person exam with the patient.
Reaction to the new rules has been mixed. Nathanial Lacktman, a partner in the Foley & Lardner law firm and chair of the firm's national Telemedicine & Digital Health Industry Team, said they were "not what most industry stakeholders were anticipating" in a blog posted today.
"The proposed rules are intended to bridge between the DEA’s current PHE waivers and a post-PHE environment," he wrote. "In so doing, DEA proposed creating two new limited options for telemedicine prescribing of controlled substances without a prior in-person exam. The options [are] both complex and more restrictive than what has been allowed for the past three years under the PHE waivers. The DEA’s proposal will discontinue the ability for telemedicine prescribing of controlled substances where the patient never has any in-person exam (with the exception of an initial prescription period of no more than 30 days’ supply). Moreover, if the patient requires a Schedule II medication or a Schedule III-V narcotic medication (with the sole exception of buprenorphine for opioid use disorder (OUD) treatment), an initial in-person exam is required before any prescription can be issued."
The proposed rules, which now go through a 30-day public comment period, were drafted with the help of the Health and Human Services Department and US Department of Veterans Affairs.
“Improved access to mental health and substance use disorder services through expanded telemedicine flexibilities will save lives,” HHS Secretary Xavier Becerra said in the press release. “We still have millions of Americans, particularly those living in rural communities, who face difficulties accessing a doctor or health care provider in-person. At HHS, we are committed to working with our federal partners and stakeholders to advance proven technologies and lifesaving care for the benefit of all Americans.”
When the PHE was enacted in January 2020 to help the nation deal with the growing pandemic, a number of waivers and exemptions were put in place by federal and state regulators to help healthcare organizations expand and be reimbursed for digital health and telehealth services. The idea behind this was to allow providers to use virtual and connected health tools and platforms to reduce the spread of the virus and make sure consumers were able to access needed healthcare services.
Many of those waivers were extended until the end of 2024 in the Consolidated Appropriations Act of 2023. But the waiver on the use of telemedicine to prescribe controlled substances wasn't included in that bill.
Passed into law in 2008, the Ryan Haight Online Pharmacy Consumer Protection Act severely restricts the prescription of controlled substances, and requires an in-person exam by a qualified provider before those drugs can be prescribed via telemedicine. Enforcement is handled by the DEA.
Writing in their Health Care Law Today blog earlier this year, Thomas Ferrante and Rachel Goodman, partners with the Foley & Lardner Law Firm and members of the firm's Telemedicine & Digital Health Industry Team, say the waiver of the in-person exam during the PHE ensured that "millions of both established and new patients were able to receive medically necessary prescriptions via telemedicine."
"There have been efforts to amend the Ryan Haight Act and encourage the DEA to activate the telemedicine special registration rule before the PHE expires, including pending federal legislation," they wrote. "However, to date, the Ryan Haight Act has not been changed and the DEA has not activated the telemedicine special registration rule."
Telehealth advocates say the new rules don't go far enough, and that the DEA still needs to set up a special registration process so that more providers can use telemedicine for behavioral health and substance abuse treatment.
"The DEA’s proposed rules are not the special registration process that Congress mandated and could gravely disrupt millions of patients’ treatments and care regimens," Robert Krayn, co-founder and CEO of telepsychiatry company Talkiatry, said in an e-mail to HealthLeaders. "Instead of taking inspiration from more modern state-level prescribing policy already introduced in Connecticut and Florida, the rules reinstate obsolete and counterproductive in-person requirements under the guise of novelty. There is nothing novel about sending vulnerable patients back into the dark ages of care delivery."
"Rather than restrict bad actors, this over-corrective proposal disadvantages and disproportionately affects mental health care, preventing responsible physicians and clinical leaders from expanding care access," he added. "The mental health care community must unite and fight for patient access to quality care, regardless of a patients’ location and socio-economic status or the societal stigma attached to their condition."
